Demystifying Social Determinants

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Dr. Pandav is the National President of Indian Public

Health Association and a Professor and Head of

Centre for Community Medicine at the All India

Institute of Medical Sciences (AIIMS). He is a

Physician, Medical Scientist, Public Health Specialist,

Epidemiologist and Health Economist. Dr Pandav has

worked as a consultant for the WHO, UNICEF,

ICCIDD, PAMM and MI at the global, regional

(including China, Africa) levels for over 50 countries,

and also at the national level in India for the last 30

years.

Dr C S Pandav

Professor & Head,

Centre for Community

Medicine, AIIMS

SESSION MODERATOR

Demystifying Social Determinants

in

Health & Nutrition

Professor Sir Michael G. Marmot

MBBS, MPH, PhD, FRCP, FFPHM, FMedSci, FBA

Director, UCL Institute of Health Equity (Marmot Institute)

Chair, European Review on the Social Determinants of Health and the

Health Divide

Director: International Institute for Society and Health;

MRC Research Professor of Epidemiology and Public Health, University

College London

He was a member of the Royal Commission on Environmental Pollution for six years, and

served as President of the British Medical Association (BMA) in 2010-2011. He is a Fellow of

the Academy of Medical Sciences, an Honorary Fellow of the British Academy, and an

Honorary Fellow of the Faculty of Public Health of the Royal College of Physicians.

In 2000 he was knighted by Her Majesty The Queen, ‘for services to Epidemiology and the

understanding of health inequalities’. Internationally acclaimed, Professor Marmot is a Foreign

Associate Member of the Institute of Medicine (IOM), and a former Vice President of the

Academia Europaea.

He was Chair of the Commission on Social Determinants of Health (CSDH) , which was set up

by the World Health Organization in 2005, and produced the report entitled: ‘Closing the Gap in

a Generation’.

AGENDA

SECTION I – Need of Society for Quality Life of its People

SECTION II – Status

SECTION III- Definition of a Fair Society

SECTION IV – Marmot Review: 6 Policy Objectives

SECTION V - Conclusion

Questions and Answers

• Social justice

• Material, psychosocial, po

litical empowerment

• Creating the conditions

for people to have control

of their lives

www.who.int/social_determinants

AGENDA







Inequalities in health within and between

countries

Inequalities between countries

Glasgow men (Calton) 54

Glasgow men(Lenzie) 82*

National data WHO 2009, Glasgow data: Hanlon et al. 2006

Under 5 mortality per 1000 live births by wealth quintile

Source: DHS

Average U5M for high income countries is 7/1000

India

2005/6

Peru

2000

AGENDA







What is a ‘fair society’?

• Health as a measure of how well we are doing as a

society;

• Distribution of health across society;

• Health inequalities – the social gradient

The Commission on

Social Determinants of

Health (CSDH) – Closing

the gap in a generation

Strategic Review of Health

Inequalities in England:

The Marmot Review – Fair

Society Healthy Lives

European

Review of

Social

Determinants

and the

Health Divide

2010-2012

AGENDA







A. Give every child the best start in life

B. Enable all children, young people and adults to maximise

their capabilities and have control over their lives

C. Create fair employment and good work for all

D. Ensure healthy standard of living for all

E. Create and develop healthy and sustainable places and

communities

F. Strengthen the role and impact of ill health prevention

Marmot Review: 6 Policy Objectives







communities


6 Policy Objectives

Moderate and severe stunting rates for children under age 5 by national

wealth (GNP per capita), 2008

EFA 2011

Reading levels in grade 3 students: regional variation India

EFA 2011







communities



Share of workers in vulnerable employment by sex, selected

countries in South Asia

ILO







communities



Minimum standards (or income) for health

living

• To live a live of dignity







communities



Empowering communities: SEWA Case Study: The

Parivartan Programme

• Improve the basic physical infrastructure within the slums and in

the homes;

• Community development;

• City-level organisation for environmental upgrading of the slums

SEWA Case Study 2008

SEWA: slum upgrading in India

• Slum upgrading in Ahmadabad, India, cost only US$

500/household.

• Community contributions of US$ 50/household.

• Following the investment in these slums, there was

improvement in health

– decline in waterborne diseases,

– children started going to school,

– women were able to take paid work, no longer having to

stand in long lines to collect water.

MELADI NAGARBefore After

Slide courtesy of Gujarat Mahila Housing SEWA Trust







communities



Social patterning of cigarette smoking among men in Mumbai,

India

1

1.1

1.2

1.3

1.4

1.5

1.6

1.7

1.8

College (reference)

Secondary Middle Primary None/illiterate

Adju

ste

d o

dds r

atio*

Sorensen et al.2005 AJPH

Source: IDF 2009

Global projections for the number of people with diabetes

(aged 20-79), 2010 - 2030

• Social justice

• Tackling the inequitable

distribution of

power, money, and

resources

• Improving the conditions

in which people are

born, grow, live, work and

age;

• Monitoring, measuring and

researchwww.who.int/social_determinants

Socioeconomic development AND

equity oriented policies

•

AGENDA







A world where

social justice is

taken seriously

AGENDA







Questions & Answers

To submit a question for Sir Michael G. Marmot,

please message Dr. C. S. Pandav via the chat

Closing Remarks

Documents

Demystifying Social Determinants