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Pan American Health Organization Washington, D.C. October 2, 2012 SOCIAL CHARTER IN THE AMERICAS From the Health Perspective From the Health Perspective.

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Presentation on theme: "Pan American Health Organization Washington, D.C. October 2, 2012 SOCIAL CHARTER IN THE AMERICAS From the Health Perspective From the Health Perspective."— Presentation transcript:

1 Pan American Health Organization Washington, D.C. October 2, 2012 SOCIAL CHARTER IN THE AMERICAS From the Health Perspective From the Health Perspective Dra. Sofialeticia Morales Senior Advisor for the MDG Coordinator of Health Promotion and Social Determinants of Health

2 The principal challenges in Health in the Americas I.

3 Poverty and Inequality

4 Poverty: A Multi-Dimensional Challenge Poverty is pronounced deprivation in well-being, and comprises many dimensions, including low incomes and the inability to acquire the basic goods and services necessary for survival with dignity. Poverty encompasses low levels of health and education, poor access to clean water and sanitation, inadequate physical security, lack of voice, and insufficient capacity and opportunity to better ones life. The state of poverty vary by degree within countries and regions. Poverty is multidimensional making the solution a challenge to apply as many of the causes of poverty are inter-related. Source: World Bank, 2010

5 Poverty's Disproportionate Impact Poverty and inequity are two of the greatest challenges of this century The global GDP per year, US$74 trillion, represents an average of $30 per day per person in the world 2.7 billion world-wide people live on less than $2 per day Six out of ten of the worlds poorest people are women Stark differences in economic opportunities explain significant health inequities between and within countries There is a 36-year-gap in average life expectancy between Malawi and Japan The life expectancy in Dominican Republic is 73.5 whereas in Haiti it is 62.2 –a gap of 11.3 years within the same island Sources: Robert Wood Johnson Foundation, 2011 Source: World Health Organization, 2011 Median income: $143,500 Median income: $58,526

6 Access to Health Services and Social Protection Programs II.

7 Poverty and Access to Health Services Social exclusion and inequity in the distribution of wealth, as well as access to basic services continues to be a priority for inclusive development in our region. According to the World Bank, in 2010, 1 out of 5 persons lived on less than $2 dollars a day, 15% of the US population and 11 of Canada´s population lived below the poverty line (2010 US census and 2009 Canada Census). It is worth noting the uneven progress among the countries of the region. As an example, on the island of Hispaniola life expectancy in the Dominican Republic is 73.5 years while in Haiti is 62.2 inter sectoral initiatives at the highest political level that involves the whole of government and that focus on reversing the negative effects of social determinants prove to be able to sustain the poverty reduction strategies adopted in the last 20 years. (e, g, Bolsa Familia and Oportunidades) In 2008, Cuba had 1 physician for every 159 people, whereas Haiti had 1 physician for every 11,500 people (World Bank, 2008) In LAC, 27% of the population is without regular access to basic health services, which equals a total of 135 million (PAHO, 2009) Source: World Bank: 2008

8 Reducir las barreras que impiden el acceso a los servicios de salud Sexo/género/identidad de género Ingreso/clase económica/social Etnia Barreras culturales y lingüísticas que afectan el acceso de los indígenas o afrodescendientes Doble descriminizacion de las mujeres Maltrato por los trabajadores salud Hombres: es menos probable que busquen servicios de atención Mujeres: violencia de género, explotación/trafico sexual, Tienen menos acceso a servicios e información Miedo al rechazo, el estigma, y la discriminación Falta de acceso a los recursos financieros, tiempo y transporte, Falta de información Orientación sexual Barreras múltiplas

9 Pobre Urbano/ Rural Analfabeta Falta poder política Género Edad productiva/reproductiva Indígena Monolingue Discapacidad El impacto de la exclusión y discriminación acumulativa

10 Universal Health Coverage of Good Quality accompanied by Social Protection Models for the most vulnerable population Target

11 Action on the social determinants and health in all policies III.

12 Poverty and Education Education determines employment opportunities, family income and participation in social protection programs These factors strongly influence accessibility to health services Evidence demonstrates that families with lower levels of education have poorer health outcomes Source: Macro International, times higher

13 Brazil: income growth and redistribution by deciles, Hailu D, Dillon SS. IPCIG & AER; OnePager July 2009;89:2 Equity in health-the backbone for the post 2015 Development Agenda

