Theadora Koller

Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries

Many intrinsically related determinants of health and disease exist, including social and economic status, education, employment, housing, and physical and environmental exposures. These factors interact to cumulatively affect health and disease burden of individuals and populations, and to establish health inequities and disparities across and within countries. Biomedical models of health care decrease adverse consequences of disease, but are not enough to effectively improve individual and population health and advance health equity. Social determinants of health are especially important in Latin American countries, which are characterised by adverse colonial legacies, tremendous social injustice, huge socioeconomic disparities, and wide health inequities. Poverty and inequality worsened substantially in the 1980s, 1990s, and early 2000s in these countries. Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to effectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies.

Equity-oriented monitoring in the context of universal health coverage.

As part of the Universal Health Coverage Collection, Ahmad Reza Hosseinpoor and colleagues discuss methodological considerations for equity-oriented monitoring of universal health coverage, and propose recommendations for monitoring and target setting.

The challenges of securing health in humanitarian crises.

By early 2004 more than one million people had sought to escape violence and suffering in the three states of the Darfur region of Sudan. More than 180 000 of these displaced people are refugees in Chad; the majority, however, remain in Darfur, crowded into more than 100 camps scattered across 540 000 [km.sup.2]. They are dependent on external help for protection, adequate supplies of safe drinking-water, facilities for sanitation, sufficient nourishment, reliable shelter, effective prevention of disease outbreaks, and access (particularly for women) to essential health services--including hospital care. After visiting Darfur in July 2004, Dr LEE Jong-Wook, Director-General of WHO, appealed for more humanitarian assistance to prevent suffering and death. So far, the extent of the international humanitarian response has been inadequate. Globally, as many as 2 billion people in more than 40 countries face high risks from crisis conditions. Responses to their needs, and to their risks of suffering and death, are just not satisfactory. Focused preparation is the key to better response. Priorities are: assessments of peoples health conditions; coordinated response strategies and joint action to tackle suffering and reduce deaths; prompt identification of gaps in the response and prompt action to fill the gaps; and repair of local systems that are essential for better health. Since the start of the Darfur crisis, priority has been given to the generation of reliable information for the assessment, analysis and monitoring of the health needs of internally displaced persons. An Early Warning and Response Network (EWARN) was established for communicable diseases and conditions of particular concern, such as womens sexual and reproductive ill-health. Two disease outbreaks--shigellosis and hepatitis E--were detected and confirmed by EWARN, whose data helped in the planning and monitoring of key health interventions. EWARN also confirmed that measles incidence fell after the measles vaccination campaign in June 2004 backed by WHO, UNICEF and the ministry of health. A systematic mortality survey is under way throughout Darfur to detect mortality rates and calibrate the surveillance system. Joint surveillance and reporting systems are vital for targeting responses and securing the financial and institutional support needed for essential humanitarian interventions. Coordination and joint action are critical for responding effectively to all aspects of complex humanitarian crises. This is especially the case when the security status and accessibility of communities is constantly changing and humanitarian actors are thinly spread across a vast geographical area with very little infrastructure, as in Darfur. Coordinated strategies, together with effective collaboration on logistic and communication systems, has proved essential to the achievement of health outcomes. Experience in Darfur emphasizes that health sector coordination and joint action should become the norm in all crisis response work. …

Applying the Innov8 approach for reviewing national health programmes to leave no one behind: lessons learnt from Indonesia

ABSTRACT The World Health Organization’s Innov8 Approach for Reviewing National Health Programmes to Leave No One Behind is an eight-step process that supports the operationalization of the Sustainable Development Goals’ commitment to ‘leave no one behind’. In 2014–2015, Innov8 was adapted and applied in Indonesia to review how the national neonatal and maternal health action plans could become more equity-oriented, rights-based and gender-responsive, and better address critical social determinants of health. The process was led by the Indonesian Ministry of Health, with the support of WHO. It involved a wide range of actors and aligned with/fed into the drafting of the maternal newborn health action plan and the implementation planning of the newborn action plan. Key activities included a sensitization meeting, diagnostic checklist, review workshop and in-country work by the review teams. This ‘methods forum’ article describes this adaptation and application process, the outcomes and lessons learnt. In conjunction with other sources, Innov8 findings and recommendations informed national and sub-national maternal and neonatal action plans and programming to strengthen a ‘leave no one behind’ approach. As follow-up during 2015–2017, components of the Innov8 methodology were integrated into district-level planning processes for maternal and newborn health, and Innov8 helped generate demand for health inequality monitoring and its use in planning. In Indonesia, Innov8 enhanced national capacity for equity-oriented, rights-based and gender-responsive approaches and addressing critical social determinants of health. Adaptation for the national planning context (e.g. decentralized structure) and linking with health inequality monitoring capacity building were important lessons learnt. The pilot of Innov8 in Indonesia suggests that this approach can help operationalize the SDGs’ commitment to leave no one behind, in particular in relation to influencing programming and monitoring and evaluation.

Tools and approaches to operationalize the commitment to equity, gender and human rights: towards leaving no one behind in the Sustainable Development Goals

ABSTRACT The objective of this article is to present specific resources developed by the World Health Organization on equity, gender and human rights in order to support Member States in operationalizing their commitment to leave no one behind in the health Sustainable Development Goals (SDGs), and other health-related goals and targets. The resources cover: (i) health inequality monitoring; (ii) barrier analysis using mixed methods; (iii) human rights monitoring; (iv) leaving no one behind in national and subnational health sector planning; and (v) equity, gender and human rights in national health programme reviews. Examples of the application of the tools in a range of country contexts are provided for each resource.

A life-course approach to health: synergy with sustainable development goals.

Abstract A life-course approach to health encompasses strategies across individuals’ lives that optimize their functional ability (taking into account the interdependence of individual, social, environmental, temporal and intergenerational factors), thereby enabling well-being and the realization of rights. The approach is a perfect fit with efforts to achieve universal health coverage and meet the sustainable development goals (SDGs). Properly applied, a life-course approach can increase the effectiveness of the former and help realize the vision of the latter, especially in ensuring health and well-being for all at all ages. Its implementation requires a shared understanding by individuals and societies of how health is shaped by multiple factors throughout life and across generations. Most studies have focused on noncommunicable disease and ageing populations in high-income countries and on epidemiological, theoretical and clinical issues. The aim of this article is to show how the life-course approach to health can be extended to all age groups, health topics and countries by building on a synthesis of existing scientific evidence, experience in different countries and advances in health strategies and programmes. A conceptual framework for the approach is presented along with implications for implementation in the areas of: (i) policy and investment; (ii) health services and systems; (iii) local, multisectoral and multistakeholder action; and (iv) measurement, monitoring and research. The SDGs provide a unique context for applying a holistic, multisectoral approach to achieving transformative outcomes for people, prosperity and the environment. A life-course approach can reinforce these efforts, particularly given its emphasis on rights and equity.

Monitoring health determinants with an equity focus: a key role in addressing social determinants, universal health coverage, and advancing the 2030 sustainable development agenda

No abstract available. (Published: 16 December 2016) Citation: Glob Health Action 2016, 9 : 34247 - http://dx.doi.org/10.3402/gha.v9.34247 This paper is part of the Special Issue: Monitoring health determinants with an equity focus . More papers from this issue can be found at http://www.globalhealthaction.net and http://www.co-action.net/2015/09/si_who/