Ttulo de la presentacin

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Health Related Millennium Development Goals in
Latin America and the Caribbean Dr. Mirta Roses
Periago Director Pan American Sanitary
Bureau Washington, D.C. July 2005

• Título de la presentación
• Autor

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From Health for All to the Millennium Declaration
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The legacy of HFA to the population of the
Americas
decomposition of 1980-2000 life expectancy
changes by cause and age
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Social exclusion in health and environment

• Population of Latin America and the Caribbean
  500 million (2004)

• 27 without regular access to basic health
  services 125 million
• 46 without health insurance, public or private
  230 million
• USA 44 million without social protection in
  health
• 685,000 children without a complete vaccination
  scheme

• 17 of births in LAC attended by unskilled health
  personnel

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Social exclusion in health and environment

• 152 million people without access to safe
  drinking water and basic sanitation

120 million people without access to health
services due for economic reasons

• 107 million people without access to health
  services for geographic reasons

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Impact of inequity on global health

• The less-developed countries have 84 of the
  worlds population
• They consume less than 11 of global health
  expenditure
• but account for 93 of the global disease burden

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Inequalities in life expectancy by income level
and gap. The Americas, 1990s
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Inequalities in access to water sanitation by
income level and gap. The Americas, 1998
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Access to water and infant death risk in the
Americas 1998
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Progress toward MDG 4 in the Americas trends
constant risk (k2003)
sustainment of current trend
full attainment of the goal
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Burden of preventable mortality in children under
5 under three scenarios of progress toward MDG 4
300,000
250,000
200,000
150,000
number of child deaths prevented
100,000
50,000
0
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
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under-5 causes of death
Causes of death in children under 5, 2000-2003
neonatal causes of death
WHO The World Health Report 2005
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Scope of the unfinished agenda on maternal
mortality in Latin America the Caribbean
Centers for Disease Control Prevention.
Achievements in Public Health 1900-1999
Healthier Mothers and Babies 48(38)849-58
Atlanta, 1999. WHO Maternal Mortality in 2000
estimates developed by WHO, UNICEF UNFPA
Geneva, 2002
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Epidemiological characterization of HIV/AIDS in
the Americas 2004
Bahamas Barbados
Bolivia Colombia El Salvador Nicaragua Peru Ecuado
r
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TB BurdenRegion of the Americas 2002
Haiti Dom. Rep. Mexico Honduras Ecuador Peru
Bolivia Brazil Nicaragua
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Total 223,057
Peru Brazil
50
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Reported Malaria Cases (1998-2003)

• Morbidity (2003)
• 910,000 cases
• 70 due to P. vivax
• 30 reduction in cases relative to 1998
• Only 12 decrease in moderate and high-risk areas

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The Current Malaria Situation

• In terms of absolute number of cases
• 10 nations with a gt50 decrease (Argentina,
  Belize, Bolivia, Costa Rica, El Salvador, Haiti,
  Honduras, Mexico, Nicaragua, and Peru)
• 5 countries with a lt50 decrease (Brazil,
  Dominican Republic, Guatemala, Guyana, and
  Paraguay)
• 6 countries with increases (Colombia, Ecuador,
  French Guiana, Panama, Suriname, and Venezuela)
• Under-reporting is likely due to weaknesses in
  health services

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MDGsHealth and Development Synergy
poverty
IT
hunger
Primary education
Gender disparity
work
Debt relief
Under 5 MORT
MDG
MAT MORT
trade
HIV/AIDS
Financial system
MAL/INF DIS
Slum dwellers
Environment
Safe water
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MDG TARGET SYNERGY FOR HEALTH

• Classic social determinants of health
• Environmental determinants of health
• New global determinants
• Health targets as contribution to poverty
  reduction and quality of life

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Implementation of the MDGs pending issues

• An operational lag in strengthening public health
  systems and in public health infrastructure.
• A structural lag in extending social protection
  in health.
• A governance lag, in terms of getting all sectors
  of government and society involved in genuine
  intersectoral action and joint participation
  efforts.
• An equity lag in responding to the health needs
  of societys most disadvantaged

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The MDGs and National Health Development

• Issues other than monitoring attainment of the
  health-related MDGs must also be addressed, such
  as
• the nature and cost of the inteventions that the
  countries must carry out to attain the
  health-related MDGs
• the necessary strengthening of the health systems
  to carry out the most critical interventions
• identification of economies of scale in
  strengthening health systems and their
  articulation with national plans, policies, and
  programs
• development of investment plans that take the
  necessary domestic and foreign investment flows
  into account and spell out the process for
  mobilizing them

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The Millennium Development Goals and the
integrated approach for National Health
Development
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Policy orientations for the attainment of the MDGs

• Promote intersectoral and interinstitutional
  action
• Strengthen the work between health and
  environment
• Improve equity and extend social protection in
  health
• Increase current expenditure and investment in
  health and make them more progressive
• Ensure integral and sustainable development of
  human resources for health

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Development of inclusive policiesHow can we
develop health policies that foster the inclusion
of excluded groups?
The portability of guaranteed access to health in
environments where informal sector employment,
population movements, and poverty will remain key
factors.
The right to health assumes strengthening
democratic governance within the framework of
social cohesion and respect for human rights.
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The Partnership between Health and Environment
for attainment of the MDGs
The MDGs that require direct interventions from
the health sector have a greater impact if they
are approached with environmental and educational
strategies.
The social determinants that impact the health of
the population are reflected in unhealthy
environments for children, as well as
inappropriate educational and work environments,
with obstacles to achieving the desired levels of
sustainable development by 2015.
The Partnership between Health and Environment,
extending it to education and the workplace is a
crucial undertaking.
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A basic Health-Environment Agenda for attaining
the MDGs

• Improve access to and the quality of drinking
  water and sanitation for health.
• Cities, slums, and neglected urban fringe areas
  as a challenge for public health.
• Environmental sustainability and ecological
  balance.
• Population growth and the challenge of sustaining
  the rate of progress toward attainment of the
  MDGs

Between 1990 and 2005 the population in the
Americas increased by 165 million (118 million
in Latin America and the Caribbean) in the next
10 years leading up to the MDG target date,
another 100 million will be added (73 million in
LAC).
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A Strategic Partnership for the MDGs
Work
Education

• Health Promoting Schools- Children- Teachers
• Prevention of HIV/AIDS

• Workers Health and Security
• Prevention of HIV/AIDS

Health
Environment

• Workers Health and Security in the Health Sector
• Professionalization of Human Resources

• Water
• Chemicals
• Healthy Environments for Children and Workers

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PAHO framework for technical cooperation
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PAHO in the 21st Century
one team, one goal
...improving health in the Americas