PreRM: Global Health Equity and Health Systems in America and the Caribbean

“Action on social determinants of health and health equity means putting social justice at the heart of social action…You are the future and the future in your hands is one that has the potential to improve lives for everybody” Professor Sir Michael Marmot, chairman of the WHO Commission on Social Determinants of Health.

A few weeks ago marked the last day of the 2013 pre-Regional Meeting of the Americas IFMSA region on “Global Health Equity and Health Systems”; and we can only say that everything went beyond our personal expectations.

On the menu of the workshop, we had trainings, dynamics, interactive lectures, videos, group presentations and small working groups on social determinants of health systems, health systems from America, advocacy, global health challenges and new approaches. We also had the opportunity to visit the National Public Hospital “San Rafael” in Santa Tecla, El Salvador. Health systems as identified by the WHO Commission on Social Determinants of Health are one of the crucial determinants of health within countries. The visit to Hospital “San Rafael” was an eye-opening experience, most of us were shocked and impressed at once: shocked because it was far from the reality we are used to; and impressed because Salvadorian health professionals were doing so much with so little. Just as one example, the lack of material is a constant burden on the health professionals, especially interns, as they must, in their daily practice, ventilate manually their patients because they don’t have enough machines to do it.
The reality is straightforward. The world as we know it has never possessed such a sophisticated arsenal of interventions and technologies for curing disease and prolonging life. Yet the gaps in health outcomes continue to widen. Much of the ill health, disease, premature death, and suffering we see on such a large scale are needless, as effective and affordable interventions are available for prevention and treatment. The power of existing interventions is not matched by the power of health systems to deliver them to those in greatest need, in a comprehensive way, and on an adequate scale. Making even harder the achievement of national and international goals without greater and more effective investment in health systems and services.
Even though there is no single set of best practices that can be put forward as a model for improved performance, as health systems are highly context-specific. There are certain shared characteristics in health systems that function well. On day #2 of the workshop we studied the WHO Framework for action on Health Systems, followed by a Comparative Health Systems session. From north to south, Quebec, Mexico, El Salvador, Costa Rica, Colombia, Peru, Argentina and Chile even an adopted latino: Sweden. This might be one of our favorite activities of this preRM, as we saw young medical students sharing their passion and knowledge on their respective national health system. And as the purpose of the Framework for Action a common understanding of what a health system is, what are the fundamental “building blocks” of health systems and what constitutes health systems strengthening were promoted.

This interactive session helped us sharpen our vision on our healthcare systems, and we developed a critical eye on what is done already and what could be done better. One striking example of what we were lucky enough to learn about was the Costa Rican health care system which since its creation in the late 1940s, Costa Rica’s Social Security System, known as the Caja, has become the country’s most-respected public institution, providing universal health-care coverage and some of the best health-care services in Latin America. What’s more the World Health Organization frequently place Costa Rica in the top country rankings in the world for long life expectancy. Add that Costa Rica tops the 2012 Happy Planet index and has embraced sustainability in its national policies: it produces 99% of its energy from renewable sources, has reversed deforestation in the country, and has committed to becoming carbon neutral by 2021.

 

Over the course of those days, we shared knowledge, we shared inspiration, and we shared hope. Slowly, step by step, with trainings on advocacy and public speaking skills along the way, we were able to individually and with a collective approach turn our “wish list” of ideas and concerns about how we might do things differently, and better, on our wards, and in our hospitals and communities into potentially generalized realities whilst creating positive health and social change. A few more sessions on what can medical students do and how can we tackle the global health challenges of today were also on the menu to tool participants up with concrete ideas on what can be done locally, nationally and internationally and turn them into global health equity advocates.

We must say: Our stay in sunny Salvador was close to perfect. We met amazing and extremely generous people, who made us feel so welcome in this beautiful country of Central America. We feel extremely blessed for had been able to share those extraordinary preRM days with a group of dynamic, energetic and enthusiastic people convinced that we can close the gap in our generation, young physicians committed to work for “a world where social justice is taken seriously”. It is definitely more than encouraging to put IFMSA mission “to offer future physicians a comprehensive introduction to global health issues” in action. It is indeed through IFMSA meetings and other opportunities that medical students develop cultural understanding, and positively influence the transnational inequalities that shape the health of our planet.

Altagracia Mares de Leon, IFMSA Global Health Equity Initiative Coordinator
Claudel P-Desrosiers, President of IFMSA-Quebec

Coordinators of the Global Health Equity PreRegional Meeting of the Americas 2013

Worlds AIDS Day at COP18 in Doha, Qatar

Dear IFMSA Family,

World AIDS day was on this past Saturday December 1st and we were more than happy to spread awareness about HIV/AIDS at COP18 this year. We had completed an action, which was targeting the impacts that discrimination has on HIV positive individuals. Some of the particular discrimination’s that were addressed within our action pertained to being denied human rights and services, such as: access to housing, service at commercial retailers, expulsion from educational institutions, termination or refusal of employment, consensual sex between men, poor treatment in healthcare settings, access to facilities, lack of confidentiality in healthcare settings, medicine in resource-poor areas with limited or no drugs, social isolation and ridicule, restrictions on travel, stay and deportation.

