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

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“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.