1. Dr. Sofialeticia Morales Millennium Development Goals & Health Targets
Senior Advisor
Millennium Development Goals & Health Targets
AG/RES (XXXVII-O/07)
POVERTY, EQUITY, AND SOCIAL INCLUSION: FOLLOW-UP TO THE DECLARATION OF MARGARITA

2. What is PAHO’s stance on the MDGs?
Global
Responding to Global Commitments, harnessing international aid, Inter-Agency alliances and collaboration as part of the UN System
What is PAHO’s stance on the MDGs?
Regional
Commitment, monitoring regional progress, evidence based knowledge sharing. Go beyond the national average to highlighting the most vulnerable people and communities
National
Support the development of national policies and programs to improve health and development through intersectorial strategies.
Local
Support mayors, empower the most vulnerable communities, work with grassroots and civil society to develop key interventions to bring change under the framework of health and development.

5. What has happened since the Millennium Summit
…and productivity increases
Over the last two decades there
has only been a 2% decrease
in the percentage of
the population living in
poverty & extreme poverty
And poverty & extreme poverty reduced
Latin America: Poverty & Extreme Poverty (Change )
Percentage People
Population Volume
Extreme Poverty
Poverty
Percentage
Millions
Gini Coefficient: Inequity among Regions 1990, 2000 & 2015
Our countries have
added 69 million
new poor in the last
26 years
Prospective studies using the Gini coefficient forecast that in 2015 Latin America will continue being the most inequitable region on the planet

6. MDG 1 HUNGER
LATIN AMERICA AND THE CARIBBEAN (25 COUNTRIES):
UNDERWEIGHT CHILDREN UNDER 5, a/ (In percentages)
While sufficient foodstuffs are produced in the region to fulfill the caloric requirements of three times the current population, 53 million people have inadequate access to food.
SOURCE: ECLAC

7. MDG 1 HUNGER
Malnutrition begins in utero: About 17% of newborns in developing countries are born with low birth weight
(UNICEF, 2006)

8. MDG 1 HUNGER Anemic Populations in Latin America
Last reported or estimated data
Less than 5 years
Pregnant
Not Pregnant
27%
24%
18%

9. MDG 1 HUNGER Working at the Local Level Ventanilla, Peru
Responding to the commitments and priorities of the national public agenda to reduce chronic malnutrition in children with coordination between the national government and the Callao region.
Work is being carried out at the inter-sectoral and interagency level in Ventanilla to tackle the social determinants of health, promoting interagency work with UNICEF and UNEP

10. MDG 1 HUNGER Areas of Collaboration Unite forces:
Poverty-Hunger-Malnutrition
Nutritional and Food Safety – PRESANCA in Central America
Evidence and Lessons Learned
CHILE – JUNAEB, BRAZIL – Bolsa Familia, MEXICO - Oportunidades
Perú – Crecer, Uruguay PANES alfabetización y salud El Salvador: Red Solidaridad Bolivia, Colombia
Early Childhood Development Network, Commission of Social Determinants of Health,
CANADA: “Putting Science into action”: Fraser Mustard & Stuart Shaniker
V Inter-American Meeting of Ministers of Education (CIDI)
Inter Agency Collaboration (OAS, PAHO/WHO, UNICEF, UNESCO-OREALC) with the leadership of Canada, Chile and Colombia.
Areas of Collaboration

11. MDG 2 EDUCATION School completion among women Selected countries
Gwatkin DR, Rutstein S, Johnson K, Suliman E, Wagstaff A, Amouzou A. Socio-Economic Differences in Health, Nutrition and Population within Developing Countries. An Overview. The World Bank, 2007; Washington DC.

12. MDG 2 EDUCATION Working at the Local Level Canelones, Uruguay
At the national level, Uruguay promotes MDG achievement through Faces, Voices and Places Initiative under the Healthy and Productive communities framework.
Community empowerment through health promoting schools and productiveInitiatives prove its impact on reducing poverty and promote development.

