CONCEPT NOTE
National Seminar on
Moving Towards Equitable Health System in India:
Key Issues and Challenges
(May06-07, 2016)
http://www.ccdgujarat.org/news.aspx
Health is a complex phenomenon that is directly of indirectly influenced by several factors, and an understanding of these factors is essential for the health services' planners to plan and deliver effective treatment. The majority of the global burden of disease and the major causes of health inequities, found within and between different countries, arise from circumstances in which people are born, grow, live, work, and age. On the other hand, factors more commonly held responsible, such as access and use of health care services,often have less impact on the community health.[1]Sustainable improvements in the health of the population and a reduction in health inequalities can be achieved by addressing factors which lie at the core of disease causation.[2]These factors are termed as "Social Determinants of Health" (SDH), a term that incorporates the various determinants of health such as social, economic,political, cultural and environmental.[3]The underlying influence of economic, environmental, social, psycho-social and political determinants has been reflected in the universal social gradient in general as well as oral health.[4]Despite rapid globalization ensuing globally, profound inequities in health,living and working conditions are experienced by millions.[5]Health system reforms in Cuba, Brazil and Thailand have shown paramount success as they addressed the wider determinants of health inequities as a national priority and implemented reforms through both policy changes and grassroots-based actions.[6],[7],[8]
Health equity is a situation where physical, financial and managerial resources are adequately available to enable every individual a healthy living.[9]Such a resource distribution can offset the existing inequalities in the health status of populations, and their future emergence, recognize being healthy as a human right. Globally, achieving health equity is still a far-fledged target for many health systems, despite significant achievements in overall health status of populations and health systems indicators.[10]
The United Nations Millennium Development Goals (MDGs) cover eight goals that UN Member States agreed to try to achieve by the year 2015. The United Nations Millennium Declaration, signed in September 2000, commits world leaders to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. The MDGs are derived from this Declaration. Each MDG had targets set for 2015, and indicators to monitor progress from the 1990 levels. Several of these relate directly to health. While some countries have made impressive gains in achieving health-related targets,others are falling behind. Often the countries making the least progress are those affected by high levels of HIV/AIDS, and economic hardship or conflict.
One of the goals in Sustainable Development Goals (SDGs) is to ensure healthy lives, and promoting the well-being for all at all ages is essential to sustainable development. Significant strides have been made in increasing life expectancy and reducing some of the common killers associated with child and maternal mortality. Major progress has been made in in creasing access to clean water and sanitation, and reducing malaria, tuberculosis, polio,and the spread of HIV/AIDS. However, many more efforts are needed to fully eradicate a wide range of diseases and to address many different persistent and emerging health issues. Health equity and social determinants are acknowledged as a critical component of the post-2015 sustainable development global agenda and of the push towards progressive achievement of Universal Health Coverage(UHC). If health inequities are to be reduced, both SDH and UHC need to bead dressed in an integrated and systematic manner.
Member States of UN adopted the Rio Political Declaration at the World Conference on Social Determinants of Health in October 2011 in Rio de Janeiro, Brazil, calling upon them to act in five areas:
Adopt improved governance for health and development
Promote participation in policy-making and implementation
Further reorient the health sector towards promoting health and reducing health inequities
Strengthen global governance and collaboration
Monitor progress and increase accountability
The Rio Political Declaration was endorsed by WHO Member States atthe Sixty-fifth World Health Assembly (WHA) in Geneva, Switzerland in May 2012.
Meeting the Millennium Development Goals, Sustainable Development Goals and other health targets urge for addressing health equity and thereby inclusive socio-economic development.[11]Attaining an equitable health system depends upon baseline health systems' characteristics and comprehensive systemic attempts to address inequality.[12]Health inequity is a greater challenge in developing countries like India due to the presence of huge inequalities; the recognized bi-directional relationship between inequality and inequity; and less systemic preparedness to address inequity due to resource constraints including lack of awareness.[13]An equitable approach in health policy is a necessity in developing countries due to the public good characteristics of health care and risk of information a symmetry.[14]There are certain technical (ideologies, knowledge etc.) and non-technical(funds, infrastructure etc.) determinants of an equitable policy approach propelled by global, national and regional factors.[15]'Path dependency', where the legacy of policy structure makes divergence difficult,is a case for technical impediment; while the existing inadequate infrastructure hindering all-encompassing approach represents a non-technical barrier.[16]
To achieve MDGs, SDGs and UHC, social determinants need to bead dressed, as there is realization that there are huge diversities within and between classes, castes, gender and extensive regional variations in both,disease burden and response by the health care systems, and others concerned with development in India. Traditionally, India has always backed a social determinants perspective in order to ensure UHC. Social determinants of health have been recognized and highlighted by the Bhore[17]and Sokhey reports,[18]the 2010 Annual Report to the People on Health,[19]and the Draft National Health Bill 2009.[20]Comparatively, the 2010 Annual Report was more specific as it highlighted nutrition, access to safe drinking water, education, poverty and marginalization to be the key social determinants of health in India.The Draft National Health Bill, 2009 indicated that health interests would guide the creation of minimum standards for food/nutrition, water, sanitation and housing, adding that an individual's right to the highest attainable standard of health could not be impaired on grounds of social or economic status.
