An Overall Panorama of Health Inequity in the Americas. PAHO s Mission and Values: Equity, Social Determinants of Health and Health in all Policies

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1 Bringing different sectors together for addressing the social determinants of health: Education and Health 1 An Overall Panorama of Health Inequity in the Americas By Dr Luiz Augusto Galvão, & Dr Kira Fortune Pan American Health Organization/Regional office of the WHO 15 September, PAHO s Mission and Values: Equity, Social Determinants of Health and Health in all Policies Health in All Policies, Equity and Education 4 Identifying Core Windows of Opportunities for Inter-sectoral Action

2 [1] An Overall Panorama of Health Inequity in the Americas At the close of the Millennium Development Goals, LAC has made significant progress The region has made strides in reducing extreme poverty, undernourishment and child mortality Life expectancy in the Region increased from 56 years in 1954 to 75 years in 2014 The increase in average life expectancy largely reflects a substantial decline in under-five mortality rates Data from the Region positively reflect a low rate of child malnutrition at around 4 percent and high immunization rate against measles at 93 percent Source: ECLAC, 2013 and 2014

3 [1] Inequity at a Glance 2.2 billion people world-wide live on less than $2 per day Stark differences in economic opportunities explain significant health inequities between and within countries There is a 32-year-gap in average female life expectancy between Mozambique and Japan The Red Line between Washington, D.C. and Shady Grove, Md. has 17 metro stops spanning 30 miles and an estimated nine-year difference in life span Median income: $143,500 The LAC regional ratio of maternal mortality per 100,000 live births is nearly ten times that of the European region, and less than one-tenth that of the African region Life expectancy in Dominican Republic is 73.5 whereas in Haiti it is 62.2 (a gap of 11.3 years within the same island) Median income: $58,526 Sources: World Bank 2011; World Health Organization 2011 and 2014 Sources: Robert Wood Johnson Foundation, 2011

4 [1] The Greatest Challenges of the 21st Century: Poverty and Inequity Despite the fact that Latin America and the Caribbean is a middle income region, the Region is one of the most unequal region in the world with regards to income levels (PAHO, 2012) Recent evidence demonstrates that more than 1 in 4 residents of the Region lives in moderate poverty (on less than US $4 a day) (World Bank, 2011) 28 million people in the Region live in extreme poverty (on less than US $1.25 a day) (World Bank, 2011) Currently 120 million people in the region of the Americas as a whole do not have access to health services due to economic reasons (PAHO, 2009) gross national income per capita ($ ppp) 40,000 35,000 30,000 25,000 20,000 15,000 10,000 poorer mid richer gap 6,000 Income Growth by Income Terciles: 1 Region of Americas ,000 gap 30,000 5, PAHO: Health in the Americas, 2012

5 [1] Key Regional Challenges in the Americas Social Exclusion Increased Urbanization Key Challenges for the Region of the Americas: Non-Communicable Diseases, Urbanization and a Changing Epidemiological Profile Health Systems Family and Peer Influences Employment National Legal and Policy Environment Ethnicity Gender Norms Cultural and Religious Values and Traditions

6 [1] Inequality and Education in Latin America and the Caribbean Both access to and quality of education in the LAC region are strongly influenced by economic status In the lowest income quintile, 56% attend secondary school and 9% continue into tertiary education, compared with 87% and 46% (respectively) for those in the highest income quintile Educational outcomes are influenced by gender, ethnicity and other factors related to social identity School outcomes vary considerably, within the region and when compared with high-income countries Average out-of-school rate by household income within countries Source: ECLAC 2014; Figure 2 from Araujo et al/world Bank (2015) [white bars indicate one sample; grey bars two samples; black bars annual samples]

7 [2] Mission in Action PAHO is an inter-governmental organization that consists of 38 Member States PAHO is strongly committed to putting equity firmly on the agenda Equity and the Social Determinants of Health are key priorities in Health Agenda for the Americas Addressing inequities through the approach of the social determinants of health and Health in All Policies is one of the objectives in PAHO s Strategic Plan

8 [2] PAHO S Strategic Plan: : Sustainable Development and Health Equity Category 3: Determinants of Health and Promoting Health Throughout the Life Course Outcomes OCM Increased leadership of the health sector to address the social determinants of health and health promotion. OPT Implementation of the WHO Health in All Policies Framework for National Action including intersectoral action and social participation to address the social determinants of health OPT Social determinants of health applied as a strategic approach in all PAHO Programs OPT Countries enabled to generate equity profiles to address the social determinants of health OPT Countries enabled to scale up local experiences using health promotion strategies to reduce health inequity and enhance community participation and empowerment OPT Countries enabled to address Post 2015 Development Agenda on health responding to the social determinants of health. Outcome Indicators Number of countries implementing the Rio Political Declaration on the social determinants of health Number of countries and territories integrating social determinants of health within their health sector programs Number of countries implementing the Health-In-All-Policies Framework for National Action Number of PAHO entities integrating social determinants of health in planning and monitoring processes. Number of countries and territories producing equity profiles addressing at least two social determinants of health Number of countries implementing health promotion strategies to reduce health inequities and increase community participation Number of national consultations specifically addressing the Post 2015 Development Agenda on health.

