Transcript SUMMIT IMPLEMENTATION REVIEW GROUP (SIRG) OEA/Ser.E

SUMMIT IMPLEMENTATION REVIEW GROUP (SIRG)
Third Regular Meeting of 2008
September 18-19, 2008
Bridgetown, Barbados
(Hilton Barbados Hotel)
PRESENTATIONS BY THE PARTNER INSTITUTIONS OF THE
JOINT SUMMIT WORKING GROUP – JSWG
PAN AMERICAN HEALTH ORGANIZATION
(Health in the Americas: Regional Challenges)
OEA/Ser.E
GRIC/O.3/Inf.2/08
18 September 2008
Original: English
Pan American Health Organization
HEALTH IN THE AMERICAS
REGIONAL CHALLENGES
SUMMIT IMPLEMENTATION REVIEW GROUP
Bridgetown, Barbados
September 18-19, 2008
Dr. Rebecca de los Rios
Life Expectancy in Latin America, 2000-05
in relation to the United States
Esperanza de Vida: Países de América Latina en 2000-05
en relación a Estados Unidos
80
77.7
73.8
75
Esperanza de Vida (Años)
COL
MEX
VEN
ARG
PAN
CUB
COR
URU
71.2
68.9
70
NIC
BRA
PER
65
ELS
ECU
PAR
HON
DOR
GUT
60
CHI
59.7
63.4
BOL
HAI
55
51.8
50
1930
1950-55
1975-80
EEUU
Source: Health in the Americas. PAHO, 2007
America Latina
2005
The burden of diseases in countries by income, 2002
(Healthy years of life lost by 1.000 population)
Latin America & Caribbean
300
250
200
Global
average
Latin Ameria
& Caribbean
Low
income
High Income
98
150
OECD
High income
100
8
112
Midle
income
45
35
39
115
120
103
29
27
39
101
108
108
50
29
12
0
26
Group I (communicable diseases)
Group II (noncommunicable diseases)
Group III (injuries)
Source: WHO
Obesity among women 16-55 yr (%)
35
30
Caribbean
25
México
Chile
20
Uruguay
USA
15
Brasil
Cuba
10
Canadá
Perú
5
0
1962
1974-78 1980-81 1988-89
Pan American
Health
Organization
1992
1994-96
NCD National surveys and representative data. E Jacoby, PAhO
1997
2000
2005
Prevalence of Adult Obesity (BMI ≥ 30 kg/m2)
in selected countries/cities of the Americas circa 2005
Belize
USA
Managua
Santiago
Barquisimeto
Central Argentina
San Jose
San Salv ador
Mex ico
Chile
Lima
Guatemala City
Buenos Aires
Tegucigalpa
Bogota
Quito
Port au Prince
Canada
0
5
10
15
20
25
30
Prevalence (%)
Pan American
Health
Organization
Source: NCD National Surveys; CAMDI Studies 2002-2006
35
40
Prevalence of overweight among children (<5 years)
in selected countries %
Argent ina
Chile
Bolivia
Perú
Costa Rica
Uruguay
Jamaic a
Canadá
Brasil
EEUU
Guatemala
Barbados
Paraguay
México
Panam á
Trinidad & Tobago
0
1
2
3
4
5
6
7
8
Reference: de Onis M, Blössner M. Prevalence and trends of overweight among
preschool children in developing countries. Am J Clin Nutr 72:1032-9: 2000.)
