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Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease


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Inspirational address during the Malaysian International Medical Students' Conference 2012, May 26, 2012, AIMST Univers

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Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease

  1. 1. Root Out, Reach Out! Young People in Addressing the Social Determinants of Noncommunicable DiseaseRamon Lorenzo Luis Rosa Guinto, MD Regional Coordinator for the Asia-Pacific Founding Coordinator, Global Health Equity InitiativeInternational Federation of Medical Students‟ Associations (IFMSA) Malaysian International Medical Students‟ Conference 2012 May 26, 2012, AIMST University, Kedah, Malaysia
  2. 2. Outline• Global health inequalities• Inequalities in noncommunicable diseases• Social determinants of health approach• The UN NCD Summit and World Conference on SDH• From Jakarta to Accra: IFMSA‟s journey to health for all• Call to action
  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. Definitions• Inequalities 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) From Mike Rowson, 2011
  6. 6. Global health inequalities From Marmot, 2007
  7. 7. Source: Dr. Ramon Paterno, University of the Philippines
  8. 8. Mortality over 25 years according to level in the occupational hierarchy: Whitehall Study(Marmot & Shipley, BMJ, 1996)
  9. 9. The Jubilee Line of Health InequalityTravelling east from Westminster, each tube stop representsup to one year of male life expectancy lost at birth (2002-06)Male LifeExpectancy Male Life78.6 (CI 76.0-81.2) Expectancy Canning Town 72.8 (CI 71.1-74.6)Female Life Expectancy84.6 (CI 82.5-86.7) Female Life Expectancy 81.4 (CI 79.3-83.6) Westminster Canary London Bridge Wharf River Thames Canada North Bermondsey Water Greenwich Waterloo Southwark Electoral wards just a few miles apart geographically have life expectancy spans varying by years. For instance, there are eight stops between Westminster and Canning TownLondon Underground Jubilee Line on the Jubilee Line – so as one travels east, each stop, on average, marks up a year of shortened lifespan. 11 Source: Analysis by London Health Observatory using Office for National Statistics data revised for 2002-06. Diagram produced by Department of Health
  10. 10. 21st Century Global Health Challenges: Five Trends that Shape the Future1 and 2: Demographic – we are getting older and living incities3: Environmental – the earth is heating up4: Economic – the economic center is shifting eastward5: Epidemiologic – we are sick with noncommunicablediseases (Center for Global Development)
  11. 11. Broad cause of death incountries, by World Bank incomegroups, 2008
  12. 12. Burden of NCDs• Two of three deaths each year• Four-fifths of these deaths are in low-income and middle- income countries• A third are in people younger than 60 years• Overall, age-specific NCD death rates are nearly two-times higher in low-income and middle-income countries than in high-income countries.• In all regions of the world, total numbers of NCD deaths are rising because of population ageing and the globalisation of risks, particularly tobacco use. Beaglehole, Bonita, et al. Lancet 2011
  13. 13. Economic burden
  14. 14. Social Production of Disease Do we not always find the diseases of the populace traceable to defects in society? Dr. Rudolf Virchow Father of Social Medicine
  15. 15. The Constitution of WHO, 1948 “Health is a state of complete physical, mental, and social well-beingand not merely the absence of disease or infirmity… a fundamental human right”
  16. 16. Source: Ravi Narayan, SOCHARA, India
  17. 17. Social Determinants of Health• Conditions in the social, physical, and economic environment in which people are born, grow, live, work, and age, including access to health care• Policies, programs, and institutions• Social structure, community factors
  18. 18. Commissioners• Sir Michael Marmot (Chair)• 18 others representing academics, politicians, civil society, senior public health bureaucrats
  19. 19. “Unequal distribution of health-damaging experiences is not in any sense a „natural phenomenon, but is a result of the toxic combination of poor social policies and programs, unfair economic arrangements and bad politics.”WHO Commission on SocialDeterminants of Health, 2008 Photo: WHO/Chris Black
  20. 20. CSDH Report: Action Areas • Equity from the startDaily Living Conditions • Healthy places- healthy people • Fair employment –decent work • Social protection across the life course • Universal health care • Health Equity in All PoliciesPower, Money and • Fair financingResources • Market responsibility • Gender equity • Political empowerment – inclusion and voice • Good global governanceKnowledge, Monitoring • Monitoring, research, trainingand Skills • Building a global movement Full report downloadable at Source: Fran Baum, Flinders University
  21. 21. Basic question: What good does it do to treat people‟s Illnesses …only to send them back to the conditions that made them sick?
  22. 22. Where is SDH in NCD summit?
  23. 23. Priority Actions Beaglehole, Bonita, et al. Lancet 2011
  24. 24. Taking Action• Reduce the exposure to risk factors• Enable health systems to respond• Set targets and measure results• Advance multisectoral action• Strengthen national capacity• Promote international cooperation
  25. 25. Where is NCD in SDH agenda? “To engage high level political support to make progress on national policies to address socialdeterminants of health to reduce health inequities”
  26. 26. Five Thematic Areas• Adopt better governance• Promote participation• Reorient the health sector• Strengthen global cooperation• Monitor progress and increase accountability
  27. 27. Beaglehole, Bonita, et al. Lancet 2011
  28. 28. Picture of Presidents inJakarta MM2011
  29. 29. Mission Our mission is to offer future physicians a comprehensive introduction to global health issues. Through our programming and opportunities, we develop culturally sensitive students of medicine, intent on influencing thetransnational inequalities that shape the health of our planet.
  30. 30. IFMSA Small Working Group onHealth Inequities
  31. 31. Accra – IFMSA GlobalHealth Equity Initiative • Institutional voice for global health equity within IFMSA • Accessible clearinghouse of information and capacity- building tools • Dynamic forum for exchange and dialogue • Key platform for advocacy and campaign for global health equity
  32. 32. Next Steps• IFMSA Global Health Equity Initiative• Lancet - University of Oslo Commission on Global Governance for Health• Next month: Rio+20 Summit on Sustainable Development• Third People‟s Health Assembly in Cape Town, July 6- 11, 2012• August Meeting 2012 in Mumbai, India – “Universal Health Care – The Time is Now!”
  34. 34. SDH to shape the post-MDG world – and NCDs to be part of it! eradicate extreme improve maternal poverty and health hunger achieve universal combat primary HIV/AIDS, malaria and education other diseasespromote gender equality ensure environmental and empower women sustainability reduce child develop a global mortality partnership for development
  35. 35. Revitalize the SDH movement and enhance capacity for SDH actionat national and sub-national levels
  36. 36. Transformative scale-up of medicaleducation – integrate SDH thinking
  37. 37. The new physician as champion of socialdeterminants approach to NCDs and health
  38. 38. “The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in diet, and in the cause andprevention of disease.” Thomas Alva Edison
  39. 39. 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
  40. 40. The Power of Young People“The youth arethe hope of the Fatherland.” Dr. Jose Rizal National Hero of the Philippines
  41. 41. Fathers of Social Medicine
  42. 42. Health for All!Alma Ata, USSR, 1978 Almaty, Kazakhstan, 2008 Thank You Very Much!