11159295561Health in the Americas Dr Mirta Roses

the political scenario of population health in the Americas: 

Bipolar world Cold War Capitalism vs Socialism Anti-colonialist movement Third World Multilateralism Unipolar world War on terrorism Capitalism hegemony Globalization Unilateralism Human insecurity & vulnerability PAHO/WHO; DPM/SDH & DPM/GPP; 2005 the political scenario of population health in the Americas

the call for equity in “Health for All” (1977-2000): 

political commitment to achieve universal access to health services recognition of health as a fundamental human right ethical basis for international commitments recognition of health as a pre-requisite to economic & human development recognition of role and responsibilities of the State in the protection of population health health systems have an essential role: Primary Health Care is the strategy for its transformation the call for equity in “Health for All” (1977-2000) PAHO/WHO; DPM/SDH & DPM/GPP; 2005

the legacy of HFA to the population of the Americas: 

the legacy of HFA to the population of the Americas PAHO/WHO: Health in the Americas, Edition 2002 decomposition of 1980-2000 life expectancy changes by cause and age

Slide5: 

Return to Democracy representative democracy democracy under economic pressure “low intensity democracies” The Washington Consensus, 1990 one agenda for economic market-oriented reforms neoliberal approach: market fundamentalism Globalization inter–dependency of countries/markets threats, risks and economic vulnerability limits to policy jurisdiction and enforcement by national states the major forces in the Pan American context PAHO/WHO; DPM/SDH & DPM/GPP; 2005

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IMPACT OF MARKET-ORIENTED REFORMS ON WELFARE STATE IN THE NINETIES SOCIAL JUSTICE ECONOMIC GROWTH STATE SOCIETY MARKETS EQUITY EFFICIENCY Labor Flexibility Low quality employment and high unemployment Low salaries Informal labor market Low coverage of social services Social inequities and social exclusion Rising social segmentation Institutional fragmentation CRISIS OF SOCIAL PROTECTION REGIME BASED ON LABOR CONTRACT, HIGHLY SEGMENTED LOW COVERAGE

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disparities in economic growth in the Americas PAHO/WHO: Health in the Americas, Edition 2002

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the depth of income inequality in the Americas, 2003 CD145/7; PAHO Program Budget Policy population ranked by income (cummulative proportion) income (cummulative proportion) line of perfect equity

inequalities in life expectancy. The Americas, 1990-2000: 

inequalities in life expectancy. The Americas, 1990-2000 PAHO/WHO: Health in the Americas, Edition 2002

Slide10: 

PAHO/WHO: Health in the Americas, Edition 2002 inequalities in access to water & sanitation. The Americas, 1998

Slide11: 

CAN Infant Mortality Rate (per 1,000 live births) and access to water systems, 1998

Slide12: 

PAHO/WHO; Governance & Policies, DPM/GPP/GP & PWR Panama; 2004 ethnic diversity and social exclusion: a case from Panama

ethnic diversity & social exclusion: a case from Panama: 

PAHO/WHO; Policies & Strategies, DPM/GPP/SP; 2004 ethnic diversity & social exclusion: a case from Panama effect of US$ 100 of increment in the annual household income

Slide14: 

health equity in the social & development agendas lack of equity was seen as a health problem in 1977; now it is clear that equity is a social, political, and developmental issue. health is increasingly seen as a pre-requisite for good governance, social stability, and sustainable development. a new health debate is also in place: PAHO/WHO; DPM/SDH & DPM/GPP; 2004 security issue; foreign policy issue; macro economic issue; human rights issue; and, global public good health as a:

Slide15: 

MDGs have brought the investment in people’s health to the very center of the global development agenda, opening new opportunities for the health sector and health organizations to gain wide support for the health agenda: gaining access to the political system; legitimizing critical social issues, such as health disparities; giving a voice to unattended groups and issues There is a close match between the challenges set by the MDGs and PAHO’s new strategic priorities and directions: address health determinants; protect health as a public good and human right; create a synergy of actors; ensure fairness of distribution. The thrust for social justice: MDG’s collective intentionality PAHO/WHO; DPM/SDH & DPM/GPP; 2005

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Implementation of the MDGs in the Region: gaps to fill the operational gap in scaling-up health systems and public health infrastructure; the structural gap in extending social protection in health; the governance gap in involving wide segments of government and society in a truly intersectoral and participatory effort; the equity gap in addressing the health needs of the poorest

PAHO framework for technical cooperation: 

PAHO framework for technical cooperation PAHO/WHO; DPM/SDH & DPM/GPP; 2005

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Centers for Disease Control & Prevention. Achievements in Public Health 1900-1999: Healthier Mothers and Babies; 48(38):849-58; Atlanta, 1999. WHO Maternal Mortality in 2000: estimates developed by WHO, UNICEF & UNFPA; Geneva, 2002 maternal mortality’s unfinished agenda in the Americas

maternal death risk in LAC: 2005-2015 scenarios: 

PAHO/WHO; Governance, Policies & Partnerships; 2005 maternal death risk in LAC: 2005-2015 scenarios maternal mortality rate in 2005 by health needs-based country groups burden of mortality to avert 2005-2010 by health needs-based country groups

Slide20: 

Measles vaccine coverage, 2001 % Source: PAHO Core Data, 2003

infant death risk in LAC: 2005-2015 scenarios: 

infant death risk in LAC: 2005-2015 scenarios PAHO/WHO; Governance, Policies & Partnerships; 2005 infant mortality rate in 2005 by health needs-based country groups burden of mortality to avert 2005-2010 by health needs-based country groups