14 Breaking the Cycle of Poverty: The Role of Social Determinants of Health Looks at the whole picture of countries (local, national, and community) addressing the inter- related factors that impact the overall health Encourages public policies to be evaluated and changed to improve health and well-being Enhances the elimination of gaps in health outcomes between social groups Allows public health professionals to look for solutions outside the health care systems to improve health Provides a framework for countries to improve the health of people while empowering and encouraging fair opportunities across the life course Contributes to achieving the Millennium Development Goals Age, sex & hereditary factors

15 Brazil: distributional effect on infant mortality inequality, Graficas desarrolladas por Oscar Mujica

16 Regional standardized national information systems in health, and vital statistics that allow the disaggregation of data by sub national level, sex, ethnicity and race as well as economic status Target

17 Urban Health

18 LAC is the most urbanized region in the developing world, with 77 percent of its population living in cities Major cities in the United States (Atlanta, Washington D.C. & New York) have the highest levels of inequality in the country, similar to Abidjan, Nairobi & Santiago In Belize, Guatemala and Peru over 50% of the urban population lives in slums, while in Barbados, Chile, Guyana, and Uruguay, less than 10% of the urban population lives in slums Infant mortality ranges from 6.5% in one central area to 16% in another part of Greater Buenos Aires, Argentina (Bernardini, 2009) In Bolivia, 93 per cent of children in small cities and towns are enrolled in primary education, compared with 68 per cent in the capital and other large cities, and 72 per cent in rural areas The Continuing Challenge of Rapid Urbanization in the Americas Urbanization in the Region of the Americas Source: UNHabitat 2009

19 The social and economic burden of NCD IV.

20 The social and economic burden of NCDs More than 200 million persons in the region suffer from and NCD 4.4 million people dying each year in the Region due to Non-communicable diseases accounting for 75% of all deaths throughout the region (PAHO Mortality database) Cardiovascular disease account for 1.9 million deaths a year; Cancer 1.1 million, diabetes 260,000 Chronic respiratory diseases 240,000. Of these deaths, 37% are among persons under 70 years of age and 80% occur in middle and low income countries. Source: WHO, 2008 Region-wide Prevalence of Obesity

21 The social and economic burden of NCDs A joint study between Harvard University and the World Economic Forum estimates that if measures are not taken, NCDs will cost middle and low income countries almost US$500,000 million per year, equivalent to 4% of its PIB. In LAC, diabetes alone represents a cost of approximately US$65,000 million a year. Risk factors associated with NCDs such as alcohol and tobacco, lack of physical activity and poor diet reflect behaviors that can be changed by healthy life styles through community and individual commitment and this opens an opportunity and presents a challenge since 3.4 million deaths can be prevented. Source: WHO, 2008

22 educational gradient in obesity prevalence; The Americas, Equity in health-the backbone for the post 2015 Development Agenda

23 Target: 25% reduction in premature mortality caused by the four leading NCDs (cardiovascular disease, cancer, diabetes and chronic respiratory disease) Target

24 A new perspective for violence and injury prevention in the scenario of Humans Security V.

25 Violence in the Americas Violence poses a significant threat to health and wellbeing within the Americas Drug trade-related violence appears to be increasing in some regions Marginalized groups are especially vulnerable to violence It is estimated that in 2005, people died as a result of violence in the Americas –67% of these deaths were a result of interpersonal violence 1. Demombynes, G. (2011). Drug Trafficking and Violence in Central America and Beyond. World Development Report Background Case Study. Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health

26 Health Promotion and the Social Determinants of Violence Health public policies to create equitable societies and healthy settings Fostering of Community empowerment and participation in the development of health communities Information provision, health education and life skill enhancement Work towards gender and economic equity and the reorientation of supportive health services Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health

27 Public health policies to create equitable societies and healthy settings Work towards gender and economic equity and the reorientation of supportive health services. Fostering of Community empowerment and participation in the development of health communities. Information provision, health education and life skill enhancement Equity, Security, Democracy, Health, Development Regional and National Level Community and Interpersonal Level Individual Level Violence Prevention Ecological Model CDC, 2011 Violence Prevention Gender Ethnicity Education Age Region Employment Status Socio-economic Status Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health

28 The Problem: Typology of Violence Self-directed: –Suicidal behavior –Self-abuse Interpersonal Violence –Family and intimate partner violence –Community violence Collective Violence –Social violence –Political violence –Economic violence WHO. (2002). World Report on Violence and Health. Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health

