Globalization and injuries in the context of the Americas

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• Globalization and injuries in the context of the
  Americas

Dr. Mirta Roses Periago Director, Pan American
Health Organization (PAHO)
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Health Determinants
Education Nutrition Water Sanitation Housing
Work Occupation Employment
New challenges Aggresiveness-Violence public
domestic, community and road safety substance
abuse
Family income Salary Social development and
economic
Well-being and Health

• System and health services
• Inclusion and coverage
• Opportunity-
• Access-Quality
• 4. Users satisfaction

Social networks Life conditions Identity and
culture Family integration Urbanization Aging
Age Gender Genetics
Adapted from WHO
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RISK FACTORS
Ecological Model
Family and friends relationship
Individual
Community
Social

• Inequities
• Norms that support violence
• Guns availability
• Police weakness/ criminal justice
• Violence in the media

• Demographic features
• Psychological and personality alterations
• Abuse history

• Conflictive relationship with parents
• Conflicts between couple
• Pressure from peers involved in violence

• Social status of women
• Unequal distribution of wealth
• Social isolation
• Illegal drug traffic

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Health for All Millennium Declaration
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The legacy of HFA to the population of the
Americas
(Decomposition of changes in the life expectancy
from 1980 to 2000 for cause and age)
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Disparities of the Economic Growth in the
Americas
PAHO/WHO Health in the Americas, 2002 Edition
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Magnitude of Inequality of Income in the
Americas 2003
Perfect equity line
ingresos (proporción acumulativa)
CD145/7 PAHO Program Budget Policy
Population classified according to its income
(Cumulative proportion)
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Unemployment continues to be high
Increase of the informality
CEPAL-2005
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The Inequity Impact on the Global Health

• Less developed countries concentrate 84 of the
  world population
• They consume less than 11 of the world health
  expenditures
• However, they bear 93 of the overall disease
  burden

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Ethic Evolution/ Ideology/Values that guide the
Social Protection Systems
Public Assistance And Charity for the poor and
indigenous
UNIVERSAL SOCIAL PROTECTION AS A CITIZENS RIGHT
STATE BENEFACTOR
Segmented Systems according to payment capacity
Formal social Security for industrial workers
20s/40s
80s/90s
50s/70s
Century XXI
Century XX
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Incidence of DiseasesAVISAs per 100 inhabitants
OMS-2005
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Expected effect in crime rate according to
changes in macroeconomic indicators
Source Fajnzylber P, Lederman D, Loaiza N, BM,
2001
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HOMICIDE RATES x 100.000 pop. (ADJUSTED)
MALE SELECTED COUNTRIES, 1996- 2005
We have to share experiences and help each other
Fuente OPS, Datos básicos
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HOMICIDE RATE x 100.000 pop. (Adjusted)
female Selected countries, 1996- 2005 Fuente
OPS, Datos básicos
Female homicide rates are lower than those of
men ratio 110 More cases are detected as
gender based (feminicide)
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Type of road user in proportion to all the
deaths by trafficin the countries of the Americas
Road user categories were not uniform across
all country data. Data for Mexico and the
United States did not differentiate between
drivers and passengers. Drivers bar for these
two countries corresponds to the total of drivers
and passenger fatalities. Sources Data compiled
from the following sources. Canada,
2002Canadian Motor Vehicle Traffic Collision
Statistics 2002, http//www.tc.gc.ca/roadsafety/tp
/tp3322/2002/page3.htm Colombia, 2002Instituto
Nacional de Medicina Legal Costa Rica,
2003INEC El Salvador, 2003National Police
Jamaica, 2003Ministry of Health (original
figures from National Police Headquarters)
Mexico, 2000Consejo Nacional de Prevención de
Accidentes Saint Lucia, 2001Royal St. Lucia
Police Force (Traffic Department) Trinidad and
Tobago, Office of the Commissioner of Police
United States, 2002NHTSA.
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Deaths by traffic accidents in Bogota,
Colombia1991-2005
Civic Culture
Change of policemen
Closing of night establishments
Source Instituto de Medicina Legal y Ciencias
Forense. Fiscalia General de la Nación
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Women () 15 to 49 years, sometime living in
union, that say to have been victims of violence
by their husband or partner
Physical violence Sexual violence
Source Measure DHS, ORC Macro, Encuestas
Demográficas y de Salud (DHS). Ecuador CEPAR,
ENDEMAIN. ORC Macro procesamientos especiales
de las DHS. (Países seleccionados)
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Model to address comprehensively family violence
(VIF)

• Regional Level
• International Forums
• Replication and exchanges
• Lessons learned

• National coalitions
• Legislation, monitoring systems
• Prevalence/advocacy study

National

• Training, University curricula s
• Policies, standards and protocols
• Surveillance and reference systems
• Prevention

Sector
Community

• Networks, support groups, men groups
• Evaluation of needs Critical Path

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Face Together the New Challenges

• CoaliciónInteramericanapara la Prevención de la
  Violencia
• BM, BID, OEA, CDC, USAID, UNESCO, OPS

Violence Prevention Inter American Coalition WB,
IDB, OAS, CDC, USAID, UNESCO, PAHO
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OUR PROPOSALS AND COMMITMENTS

• Focus in needier, vulnerable Sectors, and
  territories
• Emphasis on prevention
• Interpersonal, gender , juvenile, and
  self-inflicted
• violence
• Road safety pedestrians, motrocyclist, the
  elderly, migrants
• Strenghtening of networks and joint effort in
  road safety work together
• Strategic Plan 2008-2012

132º CE - OPS/OMS
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Health Agenda for the Americas

• Human Rights, universality,
• access and inclusion
• Pan American Solidarity
• Equity in Health
• Social Participation

2008 - 2017

• Strengthening National Health Authority
• Tackling Health Determinants
• Harnessing knowledge, science, and technology
• Strengthen Health Security
• Diminishing health inequalities among countries
  and inequities within them
• Reducing the risk and burden of disease
• Increasing social protection and access to
  quality health services
• Strengthening the management and development of
  health workers

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Challenges for 2015MDG Achievements and other
Priority Agendas
HEALTH SYSTEMS BASED ON PRIMARY HEALTH CARE
HEALTH PROMOTION
DETERMINANTES
Healthy public policies
Environment
Social Exclusion
MDG Achievements by 2015
Faces, voices and places for MDGs
Family Community
Healthy environments
Community Action
Inequity
Individual
Municipality State
Country Región
Inequalities
Personal skills
Health services reorientation
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there are many challenges ahead
UN Mandates
Integration System
External Resources Available
Inter American Systems
Socio-determinant Factors
UN Changes