Presentation delivered during the 2nd Social Oncology Forum with the theme "Social Determinants of Health in Agricultural Communities." November 10, 2013, Benguet State University, La Trinidad, Benguet.

1. Ramon Lorenzo Luis R. Guinto, MD
Consultant, International Organization for Migration and Department of Health
Member, Lancet-University of Oslo Youth Commission on Global Governance for Health

2. Source: Ravi Narayan, SOCHARA, India

3. Source: Ravi Narayan, SOCHARA, India

4. Source: Ravi Narayan, SOCHARA, India

5. Source: Ravi Narayan, SOCHARA, India

7. From Beaglehole and Bonita, 2012

8. 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)

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

16. Poorest
Less poor
Middle
Less rich
Morocco
Peru
Richest
350
300
250
200
150
100
50
0
Mali
India
(Houweling et al, 2007)
Kyrgyz
Republic

17. Infant mortality in Brazil by race and
mother's education, 1990
(Pinto da Cunha, 1997)

18. (Murphy et al, 2005)
(probability of living to 65 yrs when aged 20 yrs)

20. (Bramley et al, 2005)

21. (Marmot & Shipley, BMJ, 1996)

22. 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
78.6 (CI 76.0-81.2)
Canning Town
Female Life Expectancy
84.6 (CI 82.5-86.7)
Male Life
Expectancy
72.8 (CI 71.1-74.6)
Female Life
Expectancy
81.4 (CI 79.3-83.6)
Westminster
London Bridge
River Thames
Canada
Bermondsey Water
Canary
Wharf
North
Greenwich
Waterloo
Southwark
London Underground Jubilee Line
1
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
Source: Analysis by London Health Observatory using Office for National Statistics data revised for 2002-06. Diagram produced by Department of Health

24. 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

25. Definitions
• Horizontal equity – equal access for
equal needs
• Vertical equity – unequal access for
unequal needs
From Mike Rowson, 2011

26. 






Doctor
Pathologist
Biologist
Politician
First to recognize
leukemia
Elucidated embolism
Founded “Social
Medicine”

27. Do we not always
find the diseases of
the populace
traceable to defects
in society?
Dr. Rudolf Virchow
Father of Social Medicine

28.  Prosperity
 Education
 Liberty

30. Source: Ravi Narayan, SOCHARA, India

31. Source: David Sanders, South Africa

32. 5
4
3
2
1
0
1838
1860
1880
1900
1920
1940
1960
TB deaths
David Werner and David Sanders, Questioning the Solution:
The Politics of Primary Health Care and Child Survival.

33. 


Conditions in the
social, physical, and
economic environment in
which people are
born, grow, live, work, an
d age, including access to
health care
Policies, programs, and
institutions
Social
structure, community
factors

37. Dahlgren and Whitehead, 1991

39. From Fran Baum

43. From Fran Baum

44. “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”

45. “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...

46. …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…”

47. 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.

48. 
The Ottawa Charter for
Health Promotion
(WHO 1986) identified
8 key determinants
(prerequisites) of
health:
peace, shelter, educati
on, food, income, a
stable ecosystem, sustainable
resources, social
justice, and equity.

49. 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.

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

51. 



Social determinants of health have a direct
impact on health
Social determinants predict the greatest
proportion of health status variance (health
inequity)
Social determinants of health structure health
behaviours
Social determinants of health interact with
each other to produce health

52. “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

53. Daily Living Conditions





Power, Money and
Resources






Knowledge, Monitoring
and Skills


Equity from the start
Healthy places- healthy people
Fair employment –decent work
Social protection across the life course
Universal health care
Health Equity in All Policies
Fair financing
Market responsibility
Gender equity
Political empowerment – inclusion and voice
Good global governance
Monitoring, research, training
Building a global movement
Full report downloadable at http://www.who.int/social_determinants/en/
Source: Fran Baum, Flinders University

54. WHO Commission on
Social Determinants of
Health

55. Vicente Navarro

59. AVERAGE HOUSEHOLD MONTHLY INCOME
Poorest
5,958
Poor
Middle
Income
8,594
12,269
Rich
18,497
Richest
40,590
FOOD EXPENDITURE SHARE
67%
57%
49%
40%
27%
FIES, 2009

60. 100
80
60
40
55
20
51
45
39
34
0
Poorest
Poorest
Middle
Rich
Richest
Income
National Demographic and Health Survey, 2008

61. 


Immigration less than
20,000 foreign nationals
annually (0.3-0.5% of
Philippine population)
Emigration: 10.4 million
Filipinos in more than
200 countries and
territories (10% of
Philippine population)
Institutionalized labor
migration: 1.8 million
OFWs deployed in 2012

62. MIGRATION
HEALTH OUTCOMES
affects individual
health
stress, mental
health problems
influences other
determinants
noncommunicable
diseases
drives marginalization
and vulnerability
limited access to
healthcare; health
inequity
contributes to spread
of infectious diseases
disease outbreaks or
epidemics

64. Source: National Epidemiology Center, July 2013

70. No. 6 in the Climate
Change
Vulnerability
Index
No. 3 most
vulnerable to
disaster risks and
natural hazards
in the World Risk
Index 2011, next
to Vanuatu and
Tonga

72. Whoever would study medicine
aright must learn of the following
subjects. First he must consider the
effect of the seasons of the year and
the differences between them.
Secondly he must study the warm
and the cold winds, both those
which are in common to every
country and those peculiar to a
particular locality. Lastly, the effect
of water on health must not be
forgotten.
On Air, Water, and Places
By Hippocrates
Father of Medicine

74. 1.
Liberalisation of international food
trade
2.
Increased foreign direct investment
3.
Globalised advertising and marketing
From Sharon Friel, Australia

75. Top 10 manufacturers of packaged foods
Three quarters of world food sales involve
processed foods, for which the largest
manufacturers hold over a third of the global
market.
From Sharon Friel, Australia
Stuckler et al (2012) Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy
Commodities Including Processed Foods, Alcohol, and Tobacco. PLoS Med 9(6): e1001235. doi:10.1371/journal.pmed.1001235

76. POOR GLOBAL HEALTH
SICK WORLD
SOCIAL, POLITICAL, ECONOMIC,
CULTURAL, AND ENVIRONMENTAL
Determinants of Health

78. 1.
To adopt better governance
for health and development
2.
To promote participation in
policy-making and implementation
3.
To further reorient
the health
sector towards reducing health
inequities
4.
To strengthen global
governance and collaboration
5. To monitor progress and
increase accountability

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

81. • Health as a Precondition/Contributor
• Health as a Beneficiary
• Health as an Indicator

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

86. Reorientation of health professions education
– equity-based, systems-oriented, global
perspective, SDH thinking

87. The 21st century Filipino health
professional as champion of social
determinants approach to health

91. From Fran Baum

92. The Power of Medicine
"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
Dr. Rudolf
physicians are the natural attorneys
Virchow
of the poor, and social problems fall
Father of Social Medicine
to a large extent within their
jurisdiction.”

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

95. "Health is not
everything, but
without health
everything is
nothing."
Arthur Schopenhauer
German Philosopher