Meeting challenges to health equity:

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12th World Congress on Public Health - Istanbul
28 April 2009 Session Making a Difference in
Global Public Health Education, Research, and
Practice
Meeting challenges to health equity The role of
research for health Stephen Matlin Executive
Director
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New Yorker, 2006 and thanks to R Terry, WHO
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Preston curve
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Life Expectancies 2007
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The poor die young.
TB deaths/100,000 pop
AIDS deaths/100,000 pop
Maternal deaths/10,000 live births
Under-Five deaths/1,000 live births
Underweight children (percent)
WHO, 2004
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The poor die young.
Male life expectancy
Report of the Commission on Social Determinants
of Health. WHO 2008 www.who.int/social_determinant
s/final_report/en/
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The spectrum of health research
Biomedical research
Health policy and systems research
Social sciences and behavioural research
Operational research
The spectrum of research for health
Biological, economic, environmental,
political and social determinants of
health
Health is a state of complete physical, mental
and social well-being and not merely the absence
of disease or infirmity. The enjoyment of the
highest attainable standard of health is one of
the fundamental rights of every human being
without distinction of race, religion, political
belief, economic or social condition. WHO
Constitution 1948
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The spectrum of health research
Biomedical research
Health policy and systems research
Social sciences and behavioural research
Operational research
The spectrum of research for health
Biological, economic, environmental,
political and social determinants of
health
The carrying power of a bridge is not the
average strength of the pillars, but the strength
of the weakest pillar. I have always believed
that you do not measure the health of a society
by GNP but by the condition of its worst
off. Zygmunt Bauman
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The spectrum of health research
Biomedical research
Health policy and systems research
Social sciences and behavioural research
Operational research
The spectrum of research for health
Biological, economic, environmental,
political and social determinants of
health
Innovation research AND implementation gt
IMPACT technological AND social
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Four challenges to health equity
1. Millennium Development Goals
2008 mid-point to 2015
At the mid-point (2008) in the global effort to
achieve the MDGs by 2015, progress in many
African countries is not on track. Nevertheless,
a number of recent successes demonstrate that
rapid progress is possible across Africa when
sound national programmes are matched with
adequate development assistance and full
technical support from the international system.
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Global Monitoring Report, World Bank 2008
c. 2.8 billion people (gt40 of the worlds
population) live with some form of water
scarcity. The Millennium Development Goals
Report. UN 2008
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Water
Target 7.C Halve, by 2015, the proportion of
people without sustainable access to safe
drinking water and basic sanitation
UN-Water Global Annual Assessment of Sanitation
and Drinking-Water (GLAAS), WHO,
2008 http//www.who.int/water_sanitation_health/gl
aas_2008_pilot_finalreport.pdf
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2 m deaths every year from water-related
diseases mostly children lt age 5
Access to improved drinking water
Recent findings confirm anecdotal evidence that
women shoulder the bulk of responsibility for
collecting water when none is available on the
premises.
Though access to improved drinking water has
expanded, nearly one billion people do
without The Millennium Development Goals Report.
UN 2008 .
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UV Waterworks
Even cheaper alternative

• Solar water disinfection (Sodis)
• already in use in 20 countries
• radiation from sunlight cleans water in clear
  plastic PET bottles, by shaking and then leaving
  in the sun for at least 6 h
• www.sodis.ch

Provides affordable and safe drinking water to
about 600,000 persons daily www.waterhealth.com/w
ater-solutions/technology.php
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Access to basic sanitation
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Basic technologies
Social innovation 'Subsidy or self-respect?
Participatory total community sanitation in
Bangladesh'
Urine diverting dry toilets offer a safe and
sanitary way to deal with fecal material, can be
permanently sited as opposed to pit latrines, and
dont require water. The dry conditions kill most
pathogens and parasites, including roundworm
eggs. www.aidg.org/component/option,com_jd-wp/It
emid,34/p,1044/

• Community empowerment for 100 sanitation now
  implemented in gt100 villages in Bangladesh
• gt20 new low-cost models of toilet emerged
• www.id21.org/insights/insights45

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Four challenges to health equity
2. Urbanization

• 2007 marked a turning point in human history the
  world's urban population for the first time
  equaled the world's rural population

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(No Transcript)
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Death rate ranking of 10 main diseases in
China, 2004
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Death rate ranking of 10 main diseases in
China, 2004
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Four challenges to health equity
2. Urbanization
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Four challenges to health equity
3. Climate change
Global warming is unequivocal
Rising atmospheric temperature
Rising sea level
Reductions in North Hemisphere snow cover
Source IPCC Summary for Policymakers WG I
(2007). A. Haines
2008
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Estimated deaths from climate change in 2000
Climate Change and Human Health - Risk and
Responses. WHO 2003
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Number of extra skin cancer cases related to UV
radiation
UNEP/GRID-Arendal Maps and Graphics library
http//maps.grida.no
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Growing burden of climate disasters (UNDP 2007)

