Social Determinants of Health

Unintended Consequences of Purposive Action

• Actions can have unforeseen consequences, potentially leading to undesirable outcomes.
• These consequences arise from ignorance, negligence, gaps in knowledge, or chance.

Social Construction of Health and Illness

• The understanding and meaning of health and illness are shaped by social and cultural contexts.
• Early perceptions of HIV as a "gay plague" exemplifies this.
• The term "cancer" often evokes the idea of a monster.

Social Suffering and Structural Violence

• Pain and suffering can be caused by broad social factors, including global and local economics as well as politics.
• Bureaucratic indifference can also lead to suffering.

Biopower

• Political governance increasingly influences the control of bodies and populations through biopower.
• Using numbers and statistics to determine eligibility for health services is an example of biopower.

International Health Regulations (IHR)

• Traditional control measures like quarantine and sanitation are often inadequate in addressing modern disease spread.
• International cooperation is vital for controlling infectious diseases.
• The International Sanitary Convention (ISC) in 1892, a binding agreement focused on cholera quarantine, marked early efforts in this direction.
• The IHR in 2005 represents an agreement among 196 countries to collaborate on global health security.
• The IHR aims to prevent, protect against, control, and respond to the international spread of disease.
• Measures at ports, airports, and ground crossings are included in the IHR to limit health risks to other countries.

Actions After Declaration of Public Health Emergency of International Concern (PHEIC)

• Member states must share critical information for risk assessment, adjust response plans, and implement recommendations from the emergency committee.
• A situation is either a PHEIC or it is not; there is no middle ground.

WHO Key Areas for Emergency Risk Monitoring and Assessment

• Outbreaks of infectious diseases, including emerging or re-emerging diseases.
• Emergencies due to natural hazards like earthquakes, tsunamis, and floods.
• Emergencies caused by human-induced hazards such as explosions, crashes, and terrorism.
• Events resulting from exposure to toxic hazardous materials like food and water contamination.

WHO Criteria for Conducting Emergency Risk Assessment

• Scale of the event.
• Urgency of mounting a response.
• Complexity involving health consequences.
• Concurrent emergencies complicating the situation.
• Presence of unknown pathogens or chemical toxins.
• Need for specialized technical knowledge.
• Level of health system resources at the local level.
• Population vulnerabilities.
• Public perception and degree of panic.

Grading Health Emergencies

• Ungraded: The response does not exceed the usual country-level collaboration; the event is monitored as required.
• Grade 1: A single or multiple country event with minimal public health consequences, requiring minimal international WHO response.
• Grade 2: A single or multiple country event with moderate public health consequences, requiring a moderate international response that exceeds the country office's capacity.
• Grade 3: A single or multiple country event with substantial public health consequences, requiring a substantial international WHO response.

Drivers of Humanitarian Emergencies

• Conflicts.
• The global climate emergency.
• Economic factors.

Objectives of Humanitarian Action Response

• Saving lives.
• Alleviating suffering.
• Maintaining dignity.

The Humanitarian Space

• This is the environment needed for humanitarian actors to deliver services according to humanitarian principles without hindrance.

Humanitarian Actors

• A wide range of organizations, agencies, and networks.
• Can be local and international.
• Enable humanitarian assistance to reach people in need.

Principles of Humanitarian Response

• Humanity: Preventing and alleviating human suffering, protecting and respecting the life, health, and dignity of each individual.
• Neutrality: Not taking sides in a conflict or engaging in political, racial, religious, or ideological controversies.
• Impartiality: Providing assistance solely based on need, without discrimination based on ethnic origin, gender, nationality, political opinions, race, or religion.
• Independence: Maintaining autonomy of humanitarian objectives from political, economic, military, or other objectives.

Evolution of the Global Health Security Regime

• Unilateral quarantine regime: Characterized by unknown disease causation, limited international cooperation, and quarantine by land and sea.
• Sanitary conference regime: Marked by nascent international cooperation and conference diplomacy.
• Institutionalized sanitary coordination regime: Driven by self-interest for disease eradication everywhere and success in agreeing on international sanitary conventions.
• Health cooperation regime: Includes the establishment of the WHO, the "Health for All" movement, International Health Regulations, and emphasis on solidarity and cooperation.

