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




Ramon Lorenzo Luis Rosa Guinto, MD
              Regional Coordinator for the Asia-Pacific
       Founding Coordinator, Global Health Equity Initiative
International Federation of Medical Students‟ Associations (IFMSA)

   Malaysian International Medical Students‟ Conference 2012
       May 26, 2012, AIMST University, Kedah, Malaysia
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
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.
From Beaglehole and Bonita, 2012
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
Global health inequalities




              From Marmot, 2007
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Source: Dr. Ramon Paterno, University of the Philippines
Mortality over 25 years according to level in the
                        occupational hierarchy: Whitehall Study




(Marmot & Shipley, BMJ, 1996)
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
London Underground                             Jubilee Line                   on the Jubilee Line – so as one travels east, each stop, on
                                                                              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
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)
Broad cause of death in
countries, by World Bank income
groups, 2008
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
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
Economic burden
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
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
The Constitution of WHO, 1948

      “Health is a state of complete
 physical, mental, and social well-being
and not merely the absence of disease or
 infirmity… a fundamental human right”
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Source: Ravi Narayan, SOCHARA, India
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
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
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Commissioners
• Sir Michael Marmot (Chair)
• 18 others representing
  academics, politicians, civil society, senior public
  health bureaucrats
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
“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


                               Photo: WHO/Chris Black
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
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
Basic question: What good does it do to treat people‟s
                      Illnesses …




only to send them back to the conditions
          that made them sick?
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Where is SDH in NCD summit?
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Priority Actions




    Beaglehole, Bonita, et al. Lancet 2011
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
Where is NCD in SDH agenda?
 “To engage high level political support to make
  progress on national policies to address social
determinants of health to reduce health inequities”
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Five Thematic Areas

•   Adopt better governance
•   Promote participation
•   Reorient the health sector
•   Strengthen global cooperation
•   Monitor progress and increase accountability
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Beaglehole, Bonita, et al. Lancet 2011
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Picture of Presidents in
Jakarta MM2011
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 the
transnational inequalities that shape the health of
                    our planet.
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
IFMSA Small Working Group on
Health Inequities
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
Accra – IFMSA Global
Health 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
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!”
Root Out, Reach Out: Young People in Addressing the Social Determinants of Noncommunicable Disease
POOR GLOBAL HEALTH
      SICK WORLD



      HEALTH INEQUITY
   within and among nations




 SOCIAL, POLITICAL, ECONOMIC,
CULTURAL, AND ENVIRONMENTAL
     Determinants of Health
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 diseases

promote gender equality               ensure environmental
   and empower women                  sustainability


           reduce child               develop a global
              mortality               partnership for
                                      development
Revitalize the SDH movement and
 enhance capacity for SDH action
at national and sub-national levels
Transformative scale-up of medical
education – integrate SDH thinking
The new physician as champion of social
determinants approach to NCDs and health
“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 and
prevention of disease.”
         Thomas Alva Edison
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
The Power of Young People

“The youth are
the hope of the
  Fatherland.”

     Dr. Jose Rizal
 National Hero of the Philippines
Fathers of Social Medicine
Health for All!




Alma Ata, USSR, 1978   Almaty, Kazakhstan, 2008


         Thank You Very Much!

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

  • 1. Root Out, Reach Out! Young People in Addressing the Social Determinants of Noncommunicable Disease Ramon Lorenzo Luis Rosa Guinto, MD Regional Coordinator for the Asia-Pacific Founding Coordinator, Global Health Equity Initiative International Federation of Medical Students‟ Associations (IFMSA) Malaysian International Medical Students‟ Conference 2012 May 26, 2012, AIMST University, Kedah, Malaysia
  • 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. 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.
  • 4. From Beaglehole and Bonita, 2012
  • 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. Global health inequalities From Marmot, 2007
  • 8. Source: Dr. Ramon Paterno, University of the Philippines
  • 9. Mortality over 25 years according to level in the occupational hierarchy: Whitehall Study (Marmot & Shipley, BMJ, 1996)
  • 10. 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 London Underground Jubilee Line on the Jubilee Line – so as one travels east, each stop, on 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
  • 11. 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)
  • 12. Broad cause of death in countries, by World Bank income groups, 2008
  • 15. 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
  • 20. 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
  • 21. The Constitution of WHO, 1948 “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity… a fundamental human right”
  • 23. Source: Ravi Narayan, SOCHARA, India
  • 25. 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
  • 30. Commissioners • Sir Michael Marmot (Chair) • 18 others representing academics, politicians, civil society, senior public health bureaucrats
  • 32. “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 Photo: WHO/Chris Black
  • 34. 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
  • 35. Basic question: What good does it do to treat people‟s Illnesses … only to send them back to the conditions that made them sick?
  • 37. Where is SDH in NCD summit?
  • 43. Priority Actions Beaglehole, Bonita, et al. Lancet 2011
  • 44. 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
  • 45. Where is NCD in SDH agenda? “To engage high level political support to make progress on national policies to address social determinants of health to reduce health inequities”
  • 47. Five Thematic Areas • Adopt better governance • Promote participation • Reorient the health sector • Strengthen global cooperation • Monitor progress and increase accountability
  • 49. Beaglehole, Bonita, et al. Lancet 2011
  • 51. Picture of Presidents in Jakarta MM2011
  • 52. 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 the transnational inequalities that shape the health of our planet.
  • 54. IFMSA Small Working Group on Health Inequities
  • 60. Accra – IFMSA Global Health 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
  • 61. 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!”
  • 63. POOR GLOBAL HEALTH SICK WORLD HEALTH INEQUITY within and among nations SOCIAL, POLITICAL, ECONOMIC, CULTURAL, AND ENVIRONMENTAL Determinants of Health
  • 64. 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 diseases promote gender equality ensure environmental and empower women sustainability reduce child develop a global mortality partnership for development
  • 65. Revitalize the SDH movement and enhance capacity for SDH action at national and sub-national levels
  • 66. Transformative scale-up of medical education – integrate SDH thinking
  • 67. The new physician as champion of social determinants approach to NCDs and health
  • 68. “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 and prevention of disease.” Thomas Alva Edison
  • 69. 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
  • 70. The Power of Young People “The youth are the hope of the Fatherland.” Dr. Jose Rizal National Hero of the Philippines
  • 71. Fathers of Social Medicine
  • 72. Health for All! Alma Ata, USSR, 1978 Almaty, Kazakhstan, 2008 Thank You Very Much!