• Greatest impacts in developing countries
• Weather related insurance losses going up faster
  than population, inflation and coverage
• Climate change may be contributing
• Increases in floods, droughts, lightning strikes,
  intensity of tropical cyclones

A. Haines 2008
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Droughts - risk and vulnerability (economic loss,
as a proportion of GDP density)
Economies at risk - disasters, poverty and
agricultural dependence
UNEP/GRID-Arendal Maps and Graphics library
http//maps.grida.no
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Human Development Index (HDI) in 2002
UNEP/GRID-Arendal Maps and Graphics library
http//maps.grida.no
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Four challenges to health equity
3. Climate change

• Research on health and climate change
• The main focus of research to date has been on
  three key elements
• - assessing impacts
• - mitigation (reducing the production of
  greenhouses gases)
• - adaptation (adjusting to those changes in
  climate that cannot be avoided, to reduce their
  impact)
• Little research has been conducted to date which
  focuses on the needs of the poorest people in the
  world by whom the largest health impacts of
  climate change will be felt.

Global Forum for Health Research 2008.
www.globalforumhealth.org
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Four challenges to health equity
4. Financial crisis
A quadruple global crisis unfolds

• In the prime of globalization, we are
  experiencing an accumulation of four interrelated
  crises, mutually feeding on each other
• Climate change crisis
• Oil and energy (price) crisis
• Food (and hunger) crisis
• Financial and economic crisis
• The consequences of these crisis - individually
  and even more so combined - for development and
  all stakeholders involved (people, governments,
  civil society, private sector, NGOs, multilateral
  agencies) may be devastating.
• Hence there is an urgent need to develop
  effective strategies to prepare for all
  eventualities and to compensate and counter any
  negative fall-out.
• Hans dOrville, ADG/BSP UNESCO, 27 January 2009

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Financial Crisis
IMF Thursday 19 March 2009 World GDP to shrink
in 2009 - first time in 60 years
www.dnaindia.com/report.asp?newsid1240726
By December 2010 the number of people living on
less than 1.25 a day will be about 90 million
higher because of the far-reaching impacts of
the financial crisis. 26 March 2009
www.dfid.gov.uk/news/files/fin-crisis-update1.asp

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World Economic Outlook Update IMF 28 Jan
2009 Forecasts - GDP growth rate for Africa of
3.5 - 1.6 lower than the previous
forecast - 1.9 below the 2008 growth
rate.  The growth forecast for primary
commodity exporters is even lower Angola, for
instance, is projecting nominal GDP in 2009 to be
only 5/6 of that in 2008. http//africacan.worl
dbank.org/category/topics/financial-crisis
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Africas GDP
The relationship between OECD GDP and Africas
GDP has weakened as a result of the emergence of
countries such as China, as well as structural
changes in African economies. According to the
IMF World Economic Outlook report in April 2008,
a decline in world growth of 1 would lead to a
0.5 drop in Africas GDP, so the effects of
global turmoil on Africa (via trade, FDI, aid)
would be quite high. The correlation between
African GDP and World GDP since 1980 is 0.5, but
between 2000 and 2007, it was only 0.2. As there
have been significant structural changes (and a
move into services that were able to withstand
competition much better) as well as the rise of
China, African growth has temporarily decoupled
from OECD GDP. The global financial crisis and
developing countries Which countries are at risk
and what can be done? Dirk Willem te Velde, ODI
Background Note, October 2008
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Financial Crisis
Developing world GDP (measured in PPP) to
overtake advanced economies in 2013
Euromonitor Countries and Consumers October
2008 www.euromonitor.com/Special_Report_Developing
_world_to_overtake_advanced_economies_in_2013
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Financial Crisis and ODA
Keeping ODA afloat no stone unturned. UNCTAD
POlicy Brief no 7, March 2009 http//www.unctad.o
rg/en/docs/presspb20092_en.pdf
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Four challenges to health equity
4. Financial crisis

• The vital role of research for health at a time
  of financial crisis
• Research is not a luxury that is affordable only
  in times of plenty but is a continuing necessity
  and never more so than in hard times. For all
  countries, research is
• vital as a source of evidence about the causes,
  prevention and treatment of ill-health and to
  ensure that health resources are being used
  effectively and efficiently.
• essential to prevent health inequalities
  increasing especially for poor countries.
• Extract from intervention by the Global Forum
  for Health Research at the High-level
  Consultation on the Financial Crisis and Global
  Health, WHO, Geneva, 19 January 2009
• www.globalforumhealth.org

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Linking resources with priorities for research
for health
Tracking resources for research for health
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Linking resources with priorities for research
for health
Tracking resources for research for health

• Resources for RD for health are situated within
  the domains of
• Development cooperation (ODA)
• Health
• Research

Report Card on RD for health
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Linking resources with priorities for research
for health
Tracking resources for research for health
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Forum 2009 Innovating for the health of
all Havana, Cuba, 16-20 November 2009