Presentation given during the forum "Global Health - Why Bother?" - a pre-conference forum dedicated to the 7th Conference for Global health and Vaccination Research, September 25, 2012, The Norwegian University of Science and Technology (NTNU), Trondheim, Norway. Video of the presentation here: http://www.youtube.com/watch?v=fNeL9KXPbLQ&list=HL1348615458&feature=mh_lolz

1. Fight for Equity
Closing the Gap in OUR Generation
Ramon Lorenzo Luis Rosa Guinto, MD
Regional Coordinator for the Asia-Pacific and
Founding Coordinator, Global Health Equity Initiative
International Federation of Medical Students‟ Associations (IFMSA)
Youth Commissioner, Lancet-University of Oslo
Commission on Global Governance for Health

2. 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.

3. From Beaglehole and Bonita, 2012

4. 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)

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

7. 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

8. Definitions
• 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)
From Mike Rowson, 2011

10. Source: Ravi Narayan, SOCHARA, India

11. 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

12. Rudolf Virchow
remedy for
epidemics was:
“prosperity, education
& liberty”
Doctor, Pathologist, Biologist, Politician: first to recognize
Leukemia, elucidated embolism, founded “Social Medicine”
founded discipline of Anthropology,

13. Tuberculosis
TB deaths in England
4.5
4 BCG Vaccination
3.5
3
2.5
2 Streptomycin
1.5
1
0.5
0
1838 1860 1880 1900 1920 1940 1960
TB deaths
Werner and Sanders, Questioning the Solution: The Politics of Primary Health Care and Child Survival,
Healthwrights, 1997, p. 76. (cited also in WHO SDH Background papers)

14. 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”

15. 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”

16. Alma Ata Declaration, 1978
“Economic and social
development… is of basic
importance to the fullest
attainment of health for all and
to the reduction of the gap
between the health status of
the developing and developed
countries.”

17. Alma Ata Declaration, 1978
“Involves, in addition to the
health sector, all related
sectors and aspects of national
and community development,
in particular agriculture, animal
husbandry, food, industry,
education, housing, public
works, communications and
other sectors…”

18. Dahlgren and Whitehead, 1991

20. 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

23. “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

24. Commission on Social
Determinants of Health
1. Improve Daily Living Conditions
2. Tackle the Inequitable Distribution
of Power, Money, and Resources
3. Measure and Understand the
Problem and Assess the Impact of
Action.

25. Global Governance
http://www.goldmercury.org/global_governance_model.php

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

27. Picture of Presidents in
Jakarta MM2011

28. 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.

30. IFMSA Small Working Group on
Health Inequities

33. Country Initiatives

38. 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

40. SDH and HE to shape the post-MDG world
eradicate extreme improve maternal
poverty and health
hunger
achieve universal combat HIV/AIDS,
primary malaria and other
education diseases
promote gender equality ensure environmental
and empower women sustainability
reduce child develop a global
mortality partnership for
development

41. Revitalize the H4A movement and
enhance capacity for SDH action
at national and sub-national levels

42. Transformative scale-up of medical
education – integrate SDH & GHE thinking

43. The 21st century physician as champion
of social determinants approach to health

44. 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

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

46. Fathers of Social Medicine

47. It‟s more fun in the
Philippines