luiz galvão - abordaje conjunto de los determinantes sociales y ambientales de la salud
DESCRIPTION
Esta presentación es parte del Taller sobre la Gobernanza de la Salud, del Ambiente y del Desarrollo Sustentable, organizada por ISAGS en conjunto con IDRC, de Canadá. Clica aquí para acceder a las otras presentaciones. Esta presentación es parte del Taller sobre la Gobernanza de la Salud, del Ambiente y del Desarrollo Sustentable, organizada por ISAGS en conjunto con IDRC, de Canadá. Luiz Galvão, Manager of Sustainable Development and Environmental Health PAHO/WHO, stands out the leadership of public health in the current process of sustainable development and shows the relationship between these two themes, by emphasizing the impact on diseases is not homogeneously felt by the population and it can be related to factors as the social gradient and inequities such as basic sanitation conditions. The international agenda on the theme is highlighted, mainly when it refers to the public consultations and the possibility of including of themes of interest for development, such as health. Galvão presents one scheme for the development of a new milestone for the Post 2015 Millenium Development Goals, which adds fundamental guidelines such as: Equity, Human Rights and Sustainability; He deems as development dimensions, beyond sustainable environment, comprehensive economy, socially comprehensive development and peace and safety. In this context, the Ministers of Health must take responsibilities in the regard of promoting an environment of intersectoral dialogue and work. This presentation was part of the Workshop on Governance of Health, Environment and Sustainable Development, organized by ISAGS in partnership with the IDRC, from Canada.TRANSCRIPT
TALLER SOBRE GOBERNANZA DE LA SALUD, DEL AMBIENTE Y DEL DESARROLLO SUSTENTABLE EN UN CONTEXTO INTER SECTORIAL - ISAGSAbordaje conjunto de los determinantes sociales y ambientales de la salud. NCDs, Social determinants and Sustainable Development: The Inherent AgendaDr. Luiz A. Galvão - Gerente,Desarrollo Sostenible y Salud AmbientalRío de Janeiro, 27 Octubre, 2012
Relevancia de la Salud Publica como lider del nuevo proceso global de desarrollo sostenible
Los determinantes ambientales y sociales de la
salud son la base del nuevo esquema internacional
para el desarrollo sostenible y el liderazgo de salud
publica es necesario para que exista la sinergia
necesria para implementar de forma conjunta
soluciones a varios problemas de slaud como la
equidad, los riesgos asociados a las enfermedades
no transmisibles y el desarrollo sostenible.
Transición Rural-Urbana en las Américas, 1950-2010
0
20
40
60
80
100
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010
prop
orció
n po
blacional (%)
ALC urbano
NA urbano
ALC rural
NA rural
Pirámides de población de las subregiones principales de las Américas;
1900 - 2010
Ejemplos de protección social en salud
Argentina “Plan Nacer”“Asignación Familiar por HIjo”
Brasil “Bolsa Familia”“Programa Salud de la Familia”
Chile “Chile Solidario”“Acceso Universal con Garantías
Explícitas” (AUGE)
Colombia “Familias en Acción”
Haiti “Servicios Obstétricos Gratuitos” (SOG)“Servicios Infantiles Gratuitos” (SIG)
México “Seguro Popular de Salud”
PORTO ALEGRE COHORT, BRAZIL
•LOWER STATUS 2.6 TIMES HIGHER RISK
OF CVD DISEASE•Area relatively wealthy
• In productive agegroup
• Cerebrovascular 3 time higher than in
USA in the youngerage group
SOCIALGRADIENT
CARDIOVASCULARCONDITION
COST TOLABOR &PRODUCTIVITY
UNSUSTAINABLE
Source: Bassanesi et al. Arq Bra Card 90(6) 2008
Mexico Enfermedades cronicas atribuibles a obesidad
Las intervenciones incluidas en el cálculo son: diagnóstico y tratamiento farmacológico de diabetes mellitus tipo 2; diagnóstico y tratamiento de la neuropatía periféricasecundaria a diabetes; diagnóstico y tratamiento farmacológico de hipertensión arterial; diagnóstico y tratamiento de la dislipidemia; diagnóstico y tratamiento de lainsuficiencia cardiaca crónica; diagnóstico y tratamiento de osteoartritis; y, diagnóstico y tratamiento de cáncer de mama.2 Las enfermedades seleccionadas atribuibles al sobrepeso y la obesidad son: cáncer de mama; diabetes mellitus tipo 2; enfermedades cardiovasculares; y, osteoartritis
Para 2010, el costo atribuible para
sobrepeso y obesidad fue equivalente al
total de recursos del “Seguro Popular”
para roveer aceso universal
GradienteSocial
Enfermedades cronicas Costo al sistema
y familiasInsostenibleRiesgos
Source: Estrategia de Salud Alimentaria, 2010
Global inequalities: energy rich, energy poorA. Per capita Carbon emissions
B. Biomass use (% of all energy at national level)
Source: Wilkinson et al, Lancet 2007
A. Health impacts from
climate change:higher on those
with lower emissions
B. 2.4 billion exposed to
pollution from solid fuels:
health impacts remain with the
users
Globally, the analysis shows a payback of US$ 91 billion a year from the US$ 13 billion a year invested to halve the number of people cooking with solid fuels by
providing them with access to LPG by 2015 (Source: Fuel for Life).
GLOBAL ESTIMATES: NCDS HARVARD WEF STUDYESTIMATES IN 47 TRILLION USD THE $ BURDEN
SOCIALGRADIENT CHRONIC DISEASES
MEDICAL COST&PRODUCTIVITY
UNSUSTAINABLE
GLOBAL ESTIMATES: GALLUP
Approximately 86 percent of U.S. workers are either overweight or have chronic health conditions that cost more than $153 billion in lost productivity each year
http://m.ibtimes.com/gallup-u-s-workers-86-percent-u-s-workers-have-chronic-conditions-chronic-conditions-cost-153-billio-233376.html
Brasil: redistributional effect on infant mortality inequality, 1997-2008
Equity in health‐the backbone for the post 2015 Development A d
maternal mortality inequalities by female years of schooling, The Americas
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
population gradient by years of schooling (cumm %)
materna
l dea
ths (
cumm %
)
1990 2010
0
100
200
300
400
500
600
700
0 2 4 6 8 10 12 14
schooling (years)
materna
l mor
tality (x 10
5 liv
e births
)
1990 2010
health concentration index in 1990 = -0.44health concentration index in 2010 = -0.27
Equity in health‐the backbone for the post 2015 Development A d
concentration of social inequalities in mortality; The Americas, 2008
HCI males = -0.117
HCI females = -0.184
diabetes deaths, by gender
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
population gradient by human development (cumm %)
diab
etes
dea
ths (cum
m %
)
female male
Equity in health‐the backbone for the post 2015 Development A d
urban rural
urban-rural inequalities in progress towards MDG7
drinking water
sanitation
Equity in health‐the backbone for the post 2015 Development A d
el mayor riesgo de muerte materna se concentra sistemáticamente en la población con menor acceso a agua potable
líneas de regresión de la desigualdad curvas de concentración de la desigualdad
mortalidad materna (por 100,000 nv) 1990 2000 2010valor promedio regional 86.66 67.31 58.92
índice de desigualdad de la pendiente (desigualdad absoluta) ‐171.75 ‐125.01 ‐52.81índice de concentración de la desigualdad (desigualdad relativa) ‐0.42 ‐0.38 ‐0.18
0
75
150
225
300
375
450
525
600
675
750
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
gradiente social de acceso a agua con conexión domicil iar
mor
talid
ad m
aterna
(tasa x 10
0,00
0 nv
)
1990
2000
2010
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0
gradiente social de acceso a agua con conexión domicil iarmue
rtes m
aterna
s (% acu
m)
1990
2000
2010
Equity in health‐the backbone for the post 2015 Development A d
infant mortality by quartile of access to sanitation; The Americas, 2008
24.9
18.8
12.9
6.6
0
5
10
15
20
25
lowest second third highest
quartile of improved access to sanitation
infant m
ortality rate (x
r 1,000
live births
)
Equity in health‐the backbone for the post 2015 Development A d
maternal mortality by quartile of access to water; The Americas, 2008
138.6
88.4
57.9
23.2
0
20
40
60
80
100
120
140
lowest second third highest
quartile of improved access to water
materna
l mortality ratio
(x 1,000
live births
)
Equity in health‐the backbone for the post 2015 Development A d
human development inequalities in mortality; The Americas, 2008
external causes, by gender
37.131.0
23.7 28.5
179.3
143.6
109.0
73.7
106.4
86.4
65.550.8
0
40
80
120
160
200
lowest second third highest
human development quartile
mortality, externa
l cau
ses (
rate x 10
5 pop
) female
male
Equity in health‐the backbone for the post 2015 Development A d
Eventos globales de relevancia en desarrollo
The Future We Want
United Nations Conference on Sustainable Development (UNCSD) - Rio + 20 Rio de Janeiro, Brazil, June 20-22,
2012 convened by the UNGA in 2009
• The main outcome of the Conference was the official report ‘The future we want’
• six sections: – Our common vision; – Renewing political commitment; – Green economy in the context of sustainable development and poverty eradication; – Institutional framework for sustainable development; – Framework for action and follow‐up; and – Means of implementation.
• nine paragraphs on health reframing the debate over sustainability in terms that focus more directly on human well‐being:
http://www.uncsd2012.org/content/documents/727The%20Future%20We%20Want%2019%20June%201230pm.pdf
“The Future we Want”Preamble:• We recognize that health is a precondition for, an outcome of, and an
indicator of all three dimensions of sustainable development. We understand the goals of sustainable development can only be achieved in the absence of a high prevalence of debilitating communicable and non‐communicable diseases, and where populations can reach a state of physical, mental and social well‐being. We are convinced that action on the social and environmental determinants of health, both for the poor and the vulnerable and the entire population, is important to create inclusive, equitable, economically productive and healthy societies. We call for the full realization of the right to the enjoyment of the highest attainable standard of physical and mental health.
The Future We Want
Paragraphs on Health and population Chapter:
‐ Universal health coverage ‐ equitable universal coverage;– HIV and AIDS, malaria, tuberculosis, influenza, NTDs, and polio serious global
concerns;– Non‐communicable diseases (NCDs) challenges for sustainable development in
the 21st century: cancers, cardiovascular diseases, chronic respiratory diseases and diabetes
– Recognize that reducing air, water and chemical pollution leads to positive effects on health;
– Right to use Trade‐Related Aspects Intellectual Property Rights (TRIPS);– Strengthen health systems financing, development, retention of the health
work force;– Consider population trends and projections in development strategies and
policies;– sexual and reproductive health and all human rights in this context;– Reduce maternal and child mortality, improve health of women,men,youth &
children.
Thematic Consultations Themes
In addition to the country consultations, a number of thematic consultations are being planned. The timeline for these is May 2012 to February 2013. We understand that the provisional list of themes is as follows:
• Inequalities (across all dimensions, including gender)• Health (issues covered by MDGs 4,5 and 6, and also non-communicable diseases)• Education (primary, secondary, tertiary and vocational)• Growth and employment (including investment in productive capacities, decent
employment and social protection)• Environmental sustainability (including access to energy, biodiversity, climate
change and food security)• Governance (governance at all levels; global, national and subnational)• Conflict and fragility (conflict and post--‐conflict countries, and those prone to
natural disasters)• Population dynamics (including ageing, international and internal migration, and
urbanisation)• Food security and nutrition
Procesos para los ODS (rojo), marco de desarrollo post-2015 (azul), consultas (naranja) Implementacion y revision de los ODMs (verde)
What priority themes should SDGs address?
Esquema dee conceptos que serviran para definir el nuevo marco de desarrollo global para los ODMs despues del 2015
A COMMON AGENDA, AND ONLYSO MANY TO ACT ON IT
COMMON ELEMENTS IN THE AGENDA
PHC SDH NCDs HEALTHMDGs SUSTAINABLE PROMOTION
Governance / Stewardship
Health system actionCommunity / social participationInformation for monitoringAllignement of stakeholders
Health in All Policies / Healthy PoliciesHealth StewarshipEquity goal
Specific Concern for NCDsRequire efective Health PromotionImpact of NCDs on Development
DEVELOPMENT
Common Inherent elements
New responsibilities of Ministries of Health, will need to include at least:• understand the political requirements of the
other sectors and agendas
• build the knowledge base of policy options
•Assess the comparative health consequences
of options
• create regular platforms for dialogue and work
• evaluate and monitorModified from Adelaide statement on HiAP, 2010
Position and Find the Synergies