Ramon Lorenzo Luis Rosa Guinto discusses addressing social determinants of health through young people. He outlines how social factors like income and education impact health inequities. An international conference in Rio revived focus on social determinants. As regional coordinator, Guinto aims to engage medical students through the IFMSA and revitalize focus on social determinants in the Philippines to train a new generation of physicians as champions for this approach. His goals are to integrate consideration of social determinants into medical education at UP Manila and scale up action across the country.

1. Root Out, Reach Out!
Young People in
Addressing the
Social Determinants
of Health
Ramon Lorenzo Luis Rosa Guinto
Regional Coordinator for the Asia-Pacific and Facilitator of the Small Working Group
on Health Inequities, International Federation of Medical Students’ Associations (IFMSA)
Doctor of Medicine Class of 2012
University of the Philippines Manila

2. Outline
• Social Determinants of Health and
Health Equity
• The World Conference in Rio
• The Role of IFMSA, Medical
Students, and Young People
• My SDH Challenges

3. 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

5. Source: Ravi Narayan, SOCHARA, India

6. 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

9. SDH – Roots of Health Inequities
• 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

10. Global Inequities
Life Expectancy at Birth (Men)
Marmot, 2007

11. Mortality over 25 years according to level in the
occupational hierarchy: Whitehall
(Marmot & Shipley, BMJ, 1996)

12. Life expectancy and disability-free life expectancy at birth
by neighbourhood income deprivation, 1999-2003

13. The Jubilee Line of Health Inequality
Travelling east from Westminster, each tube stop represents
up to one year of male life expectancy lost at birth (2002-06)
Male Life
Expectancy Male Life
78.6 (CI 76.0-81.2) Expectancy
Canning Town 72.8 (CI 71.1-74.6)
Female Life Expectancy
84.6 (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 Town
on the Jubilee Line – so as one travels east, each stop, on
London Underground Jubilee Line average, marks up a year of shortened lifespan. 1
1
Source: Analysis by London Health Observatory using Office for National Statistics data revised for 2002-06. Diagram produced by Department of Health

14. LEB under 60 years
IMR over 90
MM over 150
LEB over 80 years
IMR less than 10
MM less than 15
Source: Dr. Ramon Paterno, University of the Philippines

17. Commissioners
• Sir Michael Marmot (Chair)
• 18 others representing academics, politicians,
civil society, senior public health bureaucrats

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 Social
Determinants of Health, 2008

21. CSDH Report: Action Areas
• Equity from the start
Daily Living Conditions
• Healthy places- healthy people
• Fair employment –decent work
• Social protection across the life course
• Universal health care
• Health Equity in All Policies
Power, Money and • Fair financing
Resources • Market responsibility
• Gender equity
• Political empowerment – inclusion and voice
• Good global governance
Knowledge, Monitoring • Monitoring, research, training
and Skills • Building a global movement
Full report downloadable at http://www.who.int/social_determinants/en/
Source: Fran Baum, Flinders University

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

24. The Rio World Conference
“To engage high level political support to
make progress on national policies to
address social determinants of health to
reduce health inequities”

25. Five Thematic Areas
• Adopt better governance
• Promote participation
• Reorient the health sector
• Strengthen global cooperation
• Monitor progress and increase
accountability

27. Major Achievements
• Revival of the Alma Ata spirit
• Governments start speaking the
SDH language
• WHO engagement with civil
society

28. 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.

29. The New “Alma Ata”?
• It needed to be said again.
• We know a great deal more than
we did.
• The CSDH gave practical
direction to realize Alma Ata.

32. Major Criticisms
• Avoided the crucial questions –
structural determinants of health
• Lack of coherence with other
pressing global issues
• Rio Declaration drafted behind
closed doors – lack of ambition

33. Picture of Presidents in
Jakarta MM2011

35. IFMSA Small Working Group on
Health Inequities

38. Next Steps
• General Assembly in Ghana on “Youth
and Social Determinants of Health”
• IFMSA Global Health Equity Initiative
• Lancet - University of Oslo Commission on
Global Governance for Health
• Third People’s Health Assembly in Cape
Town, July 6-11, 2012

39. POOR GLOBAL HEALTH
SICK WORLD
HEALTH INEQUITY
within and among nations
SOCIAL, POLITICAL, ECONOMIC,
CULTURAL, AND ENVIRONMENTAL
Determinants of Health

40. My Challenges
• SDH to shape the post-MDG world
radicate mprove maternal
extreme health
poverty and
hunger
chieve ombat HIV/AIDS, malaria
universal and other diseases
primary
education
romote gender equality nsure environmental
and empower women sustainability
educe child evelop a global
mortality partnership for

41. My Challenges
• Revitalize and enhance the SDH
movement in the Philippines

42. My Challenges
• UP Manila and UP College of Medicine as
leaders in action on social determinants of
health

43. My Challenges
• Transformative scale-up of medical
education – integrate SDH thinking

44. My Challenges
• The new Filipino physician as champion of
social determinants approach to health

45. 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

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

47. Fathers of Social Medicine

48. Health for All!
Alma Ata, USSR, 1978 Almaty, Kazakhstan, 2008
Thank You Very Much!