Presentation delivered at the University of Oslo Institute of Health and Society, September 24, 2012, Oslo, Norway. For more information: http://www.med.uio.no/helsam/english/research/news-and-events/events/guest-lectures-seminars/2012/global-governance.html Video of the presentation here: http://www.youtube.com/watch?v=cF_JMlV12dg&list=UU3guB0vZS8vch7_mzs_5T8Q&index=1&feature=plcp

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. Outline
• Global Health and the Philippines
• Social Determinants of Health
• The Philippine Health System
• Foreign Policy and Health
• Some Take-Home Lessons

3. 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.

4. From Beaglehole and Bonita, 2012

6. 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)

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

12. Mortality Trend: Communicable Diseases,
Malignant Neoplasms & Diseases of the Heart
Rate/100,000 Population
Philippines, 1953-2005
Malignant Neoplasms &
Communicable Diseases Diseases of the Heart
700 100
Communicable Diseases 90
600 Malignant Neoplasms
Diseases of the Heart 80
500 70
60
400
50
300
40
200 30
20
100
10
0 0
1953
'54
'55
'56
'57
'58
'59
'60
'61
'62
'63
'64
'65
'66
'67
'68
'69
'70
'71
'72
'73
'74
'75
'76
'77
'78
'79
'80
'81
'82
'83
'84
'85
'86
'87
'88
'89
'90
'91
'92
'93
'94
'95
'96
'97
'98
'99
2000
'01
'02
'03
'05
Year
Source: Philippine Health Statistics, 2005

13. Philippine Health Situation
• 6 out of 10 Filipinos who die, die without health
professional attendance
• 4 out of 10 families can not buy the medicine they need.
• 70% of health professionals serve only 30% of the
population, those who can pay.
• Our latest National Health Statistics are 3 years old
• Our health system is chronically underfunded
• 54% of our National Health expenditure comes from out
of pocket.

14. The Philippine Experience
SOCIAL DETERMINANTS
OF HEALTH

16. 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

18. 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

19. Headline, Philippine Daily Inquirer, June 1, 2006.

20. Philippines: Critical Development
Constraints
ADB, Dec 2007
We are
de-industrializing…
From Ramon Paterno, 2011

21. Disasters and Climate Change
• No. 6 in the Climate
Change
Vulnerability Index
• No. 3 most
vulnerable to
disaster risks and
natural hazards in
the World Risk
Index 2011, next to
Vanuatu and Tonga

23. Conditional Cash Transfers

24. The Philippine Experience
THE PHILIPPINE HEALTH
SYSTEM

26. Weaknesses of the
Health System
• Inappropriate & weak governance within the devolved
health system
• Antiquated and inadequate health information system
• Ineffective regulation of health goods and services
• Fragmentation of health service delivery: private vs
public, curative vs public health
• Dysfunctional health workforce
• Unfair, unjust and inadequate health care financing
From Ramon Paterno, 2011

27. Office of Secretary of Health
Attached Agencies
Regional hospital
Medical Centers Regional Offices
Sanitaria
City Health Offices Provincial Health Offices Provincial
(Chartered Cities) Hospitals
Inter-local Health Zones
City Health
Hospitals Centers City Health Offices Municipal health District
offices/ Rural hospitals
Barangay (Component Cities)
Health Unit
Health
Health
Stations City Barangay Health
Centers
Hospitals Stations
Barangay
Health
Stations

28. Pressing Health Issues
• Universal Health Care
• Reproductive Health Bill
• Sin Tax Bill

29. Universal Health Care
1. A roadmap towards universal health care through a
refocused PhilHealth
2. Particular attention to the construction, rehabilitation, and
support of health facilities
3. Attainment of Millennium Development Goals 4, 5, and 6

31. Inter-country Comparison
Source: World Health Statistics 2010

33. Reproductive Health Bill

34. Sin Tax Bill

36. Health Workforce
• Overproduction
• Maldistribution
• High out-migration
• Nil in-migration
• Low return migration
Lorenzo and Dela Rosa, 2011

37. Southeast Asia: International Flows of
Nurses and Doctors RNs and MDs

38. “Sixty percent of our
countrymen who succumb to
sickness die without seeing a
doctor.”
Department of Health-Philippines. National Objectives
for Health, 2005 – 2010. DOH: Manila, 2005.

39. The Philippine Experience
FOREIGN POLICY AND
HEALTH

40. Role in Global Health
• Recipient of development aid and humanitarian
assistance
• Participant in the trade of health services – provider of the
world’s health workforce, slow growth of medical tourism

41. Southeast
Asia
• Diverse political and
cultural systems
• Diverse health systems
• Varying levels of
economic development
• Highly vulnerable region
• Theater of FTAs

42. Association of Southeast
Asian Nations
• By the year 2020….. ASEAN will be Single Market and
Single Production Base

43. Association of Southeast
Asian Nations
• Free flow of Goods
• Free flow of Services
• Free flow of Investment
• Free flow of Capitals
• Free flow of Skilled Labor

44. ASEAN Sectoral Integration
Protocol for Healthcare

46. Trans-Pacific Partnership

47. Trans-Pacific Partnership

50. Some Take-Home Lessons
• The Philippine health system faces many governance
challenges internally – within the health sector and
beyond.
• Global forces also shape national policies – especially
those related to or impacting on health.
• Governments must look through a health lens as they
negotiate trade agreements and forge foreign relations.
• Good global and national governance will usher action
on social determinants to reduce inequalities in health.

52. 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

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

54. Fathers of Social Medicine

55. It’s more fun in the
Philippines