 

We had participants from Medsin UK, Healthy Planet UK, South African Youth Climate Collation and YOUNGO to help deliver our action and we are extremely happy that other organizations came out to support our message. Additionally, we got support from other organizations we as a delegation feel as though our message of discrimination against HIV/AIDS was effectively and clearly delivered. For a brief overview, our skit included one HIV positive person, that was actually played by myself and then there was a chain formed of the different forms of “discriminators” by holding hands. The discriminators also had had their backs faced to the HIV positive individual to further indicate and portray the discrimination that HIV positive individuals face with society. Either the viewers or our supporters tried to break the chain of discrimination and free the HIV positive individual from the discrimination. Moreover, as we presented our action, many viewers stopped to take photos and make videos of our action.

Not only was it world AIDS day this past Saturday but it was also a monumental day in Doha seeing that it was the first civil environmental march. Approximately 800 hundred civilians took the streets of Doha that morning. Within the 800 marchers there were about 100 young activists from the Arab youth climate movement that were calling the Arab leaders to take a lead in the negotiations. The initiation of this movement was a collective collaboration between several different organizations such as: 350.org, Climate Action Network, IndyAct, and the Global Climate Change.

In the evening there was an NGO party, which was hosted at a hotel resort. The hotel had a beachfront and that they were able to stand in the water, which was surprisingly quite warm, seeing that in the nights Doha has a chilly breeze. There were also camels at the party that were available to the guest if they wanted to take a ride! The party was a fantastic way to not only end but also to have a relaxing evening to end the eventful and exhausting first week of COP.

Overall the first week was successfully on many levels and we as a delegation are excited to have another productive and exciting week of COP.

Signing off from Doha and wishing the IFMSA family well,

Tanya Kondolay on behalf of the COP18 delegation.

Progress Update for the First Couple of Days of COP18 in Doha, Qatar

Dear IFMSA Family,

Excited…Nervous…Anxious…are just few of the many feelings that myself and the delegation are having on our first day at COP18 in Doha, Qatar. As we woke up this morning, we all embraced ourselves for the day ahead of us with the rest of the fifteen thousand participants and to see all the exciting opportunities that we would encounter to spread IFMAS message of the affects and importance of health with the ever-changing and unstable climate change we are experiencing today.

Our first day started off by helping the World Health Organization (WHO) to find their booth at the exhibition hall, as we are working very closely with them this year. We had a discussion with Elena and Marina about the WHO/IFMSA interview with Mohammed, the chair of GCF and the Health and Climate Change Medical Students Perspective video by IFMSA which is supported by WHO and will be debuted this Friday.

Maria and myself attended a side meeting on Monday for the Joint Implementation Supervisory Committee (JISC) and they introduced four main recommendations to CMP 8. These recommendations was to continue JI as a highly functional emission reduction, ensure operations and ERU issuance after 2012 by adopting transitional measures until CP2 comes into effect and AAU’s can be issued, review and discuss and adopt the revised JI guidelines and to increase mitigation targets and provide support for flexible mechanisms such as JI.

From attending this side event I found that the JI movement is not necessarily different from CDM in majority countries instead it appears to only differ in countries with a high CAP. Additionally, it was stated that JI is still needed in the future since the design allows for a higher environmental standard, and the unique mechanisms of ambitions and targets allows the utilization of funds from the private sector. Furthermore, it also allows creativity which cannot be detected by government and research institutes.

On Tuesday we also attended another side meeting for Clean Development Mechanism (CDM) where they proposed five main objectives. These objectives were inclusive of: improving efficiency and clarity, ensuring environmental integrity, enhancing regional distribution and sustainable development, improving stakeholder engagement and CDM fit for the future. They expressed concern that that systems are working more than it ever has and that there is a goal for a 5% cut for the next year. My professor at St. George’s University Huge Sealy actually sits on the executive board for CDM and has expressed that in terms of scalability CDM conducted 5,000 projects this year alone.

Moreover in creating a sustainable development CDM proposed that local decisions go beyond a mandate discussion and is apart of a system focus on additionally. As the meeting came to an end CDM’s closing statements where that the best way to promote a sustainable development is for authorities in government need to realize that they have the responsibility to create sustainability within their community.

Opposed to the exciting side events and exposure of JISC and CDM initiatives and goals we were also able to make connections with several parties, NGO’s and secretaries. There is a wide range of participants attending the conference and it is exciting to know that there are potential connections that IFMSA can make to promote and integrate the health aspect within the effects of climate change that we are now experiencing. It has only been a couple of days into the conference and there already shows to be some promise of the possibility to be included in documentaries with the Doha film institute and an private film organization which is based in Nepal.

Also on Tuesday we were able to have our first virtual participation session where we invited the team of officials to help us finalizing our advocacy strategy for COP18. This was a great sense of relief since we were able to share all our excitements and news as well as ask for directions and advise from IFMSA experts that have attended COP before. We feel as though the conference call was affective and are enthusiastic and looking forward to our next virtual meeting with IFMSA members to update and discuss our progress at COP.

Remember that every voice makes a difference. Take action now and continue to promote medical perspectives in correlation with health and climate change.

Well wishes to the entire IFMASian family from Doha,

Tanya Kondolay on behalf of COP18 IFMSA delegation