13. MDG 2 EDUCATION MDG 2 EDUCATION Areas of Collaboration
Strategic Alliance Health Education
Inter-American Contest of Best Practices for the Promotion of Health in the ambit 130 experiences, 10 winning experiences / Nicaragua, Brazil, Chile, Colombia, Honduras, Argentina etc/ PAHO/WHO, UNESCO-OREALC, UNICEF, CAB, Brazil: Facendo Escola
Health Promoting Schools Network – Friendly and Healthy Schools
Evidence and Lessons Learned:
Chile: Intersectorial Alliance, Brazil: Technical Ministerial Meeting,
Trinidad & Tobago,
The 1rst Caribbean Regional Curriculum Framework for Health and Family Education
EDUCN/Caribbean Education Sector: HIV and AIDS Coordination Network/ UNESCO – EDC – PAHO/WHO – St. Lucia

14. MDG 3 GENDER EQUALITY in Percentages
PROPORTION OF THE POPULATION AND INCOME THAT CORRESPONDS TO EACH SEX PER QUINTILIL
in Percentages
Fuente: Comisión Económica para América Latina y el Caribe (CEPAL),
sobre la base de tabulaciones especiales de las encuestas de hogares.

15. PROPORTION OF FEMALES HEADS OF HOUSEHOLD BY INCOME LEVEL
MDG 3 GENDER EQUALITY
PROPORTION OF FEMALES HEADS OF HOUSEHOLD BY INCOME LEVEL
Latin America (simple average 12 countries A/),Urban Areas 1990, 2002 & 2005

16. MDG 3 GENDER EQUALITY
% of women that sometime between 15 and 49 years of age that have been victims of violence by their husband or partner

17. MDG 3 GENDER EQUALITY Working at the Local Level Canton Corredores, CR
In the Canton of Corredores an initiative has been developed to strengthen the capacity of women for decision making and enhaced economic standing.
This has been done through a sustainable food production projects within the framework of nutrition and food security and healthy settings.
These give an important focus on priorities such as safe drinking water and solid waste collection and management.

18. MDG 3 GENDER EQUALITY Areas of Collaboration
Consolidated Alliance CIM and PAHO’s Gender and Ethnicity Team
Promotion of the adoption of the Vaccine Human Papilloma Virus (HPV)/ Cervical Cancer measures
Best Practices Contest for Health and Gender Equality: Let’s Get Real
Evidence and Lessons Learned
Bolivia: Building bridges between the community and health services with a gender and culturally sensitive approach
Mexico: Campaign for the prevention and control of diabetes in women
Declaration of Ministers of the Americas at the Meeting on Prevention of Violence and Injuries, México, March, 2008.
MDGs Report 2006: A look at gender equity and women self-determination in Latin America and the Caribbean/ CEPAL with Inter- Agency Collaboration 2006

19. 35 COUNTRIES& TERRITORIES IN LAC: Infant Mortalilty per 1000lb, 2007
MDG 4 INFANT MORTALITY
35 COUNTRIES& TERRITORIES IN LAC: Infant Mortalilty per 1000lb, 2007
Seven countries have a child mortality rate in children less than five years of age of 30 or more per 1000 live births;
Mortality in children less than five years of age has decreased from 31.7 to 27.0 per 1000 births (postnatal)
Despite the decrease, every year 450,000 children die in hour hemisphere and 92% of the death occur in LA and the Caribbean
Progresos en la reducción de la mortalidad infantil entre y reducción pendiente hasta 2015 a (Indicador 14, ODM)

20. Inequities are more pronounced at the
MDG 4 INFANT MORTALITY
BOLIVIA 2001,
Municipalities by Infant Mortality Rate
BOLIVIA 2001,
Municipalities by Infant Mortality Rate & Percentage
of the population witn unmet basic needs (NBI)
BOLIVIA 2001,
Municipalities by percentage of the population
with unmet basic needs (NBI)
Inequities are more pronounced at the
local level (NBI – Infant Mortality)
BOLIVIA 2001,
Municipalities according to Infant Mortality Rate
& population with unmet Basic Needs
99.77 to 100%
There is a strong correlation between the infant mortality rate in a municipality & the % of the population with unmet basic needs

21. MDG 4 INFANT MORTALITY Working at the Local Level Chalcataya, Bolivia
Has chosen the Healthy and Productive Communities Network to promoting changes in the quality of life in Chacaltaya through productive projects that generate employment and income.
Using this experience as a model, the goal is to replicate the approach in other communities of the Altiplano (Pampas Aullaga) and Chaco (Yapiroa) regions.
There is also support for the national Zero Malnutrition Program promoted by the Ministry of Health.