29 Global Mortality Due to Self-inflicted Violence WHO, 2002, The Injury Chart Book Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health

30 Global Mortality Due to Interpersonal Violence WHO, 2002, The Injury Chart Book Interpersonal violence makes up a significant portion of global mortality. However, violence related mortality disproportionally affects the region of the Americas in large numbers. Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health

31 Self-directed Violence Includes suicide and self- mutilation Suicidal behavior ranges from thinking about ending ones life to carrying out the act Risk factors include demographics, psychiatric, biological, social and environmental factors Interventions include treatment of mental disorders, behavioral therapy, relationship approaches, community based efforts, and societal approaches. WHO. (2002). World Report on Violence and Health. Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health

32 PAHO, 2009, Health Indicators Database Violence related mortality is steadily increasing over time. By 2020, interpersonal violence is projected to become the 14 th leading cause of death worldwide (16 th in 1990) and the 12 th leading cause of burden of disease and DALYs lost (19 th in 1990) Rate: IPV Trends Over Time 2001 Rate: 13.1 Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health

33 Top Twenty Countries with Highest Mortality Rate Due to Homicide in the Americas, 2006 (estimated per 1000 pop) Country Mortality rate from homicideGINI Coefficient El Salvador (2009) Colombia (2010) Guatemala33.3 Venezuela32.9 Brazil (2009) Trinidad and Tobago30.2 Anguilla29.7 Ecuador (2010) Montserrat21.6 Guyana21.2 Puerto Rico19 Paraguay (2010) Bahamas18.2 Barbados18.1 Nicaragua17.9 Belize16.4 Panama (2010) St Vincent and the Grenadines11.9 Mexico (2008) British Virgin Islands8.6 PAHO, 2010, Health Information and Analysis Project; World Bank, GINI Index, 2012 Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health

34 Males ages 15 to 29 years old in the Americas have the highest interpersonal violence mortality rate of any other age group both regionally and globally. The interpersonal violence mortality rate for males living in the Americas is This is over three times as high as the average interpersonal violence mortality rate worldwide for this group, WHO, 2002, The Injury Chart Book Male IPV Mortality Rates: Americas Ages 15-29: 68.5 Globally Ages 15-29: 19.4 Americas All Ages: 34.8 Globally All Ages: 13.2 Interpersonal Violence Mortality Rates in the Americas By Age Group, 2000 Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health

35 Low-and middle-income countries in the Americas had mortality rates due to violence that were more than four times as high as those in high-income countries in the region in High income countries had a lower violence based mortality rate than the worldwide average for 2000 (8.6) and low-and middle-income countries had one almost three times as high. WHO, 2002, The Injury Chart Book Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health

36 Family Violence: Abuse of the Elderly Elder abuse is a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person (Action on Elder Abuse UK). Categories of elder abuse: –Physical Abuse: the infliction of pain or injury, physical coercion, or physical or drug induced constraint –Psychological or Emotional Abuse: the infliction of mental anguish –Financial or Material Abuse: the illegal or improper exploitation or use of funds or resources of the older person –Sexual Abuse: non-consensual sexual contact of any kind with the older person –Neglect: the refusal or failure to fulfill a caregiving obligation Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health

37 WHO Action Points for Violence Prevention Develop safe, stable and nurturing relationships between children and their parents/caregiv ers Develop life skills in children and adolescents Reduce the availability and harmful use of alcohol Reduce access to guns, knives and pesticides Promote gender equality to prevent violence against women Change cultural and social norms that support violence Victim identification care and support programs Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health WHO, 2009, Violence Prevention: The Evidence

38 Reorientation of Health Services: Violence Prevention Providing support and care programs Strengthening the evidence base Collaboration across sectors including public health and criminal justice sectors Services to Break the Cycle of Violence Screening/ Identifying victims of violence and referral to programs Psychosocial interventions to reduce mental health problems Protection orders, prevention from being contacted Dra. Sofialeticia Morales Garza Team Leader, Health Promotion and Social Determinants of Health

39 25% reduction in mortality caused by violence. Target

40 Relationship between health and sustainable development without exclusion IV.

41 urbanrural urban-rural inequalities in progress towards MDG7 drinking water sanitation Gráficas desarrolladas por Oscar Mujica