The Draft National Health Policy 2015[21]indicated that India today possesses as never before, a sophisticated arsenal of interventions,technologies and knowledge required for providing health care to her people.Yet the gaps in health outcomes continue to widen. On the face of it, much of ill health, disease, premature death, and suffering we see on such a large scale are needless, given the availability of effective and affordable interventions for prevention and treatment. The reality is straightforward. The power of existing interventions is not matched by the power of health systems to deliver them to those in greatest need, in a comprehensive way, and on an adequate scale. The primary aim of the National Health Policy 2015 is to inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in all its dimensions: investment in health,organization and financing of healthcare services, prevention of diseases and promotion of good health through cross sectoral action, access to technologies,developing human resources, encouraging medical pluralism, building the knowledge base required for better health, financial protection strategies, and regulation and legislation for health. Key principles of the National Health Policy2015 are equity, universality, and patient centered quality of care, inclusive partnerships, pluralism, subsidiarity, accountability, professionalism,integrity, ethics, learning adaptive system, and affordability.
Despite the health policy and health bill, disparities in exposure and vulnerability to diseases and health services accessibility are pronounced in India, with the most affected people being the poorest and most disadvantageous.[22] The UHC in India necessitates the reform of the health systems. However, The UHC will be possible only if there is simultaneous focus on social determinants and promotion of social equity. Steps toward promotion of social determinants such as food and nutrition security, social security, water, sanitation, and work and income security are imperative, as are social inclusion, and equity across gender, caste and religious categories.
India accounts for more than a fourth of the world's hungry. In line with the WHO's standards for children aged 3 years, 40% are underweight, 45%are stunted, and 23% have wasting.[23] Several determinants lead to malnutrition that has an extended and mitigating lifetime influence on the health and well-being of women and their children.[24]High levels of food insecurity are prevalent even in economically developed states such as Gujarat, Maharashtra, Andhra Pradesh, and Karnataka.[25]In addition to the obvious findings in malnourished children of an increase in dental caries prevalence,[26]gingivitis in primary school children[27]and periodontitis in teenagers,[28]malnutrition has been associated with delayed tooth exfoliation and erroneous eruption patterns.[29]Malnutrition has also been shown to demote the salivary flow, and significant changes in child mortality have been noted following an improvement in nutritional status of children. Current nutrition programmes in India emphasize on supplementary nutrition and pre-school education for 4–6 years old. This is contradictory to the need to focus appropriately on the first two years of a child's life which is critical to prevent under-nutrition and its impact on general and oral health.[30]
It is well-known that the socio-economic positions of individuals,groups and places are crucial attributes for the level of systematic health and disease.[31] Inequalities in oral health mirror those in general health. Socio-economic status affects the occurrence and severity of ill health not only among individuals and groups that are deprived or poor, but at every level of social hierarchy, creating the social gradient in health.[32] For long-term ailments, rural Indian women are three times more likely to go without treatment than rural Indian men, a tendency noticed even among the non-poor. Similarly, the treatment expenses are significantly smaller for women than men.[33] Besides gender, social status has also been linked with systemic neglect and poor health. It is striking that social and caste stratification determines the health, education, employment, social, and economic outcomes in India.[34] Although studies exhibit variable results,speculation is rife that socio-economic status is associated with oral cancer.Assumptions laid down in favour of this association are access to health care facilities, health related behaviours, living environment, and/or psycho-social factors.
Public health has to move forward and develop better ways of dealing with the burden of diseases, primarily in a social context. Trans-disciplinary approach that integrates different sectors and involves multiple stakeholders is the need of the day. In the rapidly changing digital age, conservative models of social behaviour and approach may not really bear fruit. Time and again, most doctors have not been able to view health in a social context.History records that neighbourhood environment plays a crucial role in community health needs, it marks the beginning of social security, and also creates an environment conducive to social-economic progress and growth. Observational studies done in different parts of the world have identified neighbourhood attributes like poverty, race and castes with increased risk of non communicable diseases. Learning this, the US Surgeon General[35]called for need to create community neighbourhoods that focus on healthy nutrition and daily physical activity where optimum equity is existent for all.