9 [2] Rio Political Declaration Adopted by Member States, Sept 2011 Through public consultation, Member States identified Five Key Pillars: Monitoring progress Governance to tackle the root causes of health inequities Global action on social determinants The role of the health sector Promoting participation A key outcome of the Global Conference was the Rio Political Declaration

10 [2] First Regional Plan of Action on HiAP Adopted in September 2014 Line of Action 1: Establish the need and priorities for HiAP Number of countries and territories implementing the Health in All Policies Framework forcountry Action Baseline (2014): 6. Target (2019): 18. Line of Action 2: Frame planned action Number of countries and territories producing equity profiles that address at least two priority determinants of health at the national and sub-national level Baseline (2014): 1 Target (2019): 18. Line of Action 3: Identify supportive structures and processes Number of countries and territories with a specific mechanism, such as intersectoral committees or HIA, by which the health sector can engage within and beyond the public sector. Baseline (2014): 6. Target (2019): 18. Line of Action 4: Facilitate assessment and engagement Number of countries and territories with mechanisms to engage communities and civil society in the policy development process across sectors. Baseline (2014): 9. Target (2019): 18. Line of Action 5: Ensure monitoring, evaluation, and reporting Number of countries and territories that monitor, evaluate and report on progress towards introducing health and health equity in the development and implementation of government policies Baseline (2014): 0. Target (2019): 12. Line of Action 6: Build capacity Number of countries and territories with recognized institutes such as national public health institutes, universities and collaborating centers offering training courses on the implementation and monitoring of HiAP. Baseline (2014): 0. Target (2019): 8.

11 [2] Putting PAHO s Regional HiAP Plan of Action into Practice Expert Consultation on HiAP with wide range of experts defining next steps and concrete actions in implementing the Regional Plan of Action: White Paper highlighting state-of-the-art knowledge in the Region of the Americas Indicator Analysis to facilitate our work in developing Roadmap including roles and responsibilities Roadmap to guide implementation of Plan of Action over the next five years Task Force and Working Group on HiAP and SDGs established More than 65 experts involved in this Expert Consultation from the region of the Americas and beyond

12 [2] Examples of HiAP in the Americas 2 Chile Equality and personal protection have been a priorities of the Chilean administration. Creating a minimal state pension, it extended free social security and it created daycare centers for poor children, among some of their priorities. These efforts have put Chile in a good path to achieve the eight SDGs in 2015, and Chile was the only country in the region that achieved this prior 2015 Costa Rica With 15.5% of GDP, the total expenses of Costa Rica in the social sector social are the highest in Latinamerica. The average in LatinAmerica is 12.5 % (World Bank, 2007) Key investments have been made in health and education ensuring access to services for the whole population. Costa Rica has low levels of poverty and injustice, the highest life expectancy in the region and a significant level of social mobility. Brazil The percentage of the population living in poverty in 2001 was 37.5%. In 2009, poverty was reduced to 24.9%. It is estimated that the program Bolsa Familia, which emphasizes in health and education contributed to the decrease in 54% of poverty between 2001 and 2009 Brazil achieved its first SDG when it reduced the proportion of the population living in extreme poverty prior to the 2015 deadline

13 [3] Sustainable Development, Education and Equity Measuring both education and health can tell us how well development is advancing the three pillars of sustainability (social, environmental and economic), particularly with respect to equity-related objectives. Seeking synergies between health and education has benefits for both sectors: healthier students are more likely to attend school consistently, and schools can act as central resources for health information, skillsbuilding and services.

14 [3] Education and Health Are Closely Related Universal access to education is one of the most powerful determinants of child well-being, health equity and development The Health Sector needs to continue strengthening its support for and work with education actors There are many entry points for health stakeholders to work with education stakeholders Source: WHO, 2012

15 [4] Moving Forward the Post-2015 Agenda An opportunity to put a focus on: Sustainable Development Health in All Policies Equity Social Determinants of Health Education Universal Health Coverage

16 [4] The Post-2015 Sustainable Development Goals Establish a Unique Opportunity to promote the Application of Health in All Policies Sample of SDG Targets Involving Health, Education and Equity By 2030, eliminate gender disparities in education & ensure equal access to all levels of education and vocational training for the vulnerable, including persons with disabilities, indigenous peoples & children in vulnerable situations Build and upgrade education facilities that are child, disability and gender sensitive and provide safe, non-violent, inclusive and effective learning environments for all By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being Support and strengthen the participation of local communities in improving water and sanitation management Ensure universal access to sexual and reproductive health and reproductive rights Image at bottom: Guttmacher Institute

17 [4] Planned Activities and Opportunities In line with the Regional Plan of Action of HiAP and the recent Expert Consultation on Health in All Policies, a series of opportunities exist: Networks HiAP training of trainers and HiAP training to be implemented in the Region of the Americas; Regional Review of Health Inequalities to be implemented in the Region of the Americas in collaboration with Michael Marmot s Group; Evidence Technical Cooperation Document and show Case Studies on HiAP in the Region of the Americas; Developing equity profiles; SDG and HiAP Task Force established to oversee implementation of the HiAP Regional Plan of Action of HiAP and SDGs;

18 [4] What Next: Bringing it All Together Health in All Policies Expert Consultation Washington DC 2015 Regional Forum on Urban Health in Medellin in December 2015 UIPES Conference in Curitiba, Brazil in June 2016 WHO Global Conference on Health Promotion in Shanghai, China, September 2016 THANK YOU Image: National Institute for Health and Welfare; Finland

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