Inspirational address during the Malaysian International Medical Students' Conference 2012, May 26, 2012, AIMST Univers

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

16. Economic burden

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!