With rapidly proliferating climate change, a fast changing rural-to-urbanmigration, and increasing evolution of technology, it becomes imperative that social scientists and public health doctors come together to identify best practices for health promotion, and for better administration of local Government bodies.The quest to bring in social context in health promotion was known forty years ago through the efforts of Rogers who asked, "Can health sciences resolve society's problems in the absence of a science of human values and goals".[36]Only targeting behaviour and seeing human life through statistics cannot attend to social concerns that influence health outcomes, and is certainly not the most effective way for health promotion and prevention.
This national seminar will explore the synthesis of a policy process analysis of health equity, its challenges and opportunities in India. The seminar outcomes are expected to facilitate improved policy decisions towards health equity in India.This seminar intends to highlight the rationale for social determinants approach in Indian context, its application, and future recommendations for the same. Outcome from this seminar will throw light on adequate measures to be implemented by health systems to achieve the desired targets without delay.
Seminar Plan and Topics
The topics identified for the Seminar to be held on May 06-07, 2016 are just for reference for the contributors. Within the framework of the concept note, papers are invited having the following broad themes which would be futuristic in approach. Papers based on empirical research especially welcome. The following can be the main themes to be covered by the paper writers:
Achieving Health Equity: Key Issues and Challenges
Tackling Social Exclusion, including Minorities
Employment Categories and Health Inequalities
Age and Health Access
Social Determinants of Health: Their Role for Equity in Health
· Acting on Social Determinants for Health Equity in Urban Sector
· Acting on Social Determinants for Health Equity in Rural Sector
· Role of Social Scientists in Determining Social Determinants of Health
· Health and Humanity: Agents for Sustainable Development
· Role of Indigenous Knowledge in Social Determinants of Health
Health Status and Risk Factors: Issues and Challenges
· Mortality by Age and Sex
· Mortality by Cause
· Fertility by Caste and Religion
· Morbidity
· Issues in Reproductive /Maternal / New Bourn Child / Adolescent
· Immunization
· TB / Malaria / HIV-AIDS /Neglected Diseases
· Issues and Challenges in Mental Health
Health: Socio-cultural Analysis
· Nutrition v/s Malnutrition
· Infections
· Environmental Risk Factors
· Non-communicable Diseases
· Injuries
Public Health Policy and Planning
· Public Health: Building Trust,Social Capital and Social Cohesion
· Health Care Network
· Implication of Health Policy in All Related Policies
· Role of Social Scientist in Health Policy and Planning
· Inequality in Health Access
· Health Insurance Inequalities
· Health and Gender Equity
· Health Finance in Health Policy and Planning
Public Policy and Planning:Issues and Challenges
Place, Migration and Health
· Regional Disparities
· Maternal and Child HealthEnquiry among the Families of Migrants
· Reducing Disparities: A BigIssue in Sexually Transmitted Diseases and HIV/AIDS
Venue
The seminar will be held during May 06-07, 2016 at the Centre for Culture and Development, Vadodara, Gujarat. Vadodara is one of the well-developed cities, popularly called the cultural capital of Gujarat. It is well connected by rail and air network to the rest of India.The CCD campus is about 10 km from Vadodara railway station. From any point in Vadodara city, come to Gotri and take the road to Sevasi – Sindhrot. The CCD campus is about one and half kilo meter from Sevasi village on the main road,next to Baroda Homeopathic College and Xavier Technical Institute.
Submission of Papers
Researchers and other professionals are invited to submit their abstracts on the seminar themes. Those whose abstracts are selected may send a hard copy of their papers to the Director, Centre for Culture and Development, XTI Campus, Sevasi Post,Vadodara – 391 101 and must send a soft copy to the following email address: centreforculture@gmail.com.All contributors should submit their papers in soft copy, with short CV and passport sized photograph. The paper must not exceed 4,000 words limit(including tables and appendices). Abstracts of all the papers accepted will be published and distributed among the participants. Selected papers will be published as a volume.
Important Dates
Seminar Dates and Time : May 06,2016 at 09.00a.m. to May 07, 05.00p.m
Last Date for Receipt of Abstracts : April15, 2016
Last Date for Receipt of Full Length Papers : April30, 2016
Travel Support and Accommodations
Travel fare by II AC (Railway) will be reimbursed. Accommodation and local hospitality will be provided to the delegates at the institute guest house and nearby hotel/s.
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[3] KrechR. (2012): "Working on the social determinants of health is central to public health:, Journal on Public Health Policy 2012;33:279-84
[4] WattRG. (2007): From victim blaming to upstream action: Tackling the social determinants of oral health inequalities. Community Dent Oral Epidemiol2007;35:1-11
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[21] Ministry of Health and Family Welfare. The National Health Policy 2015; 2014 (Working Draft) Retrieved from http://www.mohfw.nic.in/showfile.php?lid=3014
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