Social determinants of health

Stories of positive action from around the world

Story numbers correspond to those in the Report.

Social protection for improved health

8.3: Universal social pension - Bolivia

In Bolivia, 59% of older people live on less than a US$ 1/day. One annual payment of Bs 1800 (US$ 217) is available to all resident Bolivian citizens over the age of 65. Recipients collect the one-off annual payments in cash from affiliated banks, which are usually in urban areas. The pension makes up 1.3% of GDP. Half of recipients said that this social pension was their only source of income. It is generally spent on household expenses, but also on basic medication. In addition, the pension provides older people with capital that they can choose to invest in income-generating activities or for younger generations. Not only does this have a financial value, but it also has a social value, increasing their status within the family.

In 2004, 77% of those eligible were claiming the entitlement. However, pension coverage is particularly low among women. Unfortunately, they are also in greatest need. One problem is that identification documents are needed to register, and 16% of older people who are eligible for the pension scheme do not have identity documents, so cannot prove their eligibility. Many older people in rural communities have never had a birth certificate. HelpAge International, an NGO, supports socio-legal centres in La Paz and El Alto that help older people obtain a birth certificate from the government registry office so that they can receive their pension. Reproduced, with minor editorial amendments, with permission of HelpAge International, from HelpAge International (2006b)

8.8: Oportunidades – conditional cash transfer

An example of a conditional programme used to stimulate specific behaviour is Oportunidades (formerly Progressa), the conditional cash transfer programme in Mexico. The programme involves cash transfers to families provided that children aged 0-60 months are immunized and attend well-baby clinics where their nutritional status is monitored. These children are given nutritional supplements and their parents are given health education. Pregnant women receive prenatal care, lactating women receive postpartum care, other family members receive physical check-ups once per year (where they also receive health education), and adult family members participate in regular meetings where health, hygiene, and nutritional issues are discussed.

An evaluation found that the programme had important health effects. Children born during the 2-year intervention period experienced 25% less illness in the first 6 months of life than control children, and children aged 0-35 months during the intervention experienced 39.5% less illness than their counterparts in the control group. Children in the programme were also one quarter as likely to be anaemic, and grew on average 1 cm more. Finally, the effects of the programme appear to be cumulative, increasing the longer the children stayed in the programme. Source: ECDKN, 2007b

8.8: Setting up a contributory social security system in India

Of the workforce in India, 93% is informal. These workers have no security of work and income, nor statutory social security. The Self-Employed Women’s Association (SEWA), a union of 1 million women workers in India, has been spearheading a national campaign for basic social security for informal workers. It developed a draft bill giving all informal workers the right to social security including, as a minimum, insurance, pension, and maternity benefits. Several national unions have joined this campaign. The national government set up a commission to develop laws and policies for informal workers. The commission developed a law that envisages basic coverage – health insurance, life and accident insurance, maternity benefits, and pension – for the 380 million workers in the informal economy.

When fully implemented, these benefits will cost less than 0.5% of Indian GDP. Contributions from the government, employers as a group (by way of a tax on their enterprises), and workers above the poverty line will finance the social security coverage suggested by the commission. Workers below the poverty line will not need to provide any contributions. At the time of writing, the bill is being reviewed and is expected to be presented to Parliament in its next session.