Addressing the Social Determinants of Health Health as a basic right of Filipinos   Ramon P. Paterno, MD, MPH Aug. 15. 200...
<ul><li>Basic question: What good does it do to treat people’s Illnesses … </li></ul>only to send them back to the conditi...
Objectives: At the end of this talk: the participant will be able to: <ul><li>Describe the Social Determinants Approach to...
Definition of Health: <ul><li>Health is the absence of disease </li></ul><ul><li>Health is the state of complete well-bein...
Two approaches to health <ul><li>If health is just the absence of disease </li></ul><ul><ul><li>Treat the illness –  BioMe...
The Historical context <ul><li>1847 Virchow: </li></ul><ul><li>(German) </li></ul>remedy for epidemics was: Doctor, Pathol...
The Historical Context <ul><li>…  Mr. Jagor [German ethnologist … invited me to attend a meeting of the Geographic Society...
Tuberculosis TB deaths in England Streptomycin BCG Vaccination *  David Werner, Questioning the Solution: The Politics of ...
Land Reform and TB: Japan <ul><li>The big health problem in Japan was TB, the leading cause of death since 1934 </li></ul>...
The Global Health Situation <ul><li>Improving health status: </li></ul><ul><ul><li>Increasing Life expectancy at birth </l...
WHO WHOSIS Data   Table generated http://apps.who.int/whosis/data/Search.jsp 3 3 4 8 5 24 74 129 IMR  2006 14 7 8 16 45 23...
Case Study Philippines
Economic Determinants <ul><li>Globalization -  </li></ul><ul><li>Neo Liberalization or “Free Trade” </li></ul>
Economic Determinants <ul><li>Globalization: </li></ul><ul><ul><li>One World, One Market </li></ul></ul><ul><li>Neo Libera...
Does Neo Liberal policies lead to the trickle down development? UN Human Development Report 1999 Equity: Income of the fif...
Elaboration of disparities in wealth <ul><li>The world’s richest 1% receive income = to that of the poorest 57% </li></ul>...
How Countries Got Rich; Why Countries Stay Poor <ul><li>Countries that industrialize became rich </li></ul><ul><li>Countri...
How Countries Got Rich … and Why Countries Stay Poor <ul><li>Free trade when a country’s industries are not ready to compe...
Impact of Globalization - we de-industrialized .. Philippines: Critical Development Constraints ADB Dec 2007
Growth that has no impact on the poor… Headline, Philippine Daily Inquirer, June 1, 2006.
Impact  of Poverty Income decile 2006 ( in P1000) Income Expense Savings Nat ave 172 147 25 1 st 32 35 (3) 2 nd 51 52 (2) ...
Impact on Health NDHS 2003
Can we in Health afford Moderate Greed?
Can we in health afford “moderate” greed? Inquirer Today June 25, 2008
Impact of Corruption on Health <ul><li>UNDP report: corruption at least 13% of National Budget </li></ul><ul><li>2008 P1.2...
Neri’s “Web of Dysfunction”
Crisis fatigue?
Cultural <ul><li>A sense of despair – survival mode </li></ul><ul><li>A sense of disempowerment </li></ul><ul><li>“ Pagod ...
Kick Gloria’s Con Ass
How do we address poverty? <ul><li>Poverty alleviation? </li></ul><ul><ul><li>Feeding programs </li></ul></ul><ul><ul><li>...
For genuine growth <ul><li>We need to industrialize </li></ul><ul><li>It can not be export oriented </li></ul><ul><li>Crea...
Alma Ata Primary Health Care <ul><li>Health is a Right, health is not just the absence of disease. </li></ul><ul><li>Inequ...
A New International Socio-Economic order  <ul><li>What is it? Who will define it? </li></ul><ul><li>The people, not the ex...
So why did we discuss all these? <ul><li>We are a Nation: </li></ul><ul><li>Because of our blind adherence to Neo Liberal ...
Role of a health student? <ul><li>Study the situation & the social determinants of health – the economy, the politics and ...
<ul><li>Basic question: What good does it do to treat people’s Illnesses … </li></ul>only to send them back to the conditi...
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Blue S D H Aug 15 09

  1. 1. Addressing the Social Determinants of Health Health as a basic right of Filipinos Ramon P. Paterno, MD, MPH Aug. 15. 2009 UPM
  2. 2. <ul><li>Basic question: What good does it do to treat people’s Illnesses … </li></ul>only to send them back to the conditions that made them sick?
