Lecture given during the pre-APRM workshop on Social Determinants of Health and Global Health Equity, September 11, 2012, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur

1. Global Health Inequalities:
Focus on Asia-Pacific
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. Prof. Hans Rosling

6. 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)

12. Ailing Asia: Indicators
• Between 1990 and 2001, the proportion of
people living on less than $1 per day fell
from 31 to 20 per cent.
• Five out of ten Filipinos die without seeing
a physician or any other health care
provider.

13. Ailing Asia: Indicators
• In Afghanistan, one child in four dies
before reaching the age of 5.
• Each year, across the region around one
quarter of a million women die as a result
of a normal life cycle event: pregnancy
and childbirth.

14. Ailing Asia: Indicators
• As of 2004, the Asia-Pacific region has
over 9 million people living with HIV/AIDS
and each year half a million people die.
• The highest prevalence of malaria can be
found in the Pacific, notably Solomon
Islands, where the disease affects 15 per
cent of the population.

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

17. Mortality over 25 years according to level in the
occupational hierarchy: Whitehall Study
(Marmot & Shipley, BMJ, 1996)

18. Life expectancy and disability-free life expectancy at birth
by neighbourhood income deprivation, 1999-2003

21. Angola

22. Brazil

23. Burkina Faso

24. European Union

25. 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

26. 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

29. Elaboration of disparities in wealth
• The world’s richest 1% receive income = to the poorest
57%
• The income of the world’s richest 5% = 114 X that of the
poorest 5%
» UN Human Development Report 2002

30. Champagne Glass

31. In Focus:
NONCOMMUNICABLE
DISEASES

32. 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)

33. UN High-Level Summit on NCDs

36. Broad cause of death in
countries, by World Bank income
groups, 2008

39. 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

40. Economic burden

44. Epidemiology of Inequality

47. Causes of the causes?