NSM-NCD2013 Symposium 1 - NCD Risk Factors - A social determinant and ecological analysis in low and...

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Jeffrey Cheah School of Medicine and Health Sciences

NCD risk factors: a social determinants

and ecological analysis in low and middle

income countries

Pascale Allotey, Daniel D Reidpath, Davey T, Soyiri I, Yasin S

Areas to cover

Overview of social determinants approach

– example

Advantages and disadvantages

Expanding to ecological analysis

Utility of analysis

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The social production of health inequities. Developed by World Health Organization Department of Equity, Poverty and Social

Determinants of Health

A. Irwin , O. Solar , J. Vega

United Nations Commission on the Social Determinants of Health

International Encyclopedia of Public Health null 2008 64 - 69

http://dx.doi.org/10.1016/B978-012373960-5.00673-0

WOMEN GET SICKER,

MEN DIE QUICKER

http://www.cartoonstock.com/directory/l/life-span.asp

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Crude prevalence of self reported symptoms of chronic disease by age in men and women in urban and rural settings.

Miszkurka et al. BMC Public Health 2012 12:24 doi:10.1186/1471-2458-12-24

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Figure 3

Lancet 2011;

377:680-689

(DOI:10.1016/S014

0-6736(10)61506-1)

Data on SDH

Poorly collected and

generally outside the

health sector

Poorly analysed

Poorly used

Some data on gender

http://www.worldbank.org/en/news/video/2012/06/17/slideshow-toward-gender-equality-in-east-asia-and-the-pacific

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Sugar subsidies

Addressing needs of Indigenous communities

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Supporting lower socio-economic groups

Result?

300% increase in

obesity over 15 year

period

www.lovehijau.com

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So where are the solutions here?

Analysis of policy decisions – evidence to inform, evidence of

policy process and of implementation and evaluation – eg

health impact assessments

Classical social determinants, but also ecological,

environmental sustainability, culture and history

Classic social determinants, social inequalities,

institutionalized ethnicity based policy that affects risk,

exposure and treatment

Opportunities to conceptualize

multidisciplinary questions addressing

genetics, biology, social determinants in

exposure, risk, treatment etc

Source: Walsh / Carlines in Rayner and Lang

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15 There’s a consistent 50-year upward trend in every region except Oceania.

Changes in climate are already causing harm

Major floods per decade,

1950-2000

Information overload?

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Why do we need these sorts of analyses

Remedies for obesity based on individualism have a limited effect at population level (slimming industry grows alongside obesity rates)

Personalised choice is not a public health response but an ideological one

There are no comprehensive policy structures to tackle such multi-dimensional, multi-sectoral problems and diverse political/economic interests and pressures

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