Lecture given to Learning Unit 2 students of the Integrated Liberal Arts-Medicine Program of the University of the Philippines College of Medicine, March 12, 2014, Paz Mendoza Building Fourth INTARMED batch to experience my interactive session on "Futures Thinking" for health - one of the closing sessions in the subject "History of Medicine"

1. The Future of Health
Ramon Lorenzo Luis R. Guinto, MD
Consultant, International Organization for Migration and Department of Health
Member, Lancet-University of Oslo Commission on Global Governance for Health
Member, Universal Health Care Study Group, University of the Philippines Manila
UP Medicine Class of 2012 (INTARMED)

2. Who am I?

3. Who am I?

4. Who am I?

5. Who am I?

6. Who am I?

7. Who am I?

8. Who am I?

9. Who am I?

10. Who am I?

11. IDC History of Medicine
• Lectures, lectures, lectures – from Pre-
Hippocratic to Medicine’s Dark Side!
• Papers, papers, papers!
• Visit at Co Tec Tai Museum
• Show and Tell – next week?

12. History
• History – “Histoire” – Inquiry
• Kasaysayan – “Saysay” – Meaning
• Elements of History – 5W’s and 1H
• Methods of Studying History
• Perspectives in Looking at History

13. Milestones in Global Health Thinking

14. Why Study History of Medicine?
• Understand the present
• Learn from past mistakes
• Gain inspiration
•See the future!

15. I Ka Wa Ma Mua, Ka Wa Ma Hope
The Future is in the Past!

16. Getting Better: 200 Years of Medicine
http://www.youtube.com/watch?v=Qxx14RCxblg

17. Questions
• Who or what is instrumental in the
achievement of the desired outcome?
• What are the drivers of change? Positive
drivers? Negative drivers?
• What are some of the future issues that the
each of the three movements will need to
grapple with?

18. Futures Thinking
The ability to envision scenarios
for a more desirable future

19. Can you see the future?
• Are you ready/trained?
• Is your society ready?
• How does it look to you?

20. How can you see the future?
CREATE IT!

21. Predict the future?
• Futurists cannot predict the future
• They invent preferred futures!
• Opening minds to probable and possible
futures

22. Futures Thinking: Process
• Asking the question – What will the
future look like? How far ahead you want
to think?
• Scanning the world – What are the
drivers that will shape the future?

23. Futures Thinking: Process
• Mapping the possibilities – There is no ONE
future!
– The future is WHAT I expect.
– The future is BETTER than I expect.
– The future is WORSE than I expect.
– The future is WEIRDER than I expect.

24. Futures Thinking: Process
• Asking the next question – What
happens then?
• Thinking it through – How will we get
there?

25. Seeing Futures – 3 Scales
• Future as it emerges
– The moment, present
– Tactics, flow
• Medium Range
– Strategy, planning
• Longer, imaginable, preferred vision
– What Could Be (Novelties)
– 50 years? 100 years?

26. Four Generic Alternative Futures
• Continued Growth
• Collapse
• Disciplined Society
• Transformational Society

27. WHAT’S NEXT?
CONTINUED GROWTH?

28. WHAT’S NEXT?
COLLAPSE?

29. WHAT’S NEXT?
A DISCIPLINED SOCIETY?

30. WHAT’S NEXT?
A TRANSFORMATIONAL SOCIETY?

31. Filipinas, Dentro de Cien Años
(Philippines, A Century Hence)
“We know their present. Now what
will their future be?
Will the Philippine Islands continue
to be a Spanish colony, and if so,
what kind of colony? Will they
become a province of Spain, with
or without autonomy? And to
reach this stage, what kind of
sacrifices will have to be made?
Will they be separated from the
mother country to live
independently, to fall into the
hands of other nations, or to ally
themselves with neighboring
powers?”
- Dr. Jose Rizal

32. Professor Hans Rosling
200 countries, 200 years, 4 minutes - Global Health History
from “The Joy of Stats”
http://www.youtube.com/watch?v=jbkSRLYSojo

33. 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.

34. From Beaglehole and Bonita, 2012

36. 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
Life expectancy at birth (men)
(WHO World Health Report 2006; Hanlon,P.,Walsh,D. & Whyte,B.,2006)

37. 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

38. • Doctor
• Pathologist
• Biologist
• Politician
• First to recognize leukemia
• Elucidated embolism
• Founded “Social Medicine”
Rudolf Virchow

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

40. • Prosperity
• Education
• Liberty
Remedy for Epidemics?

41. 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

42. Globalization
• Economic; trade
• Cultural diffusion
• Knowledge and
technology transfer
• Global village/family
• Interdependence
versus inequalities
• Globalization of risk
factors

43. Champagne Glass of Inequality
From UNDP Human Development Report 1992 as cited by
http://thesocietypages.org/graphicsociology/2009/05/27/champagne-glass-distribution-of-wealth/

45. Social injustice is killing
people on a grand
scale.
WHO Commission on Social
Determinants of Health

46. It is not inequalities that kill, but those
who benefit from the inequalities that kill.
Vicente Navarro
Johns Hopkins University

47. 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)

49. Present Global Health Challenges
Emerging infections • Climate Change • Noncommunicable Diseases • Neglected Tropical
Diseases • Antibiotic resistance • Impoverishment due to catastrophic health spending

50. Rebalancing society
Refashioning aid and NGOs as
instruments of change
Privileging sustainability above
profitability
Fair trade to replace free trade
Domesticating feral capital
Devising better metrics
Working with all peoples in all
nations, cities, and communities
G-20 to replace G-8 on the world
stage
Recognizing semi-sovereigns
Getting serious about urban
situations
Building solutions within networks
Involving women and youth
Enabling effective community action

51. Millennium Development Goals

52. Health in the Post-2015 Agenda

53. • Health as a Precondition/Contributor
• Health as a Beneficiary
• Health as an Indicator
Health and Sustainable Development

54. Universal Health Coverage

55. Trade and Health

56. Lancet-UiO Commission on Global
Governance for Health
Promoting inter-generational dialogue

58. The Future Walks Among
Us!
“Any useful idea about the future
must appear to be ridiculous!”

59. “The doctor of the future will give no
medicine, but will interest his patients
in the care of the human frame, ind
diet, and in the cause and prevention of
disease.”
Thomas Alva Edison

60. Create one ‘ridiculous’ idea about
the future of health in 2040.
Submit on Wednesday, March 19!

61. What is your

62. Take Home Lessons:
LU 3 and beyond
• Remember your history!
• Continue being aware of the present – which
is history a second later!
• Aim to be part of history!

63. “Vision without action is merely a dream.
Action without vision just passes time.
Vision WITH action
can change the world.”
Joel Barker

64. Yesterday is history.
Tomorrow is mystery.
Today is a gift
That is why it is called
PRESENT!

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

66. Thank you very much!