Transcript Red Iberoamericana de Ciudades Patrimonio Cultural de la

New Life for Primary Health Care:
the Social Determinants of Health
Dr. Mirta Roses Periago
PAHO/WHO
Presentation to the
WHO Commission on the Social Determinants of Health
Vancouver, Canada
June 2007
The Social Determinants of Health
in the Americas
The Region is characterized by a
demographic transition with high
population growth, and rapid and
unplanned urbanization.
Research has shown the complex
relationships between the social,
economic, environmental,
political and culture conditions –
known as the social determinants
of health – in the health of the
population and communities.
The Americas
is the most unequal
region of the World:
220 million people
living in poverty
The Social Determinants of Health (SDH)
and Primary Health Care (PHC)
New focus on the SDH and human
development recognizes that health
should be central to the development
agenda because:
– Health is a basic human need
– It is indispensable in the establishment
of democratic societies
– It is a fundamental human right
Any approach to improve health should be linked
within a broader economic, social and political
context, and should allow for the inclusion of
multiple actors and sectors
Achievements of PHC in the Americas
include:
1970
Lalonde Report establishing the concept of
the “non-medical” determinants of health.
1980
“Health for All;” expansion of PHC and vertical
programs in selected countries; SILOS;
renewal of community participation.
1990
Establishment of the concepts of sustainable
human development; health sector reforms;
elimination of polio in the Americas.
2000
Commission on Macroeconomics and Health;
focus on equity in health; MDGs; WHO
Commission on the Social Determinants of
Health.
For the past 30 years,
PHC has been
recognized
worldwide as a key
component
of effective health
systems.
Primary Health Care in the
Region of the Americas
– Need to address exclusion in
issues related to health.
There are still
challenges and
inequities to
overcome in the
countries of the
Americas
– Need to broaden social
protection as a central
element of sectoral reforms.
– Definition of new strategic and
programmatic orientations to
improve health outcomes.
– Integrate and incorporate the
Millennium Development Goals
(MDG)
The Social Determinants of Health and
Primary Health Care
PHC is a useful approach for
equitable health and human development
since it requires that more attention is placed
on the operational and structural needs of
health systems
(access, sustainability of resources, political
commitment, guarantee of high quality care,
etc.).
Core Values, Principles and Elements in a
PHC-Based Health System
Right to the highest
attainable level of
health
Equity
Solidarity
Emphasis on
promotion and
prevention
Appropriate
human
resources
Responsiveness to
peoples’ health
needs
PAHO Technical Cooperation in PHC
PAHO understands PHC as an integral part
of the development of health systems and
that the most appropriate path to produce
equitable and sustainable improvements
in the health of the people of the
Americas is to build health systems based
on PHC.
Main PHC Principles for Technical Cooperation
1. Responsiveness to people’s health
needs
2. Government accountability
3. Quality-oriented services
4. Social justice
Main PHC Principles for Technical Cooperation
5. Sustainability
6. Intersectoriality
7. Social and individual participation
Social and Environmental Aspects
of Primary Health Care
In the past few years, the
Region has faced
considerable changes:
• Rapid and unplanned
urbanization
• Structural changes in
health systems
• Climate changes
• Demographic transitions
• Increased inequity and
poverty
In the Americas,
the principles of PHC
have been adopted
and adapted
by each country
according to its own
reality and needs.
Social and Environmental Aspects
of Primary Health Care
The emphasis on the environmental aspects of PHC
has been highlighted with the definition of
“primary environmental care” (Borrini, 1990) that
includes a focus on community-based development
to achieve sustainable lifestyles with 3 elements:
• Fulfill basic human needs
• Strengthen people and community
• Optimal and sustainable use and management
of community resources
Social and Environmental Aspects
of Primary Health Care
One of the most effective answers is to consider
PHC in its most broader form,
emphasizing health promotion and prevention,
as well as active citizen and community
participation to achieve better health.
