Dr. Sofialeticia Morales Millennium Development Goals & Health Targets Senior Advisor Millennium Development Goals & Health Targets AG/RES. 2307 (XXXVII-O/07) POVERTY, EQUITY, AND SOCIAL INCLUSION: FOLLOW-UP TO THE DECLARATION OF MARGARITA

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.

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 1990-2006) 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

MDG 1 HUNGER LATIN AMERICA AND THE CARIBBEAN (25 COUNTRIES): UNDERWEIGHT CHILDREN UNDER 5, 1995-2002 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

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

MDG 1 HUNGER Anemic Populations in Latin America Last reported or estimated data 1995-2005 Less than 5 years Pregnant Not Pregnant 27% 24% 18%

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

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

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.

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.

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

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.

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

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

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.

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

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 1990-2007 y reducción pendiente hasta 2015 a (Indicador 14, ODM)

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

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.

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

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

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.

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

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)

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

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.

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 3-7 2008

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: 224.548 Peru Brazil 50% Source: Global Tuberculosis Control. WHO Report 2008. 30

Malaria Situation in the Americas 2000-2006 MDG 6 MALARIA Malaria Situation in the Americas 2000-2006 4 Countries with >75% decrease in total cases Increased migration of people makes epidemiologic surveillance and monitoring increasingly difficult 4 Countries with 50 - 74% 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

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.

MDG 7 ENVIRONMENT

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)

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.

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.

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

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

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