The Commission on Social Determinants of Health (CSDH) was tasked by the World Health Organisation (WHO) with summarising the evidence on how the structure of societies, through myriad social interactions, norms and institutions, are affecting population health, and what governments and public health can do about it. To guide the Commission, the WHO Secretariat conducted this review and summary of different frameworks for understanding the social determinants of health (SDH). Developing a conceptual framework on social determinants of health (SDH) for the CSDH needs to take note of the specific theories of the social production of health. Three main theoretical non-mutually exclusive explanations were reviewed: (1) psychosocial approaches; (2) social production of disease/political economy of health; and (3) eco-social frameworks. In turning to policy action on SDH inequities, three broad approaches to reducing health inequities can be identified, based on: (1) targeted programmes for disadvantaged populations; (2) closing health gaps between worse-off and better-off groups; and (3) addressing the social health gradient across the whole population. A consistent equity-based approach to SDH must ultimately lead to a gradients focus. However, strategies based on tackling health disadvantage, health gaps and gradients are not mutually exclusive. They can complement and build on each other.
Poverty and health
The global food system is under acute and rising pressure - and Africa's farmers are feeling its full force. There is still more than enough food in the world to feed everyone, says the Panel in this report, but population and economic growth as well as the search for low-carbon energy sources are driving up demand for arable land, while climate change, ecological constraints and lower levels of productivity growth in agriculture are limiting food supply. While these emerging strains in the global food system offer Africa some opportunities, they also carry very large risks. Higher food prices could create incentives for African governments to invest in agriculture and raise productivity, or they could lead to a dramatic worsening of poverty and malnutrition among vulnerable populations. Africa's vast untapped potential in agriculture could become a source of rural prosperity and more balanced economic growth, or it could act as a magnet for more speculative investments, land grabs and the displacement of local communities. Carbon markets might open up opportunities for small farmers to benefit from climate change mitigation efforts in rich countries, though the benefits have so far proven limited and the future of these markets remains uncertain. What is certain is that Africa's farmers will bear the brunt of dangerous climate change, with drought and unpredictable rainfall patterns reinforcing rural poverty and undermining food systems.
Maternal and child undernutrition, consisting of stunting, wasting, and deficiencies of essential vitamins and minerals, was the subject of a Series of papers in The Lancet in 2008. In the series, researchers quantified the prevalence of these issues, calculated their short-term and long-term consequences, and estimated their potential for reduction through high and equitable coverage of proven nutrition interventions. Authors of the 2008 series identified the need to focus on the crucial period from conception to a child’s second birthday - the 1,000 days in which good nutrition and healthy growth have lasting benefits throughout life. They also called for greater priority for national nutrition programmes, stronger integration with health programmes, enhanced intersectoral approaches, and more focus and coordination in the global nutrition system of international agencies, external funders, academia, civil society, and the private sector. Five years after the initial series, the the Lancet has re-evaluated the problems of maternal and child undernutrition in this document and also examines the growing problems of overweight and obesity for women and children and their consequences in low-income and middle-income countries (LMICs). Many of these countries are said to have the double burden of malnutrition - continued stunting of growth and deficiencies of essential nutrients along with the emerging issue of obesity. The Lancet also assesses national progress in nutrition programmes and international efforts toward previous recommendations.
This informal document aims at informing policymakers how best to consider the social determinants of health in the post-2015 global thematic consultations organised under the United Nations Development Group. It illustrates the concept of the social determinants of health as applied to the thematic groups, gives examples of why health is important to each theme and shows how each theme could contribute to health. In order to reduce health inequities, the UN Platform argues that there is a need to address the wider socioeconomic and structural factors that influence how people become sick, what risk factors they are exposed to, how they access services, and how they use those services. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. Integrated policy approaches are necessary in order to address the complexity of health inequities, including through national social protection floors, which address income security and the goal to establish universal access to health care simultaneously.
Concepts of ‘what constitutes mental illness’, the presumed aetiology and preferred treatment options, vary considerably from one cultural context to another. In this study, participants from four locations in Burundi, South Sudan and the Democratic Republic of the Congo, were invited to describe ‘problems they knew of that related to thinking, feeling and behaviour?’ Data were collected over 31 focus groups discussions (251 participants) and key informant interviews with traditional healers and health workers. While remarkable similarities occurred across all settings, there were also striking differences. In all areas, participants were able to describe localised syndromes characterised by severe behavioural and cognitive disturbances with considerable resemblance to psychotic disorders. Additionally, respondents throughout all settings described local syndromes that included sadness and social withdrawal as core features. However, attributed causes varied from supernatural to psychosocial and natural. The authors conclude that local conceptualisations have significant implications for the planning of mental-health interventions in resource-poor settings recovering from conflict.
