This week, the Brazilian government and the WHO opened the first World Conference on Social Determinants of Health in Rio de Janeiro. Over 50 ministers are attending as well as secretaries of health from all around the world and civil society representatives. The conference is designed to discuss the inequity of access and outcomes of health for people around the world.
As Dr. Margaret Chan, Director General of the WHO stated in her inaugural speech: “A child born into a poor household faces a life expectancy of an average of 28 years less than a child born into a rich household.
“The social determinants of health”, she went on, “arise from the conditions in which people are born, grow, live, work and age”.
HelpAge International and colleagues from the International Longevity Centre and the International Federation on Ageing and the International Association of Gerontology and Geriatrics are there to see how work on these issues.
Inequalities in health persist into old age
The conference focuses on five core themes to ensure:
- Efficient and effective governance in health systems (especially the training, management and retention of health professionals) whilst seeking to address the causes of ill health, many of which lie outside the health sector and require multi-sectoral alliances to reach sustainable outcomes and solutions.
- The participation of civil society, recognising the potential for NGOs and CSOs to provide health related data and analysis to inform policy-making and implementation.
- Universal health coverage for all – 150 million people a year are faced with huge health costs instead of being covered by general insurance or social protection programmes.
- Disagregated data is gathered and analysed to uncover health inequities and provide a framework for measuring progress towards reducing these.
- The international community comes together to accelerate progress towards the MDGs, but at the same time puts in place and builds social protection systems, tackles the impacts of climate change and the epidemic of non communicable diseases.
This conference provides a great opportunity to promote better health for older people within debates on health policies and financing. It means we can look at the deeper issues of poverty and discrimination which accumulate over a person’s life course, such that inequalities in health and other spheres persist and deepen in old age, especially for older women.
Free and appropriate healthcare
This morning I had the chance to visit a project in one of Rio’s many favelas which had trained 380 local people (old and young) as carers for older people. This included an outreach programme of home visits to dependent and bed ridden older people, which contrasted starkly with the brand new family clinic built just a mile away.
The clinic has done a lot to provide greater access to free and appropriate health care to community members, including sending health promoters into the community. However, this is still not enough to provide the type of care needed by dependent older people.
Dona Augustina, 75 years old, lives alone in a brick shack. There is a bed, toilet and kitchen in one room, which is at the end of a narrow passage between the rickety houses of the favela. The path has an open sewer running down the middle.
As she struggles to lift herself up to a sitting position in her bed and I can see that her mattress is damp from the rain that is dripping through her roof. Over the past two years, Augustina has taken part in a pilot home care programme run by local NGO “Atitude social” (with support from IBIS, Banco Santander and InterAge consultancy). But now the pilot has ended and has no more funding.
Deteriorating health, dependent on help
Augustina therefore has to cope on her own, even though her health has deteriorated even more since the end of the project. She has no family in Rio. A neighbour comes in three times a day to prepare her something to eat.
Clearly the barriers Dona Augustina has faced throughout her life, mean that now, in old age she is in bad health and lives in very poor conditions.
She told me: “Yesterday, I managed to bathe using a pot of water which I poured over myself as I sat on my toilet. But I slipped off onto the floor and had no way of getting up until later when my neighbour arrived to help.”
How can the conference help people like Dona Augustina, whose house and community, that she’s lived in for 40 years, has become her prison?
Access to healthcare: In pictures
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