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Foundations of Global Health Ramon Lorenzo Luis Rosa Guinto Regional Coordinator for the Asia-Pacific International Federation of Medical Students’ Associations (IFMSA) Doctor of Medicine Class of 2012 University of the Philippines Manila

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<ul><li>What does health mean to us? </li></ul><ul><li>What shapes health? </li></ul><ul><li>How do we measure health? </li></ul><ul><li>How can we improve health? </li></ul>Four Fundamental Questions

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What does HEALTH mean to us?

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<ul><li>“ a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity… a fundamental human right” </li></ul>The Constitution of WHO, 1948

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<ul><li>Article 25 </li></ul><ul><li>“ 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.” </li></ul>Universal Declaration of Human Rights, 1948

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<ul><li>Basic protections and entitlements needed to safeguard every person’s dignity and promote the realization of each person’s full potential </li></ul>Human Rights

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<ul><li>Universality </li></ul><ul><li>Nondiscrimination </li></ul><ul><li>Inalienable </li></ul><ul><li>Indivisible </li></ul><ul><li>Interconnected </li></ul><ul><li>Participation </li></ul><ul><li>Accountability </li></ul>Principles of Human Rights

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<ul><li>“ The Conference strongly reaffirms that health…is a fundamental human right ” </li></ul><ul><li>“ 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 ” </li></ul>Alma Ata Declaration, 1978

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Ottawa Charter for Health Promotion, 1986 <ul><li>“ a resource for everyday life, not the objective of living… a positive concept emphasizing social and personal resources, as well as physical capacities” </li></ul>

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<ul><li>“ Public goods are non-excludable and are available in the </li></ul><ul><li>public domain for all to enjoy. The public good concept implies that health cannot be reduced to a </li></ul><ul><li>commodity and needs political will and a ‘public push’.” </li></ul><ul><li>Ilona Kickbusch, 2004 </li></ul>Health as a Public Good

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<ul><li>“ the ability to adapt and to self-manage.” Huber, et al. British Medical Journal, 2011 </li></ul>A New Definition? How should we define it?

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What shapes HEALTH?

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The Determinants Approach Biological Environmental Social

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Biological Determinants

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Environmental Determinants

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Social Determinants

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<ul><li>Basic question: What good does it do to treat people’s Illnesses … </li></ul>only to send them back to the conditions that made them sick?

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<ul><li>“ This ends the debate decisively. Health care is an important determinant of health. Lifestyles are important determinants of health. But it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place.” </li></ul>Dr Margaret Chan, the DG of the WHO, at the launch of the CSDH Final Report in Geneva 28 th August 2008 Photo: WHO/Chris Black

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Tuberculosis TB deaths in England Streptomycin BCG Vaccination * David Werner, Questioning the Solution: The Politics of Primary Health Care and Child Survival, Healthwrights, 1997, p. 76. (cited also in WHO SDH Background papers)

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Source: Ravi Narayan, SOCHARA, India

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How do we measure HEALTH?

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<ul><li>Structure </li></ul><ul><li>Age </li></ul><ul><li>Sex </li></ul>Demographic Indicators <ul><li>Changes </li></ul><ul><li>Mortality – CDR, Under 5, Age-Specific, Life Expectancy at Birth </li></ul><ul><li>Fertility – CBR, Age-Specific, TFR, Replacement level </li></ul><ul><li>Migration – Urbanization, Migrants, Refugees, Internally Displaced, Travel </li></ul>

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<ul><li>Prevalence </li></ul><ul><li>Incidence </li></ul><ul><li>Disability-Adjusted Life Years </li></ul>Burden of Disease DALY = YLL + YLD

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<ul><li>Wealth = GNP, GDP </li></ul><ul><li>GINI Coefficient </li></ul><ul><li>Human Development Index </li></ul>Other Attempts to Measure Health

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Millennium Development Goals eradicate extreme poverty and hunger achieve universal primary education reduce child mortality improve maternal health combat HIV/AIDS, malaria and other diseases ensure environmental sustainability develop a global partnership for development promote gender equality and empower women

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Health Equity From Mike Rowson, 2011 <ul><li>Inequalities in health – ‘differences’ in health across individuals / population groups </li></ul><ul><li>Inequities in health – avoidable differences </li></ul><ul><li>‘ 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) </li></ul>

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Health Equity Marmot, 2007

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Life Expectancy at Birth (Men) Marmot, 2007

