SOCIAL DETERMINANTS OF HEALTH By George Alleyne July 6, … · ANT BAH BAR GUY JAM SKN TRT GHE%THE...

Caribbean Commission on Health & Development

SOCIAL DETERMINANTS OF HEALTH

ByGeorge Alleyne

July 6, 2005


Objective:

Examine some of the results of the work of the Caribbean Commission on Health and Development through the lens of the social determinants –modified or modifiable


Infant mortality rate Life expectancy1980 2004 1980 2004

The Americas 37.8 20.1 68.8 73.5

North America 11.2 6.7 74.6 74.8

Caribbean 36.9 17.3 68.1 73.5

IMR—Infant deaths/1000 live birthsLife expectancy at birth ( years)


1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

0

2

4

6

8

10

12

0

20

40

60

80

100

No. of Cases Measles Vaccine Coverage


Immunization coverage in children< 1 year

0

20

40

60

80

100

DPT-3 OPV-3 MEASLES* BCG

19992000200120022003


“Secrets” of success

Introduction of interventions that were:

.Technically feasible

.Politically supportable

.Financially affordable

.Socially desirable and acceptable


Health expenditure

ANT BAH BAR GUY JAM SKN TRT

THE(pc$US) 487 798 562 48 178 344 239

THE(pcPPP) 540 1029 844 191 229 515 367

THE %GDP 5.4 5.6 6.1 5.0 6.4 4.8 4.3

THE (Total health expenditure) as% GDP averages 5.7%


Health expenditure

ANT BAH BAR GUY JAM SKN TRT

GHE%THE 61 57 66 83 51 66 45

GHE%TGE 14 15 12 9.3 6.2 11 6.6

OOP%THE 39 43 26 17 34 34 48GHE=Government (Public) Health ExpenditureTGE=Total Government ExpenditureOOP= Out of Pocket Expenditure


Gov Expenditure in Education as % Total Gov Expenditure

1970 1980 1990 2000

Barbados 21.2 20.5 22.2 18.5

Jamaica --- 13.1 12.8 11.1

Guyana 13.2 --- --- 18.2

St. Lucia --- --- --- 16.9


The Caribbean has made impressive gains in health in the past 4-5 decades, but these are threatened by the “new” problems. These major “new” problems are:

Obesity and its co-morbidities of the chronic diseases

HIV/AIDS

The health sequelae of injuries and violence


Fig. 1 CRUDE MORTALITY RATES FOR SELECT DISEASES BY YEAR:CAREC MEMBER COUNTRIES

Heart Disease

Cerebro Disease

Cancers

Diabetes Mellitus

Hypertensive Disease

AccidentsARIs

HIV/AIDS

0

20

40

60

80

100

120

85 90 95 2000YEAR

RA

TES


Trends in Diabetes mortality

20

30

40

50

60

70

80

Rat

e/10

0,00

0

1985 1990 1995 2000

MaleFemale


0

10

20

30

40

50

60

Pre

vale

nce

(%)

1970s 1980s 1990s

YEARS

Trends in Adult Overweight/Obesityin the Caribbean

MaleFemale


0

10

20

30

40

50

Prev

alen

ce (%

)

St Kitts/Nevis Trinidad/Tobago Belize Jamaica Guyana

Fig 2 - Obestiy (BMI>30) by age in the Caribbean

18-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55+ yrs


0

10

20

30

40

50

60

70

Prev

alen

ce (%

)

M F M F M F M F M F M F M F

STK BEL JAM DOM GUY TRIN B'dos

Fig 9 - Overweight and Obese Adults by Gender in the Caribbean (1998-2002)

BMI 25-29 BMI 30+


633

1274

2374

1527

871

2662

256525392518

2028

19251892

1808

1023

532

402305

19511328132

0

500

1000

1500

2000

2500

3000

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

Num

ber o

f Cas

es


nnnm

Source:, CAREC-CDC-2004


Trends in Calorie availability

1800

1950

2100

2250

2400

2550

2700

2850

3000

1961-1963 1971-1973 1981-1983 1991-1993 2000-2001

Availability

Populationgoal


0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Prof/Clerks/service Skill/craft/elementary

Showing the change in sedentary and non sedentary jobs in the last decade - Jamaica


cars

020000400006000080000

100000120000140000160000180000

1984

1985

1986

1987

88/8

9

1990

1991

91/9

2

92/9

3

93/9

4

94/9

5

95/9

6

96/9

7

97/9

8

98/9

9

99/0

0

00/0

1

Number of cars passed for Certificate of Fitness

Showing the increase in cars use (sedentary activity) in Jamaica in the last 15 years.


Seroprevalencia VIH en Población General ENDESA 2002

0.3

0.91.2

2

0.9 0.9

1.6

0

0.5

1

1.5

2

2.5

3

15-19 20-24 25-29 30-34 35-39 40-44 45-49

Grupos de Edad

Tasa

s FemeninoMasculinoTotal

2.7% en hombres entre 30-34 años

1.5% en mujeres de 45-49 años


Seroprevalencia VIH en Bateyes - ENDESA 2002

0.9

5.7

3.7

8.4

6.1

8.8

4.1

0

2

4

6

8

10

12

14

15-19 20-24 25-29 30-34 35-39 40-44 45-49

Grupos de Edad

Tasa

s FemeninoMasculinoTotal

12% en hombres entre 40-44 años

8.8% en mujeres de 30-34 años


Current concernMany past improvements have been the result of social engineering.? Unwittingly modifying social determinantsThe current concern is whether the levers of that social change that were applicable in the past are of relevance in dealing with the new epidemiological profile.

eg. Education—yes, but differentEconomic growth-yes, but with more emphasis on distributionFood security-yes, but very differentSocial inclusion-yes, ? Expanding pilot experiments

? Reducing discriminationetc

SOCIAL DETERMINANTS OF HEALTH By George Alleyne July 6, … · ANT BAH BAR GUY JAM SKN TRT GHE%THE...

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