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inadecuate governance and conflict of interests uneasy economic adaptation to globalization ample infrastructure, but with social exclusion antiquate structures & incomplete decentralization manpower & resources reduction in public sector challenges to the National Health Development in the Americas PAHO/WHO; DPM/SDH & DPM/GPP; 2005

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The “missing middle” Strengthening Public Health Infrastructure Extending social protection in health Developing the health workforce Developing the operative capacity of health services

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strengthening reduction of health inequity solidarity in financing population health’s oriented interventions health promotion and prevention-based health care models adequate performance of essential public health functions integral and sustainable human resources development emphasis on the steering role extension of social protection in health PAHO/WHO; DPM/SDH & DPM/GPP; 2005 a new agenda for health sector reforms

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ESSENTIAL CHARACTERISTICS OF A HEALTH SYSTEM HEALTH WORKERS RESOURCES Financial Materials Organization FUNCTIONS Steering Role Financing Insurance Provision INTERMEDIATE OBJECTIVES Cost-effective interventions Quality of Care Access to Services by needs FINAL OBJECTIVES Improve Health Situation Promote and preserve healthy environments Contribute to Overcome illness and disability VALUES AND PRINCIPLES EQUITY, UNIVERSAL ACCESS, SOLIDARITY INTEGRAL CARE, EFFECTIVITY, QUALITY, EFFICIENCY HEALTH CARE MODEL

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guarantee social protection in health to all citizens contribute to the elimination of inequities in access to health services guarantee quality health services assure excluded social groups equal opportunity to receive integral health care satisfy the population’s health needs and demands eliminate the inability to pay as a barrier to access to health care PAHO/WHO XLIII Directing Council, Washington DC 2002 main challenges to health systems

The Commission on Social Determinants of Health (CSDH): 

The Commission on Social Determinants of Health (CSDH) The Commission aims to level policy change by turning existing public health knowledge into actionable goals and national policy agendas. It will: compile evidence on successful interventions and formulate policies that address key social determinants, particularly for low-income countries; raise societal debate and advocate for implementation by Member States, civil society, and global health actors of policies that address social determinants; define a medium- and long-term action agenda for incorporating social determinants of health interventions/approaches into planning, policy, and technical work within WHO.

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how do we should tackle the social determinants of health? CSDH positioning on the Mahler-Grant problem by leading a far-reaching structural critique based on a social justice vision, a ‘Copernican revolution’ in thinking and action on health policy, aimed at significant changes to states’ existing governance and budget structures and their relationships with IFIs and donors; or by developing and promoting a ‘ toolkit’ of tightly focused effective interventions that states can implement swiftly and may produce short-term results, but risk leaving the deeper causes of avoidable suffering and health inequities untouched.

Slide29: 

why policy action on social determinants of health has lagged in most settings? The blockage is a problem of knowledge. Action to address SDH has been weak because the evidence base on which to build such action is inadequate, or existing evidence has not been effectively communicated to those in a position to effect change. The blockage is a problem of power. The most important barriers to action on SDH lie in the political-economic dimension of power and profit. Policy failure on SDH is not primarily a symptom of ignorance, but a logical consequence of existing power relations. The CSDH will focus on both avenues, the scientific evidence and the political strategy to generate the concrete change it seeks.

Slide30: 

In 2001, the number of internet users (UNDP, 2003) was: 396.9 per 1,000 people in high income countries 36.8 per 1,000 people in middle income countries 1.8 per 1000 people in low income countries access to information & the digital divide

distribution of scientific papers by principal author’s country of originMEDLINE 2000-02 (n = 1.1M): 

distribution of scientific papers by principal author’s country of origin MEDLINE 2000-02 (n = 1.1M) PAHO/WHO; IKM/RU & DPM/GPP; 2004 distribution of scientific papers from Latin America & the Caribbean by area MEDLINE & LiLACS 2000-02 (n = 0.1M) the scientific voice from The Americas’ South

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HEALTH EXPENDITURE AS % OF GNP IN LAC, 1997-2000

NATIONAL HEALTH EXPENDITURES: PUBLIC VERSUS PRIVATE: 

NATIONAL HEALTH EXPENDITURES: PUBLIC VERSUS PRIVATE

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PAHO/WHO new program budget policy: distributive impact on regional income inequality CD145/7; PAHO Program Budget Policy, 2004 population ranked by income (cummulative proportion) income (cummulative proportion) PAHO resources (cummulative proportion) line of perfect equity

Slide35: 

Reaching the neediest The equity perspective must be present in the analysis and monitoring of the actions to reach the MDGs and their targets, as well as of the level of their current level of completion. Need for disaggregating the indicators so geographical areas and neglected social groups that should be targeted for special interventions can be identified. Importance of PAHO/WHO’s work on supporting the development of expanded social protection systems in the Region

Slide36: 

Strategic Goals to Support Countries Engage and increase cooperation with other partners—particularly at the country level—to obtain results. Increase health literacy and community empowerment to reach the MDGs. Improve measurement of progress through high- quality disaggregated health data at regional, subregional, and country levels. Initiate research to strengthen the evidence base and generate new knowledge.

PAHO in the 21st Century: 

PAHO in the 21st Century ...to improve the health of the Americas one team, one goal: