Good Global Governance for Action on Social

Determinants of Health

Lessons from the Philippines

Ramon Lorenzo Luis Rosa Guinto, MDRegional 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

Outline

• Global Health and the Philippines• Social Determinants of Health• The Philippine Health System• Foreign Policy and Health• Some Take-Home Lessons

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.

From Beaglehole and Bonita, 2012

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)

More than 3,000 Filipina mothers dieUNNECESSARILY annually

Country 1985-2002

Philippines 170

Thailand 36

Malaysia 30

South Korea 20

Japan 8

Italy 7

Spain 0

MATERNAL MORTALITY RATE

Per 100,000 Livebirths; 2002 UNDP Revision

LEB over 80 yearsIMR less than 10MM less than 15

LEB under 60 yearsIMR over 90MM over 150

Source: Dr. Ramon Paterno, University of the Philippines

Mortality Trend: Communicable Diseases, Malignant Neoplasms & Diseases of the Heart

Rate/100,000 PopulationPhilippines, 1953-2005

0

100

200

300

400

500

600

700

1953

'54

'55

'56

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2000

'01

'02

'03

'05

Year

Communicable Diseases

0

10

20

30

40

50

60

70

80

90

100

Malignant Neoplasms & Diseases of the Heart

Communicable Diseases

Malignant Neoplasms

Diseases of the Heart

Source: Philippine Health Statistics, 2005

Philippine Health Situation

• 6 out of 10 Filipinos who die, die without health professional attendance

• 4 out of 10 families can not buy the medicine they need.• 70% of health professionals serve only 30% of the

population, those who can pay.• Our latest National Health Statistics are 3 years old• Our health system is chronically underfunded• 54% of our National Health expenditure comes from out

of pocket.

SOCIAL DETERMINANTS OF HEALTH

The Philippine Experience

Poorest

5,958

Poor

8,594

Middle Income

12,269

Rich

18,497

Richest

40,590

Filipino Wealth Quintiles

57%67% 49%

AVERAGE HOUSEHOLD MONTHLY INCOME

40% 27%

FOOD EXPENDITURE SHARE

FIES, 2009

Incidence of Illness and Injury by Income Quintile

Poorest Poorest Middle Income

Rich Richest0

10

20

30

40

50

60

70

80

90

100

55 51 45 39 34

National Demographic and Health Survey, 2008

Headline, Philippine Daily Inquirer, June 1, 2006.

Philippines: Critical Development Constraints

ADB, Dec 2007

We are de-industrializing…

From Ramon Paterno, 2011

Disasters and Climate Change

• 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

Conditional Cash Transfers

THE PHILIPPINE HEALTH SYSTEM

The Philippine Experience

Weaknesses of the Health System

• Inappropriate & weak governance within the devolved health system

• Antiquated and inadequate health information system • Ineffective regulation of health goods and services • Fragmentation of health service delivery: private vs

public, curative vs public health• Dysfunctional health workforce• Unfair, unjust and inadequate health care financing

From Ramon Paterno, 2011

Office of Secretary of Health

Attached Agencies

Regional Offices

Provincial Health Offices

City Health Offices(Component Cities)

Inter-local Health Zones

City Hospitals

Health Centers

Barangay Health

Stations

District hospitals

Municipal health offices/ Rural Health Unit

Barangay Health Stations

Provincial Hospitals

Regional hospital Medical Centers

Sanitaria

City Health Offices(Chartered Cities)

City Hospitals

Health Centers

Barangay Health

Stations

Pressing Health Issues

• Universal Health Care• Reproductive Health Bill• Sin Tax Bill

1. A roadmap towards universal health care through a refocused PhilHealth

2. Particular attention to the construction, rehabilitation, and support of health facilities

3. Attainment of Millennium Development Goals 4, 5, and 6

Universal Health Care

Inter-country Comparison

Source: World Health Statistics 2010

Reproductive Health Bill

Sin Tax Bill

Health Workforce

• Overproduction• Maldistribution• High out-migration• Nil in-migration• Low return migration

Lorenzo and Dela Rosa, 2011

Southeast Asia: International Flows of Nurses and Doctors RNs and MDs

“Sixty percent of our countrymen who succumb to sickness die without seeing a

doctor.”

Department of Health-Philippines. National Objectives for Health, 2005 – 2010. DOH: Manila, 2005.

FOREIGN POLICY AND HEALTH

The Philippine Experience

Role in Global Health

• Recipient of development aid and humanitarian assistance

• Participant in the trade of health services – provider of the world’s health workforce, slow growth of medical tourism

Southeast Asia

• Diverse political and cultural systems

• Diverse health systems• Varying levels of

economic development• Highly vulnerable region• Theater of FTAs

Association of Southeast Asian Nations

• By the year 2020….. ASEAN will be Single Market and Single Production Base

Association of Southeast Asian Nations

• Free flow of Goods• Free flow of Services• Free flow of Investment• Free flow of Capitals• Free flow of Skilled Labor

ASEAN Sectoral Integration Protocol for Healthcare

Trans-Pacific Partnership

Trans-Pacific Partnership

Some Take-Home Lessons

• The Philippine health system faces many governance challenges internally – within the health sector and beyond.

• Global forces also shape national policies – especially those related to or impacting on health.

• Governments must look through a health lens as they negotiate trade agreements and forge foreign relations.

• Good global and national governance will usher action on social determinants to reduce inequalities in health.

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 VirchowFather of Social Medicine

The Power of Young People

“The youth are the hope of the Fatherland.”

Dr. Jose RizalNational Hero of the Philippines

Fathers of Social Medicine

It’s more fun in the Philippines