This document discusses promoting health equity in Eastern Europe and Central Asia. It summarizes evidence that social, economic, and environmental factors (SEEDs) influence health and health inequities. Key SEEDs include income, education, gender, ethnicity, and governance. The document outlines UNDP's role in addressing health equity through supporting the Sustainable Development Goals, building capacities, and facilitating collaboration between health and other sectors. It provides examples of UNDP programs that have improved health services and outcomes in several countries.

1. c
SEEDs* of Health and Health Equity
In the Context of Sustainable Human Development
Dr. Ruth Bell
Senior Advisor
UCL Institute of Health Equity
London, UK
Dr. Zlatko Nikoloski
Assistant Professorial Research
Fellow
London School of Economics
London, UK
John Macauley
Regional HHD Specialist
UNDP Istanbul Regional Hub
Istanbul, Turkey
* Social, Economic and Environmental Determinants

2. Promoting Health Equity in EECA
• Supports action for health and well-being
in a whole-of-government and whole-of-
society approach
• Adopted by all 53 WHO Europe member
states, including all EECA countries
• Its two strategic objectives are:
• improving health for all and reducing
health inequalities
• improving leadership and
participatory governance for health
INTRODUCTION

3. Promoting Health Equity in EECA
• SDG 3 and 10 focus on health and
inequity explicitly
• Ensure healthy lives and
promote well-being for all
• Reduce inequality within and
among countries
INTRODUCTION

4. Promoting Health Equity in EECA
• SDG 3 and 10 focus on health and
inequity explicitly
• Ensure healthy lives and
promote well-being for all
• Reduce inequality within and
among countries
• Health in All Policies means Health in
All SDGs
INTRODUCTION

5. INTRODUCTION

6. The social, economic and environmental
factors constituting the three interlinking
pillars of sustainable human development
and determine health and its distribution.
80 SEEDs of Health, including
• Social support/community networks
• Transparency and accountability
• Housing quality
• Access to green spaces
• Job creation
• Wealth distribution
The absence of avoidable and unjust
systematic differences in health between
groups with different levels of social
advantage and disadvantage
14 Dimensions of Inequity, including
• Gender
• Age
• Educational attainment
• Income
• Ethnicity
• Sexual orientation
• Marginalisation (including vulnerable
migrants, IDP, refugees, prisoners, sex
workers and others)
Health Equity
INTRODUCTION
SEEDs of Health

7. Health and Wealth
EVIDENCE
Turkmenistan
Uzbekistan
Moldova
Tajikistan
Kyrgyz Republic
Kazakhstan
AzerbaijanKosovo
Ukraine
Belarus
Georgia
Armenia MontenegroSerbia
Turkey
fYRoM
Bosnia and Herzegovina
Albania
64.0
66.0
68.0
70.0
72.0
74.0
76.0
78.0
80.0
0.00 2000.00 4000.00 6000.00 8000.00 10000.00 12000.00 14000.00
LifeExpectancyatBirth
GDP per capita (US$)
World Bank, 2014

8. Inter-regional and Gender Inequities
in average Life Expectancy
EVIDENCE
55
60
65
70
75
80
85
LifeExpectancy(Years)
Female Male WHO/Europe average female WHO/Europe average male
WHO, 2012

9. Gender Inequities in Premature
NCD Deaths
EVIDENCE
NCD deaths under age 70 as percentage of all
NCD deaths
0
10
20
30
40
50
60
70
80
PercentageofprematureNCDDeaths
Female Male
Global Health Observatory, 2012

10. Ethnic Inequities in Morbidity
0
10
20
30
40
50
60
70
80
0-6 years 7-14 years 15-24 years 25-34 years 35-44 years 45-54 years 55-64 years 65 years
and older
PercentageReportingIllnesses
Roma non-Roma
EVIDENCE
Percentage of Roma and non-Roma reporting
long-standing illnesses in EECA
Mihailov, 2012

11. GDP per capita, growth of GDP per capita, income inequality (Gini), institutional strength
(measured by Polity IV index).
• Socioeconomic status/Household
wealth
• Gender
• Educational attainment
• Family Composition (Marital
Status)
• Marginalised groups (Migrant
Status)
• Wealth distribution (Gini
Coefficient)
• Transparency and accountability
in governance (measured by
Polity IV Index)
• Social support/community
networks
• GDP per capita and GDP per
capita growth
• Life satisfaction
Dimensions of Inequity
significantly correlated with
self-assessed Health
SEEDs of Health significantly
correlated with self-assessed
Health status
EVIDENCE
* Based on LiTS 2010 Data for Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Georgia,
Kazakhstan, Kyrgyzstan, Macedonia, Moldova, Montenegro, Romania, Russia, Serbia, Slovenia, Tajikistan, Uzbekistan

12. 0
10
20
30
40
50
60
70
80
90
100
Percentagereportinggood/verygoodhealth
Cross-Country Inequity in (average)
self-perceived Health
EVIDENCE
Life in Transition Survey, 2010

