Health in the Americas: Regional Challenges and Strategic Directions Pan American Health Organization Health in the Americas: Regional Challenges and Strategic Directions Dr. Carissa Etienne Assistant Director SUMMIT IMPLEMENTATION REVIEW GROUP XVI Meeting March 29, 2007 Washington DC

Health Regional Challenges: Old and New problems accumulation The burden of diseases in countries by income, 2002 (Healthy years of life lost by 1.000 population) The first challenge: Old and New Problems The health situation in the region is summarized in this table, which indicates the average of healthy life years that the population of Latin America and the Caribbean has been loosing, either by premature death or by illness. The red part indicates the share due to communicable diseases, the dark blue part that due to chronic non-communicable diseases, and the light blue part that due to premature deaths or disabilities related to trauma and violence. If we compare the region with high-income countries, we can see a similar situation with regard to chronic diseases; however, the healthy years lost due to communicable diseases is almost six times higher in the region. This situation gets worse in its low-income countries, where the share of communicable diseases, associated with poverty and social exclusion, is much higher than in the medium-income countries. It is a very complex health situation, where unresolved problems, accumulated as an “unfinished agenda,” coexist with problems related to the ageing of the population, life styles, and environmental deterioration. In addition we cannot ignore the global health problems we are currently facing in a globalize world and the threat they pose to international health security with devastating consequences for the poorest and most vulnerable social groups on the continent. Source: WHO

Health Regional Challenges: Old and New problems accumulation The burden of diseases in countries by income, 2002 (Healthy years of life lost by 1.000 population) The first challenge: Old and New Problems The health situation in the region is summarized in this table, which indicates the average of healthy life years that the population of Latin America and the Caribbean has been loosing, either by premature death or by illness. The red part indicates the share due to communicable diseases, the dark blue part that due to chronic non-communicable diseases, and the light blue part that due to premature deaths or disabilities related to trauma and violence. If we compare the region with high-income countries, we can see a similar situation with regard to chronic diseases; however, the healthy years lost due to communicable diseases is almost six times higher in the region. This situation gets worse in its low-income countries, where the share of communicable diseases, associated with poverty and social exclusion, is much higher than in the medium-income countries. It is a very complex health situation, where unresolved problems, accumulated as an “unfinished agenda,” coexist with problems related to the ageing of the population, life styles, and environmental deterioration. In addition we cannot ignore the global health problems we are currently facing in a globalize world and the threat they pose to international health security with devastating consequences for the poorest and most vulnerable social groups on the continent. Source: WHO 3

The inequities The Health Regional Challenges: Infant mortality indigenous and non indigenous and place of residence Death by 1.000 live birth The second challenge: The inequities Despite the fact that in recent years there have been overall improvements in the traditional principal health indicators, the health situation in the region is characterized by large differences among and within countries. Inequalities in health are marked by significant disparities related to geography, age, gender, ethnicity, education level, and income distribution. Available indicators for the 45 million indigenous peoples are consistently worse than those for the non-indigenous population. This graphic shows the differences in the infant mortality rate. Consistently the mortality in the indigenous group is higher than in the non-indigenous in all countries. Source: ECLAC, Millennium Development Goals: A view from Latin America and the Caribbean, 2005

The Health Regional Challenges: Insufficient public expenditure for health Composition of National Health Expenditures in Latin America and the Caribbean 1980-2005 (% GDP) Third challenge Another challenge is the insufficient level of public expenditures in health. This Chart shows that, during the past few years, there has been an increase in total expenditures in health, reaching slightly more than 7% of the GDP earlier this decade. However, the level of public expenditures in health - which includes those made by the central government (purple), those by the local governments (red) and those made by public insurance systems (yellow) – reaches slightly more than 3% of the GDP. Despite of the fact of the increasing in total expenditures since 1995, the composition public-private has not change significantly in the last 15 years. As we can see, slightly more than 50% of health expenditures are in fact private expenditures, of which out-of-pocket expenditures represent the largest component (green). It should be pointed out that out-of-pocket expenditures represent a high proportion of total household expenditures among poor families. Empirical evidence shows that those countries that have implemented a universal access to health care are those that have sustained public health expenditures accounting for no less than 5 to 6% of their GDP. CARICOM’s Commission on Macro determinants has recommended this level of public expenditures in health in order to achieve universal access to health care. Source: PAHO, 2006

The Health Regional Challenges: Better distribution of the public expenditures in health Distribution of public health expenditures for quintiles of income Selected countries Q1=Poor Q5=Rich Four challenge: The distribution of the public health expenditure in health Another challenge is to improve the distribution of public expenditures in health in order to benefit the populations most in need. This Chart shows how the public expenditures in health is distributed by income quintiles groups in different countries. We can see the cases of Argentina, Colombia, Chile, Costa Rica and Jamaica, about 50% of public expenditures in health benefit the two lower income groups (purple and red). This contrasts with the situation of Guatemala and Ecuador. Increased public expenditures in health is a necessary but not a sufficient condition to achieve an equitable access to health care. Implementing policies and mechanisms to distribute the public expenditure in health to benefit the lower income groups is also an important challenge for the Region

Towards healthier societies more inclusive and more equitable Strategic Goal Towards healthier societies more inclusive and more equitable The strategic goal for the Region is to achieve healthier societies, more inclusive and more equitable

Pan American Solidarity Strategic Directions Principles and values Equity in Health Pan American Solidarity Our Principles and values are Equity in Health and the Pan American Solidarity

Millennium Development Goals Health Agenda for the Americas Strategic Directions Framework for Action Millennium Development Goals Health Agenda for the Americas Our Framework for Action is given by The Millennium Development Goals and The Health Agenda for the Americas 9

Strategic Directions Priority Areas of Action Strengthening and expanding the Public Health Programs and Services Monitoring of the health situation and public health risks Promotion of healthy behaviors Protection against harm caused by environmental factors Prevention and control of the communicable and non communicable diseases Alert system and response to threats and disasters.

Strategic Directions Towards Universal Access of Health Care Priority Areas of Action Towards Universal Access of Health Care Increase public expenditure in health (5-6% of GDP) Implementing mechanisms to reach the poor and vulnerable groups Organizing the health care delivery system to bridge the gap in access and quality of health services

Thank You Strategic Directions INVEST IN HEALTH, BUILD A SAFER FUTURE Conclusion INVEST IN HEALTH, BUILD A SAFER FUTURE Thank You