Global Health Prioritization

• It is not solely a technical or scientific process but is heavily influenced by politics and people's moral values.

Neglected Tropical Diseases

• Affect 1 billion people globally.
• 1.62 billion people require treatment annually.
• 200,000 deaths could be prevented each year.

Global Health: Canada's Commitments

• Improve the quality and accessibility of health services.
• Increase access to comprehensive sexual and reproductive health/rights.
• Improve gender-sensitive nutrition.

Understanding Global Health Prioritization

• Consider the actors involved.
• The types of frames they advance.
• Forms of collective action they organize.

Actors

• Legitimacy of actors (NGOs, corporations, etc.).
• Power and resources.
• Motives and interests.

Global Health Frames

• How publics understand and portray global health issues.
• Encompass beliefs about the issues causality and solutions.
• Obesity can be framed as a lifestyle issue or a medical condition.

Types of Frames Used to Advance Global Health Issues/Initiatives

• Securitization: Evoking fear and existential threats.
• Moralization: Bringing people together to advance issues with an ethical imperative.
• Technification: Framing issues as scientific problems needing solutions.
• Securitization is often the fastest approach.

Trends in Development Assistance for Health (DAH)

• Financial or in-kind assistance provided by international development agencies and high-income countries to low and middle-income countries to maintain or improve health.

The Global in Global Health

• Health issues that concern many countries.
• Transnational solutions.
• Transnational determinants.
• Emphasis on commonalities rather than differences.

Transnational Actors

• Improving health.
• Protecting health security.
• Promoting human rights.
• Responding to humanitarian crises.
• Facilitating international development.

Essential Functions of the Global Health System

• Production of public goods (research, development).
• Management of disease and externalities across borders (international surveillance, response).
• Mobilization of solidarity (finance, technical assistance).
• Stewardship (consensus-building global goals/priorities).

Major Governance Challenges for Global Health

• The sovereignty challenge.
• The sectoral challenge.
• The moral challenge.
• The accountability challenge.

Sectoral Challenge

• Tackling unhealthy diets and NCDs involves the WHO, the food industry, and the agriculture sector.

Accountability Challenge

• State actors are accountable to citizens and international law.

The Moral Challenge

• Rooted in need and health equity.
• Involves bringing different moral frameworks to the system.

Governance Issues During the Pandemic

• Vulnerability: Highlights that "we are not all in this together."
• Inequalities in educational opportunities.
• Migrant workers on the frontlines.
• Conditions for housing and homeless populations.
• Risks for the elderly and those in long-term care homes.

Public Health and Civil Liberties

• Public Health: Measures taken to protect against a risk.
• Civil Liberties: Commitment to secure protected rights and freedoms of individuals against incursions by the state.
• Precautionary Principle: Action should be taken to mitigate catastrophic risk, even without complete evidence of the intervention's benefits or the nature of the risk.

Food Security and Malnutrition: Definition

• Lack of regular access to enough safe and nutritious food for normal growth, development, and an active, healthy lifestyle.

Four Dimensions of Food Security

• Physical availability of food.
• Physical and economic access to food.
• Food utilization.
• Stability of food availability, access, and utilization.

Acute vs. Chronic Food Security

• Acute food insecurity manifests at a specific point in time due to sudden changes or shocks, requiring short-term assistance.
• Chronic food insecurity is long-term or persistent, resulting from poverty and a lack of access, requiring long-term development and structural measures.

Drivers of Hunger

• Political stability.
• Geographic location.
• Gender and crises.
• Climate variations and extremes.

Minimum Standards for Food Aid in Humanitarian Crisis

• Appropriateness and acceptability.
• Food quality and safety.
• Equitable distribution.
• Transparent supply chain management.

Development Food Aid

• A medium-to-long-term response to help vulnerable people develop their income and become self-reliant.
• Includes distributing tools, seeds, and livestock.
• Providing training in agricultural techniques.
• Supporting school feeding programs.
• Nutritional support.
• Improving logistics to transport food.

Tied Food Aid

• Procurement of goods and/or services from the donor country.

Emergency Food Assistance

• A short-term response to address the immediate needs of populations, refugees, and displaced people.

United Food Assistance

• The provision of commodities by one country to another, free of charge or under highly concessional terms, to assist the country in meeting its food needs.