Health Equity in a Globalizing World

Health Equity in a Globalizing World

Ramon Lorenzo Luis R. Guinto, MDMember of the Youth Commission

Lancet-University of Oslo Commission on Global Governance for Health

What is Global Health?

Health Inequities Across

the World

Global Forces that Shape

Health

The Role of Young Nursing

Leaders

What is Global Health?

Health Inequities Across

the World

Global Forces that Shape

Health

The Role of Young Nursing

Leaders

The Constitution of WHO, 1946

“a state of complete physical, mental, and social well-being and not merely the absence of disease or

infirmity… a fundamental human right”

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.”

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”

Is this global health?

Is this global health?

Is this global health?

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 Koplan, et al. 2009

those health issues that transcend national boundaries and governments and call for

actions on the global forces that determine the health of people

Ilona Kickbusch, 2006

collaborative transnational research and action for promoting health for all

Beaglehole and Bonita, 2010

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 meAn MPH Student

Present Global Health Challenges

Emerging infections • Climate Change • Noncommunicable Diseases • Neglected Tropical Diseases • Antibiotic resistance • Impoverishment due to catastrophic health spending

What is Global Health?

Health Inequities Across

the World

Global Forces that Shape

Health

The Role of Young Nursing

Leaders

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.

Professor Hans Rosling

From Beaglehole and Bonita, 2012

Glasgow, Scotland (deprived suburb) 54India 61Philippines 65Korea 65Lithuania 66Poland 71Mexico 72Cuba 75US 75UK 76Glasgow, Scotland (affluent suburb) 82

Life expectancy at birth (men)

(WHO World Health Report 2006; Hanlon,P.,Walsh,D. & Whyte,B.,2006)

Mali India Morocco Peru Kyrgyz Repub-lic

0

50

100

150

200

250

300

350

Poorest Less poor Middle Less rich Richest

Under 5 mortality (per 1000 live births) by wealth group

(Houweling et al, 2007)

LEB over 80 yearsIMR less than 10MM less than 15

LEB under 60 yearsIMR over 90MM over 150

Source: Dr. Ramon Paterno, University of the Philippines

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)

Social injustice is killing people on a grand scale.

WHO Commission on Social Determinants of Health

It is not inequalities that kill, but those who benefit from the inequalities that kill.

Vicente NavarroJohns Hopkins University

What is Global Health?

Health Inequities Across the World

Global Forces that Shape

Health

The Role of Young Nursing

Leaders

Globalization

• Economic; trade• Cultural diffusion• Knowledge and

technology transfer• Global village/family• Interdependence

versus inequalities• Globalization of risk

factors

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

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

Champagne Glass of Inequality

21st Century Global Health Challenges: Five Trends that Shape the Future

1 and 2: DemographicWe are getting older and living in cities

3: EnvironmentalThe earth is heating up

4: EconomicThe economic center is shifting eastward

5: Epidemiologic We are sick with noncommunicable diseases

(Center for Global Development)

Economic burden

IFPRI, Global Hunger Index 2010

1 billion undernourished people in the developing world… but 2 billion people

are overweight

3 drivers of dietary change

• Liberalisation of international food trade

• Increased foreign direct investment

• Globalised advertising and marketing

Source: Sharon Friel, Australia

Top 10 manufacturers of packaged foods

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

Three quarters of world food sales involve processed foods, for which the largest manufacturers hold over a third of the

global market.

Health impacts of climate change

What is Global Health?

Health Inequities Across the World

Global Forces that Shape

Health

The Role of Young Nursing

Leaders

Reorient the health sector to adopt global health perspective and social

understanding of health

Dahlgren and Whitehead, 1991

Source: Ravi Narayan, SOCHARA, India

Source: David Sanders, South Africa

Basic question: What good does it do to treat people’s Illnesses …

only to send them back to the conditions that made them sick?

Be vigilant of transitions in the global governance of health

Frenk and Moon, 2013

Millennium Development Goals

Health in the Post-2015 Agenda

“Sub-global” Governance

Lancet-UiO Commission on Global Governance for Health

Promoting inter-generational dialogue

Participate in the grand project of health system strengthening

Universal Health Coverage

"Universal coverage is the ultimate expression of fairness."

"Universal coverage is the single most powerful concept that public health has to offer."

Dr. Margaret ChanWHO Director-General65th World Health Assembly 2012

Innovate solutions to the global health workforce crisis

Advocate for transformative scale-up of health professions education

Become the 21st century health professional – thinking globally, acting locally,

committed to health equity

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.”

Bottom-up and top-down action for health equity

From Fran Baum, Australia

"Health is not everything, but without health everything is

nothing.“

Arthur SchopenhauerGerman Philosopher