Transcript Slide 1

Globalization and injuries in the
context of the Americas
Dr. Mirta Roses Periago
Director, Pan American Health Organization
(PAHO)
9th World Conference on Injury Prevention and Security Promotion
15 TO 18 MARCH, MERIDA, MEXICO
Health Determinants
Education
Nutrition
Water & Sanitation
Housing
Family income
Salary
Social development
and economic
Work
Occupation
Employment
New challenges:
Aggresiveness-Violence; public
domestic, community and road
safety; substance abuse
Well-being and Health
1. System and health
services
2. Inclusion and
coverage
3. OpportunityAccess-Quality
4. Users satisfaction
Age
Gender
Genetics
Social networks
Life conditions
Identity and culture
Family integration
Urbanization
Aging
Adapted from WHO
RISK FACTORS
Ecological Model
Family and
Social
Community
Individual
friends
relationship
•Inequities
• Social status of women
• Conflictive
•Demographic
relationship
features
•Norms that support• Unequal
violence distribution
with of
•Psychological
parents
wealth
and
•Guns availability • Social isolation • Conflicts
personality
between
alterations
couple
•Police weakness/ criminal
justice
• Illegal drug
traffic• Pressure
•Abusefrom
history
peers
•Violence in the media
involved in violence
Health for All – Millennium Declaration
EXPANSION OF DISPARITIES
INCREASE IN THE EXCLUSION
GLOBALIZATION
and new economic order
DEMOCRACY
and descentralization
Welfare state and social
security crisis
Economic and State Reforms
Health Sector Reforms
MDG
HFA
1975
1990
2000
DEMOGRAPHIC TRANSITION: population growth, urbanization and aging
EPIDEMIOLOGICAL POLARIZATION: profile coexistence of opposed risk and disease
Overwhelming Environmental and Ecological Impact
2015
The legacy of HFA to the population
of the Americas
0,40
Acute diarrheal diseases
Gained years of life expectancy from 1980 to 2000
(Regional average)
1,6
1,4
0,30
Acute respiratory infections
1,2
0,20
1,0
0,8
(Decomposition of changes in
the life expectancy from 1980
to 2000 for cause and age)
Vaccine-preventable diseases
0,10
Nutritional deficiencies
0,6
0,4
0,2
0,0
-0,2
0,00
<1
1-4
5-9
10-14
Age (Years)
15-19
20-24
residuals
violence
perinatal
cardiovascular
cancer
communicable
-0,4
Disparities of the Economic Growth
in the Americas
Superior tercile
14.000
Average GDP per capita adjusted by PPP (int. $)
12.000
10.000
8.000
6.000
Average tercile
4.000
Lower tercile
2.000
0
1978
1980
1982
1984
1986
1988
1990
1992
[PAHO/WHO: Health in the Americas, 2002 Edition]
1994
1996
1998
Magnitude of Inequality of Income
in the Americas 2003
1,0
ingresos (proporción acumulativa)
0,9
0,8
0,7
0,6
0,5
[ CD145/7; PAHO Program Budget Policy ]
0,4
0,3
0,2
0,1
0,0
0,0
0,1
0,2
The
poorer
0,3
0,4
0,5
0,6
0,7
Population classified according
to its income
(Cumulative proportion)
0,8
0,9
The
richest
1,0
11.0
10.6
10.5
10.5
10.3
53
9.8
9.5
53
9.0
8.5
8.5
52
8.0
7.5
52
7.2
Tasa de ocupación en %
Tasa de desempleo en %
10.0
9.9
10.0
Unemployment
continues to be high
54
10.7
10.5
7.0
51
6.5
6.0
51
1990
1995
1998
1999
2000
Tasa porcentual de desempleo
2001
2002
2003
2003-1
sem.
2004-1
sem.
Tasa porcentual de ocupación
Empleo Informal (como % del empleo total)
40%
Increase of the informality
30%
48%
43%
20%
30%
10%
0%
1980
1990
2000
CEPAL-2005
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
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
Formal social
Security for
industrial
workers
Century XX
20’s/40’s
50’s/70’s
80’s/90’s
Century XXI
Incidence of Diseases
AVISAs per 100 inhabitants
Latin America and the Caribbean
300
250
200
World
average
98
OCDE,
Low income
Latin
America
and the
Caribbean
Low
income
High
income
Medium
income
101
45
35
39
115
120
103
29
27
39
150
8
100
112
108
108
50
29
0
12
Grupo
(transmisibles)
Group II (communicable)
Group IIII (non
communicable)
Grupo
(no transmisibles)
Group III
violence)
Grupo
III (accidents,
(accidentes,
violencia)
OMS-2005
26
Expected effect in crime rate
according to changes in macroeconomic indicators
1% Increase
Homicides Rate
Thefts rate
G.D.P.
