Global Health Inequalities: Focus on Asia-Pacific


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Lecture given during the pre-APRM workshop on Social Determinants of Health and Global Health Equity, September 11, 2012, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur

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  • Global Health Inequalities: Focus on Asia-Pacific

    1. Global Health Inequalities: Focus on Asia-PacificRamon Lorenzo Luis Rosa Guinto, MD Regional Coordinator for the Asia-Pacific and Founding Coordinator, Global Health Equity InitiativeInternational Federation of Medical Students’ Associations (IFMSA) Youth Commissioner, Lancet-University of Oslo Commission on Global Governance for Health
    2. Alma Ata, 1978The International Conference on PrimaryHealth Care calls for urgent action by allgovernments, all health and developmentworkers, and the world community to protectand promote the health of all the people ofthe world by the year 2000.
    3. From Beaglehole and Bonita, 2012
    4. Prof. Hans Rosling
    5. Life expectancy at birth (men)Glasgow, Scotland (deprived suburb) 54India 61Philippines 65Korea 65Lithuania 66Poland 71Mexico 72Cuba 75US 75UK 76Glasgow, Scotland (affluent suburb) 82 (WHO World Health Report 2006; Hanlon,P.,Walsh,D. & Whyte,B.,2006)
    6. Ailing Asia: Indicators• Between 1990 and 2001, the proportion of people living on less than $1 per day fell from 31 to 20 per cent.• Five out of ten Filipinos die without seeing a physician or any other health care provider.
    7. Ailing Asia: Indicators• In Afghanistan, one child in four dies before reaching the age of 5.• Each year, across the region around one quarter of a million women die as a result of a normal life cycle event: pregnancy and childbirth.
    8. Ailing Asia: Indicators• As of 2004, the Asia-Pacific region has over 9 million people living with HIV/AIDS and each year half a million people die.• The highest prevalence of malaria can be found in the Pacific, notably Solomon Islands, where the disease affects 15 per cent of the population.
    9. Source: Dr. Ramon Paterno, University of the Philippines
    10. Mortality over 25 years according to level in the occupational hierarchy: Whitehall Study(Marmot & Shipley, BMJ, 1996)
    11. Life expectancy and disability-free life expectancy at birthby neighbourhood income deprivation, 1999-2003
    12. Angola
    13. Brazil
    14. Burkina Faso
    15. European Union
    16. The Jubilee Line of Health InequalityTravelling east from Westminster, each tube stop representsup to one year of male life expectancy lost at birth (2002-06)Male LifeExpectancy Male Life78.6 (CI 76.0-81.2) Expectancy Canning Town 72.8 (CI 71.1-74.6)Female Life Expectancy84.6 (CI 82.5-86.7) Female Life Expectancy 81.4 (CI 79.3-83.6) Westminster Canary London Bridge Wharf River Thames Canada North Bermondsey Water Greenwich Waterloo Southwark Electoral wards just a few miles apart geographically have life expectancy spans varying by years. For instance, there are eight stops between Westminster and Canning TownLondon Underground Jubilee Line on the Jubilee Line – so as one travels east, each stop, on average, marks up a year of shortened lifespan. 11 Source: Analysis by London Health Observatory using Office for National Statistics data revised for 2002-06. Diagram produced by Department of Health
    17. Definitions• Inequalities/Disparities in health – ‘differences’ in health across individuals / population groups• Inequities in health – avoidable differences• ‘Where systematic differences in health are judged to be avoidable by reasonable action they are, quite simply, unfair. It is this that we label health inequity.’ WHO Commission on Social Determinants of Health (2008) From Mike Rowson, 2011
    18. Elaboration of disparities in wealth• The world’s richest 1% receive income = to the poorest 57%• The income of the world’s richest 5% = 114 X that of the poorest 5% » UN Human Development Report 2002
    19. Champagne Glass
    21. 21st Century Global Health Challenges: Five Trends that Shape the Future1 and 2: Demographic – we are getting older and living incities3: Environmental – the earth is heating up4: Economic – the economic center is shifting eastward5: Epidemiologic – we are sick with noncommunicablediseases (Center for Global Development)
    22. UN High-Level Summit on NCDs
    23. Broad cause of death incountries, by World Bank incomegroups, 2008
    24. Burden of NCDs• Two of three deaths each year• Four-fifths of these deaths are in low-income and middle- income countries• A third are in people younger than 60 years• Overall, age-specific NCD death rates are nearly two-times higher in low-income and middle-income countries than in high-income countries.• In all regions of the world, total numbers of NCD deaths are rising because of population ageing and the globalisation of risks, particularly tobacco use. Beaglehole, Bonita, et al. Lancet 2011
    25. Economic burden
    26. Epidemiology of Inequality
    27. Causes of the causes?