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.

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. What is Global
Health?
Health
Inequities Across
the World
Global Forces
that Shape
Health
The Role of
Young Nursing
Leaders

3. What is Global
Health?
Health
Inequities Across
the World
Global Forces
that Shape
Health
The Role of
Young Nursing
Leaders

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. 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. 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. Is this global health?

8. Is this global health?

9. Is this global health?

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. Present Global Health Challenges
Emerging infections • Climate Change • Noncommunicable Diseases • Neglected Tropical
Diseases • Antibiotic resistance • Impoverishment due to catastrophic health spending

12. What is Global
Health?
Health
Inequities Across
the World
Global Forces
that Shape
Health
The Role of
Young Nursing
Leaders

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. Professor Hans Rosling

15. From Beaglehole and Bonita, 2012

17. 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)

19. 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

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

22. 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)

23. Social injustice is killing
people on a grand
scale.
WHO Commission on Social
Determinants of Health

24. It is not inequalities that kill, but those
who benefit from the inequalities that kill.
Vicente Navarro
Johns Hopkins University

25. What is Global
Health?
Health
Inequities Across
the World
Global Forces
that Shape
Health
The Role of
Young Nursing
Leaders

26. Globalization
• Economic; trade
• Cultural diffusion
• Knowledge and
technology transfer
• Global village/family
• Interdependence
versus inequalities
• Globalization of risk
factors

27. 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

28. 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

30. Champagne Glass of Inequality

32. 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)

35. Economic burden

36. 1 billion undernourished people
in the developing world… but 2 billion people
are overweight
IFPRI, Global Hunger Index 2010

37. 3 drivers of dietary change
• Liberalisation of international food trade
• Increased foreign direct investment
• Globalised advertising and marketing
Source: Sharon Friel, Australia

38. 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

40. Health impacts of climate change

42. What is Global
Health?
Health
Inequities Across
the World
Global Forces
that Shape
Health
The Role of
Young Nursing
Leaders

43. Reorient the health sector to adopt global
health perspective and social
understanding of health
Dahlgren and Whitehead, 1991

45. Source: Ravi Narayan, SOCHARA, India

46. Source: David Sanders, South Africa

47. Basic question: What good does it do to treat
people’s Illnesses …
only to send them back to the conditions that
made them sick?

48. Be vigilant of transitions in the global
governance of health
Frenk and Moon, 2013

49. Millennium Development Goals

50. Health in the Post-2015 Agenda

51. “Sub-global” Governance

52. Lancet-UiO Commission on Global
Governance for Health
Promoting inter-generational dialogue

53. Participate in the grand project of
health system strengthening

54. Universal Health Coverage

55. "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

56. Innovate solutions to the global
health workforce crisis

57. Advocate for transformative scale-up
of health professions education

58. Become the 21st century health professional –
thinking globally, acting locally,
committed to health equity

59. 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.”

60. Bottom-up and top-down action for
health equity
From Fran Baum, Australia

61. "Health is not
everything, but
without health
everything is
nothing.“
Arthur Schopenhauer
German Philosopher