The aim of this study was to examine growth indicators and dietary intake patterns of orphans and vulnerable children aged 4-18 years residing in state-run residential care facilities in Durban, South Africa. Thirty-three girls and 110 boys, aged 5-18 years, in three different children’s homes participated in the study. The results showed that stunting and overweight were prevalent in this group: 4.7% of the boys aged 4-8 years and 3.3% of the boys aged 14-18 years were severely stunted, while 13.3% of the girls aged 9-13 years and 20% of the girls aged 14-18 years were stunted. A small number were wasted. At the same time, 33.3% of the girls aged 4-8 years and 33.4% of the girls aged 9-13 years were at risk of being overweight, while 26.7% of the girls aged 14-18 years were overweight. One hundred per cent or more of the dietary reference intakes for energy, protein, carbohydrate and most of the micronutrients were met, except for calcium and iodine. A low intake of vitamin C among older boys and girls was reported. None of the groups met the recommended fibre intake. The authors call for the development and implementation of a comprehensive nutrition education programme for both child care workers and children.
Wealthy states are currently purchasing millions of hectares of land in poor states throughout Africa. This is a problem for many reasons, including increasing rural poverty and driving millions of people off land that they have been farming for generations. These land purchases also have environmental effects and are resulting in food shortages and food insecurity across Africa. In this paper, the author discusses this controversial practice and concludes that these land purchases should be considered land grabs. He focuses on the environmental effects that such land grabs have and also discusses the social effects of these land grabs on the communities in which they are taking place. The author concludes that African states must immediately recognise that these deals have environmental repercussions that harm not only the natural resources, but their citizens as well; and should thus put measures in place to curb the incidences and conclusion of these deals. African governments should instead sell such land to African entities, or at the very least, entities that will be required to keep a portion of all grown food in the host state to feed the populace. They must also reform land tenure and land registration laws to ensure that their citizens are not forced off land that they have farmed for generations. Only when African states control their land can they ensure that their citizens do not go hungry.
At the Annual World Bank Conference on Land and Poverty convened in early April 2013 in Washington, DC, the World Bank Group issued this statement. In the light of land grabs by multinationals that displace smallholder farmers, the Group argues that modern, efficient and transparent policies on land rights are vital to reducing poverty and promoting growth, agriculture production, better nutrition and sustainable development. It supports and endorses the Voluntary Guidelines on the Responsible Governance of Tenure of Land, Fisheries and Forests in the Context of National Food Security (the VGs). These guidelines are a major international instrument to inform specific policy reforms, and inform Bank procedures and guidance to clients. The World Bank Group is already working with countries to implement the VGs, with a special focus on Africa. With its partners, it has also developed the Land Governance Assessment Framework (LGAF) as a diagnostic tool to assess the status of land governance at the country level. LGAF assessments have been carried out - or are underway - in 18 countries, 10 of them in Africa.
In this paper, the authors call for a post-2015 framework to support a vision of the world where poor women and men have dignity and are able to flourish through participating in enabling societies and equitable economies that operate within safe ecological boundaries nationally and globally. The framework will: prioritise global issues that support and facilitate transformational change; keep issues that matter most to people in poverty on the international agenda; secure national action that drives progress on the ground; and enable better accountability, data collection, and monitoring and evaluation. CAFOD has identified three areas for action: empowering governance, which enables people to participate in the decision-making which affects their lives; the need for poor women and men to be able to participate in equitable economies and get a fair return for their contribution; and, resilient livelihoods, so that people’s dignity and flourishing are not undermined by environmental shocks and stresses, and development pathways are within ecological limits. These have the potential to transform the lives of people in poverty through addressing the underlying causes of poverty that prevent people from achieving their own aspirations.
To achieve maximum impact on food and nutrition security, knowledge and research policy should focus on local agriculture and food sectors - this means including small-scale farmers in regional food chains as well as making investments in the food system work for the rural poor by taking into account local environmental and cultural values. This article focuses on what a knowledge agenda on food and nutrition security should look like and what actors should be involved. The author argues that one of the main causes of current economic growth without food security is that small-scale farmers are not included in the formal food system and do not benefit from investments in agriculture and food, especially in sub-Saharan African. They also lack access to knowledge to improve their situation. To help create resilient and inclusive food markets, the author recommends strengthening cooperatives and producer organisations, developing comprehensive business models, designing a framework for public-private partnerships that include small-scale farmers and takes into account local cultural and environmental values, taking away the constraints to access knowledge by farmers, and pursuing coherent policies.