1. PRESENTATIONS BY THE PARTNER INSTITUTIONS OF THE JOINT SUMMIT WORKING GROUP – JSWG PAN AMERICAN HEALTH ORGANIZATION (Health in the Americas: Regional Challenges) SUMMIT IMPLEMENTATION REVIEW GROUP (SIRG)OEA/Ser.E Third Regular Meeting of 2008 GRIC/O.3/Inf.2/08 September 18-19, 2008 18 September 2008 Bridgetown, Barbados Original: English (Hilton Barbados Hotel)

2. Pan American Health Organization HEALTH IN THE AMERICAS REGIONAL CHALLENGES SUMMIT IMPLEMENTATION REVIEW GROUPDr. Rebecca de los Rios Bridgetown, Barbados September 18-19, 2008

3. Life Expectancy in Latin America, 2000-05 in relation to the United States Source: Health in the Americas. PAHO, 2007

4. Source: WHO The burden of diseases in countries by income, 2002 (Healthy years of life lost by 1.000 population)

5. 2005 Pan American Health Organization Obesity among women 16-55 yr (%) Chile USA Perú Brasil Canadá México Uruguay Cuba NCD National surveys and representative data. E Jacoby, PAhO Caribbean

6. Pan American Health Organization Prevalence of Adult Obesity (BMI 30 kg/m2) in selected countries/cities of the Americas circa 2005 Source: NCD National Surveys; CAMDI Studies 2002-2006

7. Prevalence of overweight among children (<5 years) in selected countries % Reference: de Onis M, Blössner M. Prevalence and trends of overweight among preschool children in developing countries. Am J Clin Nutr 72:1032-9: 2000.)

8. Pan American Health Organization Prevalence of Adult Diabetes in selected Countries/cities of the Americas circa 2005 Source: NCD National Surveys; CAMDI Studies 2002-2006

9. Pan American Health Organization Regional Strategies to tackle NCD Epidemic Integrated Approach to the Prevention and Control of Chronic Diseases (population and individual interventions) Integrated public policies: Key actions include fiscal/policy incentives for production and consumption of healthy foods, guidelines to regulate the marketing and sale of foods to children, wide promotion of fruit and vegetable consumption, the elimination of trans fats in processed foods, workplace wellness initiatives, physical education curricula and healthy feeding programs in schools, urban planning that encourages walking and biking, improved access to recreation and sports through partnerships, and massive education campaigns Integrated Approach to the Prevention and Control of Chronic Diseases (population and individual interventions) Integrated public policies: Key actions include fiscal/policy incentives for production and consumption of healthy foods, guidelines to regulate the marketing and sale of foods to children, wide promotion of fruit and vegetable consumption, the elimination of trans fats in processed foods, workplace wellness initiatives, physical education curricula and healthy feeding programs in schools, urban planning that encourages walking and biking, improved access to recreation and sports through partnerships, and massive education campaigns

10. Fuente: Lutter CK, Chaparro CM, La desnutrición en lactantes y niños pequeños en América Latina y el Caribe: Alcanzando los objetivos de desarrollo del milenio. Washington. D.C, OPS © 2008 underw eight stunting wasting overweight

11. For the countries more affected the cost of malnutrition is equivalent to 6% and 11% of GDP Total cost (left axel)GDP Percentage (right axel) Source: ECLAC, 2007

12. Chronic malnutrition determinants Youth Pregnant women Infants 6 m a 2 years Pre-school children School children Infants < 6 m Delivery and Newborn Illiteracy Lack of basic sanitation Lack of acces to safe water Environmental pollution Food insecurity Inadequate housing Unemployment Borne Vector Diseases Violence

13. Pan American Health Organization Regional Strategies to tackle Chronic Malnutrition PAHO Regional Strategy on Nutrition and Health Development 2006-2015 Joint Actions to improve efficiency for the response to the food and nutrition crisis: Social and economic determinants approach. Pan American Alliance on Nutrition and Development. Agreement among UN Agencies for Latin America and the Caribbean (PAHO, UNFPA, UNICEF, WFP, UNDP, ECLAC) launched in July, 2008. Working group has been set up to define the Plan of Action. The Alliance will joint efforts with the Inter-american institutions, civil society, and non-profit organizations. PAHO Regional Strategy on Nutrition and Health Development 2006-2015 Joint Actions to improve efficiency for the response to the food and nutrition crisis: Social and economic determinants approach. Pan American Alliance on Nutrition and Development. Agreement among UN Agencies for Latin America and the Caribbean (PAHO, UNFPA, UNICEF, WFP, UNDP, ECLAC) launched in July, 2008. Working group has been set up to define the Plan of Action. The Alliance will joint efforts with the Inter-american institutions, civil society, and non-profit organizations.

14. Infant mortality indigenous and non indigenous and place of residence < 1 year old Death by 1,000 live birth Source: ECLAC, Millennium Development Goals: A view from Latin America and the Caribbean, 2005

15. 1/12/2014 Organización Panamericana de la Salud 2008 Evolution of Neonatal and Infant Mortality in the Region of the Americas by Time Period YEAR Source: Estimates based on PAHO, 2000, 2006 Infant mortality Neonatal mortality 48 %

17. Percentage of deliveries attended by health care professionals by income in selected countries (circa 2002) Source: Eclac, 2006

18. Percentage of households with health insurance (public and private) by income Source: Eclac, Social Protection 2006

19. The public expenditure for health care (%GDP)

20. The countries that need more are the ones that spend less Global malnutrition and public social expenditure social per capita (2004 y 2005) Social expenditure per capita (left axel)Malnutrition (right axel)

21. NEA ARU USA CAN

22. CUB URU ANG BAR BOL PAN VNZ BRA BER CHI DOM ELS HON PAN SUR SVG SLU BAH COL GRE JAM NIC ANT HAI ECU GUT MEX PAR PER SKN TRT NEA ARU USA CAN BEL DOR ARG COR TCI MNT

23. The Impact of public expenditures in health Distribution of public health expenditures for quintiles of income Q1=Poor Q5=Rich

24. Pan American Health Organization Regional Strategies to Improve Access to Health Care Towards Universal Access to Health Care in 2015 Integrated Public Policies to improve access to health care, especially for the poor –To increase public expenditure in health up to 6% of the GDP – To implement mechanisms to reach the poor to improve the impact of public expenditure in access to health care (health public insurance, social health protection programs etc. ) Strengthening Health Care Systems and Services based on Primary Health Care Towards Universal Access to Health Care in 2015 Integrated Public Policies to improve access to health care, especially for the poor –To increase public expenditure in health up to 6% of the GDP – To implement mechanisms to reach the poor to improve the impact of public expenditure in access to health care (health public insurance, social health protection programs etc. ) Strengthening Health Care Systems and Services based on Primary Health Care

25. Pan American Health Organization ENSURING OUR PEOPLES HEALTH SECURING OUR PEOPLES FUTURE Thank you, Gracias, Obrigada, Merci