13. • Marginalised groups (for all key
population groups studied)
• Socio-economic status (for PWID,
SW and prisoners)
• Gender (for PWID and SW), which
is related to gender-based
violence
• Sexual orientation (for MSM)
• Life course stage
Dimensions of Inequity for HIV
• Access to healthcare &
availability of healthcare
services
• Discrimination and stigma
• Exposure to violence & effective
policing
• Human rights
• Transparency and accountability in
governance
• Treatment adherence
SEEDs of HIV
EVIDENCE

14. Marginalization and Sexual
Orientation-related Inequities in
Morbidity
EVIDENCE
I am a prisoner.
I am a man who has
sex with other men.
I am an injecting
drug user.
I am a sex worker.
9
5.7
2.2
0.9
PWID MSM SW
HIVPrevalence(%)
General adult population
UNAIDS, 2014

15. HIV Treatment Coverage
(Access to Healthcare)
EVIDENCE
15
20
25
30
35
40
45
50
Republic of
Moldova
Armenia Kyrgyzstan Belarus Kazakhstan Georgia
HIVTreatmentCoverage(%)
Eastern Europe and Central Asia Global East and Southern Africa

16. International funding as % of total
funding for national HIV responses
EVIDENCE
0 20 40 60 80 100
Armenia, 2012
Kyrgyzstan, 2013
Moldova, 2013
Georgia, 2014
Ukraine, 2010
Belarus, 2013
Kazakhstan, 2013
Russia, 2008

17. E-Discussion Feedback: UNDP’s Role
in Addressing Health Equity & HIV
PROGRAMMATIC ACTION
Outreach and Contributions
• 3 Mailouts to 2000+
direct contacts
• #TalkInequality
76 Tweets, 107
Retweets, 54 Likes
and counting
• 16 contributions
from UKR(5),
TUR(4), SRB (2),
BLR, TAJ, UZB, US
and NZ including
UNDP (7), CSO (5),
Academia and
Government
Engage the whole of government and
society to
• forge alliances between health and other
sectors
• promote human rights
• empower civil society
Support the SDGs and Health 2020 and build
commitment to address HIV as part of the
health equity and sustainable human
development agendas
Support programmatic action to
• build capacities
• improve allocative and technical efficiency
• facilitate collaboration and knowledge
exchange

18. Accumulation of positive and negative
effects on health and wellbeing
Life course stages
Pre-natal
Family Building
Pre-school School Training Employment Retirement
PROGRAMMATIC ACTION
Life Course Approach: Adding Value
for Development Programming
Macro-level Context: Sustainable Development
Systems: GovernanceWider Society: Resilience

19. • Fully operational
• Agreed Work Plan and Agency Division
of Labor
• Reporting to the Regional Director’s
Working Group across all agencies
• First issue based coalition for
operationalizing the SDGs
• Other Coalitions to be developed on
gender and migration
Regional UN Inter-Agency Thematic
Group on NCDs and SEEDs of Health
PROGRAMMATIC ACTION

20. PROGRAMMATIC ACTION
Procurement Support Services to
The Ministry of Health of Ukraine
Global Fund Partnership:
HIV, Tuberculosis and Malaria
“We have broken a big corruption scheme in
medicine procurements (…) and several-fold
price reduction for some drugs serves as a
direct proof.”
- Egor Sobolev, Chairman Verkhovna Rada
Committee on Preventing and Fighting Corruption
• In Kyrgyzstan, local Tuberculosis
Centers increased average fund delivery
rates from 5% to 85-95%
• In Belarus, 37,000 people access
anonymous counselling, 700 patients
receive methadone and 70,000
prisoners access HIV services as of
2011

21. Phase I: SEEDs of H/HE Analysis
of UNDP Eurasia Project Portfolio
• Develop SEEDs screening tool
• Monitor co-benefits for health &
development
• Scale up
• Disseminate
Phase II: Integration of SEEDs of
H/HE in Belarus Country Portfolio
PROGRAMMATIC ACTION

22. THANK YOU FOR YOUR
ATTENTION.
Dr. Christoph Hamelmann
Regional Team Leader (EECA),
Senior Advisor (Arab
States), HHD, Coordinator,
Secretariat UN iIATT SPHS
christoph.hamelmann@undp.org
twitter: @cahamelmann
John Macauley
Regional Programme Specialist,
HHD (EECA)
john.macauley@undp.org
twitter: @johnmacauley
Esther Werling
Consultant, SEEDs of Health
and Health Equity, HHD (EECA)
esther.werling@undp.org
twitter: @estherwerling
Dr. Ruth Bell
Senior Advisor
UCL Institute of Health Equity
r.bell@ucl.ac.uk
Dr. Zlatko Nikoloski
Assistant Professorial Research
Fellow
London School of Economics
z.nikoloski@lse.ac.uk