Health Equity in a Globalizing World


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Presentation delivered during the 4th National Convention and General Assembly of the Alliance of Young Nurse Leaders & Advocates-International with the theme "MDGs and Beyond: Positioning the Role of Nurses in Global Health." December 14, 2013, Cabanatuan City, Nueva Ecija, Philippines.

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  • I mentioned in general terms the two key health issues touched on by WTO agreements – health workers and medicines. It is best if the GATS and TRIPS can be shown in words in order to emphasize the specific agreements that affected health workers and essential medicines.
  • The Lancet called climate change the biggest global health threat of the 21st century.
  • There is a huge evidence showing the links between climate change and health.
  • Health Equity in a Globalizing World

    1. 1. Health Equity in a Globalizing World Ramon Lorenzo Luis R. Guinto, MD Member of the Youth Commission Lancet-University of Oslo Commission on Global Governance for Health
    2. 2. What is Global Health? Health Inequities Across the World Global Forces that Shape Health The Role of Young Nursing Leaders
    3. 3. What is Global Health? Health Inequities Across the World Global Forces that Shape Health The Role of Young Nursing Leaders
    4. 4. The Constitution of WHO, 1946 “a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity… a fundamental human right”
    5. 5. Universal Declaration of Human Rights, 1948 Article 25 “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
    6. 6. Alma Ata Declaration, 1978 • “The Conference strongly reaffirms that health…is a fundamental human right” • “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”
    7. 7. Is this global health?
    8. 8. Is this global health?
    9. 9. Is this global health?
    10. 10. What is Global Health? an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide those health issues that transcend national boundaries and governments and call for actions on the global forces that determine the health of people Koplan, et al. 2009 Ilona Kickbusch, 2006 collaborative transnational research and action for promoting health for all means taking care of people you don’t know and people you can’t see but who you know were there and were special, just like you and me Beaglehole and Bonita, 2010 An MPH Student
    11. 11. Present Global Health Challenges Emerging infections • Climate Change • Noncommunicable Diseases • Neglected Tropical Diseases • Antibiotic resistance • Impoverishment due to catastrophic health spending
    12. 12. What is Global Health? Health Inequities Across the World Global Forces that Shape Health The Role of Young Nursing Leaders
    13. 13. Alma Ata, 1978 The International Conference on Primary Health Care calls for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world by the year 2000.
    14. 14. Professor Hans Rosling
    15. 15. From Beaglehole and Bonita, 2012
    16. 16. 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)
    17. 17. Under 5 mortality (per 1000 live births) by wealth group Poorest Less poor Middle Less rich Richest 350 300 250 200 150 100 50 0 Mali India Morocco (Houweling et al, 2007) Peru Kyrgyz Republic
    18. 18. Source: Dr. Ramon Paterno, University of the Philippines
    19. 19. Inequality versus Inequity • 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)
    20. 20. Social injustice is killing people on a grand scale. WHO Commission on Social Determinants of Health
    21. 21. It is not inequalities that kill, but those who benefit from the inequalities that kill. Vicente Navarro Johns Hopkins University
    22. 22. What is Global Health? Health Inequities Across the World Global Forces that Shape Health The Role of Young Nursing Leaders
    23. 23. Globalization • Economic; trade • Cultural diffusion • Knowledge and technology transfer • Global village/family • Interdependence versus inequalities • Globalization of risk factors
    24. 24. Impact of Trade on Health • WTO expanded the reach of trade to include internationally-traded services (including health services) and intellectual property – General Agreement on Trade in Services (GATS) allowed cross-border flow of health workers, especially from the global South to the global North – Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) affected access to essential medicines in the developing world
    25. 25. World Bank’s Structural Adjustment Program • Cuts in public spending • Removal of price controls • Freezing of wages • Emphasis on production for export • Trade liberalization • Incentives for foreign investment • Privatization of public sector services • Devaluation • Widening of inequalities • Reduced purchasing power for the poor (increased prices, withdrawal of subsidies, freezing of wages) • Downsizing of public sector and safety net programs • User pays in health care • Reduced support for subsistence agriculture From David Legge, Australia
    26. 26. Champagne Glass of Inequality
    27. 27. 21st Century Global Health Challenges: Five Trends that Shape the Future 1 and 2: Demographic We are getting older and living in cities 3: Environmental The earth is heating up 4: Economic The economic center is shifting eastward 5: Epidemiologic We are sick with noncommunicable diseases (Center for Global Development)
    28. 28. Economic burden
    29. 29. 1 billion undernourished people in the developing world… but 2 billion people are overweight IFPRI, Global Hunger Index 2010
    30. 30. 3 drivers of dietary change • Liberalisation of international food trade • Increased foreign direct investment • Globalised advertising and marketing Source: Sharon Friel, Australia
    31. 31. 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. 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
    32. 32. Health impacts of climate change
    33. 33. What is Global Health? Health Inequities Across the World Global Forces that Shape Health The Role of Young Nursing Leaders
    34. 34. Reorient the health sector to adopt global health perspective and social understanding of health Dahlgren and Whitehead, 1991
    35. 35. Source: Ravi Narayan, SOCHARA, India
    36. 36. Source: David Sanders, South Africa
    37. 37. Basic question: What good does it do to treat people’s Illnesses … only to send them back to the conditions that made them sick?
    38. 38. Be vigilant of transitions in the global governance of health Frenk and Moon, 2013
    39. 39. Millennium Development Goals
    40. 40. Health in the Post-2015 Agenda
    41. 41. “Sub-global” Governance
    42. 42. Lancet-UiO Commission on Global Governance for Health Promoting inter-generational dialogue
    43. 43. Participate in the grand project of health system strengthening
    44. 44. Universal Health Coverage
    45. 45. "Universal coverage is the ultimate expression of fairness." "Universal coverage is the single most powerful concept that public health has to offer." Dr. Margaret Chan WHO Director-General 65th World Health Assembly 2012
    46. 46. Innovate solutions to the global health workforce crisis
    47. 47. Advocate for transformative scale-up of health professions education
    48. 48. Become the 21st century health professional – thinking globally, acting locally, committed to health equity
    49. 49. Role of the Health Sector “The health sector is a defender of health, advocate of health equity, and negotiator for broader societal objectives. It is important therefore that ministers of health, supported by the ministry, are strongly equipped to play such as stewardship role within government.”
    50. 50. Bottom-up and top-down action for health equity From Fran Baum, Australia
    51. 51. "Health is not everything, but without health everything is nothing.“ Arthur Schopenhauer German Philosopher