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Travelling east from Westminster, each tube stop represents up to one year of male life expectancy lost at birth (2002-06) Westminster Waterloo Southwark London Bridge Bermondsey Canada Water Canary Wharf North Greenwich Canning Town London Underground Jubilee Line The Jubilee Line of Health Inequality 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 on the Jubilee Line – so as one travels east, each stop, on average, marks up a year of shortened lifespan. 1 River Thames 1 Source: Analysis by London Health Observatory using Office for National Statistics data revised for 2002-06. Diagram produced by Department of Health Male Life Expectancy 72.8 (CI 71.1-74.6) Female Life Expectancy 81.4 (CI 79.3-83.6) Male Life Expectancy 78.6 (CI 76.0-81.2) Female Life Expectancy 84.6 (CI 82.5-86.7)

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LEB over 80 years IMR less than 10 MM less than 15 LEB under 60 years IMR over 90 MM over 150 Source: Dr. Ramon Paterno, University of the Philippines

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More than 3,000 Filipina mothers die UNNECESSARILY annually MATERNAL MORTALITY RATE Per 100,000 Livebirths; 2002 UNDP Revision Source: Dr. Ramon Paterno, University of the Philippines Country 1985-2002 Philippines 170 Thailand 36 Malaysia 30 South Korea 20 Japan 8 Italy 7 Spain 0

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How can we improve HEALTH?

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The Current Model of Health Preventive Promotive Curative Rehabilitative

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A Proposed New Paradigm of Health Health Justice Health Creation Health Sustainability Health Protection

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Types of Activities

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1978: Alma Ata Declaration

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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.

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Primary Health Care <ul><li>Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. </li></ul>

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Primary Health Care Principles Community participation Multidisciplinary Health promotion and disease prevention Appropriate technology Equity Social understanding of health Global cooperation and peace Call for a New International Economic Order

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Disease-oriented Interventions

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Health Systems Strengthening

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Action on Social Determinants

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What is GLOBAL HEALTH?

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Evolution of Global Health International Health Public Health Global Health Tropical Medicine

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<ul><li>an area for study, research, and practice that places a priority on improving health and achieving health equity for all people worldwide </li></ul><ul><li>Koplan, et al. 2009 </li></ul>What is Global Health?

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<ul><li>those health issues that transcend national boundaries and governments and call for actions on the global forces that determine the health of people </li></ul><ul><li>Ilona Kickbusch, 2006 </li></ul>What is Global Health?

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<ul><li>Health issues where the determinants circumvent, undermine or are oblivious to the territorial boundaries of states, and are thus beyond the capacity of individual countries to address through domestic institutions. Global health is focused on people across the whole planet rather than the concerns of particular nations. Global health recognises that health is determined by problems, issues and concerns that transcend national boundaries </li></ul><ul><li>UK Government, 2008 </li></ul>What is Global Health?

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<ul><li>worldwide improvement of health, reduction of disparities, and protection against global threats that disregard national borders </li></ul><ul><li>Macfarlane, et al., 2008 </li></ul>What is Global Health?

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<ul><li>collaborative trans-national research and action for promoting health for all </li></ul><ul><li>Beaglehole and Bonita, 2010 </li></ul>What is Global Health?

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Brief History of Global Health http://www.dipity.com/GHhub/Global-Health-Care/

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<ul><li>1 and 2: Demographic – we are getting older and living in cities </li></ul><ul><li>3: Epidemiologic – we are sick with noncommunicable diseases </li></ul><ul><li>4: Environmental – the earth is heating up </li></ul><ul><li>5: Economic – the economic center is shifting eastward </li></ul><ul><li>(Center for Global Development) </li></ul>21st Century Global Health Challenges: Five Trends that Shape the Future

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<ul><li>3 F(ast) </li></ul><ul><li>Crises </li></ul><ul><li>Food </li></ul><ul><li>Fuel </li></ul><ul><li>Financial </li></ul>Five Global Crises Slow-burn Crises Climate Change Development Global Health Watch 3, 2011

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Six Minds for our Global Health Future “ Futures” Thinking Mind Systems Thinking Mind “ Determinants” Mind Rights-Based Mind People-Centered Mind Evidence-Based Mind

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Global health 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 me. From an MPH student

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“ 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

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“ The principle upon which the fight against disease should be based is the creation of a robust body; but not the creation of a robust body by the artistic work of a doctor upon a weak organism; rather, the creation of a robust body with the work of the whole collectivity, upon the entire social collectivity.” Che Guevara “ On Revolutionary Medicine”

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The Power of Medicine &quot;Medicine is a social science, and politics is nothing else but medicine on a large scale. Medicine, as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution ; the politician, the practical anthropologist, must find the means for their actual solution....The physicians are the natural attorneys of the poor , and social problems fall to a large extent within their jurisdiction.” Dr. Rudolf Virchow Father of Social Medicine

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

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Fathers of Social Medicine

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Thank You Very Much! Health for All! Alma Ata, USSR, 1978 Almaty, Kazakhstan, 2008