Youth Perspectives on Social Determinants, Health Equity, and Global Governance

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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 …

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.

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  • 1. Ramon 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. 1. There is an inequitabledistribution of health within and between countries.
  • 3. From Beaglehole and Bonita, 2012
  • 4. 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)
  • 5. Source: Dr. Ramon Paterno, University of the Philippines
  • 6. Alma Ata, 1978The existing gross inequality in the healthstatus of the people particularly betweendeveloped and developing countries as wellas within countries is politically, socially andeconomically unacceptable…
  • 7. 2. Health inequities are rootedin social inequalities – the social determinants of health.
  • 8. Source: Ravi Narayan, SOCHARA, India
  • 9. Filipino Wealth Quintiles AVERAGE HOUSEHOLD MONTHLY INCOME MiddlePoorest Poor Rich Richest Income 5,958 8,594 12,269 18,497 40,590 FOOD EXPENDITURE SHARE 40% 27% 67% 57% 49%FIES, 2009
  • 10. 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 IncomeNational Demographic and Health Survey, 2008
  • 11. “Unequal distribution ofhealth-damagingexperiences is not in anysense a ‘naturalphenomenon, but is a resultof the toxic combinationof poor social policiesand programs, unfaireconomic arrangementsand bad politics.”WHO Commission on Social Determinants of Health, 2008
  • 12. Commission on SocialDeterminants 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.
  • 13. Basic question: What good does it do to treat people’s Illnesses …only to send them back to the conditions that made them sick?
  • 14. 3. Global governancearrangements need to tackle thesocial determinants at all levels.
  • 15. 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 forFrom David Legge subsistence agriculture
  • 16. 3 drivers of dietary change1. Liberalisation of international food trade2. Increased foreign direct investment3. Globalised advertising and marketing From Sharon Friel, Australia
  • 17. 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, AustraliaStuckler et al (2012) Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities IncludingProcessed Foods, Alcohol, and Tobacco. PLoS Med 9(6): e1001235. doi:10.1371/journal.pmed.1001235
  • 18. Governance Areashttp://www.goldmercury.org/global_governance_model.php
  • 19. Global Governance
  • 20. Subglobal Governance
  • 21. National Governance
  • 22. Social injustice iskilling people on a grand scale. WHO Commission on Social Determinants of Health
  • 23. It is not inequalities that kill, but those who benefit from the inequalities that kill. Vicente Navarro
  • 24. HEALTH INEQUITY within and among nationsDOMINANCE OF NEGATIVE SOCIAL DETERMINANTS OF HEALTH DYSFUNCTIONAL GLOBAL GOVERNANCE SYSTEM
  • 25. 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
  • 26. Reorientation of health professions education – equity-based, systems-oriented, global perspective, SDH thinking
  • 27. The 21st century health professional as champion of social determinants approach to health
  • 28. 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
  • 29. The Power of Young People“The youth arethe hope of the Fatherland.” Dr. Jose Rizal National Hero of the Philippines
  • 30. Where are the innovations in global health?
  • 31. We young people would like to be part!
  • 32. Health for All!Alma Ata, USSR, 1978 Almaty, Kazakhstan, 2008 Thank You Very Much!