Health Equity in a Globalizing World
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Transcript of 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