22. MDG 5 MATERNAL HEALTH Haiti & Guatemala
Honduras, Nicaragua, Peru, Bolivia, Paraguay, Guyana, & Suriname

23. MDG 5 MATERNAL HEALTH
Percentage of youth (15-19 year) that are already mothers or are pregnant by educational level
40% of unsafe abortions are done to women between the ages of 15 and 24
40% of young mothers are anemic
Adolescent mothers are 2x as likely to die
as a result of pregnancy related complications,
this is higher among those under 15
Fuente: DHS

24. MDG 5 MATERNAL HEALTH Working at the Local Level El Cotorro, Habana
Cuba has joined the initiative with the Cotorro community. This community was selected because of the innovative way in which the socioeconomic vulnerability challenges have been address.
The community is a suburban area and sets an example for its high coverage of health services and low morbidity and mortality rates.

25. MDGs 4 & 5 Maternal Health Infant Mortality
UNDP/PAHO/WHO/CEPAL/UNICEF are focusing their work to collaboratively help advance in the reduction of infant mortality and the improvement of maternal health. We ask the OAS to join this effort
Meeting of United Nations Regional Directors and the Inter American System (June 24-25, 2008)
Evidence and Best Practices
Casas Hogar for Mothers (ambulatory)
Centros de Desarrollo
Unidades Moviles
Barrio Adentro / Misiones

26. MDG 6 HIV/AIDS
It is stimated that 1.6% of women & 0.7% of men are infected with HIV/AIDS in the Caribbean, and that 0.3% of women and 0.5% of man in Latin America
Steep increase of new cases (adolescent, MSM, SW, IDU women and others)

27. Country Classification according to HIV and Tuberculosis epidemiology
MDG 6 HIV/AIDS
Country Classification according to HIV and Tuberculosis epidemiology
Countries with Generalized HIV Epidemic
Countries with Concentrated or Low Level HIV Epidemic
High TB Incidence*
Low&Medium TB Incidence a
High TB Incidence *
Low and Medium TB Incidencea
Haiti
Dominican Republic
Honduras
Guatemala
Guyana
Suriname
Jamaica
Trinidad y Tobago
Barbados
Bahamas
Belize
Brazil
México
El Salvador
Peru
Bolivia
Nicaragua
Paraguay
Ecuador
Cuba
Costa Rica
Chile
Uruguay
Argentina
Venezuela
Panamá
Puerto Rico
Canada
Colombia
United States of America
* Estimated TB incidence over 50 per 100,000; a Estimated TB incidence below 50 per 100,000 population

28. MDG 6 HIV/AIDS Working at the Local Level
Rosario de Mora, Santiago Texacuangos, San Salvador
Has launched an integrated strategy for municipal health development.
The strategy employs an intersectoral, multiprogrammatic approach to
influence health determinants through participatory activities
These are centered on situation analysis, the identification of problems, and support for the design of local health plans grounded in the renewed PHC, reducing inequities, and extending social protection through a family health model.

