Sylvie Stachenko

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Health Promotion and Economic DevelopmentIntera
ctions and Dilemmas
Sylvie Stachenko Deputy Chief Public Health
Officer
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Road Map

• 1. Clarifying our understanding
• Exploring the interactions
• Investing in health for sustainable development

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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
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Determinants of HealthBroadening Involvement
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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

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Influence of Globalization on Health
Source Spiegel, Labonte and Ostry,
International Joint Occupational Environmental
Health, 2004
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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
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Mediascapes Diet and Obesity
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Exploring the Interactions
Health promotion
Economic development
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Life Expectancy and Income per capita for
Selected Countries, 20th Century
Source World Development Report, 1993
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Health Care Spending and Life Expectancy
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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
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Increasing Health Inequalities Between and
Within Countries
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Some Groups are More Vulnerable than Others
Percent
Low Income by Family Type
Source Improving the Health of Canadians, 2004
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The Social Gradient
Occupational class differences in life
expectancy, England and Wales, 1997-1999
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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

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The Challenge of Cardiovascular Disease in
Developing Economies
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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
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The Poverty Spiral
Source WHO, An estimation of the economic
impact of chronic noncommunicable diseases in
selected countries, 2006
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Loss of Labour Force
Projected Chronic Disease Death Rates By
Country, Age 30 69 years, 2005
Source WHO, Preventing Chronic Diseases A
Vital Investment, 2005
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Full-Income Losses
Full-income losses due to heart disease, stroke
and diabetes in 2005 compared with 2015 estimates
Source WHO, Preventing Chronic Diseases A
Vital Investment, 2005
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Investing in Health for Sustainable Development
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Human Development and Balanced Growth
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UN Measures of Human Development
Source United Nations Development Program,
Human Development Report 1998
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The Impact of Income on Human Development Selected
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 6
3 56
GDPper capita 62,298 37,670 37,562 26,750 10,27
4 9,168 8,280 7,790 6,854
Luxembourg Norway United States Sweden Chile M
exico Uruguay Brazil Panama
Source World Development Report, 2005
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Policy Choices can have Major Effects
Source UNICEF Innocenti Research. (2000). A
League Table of Child Poverty in Rich
Nations. Innocenti Report Card No.1.
FlorenceUNICEF Innocenti Research Centre.
ltwww.unicef-icdc.orggt.
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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.
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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

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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
• Canadas Public Health
• Network

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Community Driven Development
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Strategic Knowledge Development
What Kinds of Research?

• 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

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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
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Health Promotion and Economic Development
The success of an economy and a society cannot
be separated from the lives that the members of
society are able to leadwe not only value living
well and satisfactorily, but also appreciate
having control over our own lives.
The success of an economy and a society cannot
be separated from the lives that the members of
society are able to leadwe not only value living
well and satisfactorily, but also appreciate
having control over our own lives. Amartya
Sen, Development as Freedom (1999)
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Health Promotion and Economic Development
Obrigada!