1. Addressing Social Determinants of Health to Ensure Health Rights Dr. Thelma Narayan Community Health Cell, Bangalore 4 th February 2008 Bringing together People & Public Health, Human Rights and Development Communities.

2. Tackling Social Determinants of Health in an Era of Globalization. There is an urgent need to address the root cause of inequalities in disease, disability and health. Social conditions in which people live and work are referred to as the social determinants of health. WHO Commission on Social Determinants of Health (WHO- CSDH, 2005 -2008) Need for policies and practice that tackle social costs of unfair, avoidable suffering

3. Often aggravate deep rooted Social Inequalities that determine health Gender Race, Ethnicity Language Belief system Disabilities Politico-economic determinants (trade, commodity pricing, foreign relations) backed by unprecented wealth and concentration of power

4. Corporate led globalization, Neo-liberal economic reforms, Negative macro-policies Corporate led globalization, Neo-liberal economic reforms, Negative macro-policies Adversely affect the social majority, nationally & globally Livelihoods, Incomes, Food security, Increased conflict, War and violence, Access to water, Access to health care, Environmental degradation,

5. Development : A Right to Health Perspective What are the people saying

6. Health Status in India National Family Health Survey ( NFHS) 3 – 2005-2006 NFHS 1 (1992-93), NFHS 2 ( 1998 -99) Trends in Childrens Nutritional Status Percentage of Children under age three years. Nutritional StatusNFHS 2NFHS 3 Stunting (Low height for age) 5145 Wasting ( Low weight for height) 2023 Underweight ( Low weight for age) 4340 Source: India, NFHS – 3, Key findings. In Bihar the Child Nutrition situation has become worse from 1998 -99 to 2005-06

7. ANAEMIA Women – 53% Men- 24% Children- 70% ( 6-59 months) Source: India, NFHS- 3, Key Findings.

8. Proximal Health Determinants Toilets: Three fourth of rural households have no toilets. 55% of all households (urban and Rural) have no toilets. Water: 25% of all households have water piped in to their dwelling, yard or plot. Source: NFHS 3

9. Poverty & Health Effects Every hour > 1,200 children die, equivalent to 3 tsunamis a month, every month, due to a single pathology – poverty ……but, with a little response Every hour > 1,200 children die, equivalent to 3 tsunamis a month, every month, due to a single pathology – poverty ……but, with a little response

10. INDIA : ? Shining Global example Overall employment growth in 1990s was 2/3 rd to half of 1980 For agricultural labourers, bulk of poor in India, rate of growth of real wages per annum almost halved in the 1990s, compared to 1980s. Worsening of working conditions of labourers in the informal sector and agriculture in past decade Open unemployment serious - Jeyarajan and Swaminathan, 2003 JOBLESS GROWTH

11. Informalization, Casualization of work, High prevalence of child and elderly labour, Work with low skills, low capital, low earnings, No social security, Adverse health effects, poor access to health care, Burden on women, Poverty, deprivation and quality of employment

12. Trade, Development and Health Over 2/3 rd of the poor are small farmers / agricultural laborers Unfair trade undermines their livelihood Led by EU and USA developed country agricultural subsidies are over $ 350 billion a year, ie, almost $ 1 billion a day, supporting large farmers and corporate agri-business For a fraction of the cost universal education, health and water for all can be achieved. UNDP, 2006

13. Disparities hampering progress are systematic, reflecting hierarchies of advantage and disadvantage and public policy choice - UNDP, 2005

14. Globalization from Below The Peoples Health Movement A Globalization of solidarity and informed action working on determinants of health; Bringing the Public back into Public Health, present in 90 countries; Multilevel functioning: - Community - Government - Global policy advocacy Coalition with broader movements

15. Globalization Of Health From Below Jan Swasthya Sabha, Kolkata 2000 Over 2000 participants in 5 peoples health trains Mobilization across 19 states Adopted 20 point Indian Peoples Charter Launched the Jan Swasthya Abhiyan, campaigning for Health for All Now Health as a Fundamental Human Right

16. Globalization Of Health From Below The First Global Peoples Health Assembly In 2000 December 1454 health activists from 75 countries met in Savar, Bangladesh to discuss the challenge of attaining Health for All, Now! Over 250 Indian delegates attended

17. Globalization Of Health From Below The Peoples Charter for Health Health is a social, economic and political issue and above all a fundamental human right.

18. Globalization Of Health From Below The Peoples Charter for Health Health for all means that powerful interests have to be challenged, that globalisation has to be opposed, and that political and economic priorities have to be drastically changed.

19. Globalization Of Health From Below Right to Health Movement

20. Globalization Of Health From Below Campaigns on Gender Issues Campaign Against Sex Selective Abortion or Female Foeticide – 2001 onwards Campaign on Violence against Women as a Public Health Challenge – 2000 onwards Womens Access to Primary Health Care - 2003 Peoples Tribunal on Population Policies – 2004 Gender and Power Issues in Medical Education Womens Health Charter - 2007

21. Globalization Of Health From Below Interaction with National With National Rural Health Mission (NRHM) Members of Task Force and Advisory Committee Shifted the missions focus from Demography to Public Health Community Monitoring People Rural Health Watch ASHA Mentoring Group

22. Globalization Of Health From Below Globalizing solidarity from over 80 countries at the Second Peoples Health Assembly, Cuenca Ecuador

23. Globalization Of Health From Below The Cuenca Declaration 2005 The human right to health and health care must take precedence over the profits of corporations, especially the profiteering of pharmaceutical companies.

24. Massive poverty and obscene inequality are social evils, like slavery and apartheid - Mandela, 2005 Massive poverty and obscene inequality are social evils, like slavery and apartheid - Mandela, 2005

25. Public Health – an art and science; and also a movement dedicated to the equitable improvement of health and well-being (of communities with their full participation). First and foremost, public health leaders must be catalysts for the public health movement……… The justification for action is that health is both an end in itself – a human right……..as well as a prerequisite for human development - WFPHA, 2004