Sylvie Stachenko Deputy Chief Public Health Officer Health Promotion and Economic Development :...

Sylvie Stachenko

Deputy Chief Public Health Officer

Health Promotion and Economic Development:Interactions and Dilemmas

Health Promotion and Economic Development

Road Map

1. Clarifying our understanding

2. Exploring the interactions

3. Investing in health for sustainable development


Broadening the Landscape for Health

What good does it do to treat people's illnesses ... then send them back to the conditions that

made them sick?Source: Michael Marmot, Reducing Health Disparities Symposium, Toronto, March 2006


Determinants of HealthBroadening Involvement


Key Milestones

• Lalonde Report 1974. . . health more than medical services

• Ottawa Charter 1986. . . prerequisities for health

• Jakarta Declaration 1997. . . investments for health development

• Mexico Statement 2000. . . health necessary for social and economic development

• Bangkok 2005. . . influence of globalization on health


Influence of Globalization on Health

Source: Spiegel, Labonte and Ostry, International Joint Occupational Environmental Health, 2004


Finanscapes: The Trade, Diet and Health Nexus

• Market-oriented agriculture policies

• Open and increased food trade

• Retail restructuring (superstores)

• Global agribusiness and transnational food companies

Annual Turnover Selected US TFCs

$258.6 billion

$66.7 billion

$22 billion


Mediascapes: Diet and Obesity

Exploring the Interactions

Health promotion

Economic development


Life Expectancy and Income per capita for Selected Countries, 20th Century

Source: World Development Report, 1993


Health Care Spending and Life Expectancy


Under-5 Mortality Ratesby Income Groups of Countries

Source: The Lancet, “Applying an equity lens to child health and mortality: more of the same is not enough” Vol. 362, #9379, July 2003


Increasing Health Inequalities Between and Within Countries

UNDER 5 MORTALITY RATES BY UNDER 5 MORTALITY RATES BY SOCIOECONOMIC QUINTILE OF HOUSEHOLDSOCIOECONOMIC QUINTILE OF HOUSEHOLD

0

50

100

150

200

Indonesia Brazil India Kenya

Poorest fifth 2nd poorest fifth Middle fifth

2nd richest fifth Richest fifth

Under 5 mortalityper 1000

Victora et al Lancet , 362, 233-241 (2003)


Some Groups are More Vulnerable than Others

Low Income by Family Type

Percent

Source: Improving the Health of Canadians, 2004


The Social Gradient Occupational class differences in life

expectancy, England and Wales, 1997-1999


Commission on Macroeconomics and Health

•Positioned health as a determinant of economic development

•Focused on low and middle income countries

•Focused primarily on communicable diseases


The Challenge of

Cardiovascular Disease

in Developing Economies


The Cost of Lifestyle and Unhealthy Environments

Obesity in Europe

Country Direct costs in Euros (millions) % health expenditure

England (1995 816 (+3,270 indirect) 1.5%

France (1992) 640 – 1,320 1.5%

Germany (1996) 10,600 N/A

Portugal (1996) 230 3.5%

Netherlands (1981-89) 454 4%

Source: International Obesity Task Force, 2002


The Poverty Spiral

Source: WHO, An estimation of the economic impact of chronic noncommunicable diseases in selected countries, 2006


Projected Chronic Disease Death Rates

By Country, Age 30 – 69 years, 2005

Source: WHO, Preventing Chronic Diseases: A Vital Investment, 2005

Loss of Labour Force


Full-Income Losses

Source: WHO, Preventing Chronic Diseases: A Vital Investment, 2005

Full-income losses due to heart disease, stroke and diabetes in 2005 compared with 2015 estimates

Investing in Health for Sustainable Development


Human Development and Balanced Growth


UN Measures of Human Development

Source: United Nations Development Program, Human Development Report 1998


Source: World Development Report, 2005

The Impact of Income on Human DevelopmentSelected Countries

Human PovertyIndex Rank

Index 2

8

2

17

1

Index 1

2

13

1

20

9

Human DevelopmentIndex Rank

4

1

10

6

37

53

46

63

56

GDPper capita

62,298

37,670

37,562

26,750

10,274

9,168

8,280

7,790

6,854

Luxembourg

Norway

United States

Sweden

Chile

Mexico

Uruguay

Brazil

Panama


Source: UNICEF Innocenti Research. (2000). A League Table of Child Poverty in Rich Nations.Innocenti Report Card No.1. Florence:UNICEF Innocenti Research Centre. <www.unicef-icdc.org>.

Policy Choices can have Major Effects


Making the Healthy Choices the Easy Choices

Manipulating Sales Taxes can Benefit the Diet of the Poor

Source: Smed S & Denver S. Food & Resource Economics Ints. KVL Univ., Denmark, April 2005.


Towards Intersectoral Policy Approaches

• Whole of government approaches

• Broad commitment to health as a collective goal

• Community participation

• Challenges

• Limited incentives for working across sectors

• Accountability and financial structures not conducive to collaboration

• Knowledge deficit re effectiveness

• Political will and leadership


Emerging Collaboration Models

at International and National Levels

• NGO alliances– Global Prevention Alliance on Obesity (IOTF)

– Chronic Disease Prevention Alliance of Canada

• Interministerial mechanisms– Sweden

– UK

– British Columbia, Canada

• Multilevel networks– Canada’s Public Health Network


Community Driven Development


Strategic Knowledge Development

• Studies on social and other determinants

• Health modelling and economic analysis

• Health policy and system governance analysis

• Inter/trans disciplinary and multi-sectoral public policy and implementation research

• Translational research

• New evaluation tools e.g. health impact assessment of policy proposals

What Kinds of Research?


Investing in Public Health and Health Promotion

“Over the next 20 years, ensuring that care is of a high clinical quality and provided with minimum waiting will not be sufficient… [We need to strike] an appropriate balance between … health and social care, between primary and secondary care and between treatment and prevention.”

… Wanless Report, 2002, UK

“The success of an economy and a society cannot be separated from the lives that the members of society are able to lead…we not only value living well and satisfactorily, but also appreciate having control over our own lives.”

… Amartya Sen, Development as Freedom (1999)


“The success of an economy and a society cannot be separated from the lives that the members of society are able to lead…we not only value living well and satisfactorily, but also appreciate having control over our own lives.”

Health Promotion and Economic Development Health Promotion and Economic Development

Obrigada!

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Sylvie Stachenko Deputy Chief Public Health Officer Health Promotion and Economic Development :...

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