  3. 3. Objectives: At the end of this talk: the participant will be able to: <ul><li>Describe the Social Determinants Approach to Health. </li></ul><ul><li>Describe major macro political, economic, and cultural factors that have influenced the health of populations; </li></ul>
  4. 4. Definition of Health: <ul><li>Health is the absence of disease </li></ul><ul><li>Health is the state of complete well-being – physical, mental, social </li></ul>
  5. 5. Two approaches to health <ul><li>If health is just the absence of disease </li></ul><ul><ul><li>Treat the illness – BioMedical technological approach </li></ul></ul><ul><li>If health and ill health are multifactorial </li></ul><ul><ul><li>Address the factors that affect health – The social conditions in which we live in are the major Social Determinants of Health or ill health: </li></ul></ul><ul><ul><ul><li>Employment or lack of employment </li></ul></ul></ul><ul><ul><ul><li>Housing </li></ul></ul></ul><ul><ul><ul><li>Food security </li></ul></ul></ul><ul><ul><ul><li>Education or lack of it </li></ul></ul></ul><ul><ul><ul><li>Living conditions – sanitation, safe water </li></ul></ul></ul>
  6. 6. The Historical context <ul><li>1847 Virchow: </li></ul><ul><li>(German) </li></ul>remedy for epidemics was: Doctor, Pathologist, Biologist, Politician: first to recognize Leukemia, elucidated embolism, founded “Social Medicine” founded discipline of Anthropology, “ prosperity, education & liberty”
  7. 7. The Historical Context <ul><li>… Mr. Jagor [German ethnologist … invited me to attend a meeting of the Geographic Society and introduced me to the most famous professors and scholars … the famous Virchow. The scholar told me jestingly that he wished to study me ethnographically. I replied that I was willing to submit to his study for the love of science … At the table I was seated beside him and he understood my German ______ fairly well. </li></ul><ul><ul><ul><ul><ul><li>Rizal letter to Blumentritt, 12 January 1887, Jaegerstrasse, Berlin. </li></ul></ul></ul></ul></ul>
  8. 8. Tuberculosis TB deaths in England Streptomycin BCG Vaccination * David Werner, Questioning the Solution: The Politics of Primary Health Care and Child Survival, Healthwrights, 1997, p. 76. (cited also in WHO SDH Background papers)
  9. 9. Land Reform and TB: Japan <ul><li>The big health problem in Japan was TB, the leading cause of death since 1934 </li></ul><ul><ul><li>Mass inocultations led to reduction of death rate from 280/100t to 181/100t in 3 yrs </li></ul></ul><ul><ul><li>70 % of farmers paid 50 – 70% of gross farm output </li></ul></ul><ul><ul><li>Land reform turned millions of tenant farmers into free landholders; involved 30,000,000 tracts of land </li></ul></ul>
  10. 10. The Global Health Situation <ul><li>Improving health status: </li></ul><ul><ul><li>Increasing Life expectancy at birth </li></ul></ul><ul><ul><li>Improving Infant Mortality rate </li></ul></ul><ul><ul><li>Improving Maternal Mortality ratio </li></ul></ul><ul><li>BUT increasing disparities in Health among nations and within nations </li></ul>
  11. 11. WHO WHOSIS Data Table generated http://apps.who.int/whosis/data/Search.jsp 3 3 4 8 5 24 74 129 IMR 2006 14 7 8 16 45 230 950 1100 MMR 2005 80 43,300 Singapore 79 33,170 Finland 81 32,240 France 78 11,300 Chile 78 - Cuba 68 3,430 Philippines 50 980 Tanzania 47 270 DR Congo LEB 2006 GN Income per capita ($)
  12. 12. Case Study Philippines
  13. 13. Economic Determinants <ul><li>Globalization - </li></ul><ul><li>Neo Liberalization or “Free Trade” </li></ul>
  14. 14. Economic Determinants <ul><li>Globalization: </li></ul><ul><ul><li>One World, One Market </li></ul></ul><ul><li>Neo Liberalization or “Free Trade” </li></ul><ul><ul><li>Free flow of goods, services & human resources </li></ul></ul><ul><ul><li>Migration – right to travel! </li></ul></ul><ul><ul><li>Markets freed from govt interference </li></ul></ul><ul><ul><li>Economic growth key to rapid development and better life for all! </li></ul></ul>
  15. 15. Does Neo Liberal policies lead to the trickle down development? UN Human Development Report 1999 Equity: Income of the fifth of the world’s population 1960 1990 1997 Richest countries 30 60 74 Poorest countries 1 1 1
  16. 16. Elaboration of disparities in wealth <ul><li>The world’s richest 1% receive income = to that of the poorest 57% </li></ul><ul><li>The income of the world’s richest 5% = 114 X that of the poorest 5% </li></ul><ul><ul><ul><ul><ul><li>UN Human Development Report 2002 </li></ul></ul></ul></ul></ul>
  17. 17. How Countries Got Rich; Why Countries Stay Poor <ul><li>Countries that industrialize became rich </li></ul><ul><li>Countries that remained agricultural remained poor … </li></ul><ul><li>Countries developed by government intervention, by protecting their industries, </li></ul><ul><li>These countries did not practice Free Trade </li></ul>Erick Reinert, Norwegian Historical Economist
  18. 18. How Countries Got Rich … and Why Countries Stay Poor <ul><li>Free trade when a country’s industries are not ready to compete result in: </li></ul><ul><li>De – agriculturalization </li></ul><ul><li>De – industrialization </li></ul><ul><li>Depopulation </li></ul>
  19. 19. Impact of Globalization - we de-industrialized .. Philippines: Critical Development Constraints ADB Dec 2007
  20. 20. Growth that has no impact on the poor… Headline, Philippine Daily Inquirer, June 1, 2006.