Faces, Voices, and Places of the MDGs is a regional
initiative that targets the poorest and most
vulnerable communities in Latin America and the
Caribbean to help them achieve the MDGs from
the perspective of health.
Reviews the experiences
Communities
are chosen of
bywork
national
doneMinisters
since Alma
of Health
Ata andinrecollaboration
energizes
themwith
through
PAHO/WHO
local work
Representatives
with a concrete
(PWRs).
objective;
"Our
greatest
concern
must
always
rest with
Selection istowards
advancing
based onthe
their
MDGs.
extreme conditions of vulnerability
and
poverty. To date there
in 26 communities
in 13 These
countries
disadvantaged
andare
vulnerable
groups.
participating.
groups
are often hidden,
live inis to
remote
rural
This initiative’s
the Region
from the
The
initiative contribution
analyzes to
local
realities, shift
develops
critical
areas
or
shantytowns
and
have
little
political
analysis
of MDG
participatory,
action-oriented
interventions,
andindicators
provides to
targeted
technical
assistance with the
research
thatPAHO/WHO
fosters local empowerment.
support of
technical units and other UN system
voice."
agencies.
Puts
emphasisfor
on improving
conditions
of peoples
andtotheir
It is the
a catalyst
change, that
coordinates
actions
allow
territories
through
theleaders
community
self-management
political leaders,
the
and inhabitants
of the model.
communities,
NGOs, IOs, and the international cooperation community work
Empowers individuals and the community via a horizontal
together at the local level.
exchange partnership between local communities and providers
Is
foster a citizenry that exercises its capacity for
of designed
technical to
assistance.
change through their collective and individual power.
Dr Margaret Chan
WHO Director-General
Community
Active
Selected
Movement
WHO Commission on Social Determinants
of Health / Knowledge Networks and Faces,
Voices and Places
Social Exclusion
The
initiative is aimed
at addressing the most vulnerable, neglected and
Measurement
and Evidence
economically
deprived
communities.
In Ventanilla, Peru, through
The
initiative’s
initial diagnosis
Women
and Gender
Equity includes a thorough study of available data
participatory
action research
methodology
exercises
the
community
and
on
the
community,
setting
of
baselines
and
targeting
and
monitoring
ofand
In
Chiquimula
and
El
Estor
regions
of
Guatemala
multi-cultural
Priority
Public
Health
Conditions
its
citizens
are
being
empowered
to
reduced
social
exclusion.
advances.
Through
the
PAHO
- CEPAL-CELADE
Agreement,
census
gender
perspectives
have
driven
the work.
This control
will
leadhas
to the
In
Santa
Fe
de Veraguas
in Panama,
malaria
been
Urban
Settings
data
from 19 LAC
countries
was
analyzed
and sub-national
poverty
maps at
development
of healthy
mechanisms,
processes
and actions
to be taken
approached
with
a
focus
on
socially
and
economically
disadvantaged
In four
communities
in the
Greater
Sanmost
Salvador
area communities.
in El Salvador work
were
created
to
facilitate
targeting
of
the
vulnerable
the
local
level
to
reduce
gender-based
inequities
in
health.
Early
Child
Development
groups.
Interventions
andthe
actions
to improve and
the situation
will address
the
is underway
to address
most vulnerable
marginalized
communities.
In Yuty,
Caazapa,
Paraguay,
efforts involving
the community
component
social
determinants
causing
inequities
inmulti-programmatic,
health outcomes,
barriers
andto
will of the
The
strategy
employs
an intersectorial,
approach
IMCI strategy
underway
facilitate
access
to
health
care.through
influence
healthare
determinants
throughparticipatory
participatoryplanning
activitiesexercises
centered with
on local
leaders. analysis.
These have led to disease prevention and health promotion activities
situation
under MDGs 1, 4 and 5. These provide opportunities to young children and
their mothers in shaping sound lifelong health and development status.