Presentation given in the panel entitled "Human Rights and Global Governance for Health" during the 7th Conference for Global health and Vaccination Research, September 26-27, 2012, Clarion Hotel and Congress, Trondheim, Norway.

1. Ramon Lorenzo Luis Rosa Guinto, MD
Regional Coordinator for the Asia-Pacific and
Founding Coordinator, Global Health Equity Initiative
International Federation of Medical Students’ Associations (IFMSA)
Youth Commissioner, Lancet-University of Oslo
Commission on Global Governance for Health

2. 1. There is an inequitable
distribution of health within and
between countries.

4. From Beaglehole and Bonita, 2012

5. Life expectancy at birth (men)
Glasgow, Scotland (deprived suburb) 54
India 61
Philippines 65
Korea 65
Lithuania 66
Poland 71
Mexico 72
Cuba 75
US 75
UK 76
Glasgow, Scotland (affluent suburb) 82
(WHO World Health Report 2006; Hanlon,P.,Walsh,D. & Whyte,B.,2006)

7. Source: Dr. Ramon Paterno, University of the Philippines

8. Alma Ata, 1978
The existing gross inequality in the health
status of the people particularly between
developed and developing countries as well
as within countries is politically, socially and
economically unacceptable…

9. 2. Health inequities are rooted
in social inequalities – the social
determinants of health.

10. Source: Ravi Narayan, SOCHARA, India

12. Filipino Wealth Quintiles
AVERAGE HOUSEHOLD MONTHLY INCOME
Middle
Poorest Poor Rich Richest
Income
5,958 8,594 12,269 18,497 40,590
FOOD EXPENDITURE SHARE
40% 27%
67% 57% 49%
FIES, 2009

13. Incidence of Illness and
Injury by Income Quintile
100
90
80
70
60
50
40
30 55 51 45 39
20 34
10
0
Poorest Poorest Middle Rich Richest
Income
National Demographic and Health Survey, 2008

15. “Unequal distribution of
health-damaging
experiences is not in any
sense a ‘natural'
phenomenon, but is a result
of the toxic combination
of poor social policies
and programs, unfair
economic arrangements
and bad politics.”
WHO Commission on Social Determinants
of Health, 2008

16. Commission on Social
Determinants of Health
1. Improve Daily Living Conditions
2. Tackle the Inequitable Distribution
of Power, Money, and Resources
3. Measure and Understand the
Problem and Assess the Impact of
Action.

17. Basic question:
What good does it do to treat people’s Illnesses …
only to send them back to the conditions
that made them sick?

18. 3. Global governance
arrangements need to tackle the
social determinants at all levels.

19. Structural Adjustment
• Cuts in public spending • Widening of inequalities
• Removal of price • Reduced purchasing
controls power for the poor
• Freezing of wages (increased
• Emphasis on production prices, withdrawal of
for export subsidies, freezing of
• Trade liberalisation wages)
• Incentives for foreign • Downsizing of public
investment sector and safety net
• Privatisation of public programs
sector services • User pays in health care
• Devaluation
• Reduced support for
From David Legge
subsistence agriculture

20. 3 drivers of dietary change
1. Liberalisation of international food trade
2. Increased foreign direct investment
3. Globalised advertising and marketing
From Sharon Friel, Australia

21. Top 10 manufacturers of packaged foods
Three quarters of world food sales involve
processed foods, for which the largest
manufacturers hold over a third of the global
market. From Sharon Friel, Australia
Stuckler et al (2012) Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities Including
Processed Foods, Alcohol, and Tobacco. PLoS Med 9(6): e1001235. doi:10.1371/journal.pmed.1001235

22. Governance Areas
http://www.goldmercury.org/global_governance_model.php

23. Global Governance

24. Subglobal Governance

25. National Governance

26. Social injustice is
killing people on a
grand scale.
WHO Commission on Social
Determinants of Health

27. It is not inequalities that kill, but
those who benefit from the
inequalities that kill.
Vicente Navarro

28. HEALTH INEQUITY
within and among nations
DOMINANCE OF NEGATIVE SOCIAL
DETERMINANTS OF HEALTH
DYSFUNCTIONAL GLOBAL
GOVERNANCE SYSTEM

32. A Time for Questioning
• The economic model we follow
• The relations between nations
• The boundaries between the global and the local
• The role of non-state actors (private sector, religion, civil
society, etc.)
• The adequacy and effectiveness of, as well as gaps and
defects in existing governance structures
• The individuals and groups that govern these structures
• The basis for action at all levels

33. Reorientation of health professions
education – equity-based, systems-
oriented, global perspective, SDH thinking

34. The 21st century health professional as champion of
social determinants approach to health

35. The Power of Medicine
"Medicine… has the
obligation to point out
problems and to attempt
their theoretical
solution…The physicians
are the natural attorneys
of the poor…”
Dr. Rudolf Virchow
Father of Social Medicine

36. The Power of Young People
“The youth are
the hope of the
Fatherland.”
Dr. Jose Rizal
National Hero of the Philippines

37. Where are the innovations in global health?

38. We young people would like to be part!

39. Health for All!
Alma Ata, USSR, 1978 Almaty, Kazakhstan, 2008
Thank You Very Much!