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Trade and the Social Determinants of Health

Presented at LSHTM March 14, 2013 and March 13, 2014
by

Courtney McNamara

on 4 October 2015

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Transcript of Trade and the Social Determinants of Health

TRADE
HEALTH
&
Fundamental determinants =SOCIAL POSITION
"Medicine is a social science, and politics is nothing else but medicine on a large scale.
"T
here is a connection between good public health and a society characterised by
financial and social security, equality in living conditions, equal rights and justice. Financial stress and social insecurity causes ill health,
primarily poor mental health, and leads to increased health inequalities"
Swedish National Institute of Public Health
http://www.fhi.se
Resources to meet daily needs
Educational, economic, and job opportunities
Health care services
Quality of education & job training
Community-based resources
Transportation
Public safety
Social support
Social norms and attitudes (
e.g., discrimination, racism, and distrust of government
)
Exposure to
crime, violence, and social disorder
Socioeconomic conditions
Residential segregation
Language/Literacy
Access to mass media and emerging technologies
(e.g., cell phones, the Internet, and social media)
Culture
SDOH in the United States:
HealthyPeople.gov
Aboriginal status
disability
early life
education
employment and working conditions
food insecurity
health services
gender
housing
income and
income distribution
race
social exclusion
social safety net
health services
unemployment and job security
Raphael (2009)
SDOH in Canada:
SDOH in Sweden
stress
early life
social exclusion
work
transport
unemployment
social support
addiction
food
SDOH in Australia
http://www.sahealth.sa.gov.au
Healthy People 2020
CONTEXTUALIZED RISK FACTORS
FUNDAMENTAL DETERMINANTS OF HEALTH
INDIVIDUAL RISK FACTORS
Ex: Access to parks, Healthy foods, and Health care
Ex: Diet, Lack of Exercise, High Blood Pressure
Ex: Income, Power, Knowledge, Prestige
THE SOCIAL DETERMINANTS OF
ALMA ATA DECLARATION
Economic and social development as a pre-requisite for the attainment of Health For All
1978
1998
THE BLACK REPORT (UK)
Need for interventions in sectors such as education, housing and social welfare, in addition to improved clinical care.
Acheson Report (UK)
Need actions to aimed at addressing poverty, education, employment, housing, transport, nutrition, ethnicity, gender, and health care
1980
INSTITUTE OF MED (US)

Need “broad perspective [of health that] takes into account the potential effects of social connectedness, economic inequality, social norms, and public policies”
2002
WHO Commission on SDOH

“Inequities are killing people on a grand scale"
2008
The Adelaide Statement on Health in All Policies (WHO/Australia)
The causes of health and well-being lie outside the health sector and are socially and economically formed
2010
Medicine, as a social science, as the science of human beings,
has the obligation to point out problems and to attempt their theoretical solution:
the politician, the practical anthropologist, must find the means for their actual solution."
Rudolf Virchow (German Doctor, 1821-1902)
The resources by which people control the conditions of their life.

Includes: food, housing, income, education, employment, our physical environments
Social Determinants of Health
Contextualized Risk Factors vs. Fundamental Determinants
Structural vs.
Social Determinants
SDOH as a Political Discourse
Link And Phelan (1995)
Trade & healthcare, tobacco, alcohol and unhealthy foods; access of medicines
STRUCTURAL
SOCIAL
TRADE??
Ex: Level of income via unemployment insurance and paid sick time; job training services
Fundamental / Structural
Contextualized Risk Factors
Ex: Influencing peoples access to health care
PUBLIC POLICIES
TRADE
Import Tariffs
'Spending Capacity'
Public healthcare
Education
Water/sanitation
Gender empowerment programs
Enforcement of occupational, environmental & labour rights and standards.
$$$
Trade Liberalization
Low and Middle-Income Countries
LABOUR MARKETS
Industrial zone with tax and other regulatory exemptions
EPZ:
Young women, migrants. from poor backgrounds
Long hours, temporary contracts
Inability to collectively organize
HEALTH
Physical Working Conditions
Income, Power
Clothing and Textile Sector
Quota Based prior to 2005
Ex: Phillipines
4,198,176
United States
'Quota-hopping'
Courtney McNamara
Norwegian University of Science and Technology
Courtney.McNamara@ntnu.no
Webinar for APHA Trade and Health Forum
October 2015
Clothing and Textile Sector
Important source of economic growth & employment (fundamental determinant)
Clothing and Textile Sector
2005 Expiration of Trade Agreement: Multi-Fibre Arrangement
Countries no longer bound by Quotas
Ex: Phillipines
United States
Removed incentives for companies to set up factories in other countries
Clothing and Textile Sector
Political Contexts
Conservative government & political apathy
TRADE
Political Parties:
Political Traditions:
Commitments to social programs (ex. healthcare, childcare, education, unemployment benefits)
Dominant structure of a country’s social commitments
Ex: Sweden
Ex: US
Political Actors
“both the masking of the political nature of health, and the forms of the social structures and processes that create, maintain and undermine health, are determined by the individuals and groups that wield the greatest political power”
Bambra, Fox, & Scott-Samuel, 2005
"And yet, this is where the report falls short. It is not inequalities that kill, but those who benefit from the inequalities that kill.”
Vincente Navarro, 2010
(ex. via Trade Agreement, Loan Condition)
Tobacco Companies
Raphael 2011
Health varies by political tradition
Typically, health better in SD nations
Understandings of SDOH
SDOH Policies deemed acceptable
Countries' Unequal Bargaining Positions
-T&C Sector & Fundamental determinants
2005-2009
-Contextualize risk factors assoc. with smoking
Full transcript