29. MDG 6 HIV/AIDS Areas of Collaboration
Support the promotion and protection of Human Rights
Strengthen inter-sectorial action (health-education-labour- finance-social development) as a means to reduce the number of new cases, particularly in the school ambit
Political Advocacy to revitalize the HIV/AIDS prevention agenda
Mexico City’s International HIV/AIDS Conference August

30. MDG 6 TUBERCULOSIS New Reported TB Cases Americas, 2006 Total: 224.548
Haití
Dom. Rep.
México
Honduras
Ecuador
Perú
Bolivia
Brasil
Nicaragua
Guyana
Colombia
Guatemala
80%
Total:
Peru
Brazil
50%
Source: Global Tuberculosis Control. WHO Report 2008. 30

31. Malaria Situation in the Americas 2000-2006
MDG 6 MALARIA
Malaria Situation in the Americas
4 Countries with >75% decrease in total cases
Increased migration of people makes epidemiologic surveillance and monitoring increasingly difficult
4 Countries with % decrease in total cases
7 Countries with <50% decrease in total cases
18 countries transmission-free
21 endemic countries
11 countries South America (73% cases P. vivax)
8 countries Central America (94% cases P. vivax)
2 countries in Hispaniola (almost 100% P. falciparum)
70% cases in the Region P. vivax
29% P.falciparum
<1% P. malariae
(Brazil,Guyana & Suriname)
Active participation of many sectors, particularly civil society and communities, remains lacking in many countries.
6 Countries with increases
18 Malaria-free countries
Decrease P. falciparum fatality rate from 13 to 4 per 10,000
20% decrease in malaria cases for the entire Region

32. MDG 6 MALARIA Working at the Local Level V Sanitary Region Objective
To prevent the reintroduction of DDT for malaria control through the demonstration and evaluation of alternative and integrated methods of vector control that are cost effective, replicable, and sustainable.
Beneficiaries
Rural populations affected by malaria, public institutions that have to face the problem of malaria control, populations affected by the use of the DDT in the past, workers of vector control who have been exposed to DDT, women, and children who live in unhealthy settings close to vector breeding sites.

33. MDG 7 ENVIRONMENT

34. 52.7 million of people without access to safe drinking water
MDG 7 ENVIRONMENT
52.7 million of people without access to safe drinking water
Con Acceso*: Hogares y otros accesos a través de pilas, fuentes públicas y pozos protegidos.
Fuente: Evaluación de Medio Término del Programa Conjunto de Monitoreo (PCM) del abastecimiento de agua y saneamiento de OMS y UNICEF (2006)

35. MDG 7 ENVIRONMENT Working at the Local Level
El Bongo Pencalá Los Encuentros
Guatemala
Scarcity of safe and reliable sources of safe drinking water is one of the main problems in these communities.
Sanitation is also a key problem causes increased prevalence of preventable diseases
Of the main obstacles for resolving these issues is the construction and community management of aqueducts to channel water sources available but currently out of reach.

36. MDG 7 ENVIRONMENT Areas of Collaboration
Meeting of Ministers of Health and Environment OAS-PAHO/WHO-UNEP to strengthen the alliance Health Environment
Working with the Department of Sustainable Development in the water and sanitation initiative. (OAS, PAHO,UNEP.

37. MDG 8 PARTNERSHIPS Working at the Local Level Nabon, Azuay
Work is being carried out in the municipality of Nabón in Azuay Province, which has a database, maps, social indicators, and an intersectoral, interagency intervention proposal with political backing and local
investment.
National and international partnerships for development and inter-agency and intersectoral collaboration have been key for the achievements. Although progress has been made these partnerships need to be strengthened and shared with other communities through out the region

38. MDG 8 PARTNERSHIPS From The Millennium Declaration to Local Action:
Pool political will, technical expertise and targeted financial resources to extend the Faces, Voices and Places initiative to the poorest communities in each country. That no country is left out of this initiative
To work in the Caribbean a new strategy for FVP with the MDGs Plus Strategy
To work together to reinforce the role of the Inter American system in empowering Haiti.
Address poverty and social inclusion in areas that are predominantly populated by indigenous populations, transcend borders and are marked by biodiversity and are chronically neglected. La Mosquitia in Central America, the Andean Antiplano, the South American Chaco and the Amazon Region.
POVERTY, EQUITY, AND SOCIAL INCLUSION

39. MDG 8 PARTNERSHIPS Inter Agency – Inter Sectorial
Collaboration Mechanism:
For advocacy & commitment
To include pro-tempore presidents of ministerial meetings