Category Archives: World

Renewed health advocacy strategies used by Medical students

Social determinants of health including socioeconomic, cultural and environmental conditions are the main causes of poor health and associated inequities between and among various racial, ethnic, or other demographic groups and countries.2

In response to global political and economic forces, some countries integrate health and human rights into medical education.2 Changing and modifying of social determinants are essential to improve health via transformation of policies, rules, regulations and legislations among various sectors related to public health, business, industry and medicine. However, it is not the sole responsibility of policy makers and institutions to modify these social determinants.2 Subsequent individual advocacy efforts, a change in people’s cultures and beliefs and how they think about the issues can support and modify social determinants of health.2

Health advocacy is “the processes by which the actions of individuals or groups attempt to bring about social and organisational change on behalf of a particular health goal, program, interest or population”.2

“Advocacy has the potential to shape or change policy in a way that impact the health of thousands, if not millions, of people”.2

Communication is the most basic level of health advocacy. Messages are sent to persuade and influence others. Advocacy efforts are more effective and attractive when various tools aid with the communication process such as technological advances including software and associated devices.2

Young adults aged 18 to 29 are disengaged in civil activities. Most young adults lack knowledge of political topics and processes, registering to vote and participation in actions beyond voting.2 They are not involved in political affairs because “they are alienated from the institutions and processes of civil life and lack the motivation, opportunity, and ability to overcome this alienation”.2

Adolescents aged 12 to 17 are a largely untapped resource within communities and can be civically active. They can be involved in community organising and advocacy projects, being provided with opportunities to successfully participate in social change and civic affairs and develop skills into adulthood.2

There are various communication devices which use wireless technology to send information and communicate with other devices across distances.2 Mobile phones are the most common tool of communication devices as they can transmit voice data and send text and multimedia messages. Internet access is available through web-enabled mobile phones. Internet allows access to social networking sites such as Facebook, blogs and twitters which strengthen existing social networks, find new friends and expand networks.2 These technologies allow sharing of information at a faster pace, recruiting more people and using a variety tools to implement the necessary action for social change. Youth advocates can use mobile phones and social networking sites to recruit people to join the cause, organise collective action, raising awareness and shaping attitudes, raising funds to support the cause and communicating with decision makers.2

Social justice curriculum can be integrated as part of medical education.1 There should be a focus on methods which promote critical thinking and self-reflection to guide curriculum development.1 There are several opportunities which can model and teach principles of social justice within a medical school such as site visits during community projects, role playing, reading groups, reflective journaling, small group discussions and use of social media such as mobile phones and social networking sites.1 According to JABSCOM social justice curriculum, education of social justice can be brought about through lectures, group discussions and posting on blogs.1 Following that, implementation involves professional skills development, community services and experimental learning in medical school through public speaking, public policy advocacy, community-based action projects and literature-based research presentation.1 Evaluation includes social awareness and life-long personal growth through self-reflective essays, continuation in learning and actions and pre-/post-program evaluations.1


  1. Hixon, AL, Yamada S, Farmer, PE & Maskarinec GG. Social justice: The heart of medical education. Social Medicine [Internet]; 2013 [cited 2014 Apr 9];7(3):161-168. Available from:…/671/1380‎
  1. Thackeray R & Hunter M. Empoweeing Youth: Use of Technology Advocacy to Affect Social Change. Journal of Computer-Mediated Communication [Internet]; 2010 [cited 2014 Apr 9];15(4):575-591. Available from:

Unequal distribution of wealth globally


Figure 2-2.  Average global wealth variation across countries and regions. Levels of wealth (USD) are measured as wealth per adult.

Figure 2-2 shows the distribution of wealth across the world, varying from one country to another.1Oxfam reports from this year have revealed that nearly half of the world’s wealth is owned by one percent of the world’s population. Whilst some economic inequality is required in a healthy economy to drive growth and to reward those who contribute and work hard in society, such extreme disparity in wealth does the opposite of encouraging this. Extreme economic inequality can lead to the exacerbation of social problems, which have eventual negative impacts on population health.

The richest countries are in North America, Western Europe, include Australia and other Asia-pacific and Middle Eastern countries, highlighted in red. The levels of health in these countries are more than USD$100,000 per adult.1Some European Union (EU) countries such as Portugal, Malta and Slovenia, belong to the “intermediate wealth”group with levels of wealth ranging from USD$25,000 to USD$100,000.1

Countries such as China, Russia, Indonesia, South Africa Brazil, Philippines, Egypt and Iran have levels of wealth ranging from USD$5,000 to USD$25,000.  These nations cover a large area of the world and are also highly populated.The countries with wealth levels below USD$5,000 are in Central Africa and South Asia.1


Wealth Distribution- looking at Africa, Asia-Pacific, China, Europe, India, Latin America and North America

Figure 3 shows that in Africa 91.4% of adults earn less than USD$10,000 in comparison to the world where only 68% earn less than USD$10,000.1 94.4% of adults in India earn less than USD$10,000. But the proportion is 47% in Europe, 58% in China, and 31% in North America. In contrast, only 26% of adults in Europe and 37% of adults in North America earn more than USD$100,000.1


  1. Credit Suisse (Switzerland). Global wealth Databook 2013 [Internet]. Credit Suisse (Switzerland); 2013 [cited 2014 Apr 8]. Available from:
  2. Oxfam. Oxfam briefing paper 2014 [Internet]. Oxfam (Australia); 2014 [cited 2014 Apr 8]. Available from:

WHO Europe- Advocating for Equity in Health delivery

World Health Organisation (WHO) Europe has many strategies to promote health and address the social determinants of health.1 These strategies can be grouped into areas of work such as promoting the health of vulnerable groups, strengthening local-level and sub-national level governance.1

The efforts towards improving health of populations experiencing poverty and social exclusion are undermined by the inability of health systems to provide equity.1 Insufficient  targeting on the determinants of health will also obstruct efforts to improve population health.1

Healthy cites: A powerful movement towards a sustainable solution

Achieving health and equity in the delivery of all local policies


Healthy Cities is a major public health movement and a beacon of hope  for efforts to achieve social justice.1 It is changing the how the local government, communities and individuals think and make decisions about health to create a more equitable and sustainable city.1 There are three prerequisites for city action including vision, organisation and networking. It is equally important how city administrations organise the delivery of this vision.1 WHO gives strategic leadership and technical support for reaching the goals of each five-year phase of Healthy Cities.1

Poverty and poor health are major challenges for cities.  Threats to good health for populations in cities include violence, social exclusion, pollution, lack of housing and unemployment.1 Efficient and well thought out city development and planning may be key to moving towards improved health equity for cities.1 Coherent policy and action is required by all government sectors and at various government levels. 1  Improvements to living standards will be based upon institutional changes and explicit political commitment.1 City governments have a vital role as advocates of health and especially providing tailored assistance to the most disadvantaged of groups.1

In the Regions for Health Network system, many nations within Europe have joined together to better address the social determinants of health and inequalities.1 As part of this health network program, within the countries participating, regions have been given defined political responsibilities.1 Involvement of stakeholders that are now working at sub-national levels has had positive results .1  For this progress to continue and expand more countries from Central and Eastern Europe may also be included in the future .1 It is however acknowledged that it can be challenging to design collaborative agreements which still work with the existing structures whilst catering to the diversity of newer arrangements.1 Successful approaches are likely those that undergo adaption and assessment before implementation.1 Evidence based approaches have been a goal for the members of the network system.1 Mutual commitment of WHO and sub-national bodies allows action to be based on a common agenda to promote health, reduce health inequities and strengthen regional governance in the area.1




  1. World Health Organisation (EU). Promoting health and reducing health inequities by addressing the social determinants of health [Internet]. World Health Organisation (EU); [cited 2014 Apr 5]. Available from:

Global strategies: The Millennium Development goals

Millennium Development goals are a set of targets implemented by the world’s nations to fight against global poverty and inequality by 2015. There are eight achievable commitments to improve the wellbeing of the world’s poorest people.

The first goal is to eradicate extreme hunger and poverty.

  • To reduce the proportion of people whose income is less than $1 a day by ½ between 1990 and 2015.1
  • To reduce the proportion of people who suffer from hunger between 1990 and 2015.1
  • To provide job opportunities and employment for all.1

The second goal is to achieve universal primary education for children everywhere, regardless of gender, by 2015.1

The third goal is to promote gender equality and empower women by eliminating gender disparity in all levels of education by 2015.1

The fourth goal is reducing the under-five child mortality by 2/3 between 1990 and 2015.1

The fifth goal is improving maternal health.

