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Ramon Lorenzo Luis Rosa Guinto, MD           Regional Coordinator for the Asia-Pacific and       Founding Coordinator, Glo...
Outline•   Global Health and the Philippines•   Social Determinants of Health•   The Philippine Health System•   Foreign P...
Alma Ata, 1978The International Conference on PrimaryHealth Care calls for urgent action by allgovernments, all health and...
From Beaglehole and Bonita, 2012
Life expectancy at birth (men)Glasgow, Scotland (deprived suburb)                              54India                    ...
Source: Dr. Ramon Paterno, University of the Philippines
Mortality Trend: Communicable Diseases,                                 Malignant Neoplasms & Diseases of the Heart       ...
Philippine Health Situation• 6 out of 10 Filipinos who die, die without health  professional attendance• 4 out of 10 famil...
The Philippine ExperienceSOCIAL DETERMINANTSOF HEALTH
Filipino Wealth Quintiles             AVERAGE HOUSEHOLD MONTHLY INCOME                           MiddlePoorest          Po...
Incidence of Illness and                                   Injury by Income Quintile   100    90    80    70    60    50  ...
Headline, Philippine Daily Inquirer, June 1, 2006.
Philippines: Critical DevelopmentConstraintsADB, Dec 2007  We are  de-industrializing…                 From Ramon Paterno,...
Disasters and Climate Change                  • No. 6 in the Climate                    Change                    Vulnerab...
Conditional Cash Transfers
The Philippine ExperienceTHE PHILIPPINE HEALTHSYSTEM
Weaknesses of the                              Health System• Inappropriate & weak governance within the devolved  health ...
Office of Secretary of Health                                                                Attached Agencies Regional ho...
Pressing Health Issues• Universal Health Care• Reproductive Health Bill• Sin Tax Bill
Universal Health Care1. A roadmap towards universal health care through a   refocused PhilHealth2. Particular attention to...
Inter-country Comparison      Source: World Health Statistics 2010
Reproductive Health Bill
Sin Tax Bill
Health Workforce•   Overproduction•   Maldistribution•   High out-migration•   Nil in-migration•   Low return migration   ...
Southeast Asia: International Flows ofNurses and Doctors RNs and MDs
“Sixty percent of ourcountrymen who succumb tosickness die without seeing a           doctor.” Department of Health-Philip...
The Philippine ExperienceFOREIGN POLICY ANDHEALTH
Role in Global Health• Recipient of development aid and humanitarian  assistance• Participant in the trade of health servi...
Southeast            Asia• Diverse political and  cultural systems• Diverse health systems• Varying levels of  economic de...
Association of Southeast                      Asian Nations• By the year 2020….. ASEAN will be Single Market and  Single P...
Association of Southeast           Asian Nations    •   Free flow of Goods    •   Free flow of Services    •   Free flow o...
ASEAN Sectoral IntegrationProtocol for Healthcare
Trans-Pacific Partnership
Trans-Pacific Partnership
Some Take-Home Lessons• The Philippine health system faces many governance  challenges internally – within the health sect...
The Power of Medicine      "Medicine… has the    obligation to point out   problems and to attempt        their theoretica...
The Power of Young People“The youth arethe hope of the  Fatherland.”     Dr. Jose Rizal National Hero of the Philippines
Fathers of Social Medicine
It’s more fun in thePhilippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines
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Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines

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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

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Good Global Governance for Action on Social Determinants of Health: Lessons from the Philippines

  1. 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. 2. Outline• Global Health and the Philippines• Social Determinants of Health• The Philippine Health System• Foreign Policy and Health• Some Take-Home Lessons
  3. 3. Alma Ata, 1978The International Conference on PrimaryHealth Care calls for urgent action by allgovernments, all health and developmentworkers, and the world community to protectand promote the health of all the people ofthe world by the year 2000.
  4. 4. From Beaglehole and Bonita, 2012
  5. 5. 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)
  6. 6. Source: Dr. Ramon Paterno, University of the Philippines
  7. 7. 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 YearSource: Philippine Health Statistics, 2005
  8. 8. 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.
  9. 9. The Philippine ExperienceSOCIAL DETERMINANTSOF HEALTH
  10. 10. 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
  11. 11. 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
  12. 12. Headline, Philippine Daily Inquirer, June 1, 2006.
  13. 13. Philippines: Critical DevelopmentConstraintsADB, Dec 2007 We are de-industrializing… From Ramon Paterno, 2011
  14. 14. 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
  15. 15. Conditional Cash Transfers
  16. 16. The Philippine ExperienceTHE PHILIPPINE HEALTHSYSTEM
  17. 17. 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 financingFrom Ramon Paterno, 2011
  18. 18. 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 HealthHospitals 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
  19. 19. Pressing Health Issues• Universal Health Care• Reproductive Health Bill• Sin Tax Bill
  20. 20. Universal Health Care1. A roadmap towards universal health care through a refocused PhilHealth2. Particular attention to the construction, rehabilitation, and support of health facilities3. Attainment of Millennium Development Goals 4, 5, and 6
  21. 21. Inter-country Comparison Source: World Health Statistics 2010
  22. 22. Reproductive Health Bill
  23. 23. Sin Tax Bill
  24. 24. Health Workforce• Overproduction• Maldistribution• High out-migration• Nil in-migration• Low return migration Lorenzo and Dela Rosa, 2011
  25. 25. Southeast Asia: International Flows ofNurses and Doctors RNs and MDs
  26. 26. “Sixty percent of ourcountrymen who succumb tosickness die without seeing a doctor.” Department of Health-Philippines. National Objectives for Health, 2005 – 2010. DOH: Manila, 2005.
  27. 27. The Philippine ExperienceFOREIGN POLICY ANDHEALTH
  28. 28. 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
  29. 29. Southeast Asia• Diverse political and cultural systems• Diverse health systems• Varying levels of economic development• Highly vulnerable region• Theater of FTAs
  30. 30. Association of Southeast Asian Nations• By the year 2020….. ASEAN will be Single Market and Single Production Base
  31. 31. 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
  32. 32. ASEAN Sectoral IntegrationProtocol for Healthcare
  33. 33. Trans-Pacific Partnership
  34. 34. Trans-Pacific Partnership
  35. 35. 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.
  36. 36. 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
  37. 37. The Power of Young People“The youth arethe hope of the Fatherland.” Dr. Jose Rizal National Hero of the Philippines
  38. 38. Fathers of Social Medicine
  39. 39. It’s more fun in thePhilippines

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