Falls on 2.4%
Falls on 13.7%
Coefficient
GINI
Increases a 1.5% Increases a 2.6%
Source: Fajnzylber P, Lederman D, Loaiza N, BM, 2001
HOMICIDE RATES x 100.000 pop.
(ADJUSTED) MALE
SELECTED COUNTRIES, 1996- 2005
140.0
Rate/100,000
120.0
Argentina
100.0
Brazil
Canada
80.0
60.0
Colombia
El Salvador
40.0
Paraguay
Mexico
USA
20.0
0.0
96
97
98
99
00
01
02
03
04
05
Year
We have to share experiences and help each other
Fuente: OPS, Datos básicos
HOMICIDE RATE x 100.000 pop.
(Adjusted) female
Selected countries, 1996- 2005
16.0
Fuente: OPS, Datos básicos
Rate/100,000
14.0
Argentina
12.0
Brazil
Canada
10.0
8.0
Colombia
El Salvador
6.0
Mexico
Paraguay
4.0
USA
2.0
0.0
96
97
98
99
00
01
02
03
04
05
Year
Female homicide rates are lower than those of men:
ratio 1:10
More cases are detected as gender based (feminicide)
Type of road user in proportion to all the deaths by traffic
in the countries of the Americas
Canada
Colombia
Costa Rica
El Salvador
Jamaica
Mexico*
Saint Lucia
Trinidad and Tobago
United States*
0%
20%
40%
60%
80%
100%
Pedestrians
Drivers
Passengers
Cyclists
Motorcyclists
Other/Not specified
+ 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, 2002—Canadian Motor Vehicle Traffic Collision Statistics 2002, http://www.tc.gc.ca/roadsafety/tp/tp3322/2002/page3.htm;
Colombia, 2002—Instituto Nacional de Medicina Legal; Costa Rica, 2003—INEC; El Salvador, 2003—National Police; Jamaica, 2003—Ministry of Health (original figures from National Police
Headquarters); Mexico, 2000—Consejo Nacional de Prevención de Accidentes; Saint Lucia, 2001—Royal St. Lucia Police Force (Traffic Department); Trinidad and Tobago, Office of the
Commissioner of Police; United States, 2002—NHTSA.
Deaths by traffic accidents in Bogota, Colombia
1991-2005
Civic
Culture
1600
Number of deaths
1400
1387
1284
1301
1341
1200
Change of policemen
1260
1000
1089
931
800
914
878
834
600
745
697
585
Closing of night
establishments
400
200
655
546
Years
Source: Instituto de Medicina Legal y Ciencias Forense. Fiscalia General de la Nación
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
0
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
%
60
Violencia física
Violencia sexual
53
50
41
39
40
31
30
22
20
15
10
12
15
12
11
6
10
14
4
0
Bolivia
(2003)
Perú
(20042005)
Colombia
(2005)
Ecuador
(2004)
República
Dominicana
(2002)
Honduras
(20052006)
Haití
(20052006)
Source: Measure DHS, ORC Macro, Encuestas Demográficas y de Salud (DHS). Ecuador: CEPAR,
ENDEMAIN. ORC Macro: procesamientos especiales de las DHS. (Países seleccionados)
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
Sector
Community
Training, University curricula s
Policies, standards and protocols
Surveillance and reference systems
Prevention
 Networks, support groups, men groups
Evaluation of needs: Critical Path
Face Together the New Challenges
Violence Prevention Inter American Coalition
WB, IDB, OAS, CDC, USAID, UNESCO, PAHO
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
Health Agenda for the Americas
2008 - 2017
• Human Rights, universality,
access and inclusion
• Pan American Solidarity
• Equity in Health
• Social Participation
• 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
Challenges for 2015:
MDG Achievements and other Priority Agendas
HEALTH SYSTEMS BASED ON PRIMARY HEALTH CARE
HEALTH
PROMOTION
DETERMINANTES
Environment
Región
Municipality
Individual
Country
State
Family Community
Social
Exclusion
Healthy public
policies
Healthy
environments
Inequity
Community
Action
Inequalities
Personal skills
Health services
reorientation
Faces,
voices
and
places
for
MDGs
MDG
Achievements
by 2015
… there are many
challenges ahead
UN
Mandates
Country
Public
Policy
Change in the
economic
performance
External
Resources
Available
Member
capacity
Integration
System
Inter American
Systems
Socio-determinant
Factors
UN
Changes