  • The maternal mortality ratio is reduced by ¾ between 1990 and 2015.1
  • To achieve universal access to reproductive health.1

The sixth goal is to combat HIV/AIDS, malaria and other diseases

  • To stop and reverse the spread of HIV/AIDS by 2015.1
  • Achieving universal access to HIV/AIDS treatment by 2010.1
  • Stop and reverse the incidence of malaria and other major diseases by 2015.1

The seventh goal is to ensure environmental sustainability.

  • Halve the proportion of people without sustainable access to safe drinking water and basic sanitation by 2015.1
  • The integration of principles of sustainable development into country policies and programs and reversing the loss of environmental resources.1

The final goal is developing a global partnership for development by addressing the special needs of least developed countries.1 This goal allows development of open and non-discriminatory trading and financial system. Cooperation with private sectors to obtain  benefits of new and latest technologies, such as gaining information and communications. Last but not least, to cooperate with pharmaceutical companies to provide access to affordable essential drugs.

Challenges for the future

MDGs have achieved significant progress since 1990 where 700 million fewer people live in extreme poverty.  5.1 million more children, aged 5 years old or younger, survive each year since 1990.1

Despite these achievements, 1 billion people continue to suffer in poverty. Though more children are able to attend school now, there will still be a skewed distribution of access to early learning and secondary education globally.1 287,000 women who are mostly from those populations who are living in poverty still die from preventable and treatable pregnancy and birth complications.1 A significant number of children who die in their first day or month of life remains, with 6.9 million children under-five dying every year.1

These statistics show how different quality in life is in less developed nations compared to developed. Whilst we enjoy living in privileged countries, many communities and individuals continue to suffer from environments which they are essentially trapped in. Targeting social injustice in many nations will likely amplify the effect of the aid that is delivered by WHO under these goals.

It is clear that strategies that involve clear targets and timelines are important for giving us something to work towards. By providing a framework that is easy to understand and promote, WHO is allowing us to becoming better informed.



  1. Australian Government Department of Foreign Affairs and Trade (AU). Millennium Development Goals [Internet]. Australian Government Department of Foreign Affairs and Trade (AU); 2013 [updated 2013 Nov 21; cited 2014 Apr 1]. Available from:

Global wealth-inequality at a larger scale

‘bring power back to the people , and change the rules that create inequality and poverty around the world’ (The Rules, 2014)

With the power of technology to spread awareness about the injustices that exist around the world, non government organisations and grass roots advocacy groups are emerging.

One such group which works as a series of networks spread across the world, is ‘The Rules’ (see the link below for access to their current web page). Independent from major corporations, these groups have arisen from the minds of genuinely passionate, community driven individuals, who are focused on improving the lives of the poor and marginalised. Campaigns are run from multiple countries, and promote inclusivity of individuals as well as communities.

The campaigns are essentially run by 70 or so people worldwide. Despite being a small number of people, the international and diverse nature of this decentralised team affords a less rigid approach to advocate  social justice. Members are from a variety of backgrounds and can contribute a wide set of skills and knowledge to the campaigns.


link: The Rules-a group demanding change and a stop to the social injustices of today



What has Social Justice got to do with our Health?

Social determinants of health-ourselves and globally


WHO defines the social determinants of health:

“The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”

which itself is shaped by policy choices.3 Social determinants of health are the main cause of health disparities within and between countries. It is viewed as the unfair and avoidable differences in health status within and between countries.3 The social determinants of health on one hand includes accessibility to clean water and sanitation, food security, gender equality, economic and social security, and access to appropriate healthcare resources.3 On the other hand, international sanctions which lead to unhealthy living environments, war effects which results in refugees and internally displaced people, and poverty which includes labour and employment conditions and the distribution of resources within and among antions.3

Health is part of wellbeing, of how people feel and function and contributed by social and economic wellbeing. There are various determinants which contribute to health such as social, cultural, socioeconomic, environmental, behavioural and genetic factors.1

The inequitable distribution of money, power and resources will play a significant role in affecting health. The upstream (macro-level) factors of health include social determinants of health such as government, resources, culture and socioeconomic.2

Global health emphasises the improvement on health and achieve equity of health for all people worldwide. Moreover, global health focuses on geographical reach which transcend national boundaries and allows global cooperation for developing and implementing health solutions and promotes population-based prevention with clinical care of individuals. Global factors can directly affect government policies.