  21. 21. Impact of Poverty Income decile 2006 ( in P1000) Income Expense Savings Nat ave 172 147 25 1 st 32 35 (3) 2 nd 51 52 (2) 3 rd 65 66 (.5) 4 th 81 79 2 5 th 100 95 5 10th 617 461 156
  22. 22. Impact on Health NDHS 2003
  23. 23. Can we in Health afford Moderate Greed?
  24. 24. Can we in health afford “moderate” greed? Inquirer Today June 25, 2008
  25. 25. Impact of Corruption on Health <ul><li>UNDP report: corruption at least 13% of National Budget </li></ul><ul><li>2008 P1.2T budget = P156B enough to initially fund Universal Health Care </li></ul><ul><li>How much would UHC cost? </li></ul><ul><ul><li>2005 NSCB National Health Accounts 2005 </li></ul></ul><ul><ul><li>Total National Health Expenditure – P200B </li></ul></ul><ul><ul><ul><li>Govt National / Local – 29% </li></ul></ul></ul><ul><ul><ul><li>PhilHealth – 11% </li></ul></ul></ul><ul><ul><ul><li>Out of Pocket – 49% </li></ul></ul></ul><ul><ul><li>2006 – OOP – 56% </li></ul></ul>
  26. 26. Neri’s “Web of Dysfunction”
  27. 27. Crisis fatigue?
  28. 28. Cultural <ul><li>A sense of despair – survival mode </li></ul><ul><li>A sense of disempowerment </li></ul><ul><li>“ Pagod na ang mga tao sa EDSA” </li></ul><ul><li>And yet in community medicine, one of our goals is an empowered community … </li></ul>
  29. 29. Kick Gloria’s Con Ass
  30. 30. How do we address poverty? <ul><li>Poverty alleviation? </li></ul><ul><ul><li>Feeding programs </li></ul></ul><ul><ul><li>P500 cash transfers </li></ul></ul><ul><ul><ul><li>Apparently to be funded by WB loan </li></ul></ul></ul><ul><ul><li>Medical missions </li></ul></ul><ul><ul><li>PCSO </li></ul></ul><ul><li>Or Poverty eradication? </li></ul>
  31. 31. For genuine growth <ul><li>We need to industrialize </li></ul><ul><li>It can not be export oriented </li></ul><ul><li>Create a domestic market – address the poverty of the majority – Land Reform </li></ul><ul><li>Ensure Food Security first </li></ul><ul><li>Industrialize initially to support agriculture and food security </li></ul><ul><li>Not aid nor charity but FAIR trade </li></ul>
  32. 32. Alma Ata Primary Health Care <ul><li>Health is a Right, health is not just the absence of disease. </li></ul><ul><li>Inequities in health are not acceptable </li></ul><ul><li>Inequities in health are rooted in inequities in society </li></ul><ul><li>Socio-Economic development within a new International Socio-Economic order is essential for the attainment of Health for All. </li></ul>
  33. 33. A New International Socio-Economic order <ul><li>What is it? Who will define it? </li></ul><ul><li>The people, not the executives of Financial & Banking institutions </li></ul><ul><li>A society with justice and equity with a developed economy that can provide </li></ul><ul><ul><li>Work for all </li></ul></ul><ul><ul><li>Housing for all </li></ul></ul><ul><ul><li>Food for all </li></ul></ul><ul><ul><li>Education for all </li></ul></ul><ul><ul><li>Health for all </li></ul></ul>
  34. 34. So why did we discuss all these? <ul><li>We are a Nation: </li></ul><ul><li>Because of our blind adherence to Neo Liberal Policy </li></ul><ul><li>Have remained underdeveloped and poor </li></ul><ul><li>Because we remain poor, we remain unhealthy </li></ul><ul><li>What then is the role of a health student, of UP Manila? </li></ul>
  35. 35. Role of a health student? <ul><li>Study the situation & the social determinants of health – the economy, the politics and the culture </li></ul><ul><li>Health can be used to make people accept an unjust society </li></ul><ul><ul><li>Medical missions, charity work </li></ul></ul><ul><li>Health can be used to empower people … </li></ul><ul><li>Arouse, organize, mobilize … </li></ul>
  36. 36. <ul><li>Basic question: What good does it do to treat people’s Illnesses … </li></ul>only to send them back to the conditions that made them sick?
  37. 37. Thank you

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