42 el mayor riesgo de muerte materna se concentra sistemáticamente en la población con menor acceso a agua potable Graficas desarrolladas por Oscar Mujica

43 infant mortality by quartile of access to sanitation; The Americas, 2008 Gráficas desarrolladas por Oscar Mujica

44 maternal mortality by quartile of access to water; The Americas, 2008 Gráficas desarrolladas por Oscar Mujica

45 Vision of Health in the Americas Values of Equity and Pan-Americanism Focus on: Key Countries Special Populations Technical Priorities Special Populations KeyCountries PAHOVision Equity Pan- Americanism TechnicalPriorities PAHOs Core Commitment

46 Addressing the Causes… In 2008, The Commision on the Social Determinants of Health launched Closing the Gap in a Generation, putting equity firmly on the global agenda The Commission made three over-arching recommendations: 1)To improve daily living conditions 2)To tackle the inequitable distribution of power, money and resources 3)To measure and understand the problem and assess the impact of action

47 Institutional Initiatives

48 Health inequalities matter Social Justice Empowerment Material Psychosocial political Creating conditions for people to lead flourishing lives Safety Motherhood UN accountability Health of mother and Child Faces, Voices and Places Social Protection in Health

49 Early child development and education Healthy Places Fair Employment Social Protection Universal Health Care Health Equity in all Policies Fair Financing Good Global Governance Market Responsibility Gender Equity Political empowerment – inclusion and voice Health Promotion and Social Determinants of Health

50 Mission in Action PAHO is strongly committed to putting equity firmly on the agenda Equity and the Social Determinants of Health are key priorities in Health Agenda for the Americas Addressing inequities through the approach of The social determinants of health is one of the objectives in PAHOs Strategic Plan

51 To make the most neglected communities seen and heard in meeting the targets of the MDGs Going beyond the averages: addressing the dangerous & unjust illusion resulting from averages in health statistics Enhancing inter-sectoral action for participatory local development by working with Ministries of Health and national & local governments The Goal of this Initiative is: Faces, Voices and Places

52 Aplicacion de los ODM y DSS en las comunidades pobres Ampliación de la Cobertura 26 países, en 50 municipalidades. Territorios Trasnacionales Trabajo inicial en el Chaco Sudamericano con miras a expandirse e inicio del trabajo en La Mosquitia. Sistematización de los procesos llevados a cabo en los países a través de los Folletos de RVL Enfoque de equidad genero y cultural, sistemas de informacion para decisiones, participacion de mujeres y hombres, monitoreo social ROSTROS VOCES Y LUGARES de de la OPS AVANCES

53 2.From the perspective of the social determinants of health & the MDGs 3. Highlighting the most vulnerable municipalities 1.Uses standardized census data Regional Atlas of Sub National Vulnerability Geo-referenced Analysis of Inequity

54 Observatories in the region opens up opportunities for training, research and monitoring, serving as dissemination points for best practices in policy by focusing on legislation, regulation, public policies and international health policy. CARMEN NCD Policy Observatory : a platform for the network of American countries and institutions engaged in the systematic analysis of non-communicable disease (NCD) policies Virtual Campus: A PAHO/WHO public health technical cooperation strategy serving key actors Regional Health Observatory: An institutional resource to facilitate access to health data, statistics and information from the Region of the Americas EQUIDAD listserv : S pecialized resource serving 65,000 in 170 countries designed to disseminate information, promote communication and interdisciplinary links on Equity, Health and Human Development Building and Sharing Evidence

55 Health Equity as a Development Outcome Participation Voice Agency Empowerment Psychosocial Material Political Health EquityDaily Living Conditions Early life Physical and social environments Working conditions Social Protection Health Care Structural Drivers Societal norms and values Social Inequities Governance and Financing Economic Growth and Social Policy

56 Addressing Social Justice Investing in tomorrows New Generation Developing Equity- based Policies Investing in Health and Education Translating the Agenda into Action Requires: Universal coverage of health services and social protection programs for the most vulnerable Equity in itself Is a worthy goal due to its Moral implications GDP indicator that reflect social investment Investing in Education and Health can promote Equity and help directly and indirectly to reduce poverty Many of todays Policies will affect the welfare of tomorrows generation, thus, affecting inter- generational equity Policies that Promote equity Can boost Social cohesion And reduce Political conflict

57 The principal challenges make a congruent process between the MDGs debate post 2015 and the Social Charter

58 Thank you


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