Upstream factors (macro-level) such as government policies, global forces and cultural factors affect economic, welfare, health, housing transport and taxation of the country. Environmental factors such as geographical location, remoteness, natural or built will also affect the socioeconomic factors.Socioeconomic factors are affected by government policies and contribute to  local economy, markets, wealth and education opportunities.2  Socioeconomic factors also include housing, migration status, food security and access to services. Education creates employment opportunities and occupations generate income and wealth of individuals.

These political, environmental and socioeconomic factors will affect midstream (intermediate-level) factors of health such as psychological factors which contribute to health behaviours.1 Psychological factors include stress, depression, anxiety and expectations which induce poor health behaviours such as the use of tobacco, illicit drugs and alcohol.

These psychological factors also affect health behaviours of individuals. Health behaviours include diet/nutrition, smoking, alcohol, physical activity, self-harm/addictive behaviours and preventative health care use. Accessibility, availability, affordability and utilisation of health care system is one of the midstream factors which affect the downstream factors.

Midstream factors directly affect downstream factors (micro-level) such as physiological, biological and health of individuals in a country or population. Physiological systems include endocrine and immune, which affects biological reactions such as glucose intolerance, body mass index, hypertension, fibrin production, adrenalin, suppressed immune response and blood lipid levels.1 Health outcomes of a population include life expectancy, morbidity and mortality.2

Individual physical and psychological makeup such as genetics, antenatal environment, gender, ageing, life course and inter-generational influences affect all levels of factors of health (from upstream to downstream factors).

Global interaction, communication and cooperation across nations and countries are global factors which contribute to the inequitable distribution of money, resources and power. Political structures, culture, affluence, social cohesion, social inclusion, media and language are community-level factors which contribute to health disparities due to inequitable distribution of money, resources and power. Individuals’ income, wealth, education and employment contribute to inequitable distribution of money, power and resources. Moreover, individuals’ health behaviours such as smoking and individuals’ psychological factors such as trauma and stress contribute to health disparities.

An inequitable distribution of money, resources and power in a country will definitely affect the state of health in the country and contribute to health inequalities of the people such as midstream (psychological and health behaviours) and downstream (health wellbeing) factors.1 Power represents government policies and culture, whereas money and resources refer to education, income level and job opportunities and healthcare access.2

People with higher income and social status generally have better health than people with lower income and social status.4 The greater the gap between the richest and the poorest people, the greater the differences in health.4 People with low education levels have poor health, more stress and lower self-confidence compared to people with higher education levels.4 Equal distribution and access of health services which prevent and treat diseases lead to better health. Social support network such as greater support from families, friends and communities provide better health outcomes. Culture, customs and traditions and the beliefs of the family and community affect health.4 Physical environment where there are equal distribution of safe water and clean air, health workplaces, safe houses, communities and roads all contribute to healthier lives. People in employment are generally healthier in particular to those who have control over their working conditions.4


1.  National Centre for Epidemiology and Population Health (AU). Health equity in Australia: A policy framework based on action on the social determinants of obesity, alcohol and tobacco [Internet]. National Centre for Epidemiology and Population Health (AU); 2009 [cited 2014 Mar 10]. Available from:$File/commpaper-hlth-equity-friel.pdf

2.  U.S Department of Health and Human Services (USA). Social determinants of health [Internet]. U.S Department of Health and Human Services (USA); 2013 [updated 2013 Nov 13; cited 2014 Mar 10]. Available from:

3.  Hixon, AL, Yamada S, Farmer, PE & Maskarinec GG. Social justice: The heart of medical education. Social Medicine [Internet]; 2013 [cited 2014 Apr 9];7(3):161-168. Available from:…/671/1380

4.  World Health Organisation. Social determinants of health [Internet]. World Health Organisation [cited 2014 Apr 9]. Available from: