Colombia + 4 more

Closing the gaps in health in the least protected populations

Situation Report
Originally published


Provisional Agenda Item 3.2 CD47/6 (Eng.)
Annual report of the director of the Pan American Sanitary Bureau

To the Member States:

In accordance with the provisions of the Constitution of the Pan American Health Organization, I have the honor of presenting the 2005-2006 annual report on the activities of the Pan American Sanitary Bureau, Regional Office of the World Health Organization. The report highlights technical cooperation that has taken place during this period, especially the progress made in reducing gaps in health, to the benefit of the least protected populations, all within the framework of the Strategic Plan for the Pan American Sanitary Bureau, 2003-2007, adopted by the Governing Bodies of the Pan American Health Organization.

Mirta Roses Periago

Chapter 1


1. The search for equity in health is one of the main objectives that guide PAHO's actions in the Americas, a region that continues show inequities. These inequities can be measured in terms of resource allocation, the design and implementation of health policies, and the outcomes from the implementation of such policies. In the field of health, inequities are manifested in unequal access to services, the adaptation of infrastructure to address priority problems, disparities that are particularly apparent between rural and urban areas, in areas where poverty is highly concentrated, and the situations of disadvantaged groups such as women, children, indigenous populations, young people, and the elderly, or in populations exposed to greater risks, with a greater incidence of disease or higher levels of social exclusion.

Measuring Health Inequalities

2. Identifying and measuring disparities and having an understanding of the specific health status of the population and its trends¯while also identifying the most critical groups and areas¯are essential for gathering adequate and relevant information that can be used in decision-making, developing health policies, and evaluating the results of initiatives. Measuring inequalities among countries and within a given country is a first step in the effort to reveal differences and foster decision-making that leads to actions and strategies designed to reduce, and ultimately eliminate, these inequalities.

3. In early 2005 in Argentina, a working group on inequalities in health was constituted in conjunction with the Ministry of Health. It sponsored a workshop on methodologies for determining health inequalities. A computer software known as "Brechas" ("Gaps") also was developed to promote and facilitate the analysis of health inequalities in Argentina and other countries in the Region.

4. Progress also has been made in disaggregating health data at the subnational level. In the series Health Situation in the Americas: Basic Indicators, the booklets present up-to-date information by province or state, and even by municipio or district; similar gains have been made in the Immunization Newsletter. The biennial regional statistical booklet, Gender, Health, and Development in the Americas, also deserves mention. This joint PAHO, United Nations Development Fund for Women (UNIFEM), and United Nations Populations Fund (UNFPA) receives funding from the Ford Foundation and the governments of Norway and Sweden. The publication disaggregates core data by gender. Similarly, data on antiretroviral coverage, sexually transmitted diseases, and HIV/tuberculosis co-infection have been added to the information published on Human Immunodeficiency Virus (HIV).

5. The Ministerial Summit on Health Research, held in Mexico in November 2004, and its declaration on health research and knowledge have led to the creation of a research registry that supports the regional launching of the International Clinical Trials Registry Platform (ICTRP). Progress also was also made in the effort to align PAHO's regional research agenda with that of the World Health Organization (WHO). The Organization supported countries through innovative cooperation strategies designed to achieve better use of scientific evidence to inform decisions on health, and contributed toward the development and strengthening of a network of experts and related institutions.

6. PAHO helped participated in the drafting of the joint report of the UN regional agencies, Millennium Development Goals: A View from Latin America and the Caribbean, published by the Economic Commission for Latin America and the Caribbean (ECLAC). PAHO was charged with writing the chapter on health and the Millennium Development Goals (MDG), which included contributions from UNFPA.

7. The Central American Survey on Diabetes, Hypertension and Risk Factors for Chronic Diseases, which is part of the Central American Initiative on Diabetes, represents a one-of-a-kind approach that relies on a single methodology to monitor chronic diseases and risk factors in an entire subregion. The survey studied the prevalence of diabetes, hypertension, obesity, and overweight, among other risk factors, in 8,383 individuals in the seven Central American countries; nearly 75% of them were administered blood tests to detect diabetes and high cholesterol. The Institute of Nutrition of Central America and Panama (INCAP) helped train and standardize the interviewers and optometrists; this important aspect of this endeavor helped increase the countries' technical capacity for surveillance of chronic diseases and risk factors.

8. The Survey of Risk Factors for Chronic Noncommunicable Diseases, which was conducted in Argentina in 2005, is designed to analyze inequalities by population groups. Results will make it possible to quantify health differences in vulnerable groups, target activities in the health sector, and facilitate promotion in other sectors.

9. The Caribbean Commission on Health and Development, which is a response to a regional and global initiative, presented a report on the health situation in the Caribbean and possible solutions to be pursued. The report concludes that the issues whose improvement would have the greatest effect on health are obesity and chronic noncommunicable diseases, HIV/AIDS, and violence. The report also urges that resources be mobilized to strengthen national and regional capabilities in health measurement and health statistics.

10. Ten years from the deadline set for meeting the Millennium Development Goals, various plans for social protection in health in the Region have been analyzed. Among the topics studied are the ability to improve equity in access to and use of health services, the capability to counteract social determinants harmful to health, and the ability to expand coverage and access to technically appropriate health programs.

11. The Global Youth Tobacco Survey-which collects information on prevalence, attitudes, and beliefs with regard to tobacco consumption-continued to be carried out in 2005. Meetings were held with government officials to analyze survey data as a way to formulate public policy for smoking control. To date, the survey has been used in almost every country in the Region.

12. In regards to epidemiological surveillance, PAHO continues to monitor the countries' progress in eradicating polio and eliminating measles and rubella on a weekly basis. In 2005, the weekly surveillance of congenital rubella syndrome was added to this effort. The countries, in turn, monitor progress at the municipal level. Most Regional surveillance indicators surpass the goal of 80%.

13. The SABE survey (Health, Well-being and Aging) was designed and conducted using a representative sample of 10,000 adults older than 60 years of age in seven capitals in the Region: Brasilia, Brazil; Bridgetown, Barbados; Buenos Aires, Argentina; Havana, Cuba; México City, Mexico; Montevideo, Uruguay; and Santiago, Chile. Bridgetown, Barbados; Brasilia, Brazil; Havana, Cuba; Santiago, Chile; Mexico City, Mexico; and Montevideo, Uruguay. Results revealed the health status of this population group and implications for the Region's health systems. Based on the information gathered by the survey, strategic guidelines have been developed to improve access to better services, train human resources in health to cope with the needs of this age group, achieve better health care and monitoring of older adults, implement regulatory frameworks to protect senior citizens living in long-term care institutions, and conduct public health research to identify major threats. A framework has also been proposed to help define public health system functions that promote health and well-being in old age, as well as standards to evaluate these functions and to establish performance and result indicators.

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