Prevalence of Adult Diabetes in selected
Countries/cities of the Americas circa 2005
Belize
Mexico
USA
Managua
Ontario
Guatemala City
Bogota
San Jose
San Salvador
Port au Prince
Santiago
Central Argentina
Chile
Buenos Aires
Tegucigalpa
Barquisimeto
Quito
Lima
0
Pan American
Health
Organization
2
4
6
8
Prevalence (% )
10
Source: NCD National Surveys; CAMDI Studies 2002-2006
12
14
Regional Strategies to tackle
NCD Epidemic
•
Integrated Approach to the Prevention and Control of Chronic Diseases
(population and individual interventions)
•
Integrated public policies: Key actions include fiscal/policy incentives for
production and consumption of healthy foods, guidelines to regulate the
marketing and sale of foods to children, wide promotion of fruit and
vegetable consumption, the elimination of trans fats in processed foods,
workplace wellness initiatives, physical education curricula and healthy
feeding programs in schools, urban planning that encourages walking
and biking, improved access to recreation and sports through
partnerships, and massive education campaigns
Pan American
Health
Organization
Prelalence of underweight, stunting, wasting, and overweight
% Children ≤ 5 years old
Re
p
underw
Bajo
peso
eight
r,
20
Ni
03
ca
ra
gu
a,
20
01
Ec
ua
do
r,
20
Pe
04
ru
,2
00
420
08
Ha
iti
,2
00
Ho
5
nd
ur
as
,2
00
5
Bo
liv
ia,
20
Gu
03
ate
m
ala
,2
00
2
ad
o
00
5
El
Sa
lv
bi
om
Co
l
ico
,2
a,
2
00
6
96
19
M
ex
00
2
Br
az
il,
in
Do
m
ub
lic
a
Ar
g
en
t
in
ica
na
,2
a,
2
00
6
60
50
40
% 30
20
10
0
Baja
talla
stunting
wastingaguda
Desnutricion
Sobrepeso
overweight
Fuente: Lutter CK, Chaparro CM, La desnutrición en lactantes y niños pequeños en América Latina y el Caribe: Alcanzando los objetivos de
desarrollo del milenio. Washington. D.C, OPS © 2008
Millons of dollars
For the countries more affected the cost of
malnutrition is equivalent to 6% and 11% of GDP
Total cost of global malnutrition
4800
4400
4000
3600
3200
2800
2400
2000
1600
1200
800
400
0
VEN
CRI
PAR
PAN
PER
Total cost
Costo
total (left
(ejeaxel)
izquierdo)
Source: ECLAC, 2007
COL
ECU
RDO
NIC
12%
11%
10%
9%
8%
7%
6%
5%
4%
3%
2%
1%
0%
BOL
ELS
HON
GDP Percentage
Porcentaje
del PIB(right
(eje axel)
derecho)
GUA
Chronic malnutrition
determinants
School children
Pre-school
children
Infants
6 m a 2 years
Illiteracy
Infants
<6m
Violence
Delivery and Newborn
Unemployment
Food insecurity
Pregnant women
Borne Vector Diseases
Inadequate housing
Environmental pollution
Lack of acces to safe water
Youth
Lack of basic sanitation
Regional Strategies to tackle
Chronic Malnutrition
•
PAHO Regional Strategy on Nutrition and Health Development 2006-2015
•
Joint Actions to improve efficiency for the response to the food and
nutrition crisis: Social and economic determinants approach.
•
Pan American Alliance on Nutrition and Development. Agreement
among UN Agencies for Latin America and the Caribbean (PAHO,
UNFPA, UNICEF, WFP, UNDP, ECLAC) launched in July, 2008. Working
group has been set up to define the Plan of Action.
•
The Alliance will joint efforts with the Inter-american institutions, civil
society, and non-profit organizations.
Pan American
Health
Organization
Infant mortality indigenous and non indigenous and place
of residence
< 1 year old Death by 1,000 live birth
100
90
80
70
60
50
40
30
20
10
0
Bolivia 2001
Urbana no indígena
Ecuador 2001
Urbana indígena
Guatemala 2002
Rural no indígena
Rural indígena
México 2000
Total no indígena
Panamá 2000
Total indígena
Source: ECLAC, Millennium Development Goals: A view from Latin America and the Caribbean, 2005
Evolution of Neonatal and Infant Mortality in the
Region of the Americas by Time Period
Per 1000 live births
50
Infant mortality
Neonatal mortality
40
48 %
30
20
10
0
1995
2000
2005
YEAR
Source: Estimates based on PAHO, 2000, 2006
7/7/2015
Organización Panamericana de la Salud 2008
Percentage of deliveries attended by health care
professionals by income in selected countries
(circa 2002)
100%
Porcentaje de partos atendidos por personal especializado
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Guatemala (35%)
Perú (56%)
Bolivia (57%)
Nicaragua (65%)
Paraguay (66%)
Colombia (85%)
Brasil (88%)
Rep. Dominicana
(95%)
Income
Low income
Source: Eclac, 2006
Quintil 2
Quintil 3
Quintil 4
High Income
Percentage of households with health insurance
(public and private) by income
100%
% of households with health insurance
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Argentina
2004 (57%)
Costa Rica
2004 (81%)
Chile 2003
(64%)
Panamá 2004 México 2004
(49%)
(50%)
Perú 2003
(40%)
Paraguay
2000 (19%)
Guatemala
2004 (21%)
El Salvador
2004 (19%)
Ecuador
2004 (18%)
Bolivia 2002
(16%)
Quintil of income
Low income
Quintil 2
Source: Eclac, Social Protection 2006
Quintil 3
Quintil 4
High Income
Nicaragua
2001 (9%)
The public expenditure for health care
(%GDP)
Changes in the Composition of National Health Care Expenditure over Time. Latin American
and the Caribbean, 1980-2005
8.0
7.0
NHE as % of GDP
6.0
5.0
4.0
3.0
2.0
1.0
0.0
1980
Central Gov.
1985
Local Gov.
1990
Public Insurance
1995
Household's Final Cons.
1998-2000
2004-05
Private Ins./Prepaid Medic.
The countries that need more
are the ones that spend less
1,800
1,700
1,600
1,500
1,400
1,300
1,200
1,100
1,000
900
800
700
600
500
400
300
200
100
-
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
CRI
PAR VEN RDO PAN COL BOL PER ECU NIC ELS HON GUA
Gasto
per cápita
(eje izquierdo)
Desnutrición
(eje derecho)
Socialsocial
expenditure
per capita
(left axel)
Malnutrition (right
axel)
Prevalence
USD PPA per cápita
Global malnutrition and public social expenditure social per capita (2004 y 2005)
Trends in Public Expenditures in Health as % of GDP in Canada, Latin America and the
Caribbean (LAC) and the United States of America; Selected periods 1960-2006
9.0%
8.1%
8.0%
7.5%
Public Expenditure in Health - % GDP
7.6%
7.6%
7.2%
7.2%
7.1%
7.0%
7.2%
7.4%
NEA
ARU
6.4%
6.0%
6.0%
5.0%
4.9%
5.0%
USA
4.3%
3.7%
4.0%
3.0% 2.4%
CAN
3.6%
2.6%
2.4%
3.20%
2.80%
3.40%
3.45%
3.50%
3.40%
19952000
2000-05
2006
2.80%
1.7%
2.0%
1.2%
1.3%
1.0%
0.0%
1960
1960-65 1965-70 1970-75 1975-80 1980-85 1985-90 1990-95
Year
US
CAN
LAC
Line 4
Line 5
Public Expenditures in Health in LAC 2005-06 in relation to trends in Public Expenditures in
Health in Canad a 1960-2006
14.0%
Public Expenditure in Health - % GDP
12.0%
BRA
NEA
BER
ARU
CHI
10.0%
DOM
MNT
ELS
ECU
GUT
8.0%
MEX
PAR
6.0%
PER
SKN
4.0%
ARG
COL
SUR
COR
GRE
SVG
JAM
SLU
TCI
4.9%
7.5%
7.2%
7.2%
7.4%
CAN
6.0%
3.7%
3.40%
BEL
DOR
0.0%
1960
BAH
7.2%
7.6%
2.6%
2.4%
2.0%
URU
PAN
NIC
TRT
USA
CUB
HON
ANT
HAI
1960-65 1965-70 1970-75 1975-80 1980-85 1985-90 1990-95 19952000
USA
CAN
Year
LAC Average
NEA
ARU
2000-05
2006
The Impact of public expenditures in health
Distribution of public health expenditures for quintiles of income
Q1=Poor Q5=Rich
Perú
Jamaica
Guatemala
Ecuador
Costa Rica
Chile
Colombia
Argentina
0%
20%
Quintil 1
40%
Quintil 2
Fuente: Suárez (2001) y Trejos (2002)
60%
Quintil 3
Quintil 4
80%
Quintil 5
100%
Regional Strategies to Improve Access
to Health Care
•
Towards Universal Access to Health Care in 2015
•
Integrated Public Policies to improve access to health care, especially
for the poor
–
–
•
To increase public expenditure in health up to 6% of the GDP
To implement mechanisms to reach the poor to improve the impact of
public expenditure in access to health care (health public insurance, social
health protection programs etc. )
Strengthening Health Care Systems and Services based on Primary
Health Care
Pan American
Health
Organization
Pan American Health Organization
ENSURING OUR PEOPLES’ HEALTH
SECURING OUR PEOPLES’ FUTURE
Thank you, Gracias, Obrigada, Merci