globalization and injuries in the context of the americas dr. mirta roses periago director, pan...
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Globalization and injuries in the context of the Americas
Dr. Mirta Roses Periago
Director, Pan American Health Organization (PAHO)
15 TO 18 MARCH, MERIDA, MEXICO
9th World Conference on Injury Prevention and Security Promotion
Well-being and Health
EducationNutritionWater & SanitationHousing
WorkOccupationEmployment
New challenges:New challenges:Aggresiveness-Violence; public Aggresiveness-Violence; public domestic, community and road safety; domestic, community and road safety; substance abusesubstance abuse
New challenges:New challenges:Aggresiveness-Violence; public Aggresiveness-Violence; public domestic, community and road safety; domestic, community and road safety; substance abusesubstance abuse
Family incomeSalarySocial developmentand economic
1. System and health services
2. Inclusion and coverage
3. Opportunity- Access-Quality4. Users satisfaction
Social networksLife conditionsIdentity and cultureFamily integrationUrbanizationAging
AgeGenderGenetics
Adapted from WHO
Health Determinants
Ecological Model
RISK FACTORS
IndividualFamily and friends relationship
CommunitySocial
•Demographic features•Psychological and personality alterations•Abuse history
• Conflictive relationship with parents• Conflicts between couple• Pressure from peers involved in violence
• Social status of women• Unequal distribution of wealth• Social isolation• Illegal drug traffic
•Inequities•Norms that support violence•Guns availability•Police weakness/ criminal justice•Violence in the media
DEMOCRACYand
descentralization
1975 1990 2000 2015
MDGHF
A
Welfare state and social security crisis
Economic and State ReformsHealth Sector Reforms
GLOBALIZATIONand new economic order
DEMOGRAPHIC TRANSITION: population growth, urbanization and aging
EPIDEMIOLOGICAL POLARIZATION: profile coexistence of opposed risk and disease
Overwhelming Environmental and Ecological Impact
EXPANSION OF DISPARITIES INCREASE IN THE EXCLUSION
Health for All – Millennium DeclarationHealth for All – Millennium Declaration
-0,4
-0,2
0,0
0,2
0,4
0,6
0,8
1,0
1,2
1,4
1,6
Gai
ned
year
s of
life
exp
ecta
ncy
from
198
0 to
200
0 (R
egio
nal a
vera
ge)
residuals
violence
perinatal
cardiovascular
cancer
communicable
0,00
0,10
0,20
0,30
0,40
<1 1-4 5-9 10-14 15-19 20-24Age (Years)
Acute diarrheal diseases
Acute respiratory infections
Vaccine-preventable diseases
Nutritional deficiencies
(Decomposition of changes in the life expectancy from 1980
to 2000 for cause and age)
The legacy of HFA to the populationof the Americas
19981996199419921990198819861984198219801978
Ave
rage
GD
P p
er c
apita
adj
uste
d by
PP
P (
int.
$)
14.000
12.000
10.000
8.000
6.000
4.000
2.000
0
Superior tercile
Average tercile
Lower tercile
Disparities of the Economic Growth in the Americas
[PAHO/WHO: Health in the Americas, 2002 Edition]
Magnitude of Inequality of Income in the Americas 2003
[ CD145/7; PAHO Program Budget Policy ]
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 classified according to its income
(Cumulative proportion)
The poorer
ingre
sos
(pro
porc
ión
acu
mula
tiva)
The riches
t
Perfe
ct e
quity
line
7.2
8.5
9.9
10.5
10.09.8
10.610.5
10.7
10.3
6.0
6.5
7.0
7.5
8.0
8.5
9.0
9.5
10.0
10.5
11.0
1990 1995 1998 1999 2000 2001 2002 2003 2003-1sem.
2004-1sem.
Ta
sa
de
de
se
mp
leo
en
%
51
51
52
52
53
53
54T
as
a d
e o
cu
pa
ció
n e
n %
Tasa porcentual de desempleo Tasa porcentual de ocupación
Unemployment continues to be high
Empleo Informal (como % del empleo total)
30%
43%48%
0%
10%
20%
30%
40%
1980 1990 2000
Increase of the informality
CEPAL-2005CEPAL-2005
The Inequity Impact on the Global HealthThe Inequity Impact on the Global Health
•Less developed countries concentrate 84% of the world population…
•They consume less than 11% of the world health expenditures
•However, they bear 93% of the overall disease burden
Ethic Evolution/ Ideology/Values that guide the Social Protection Systems
20’s/40’s 80’s/90’s50’s/70’s Century XXI
Formal socialSecurity forindustrial workers
Public AssistanceAnd Charity for
the poor and indigenous
Century XX
STATEBENEFACTOR
Segm
ente
d
Syste
ms
acco
rdin
g to
paym
ent
capa
city
UNIVERSAL SOCIAL
PROTECTION AS A
CITIZENS RIGHT
Incidence of DiseasesIncidence of DiseasesAVISAs per 100 inhabitantsAVISAs per 100 inhabitants
OMS-2005
29 29 27 39 26
112
108
115 120 103108
98
45 35 39
101
12
8
0
50
100
150
200
250
300
Grupo I (transmisibles)Grupo II (no transmisibles)Grupo III (accidentes, violencia)
Latin America and the Caribbean
High income
Medium income
LowincomeLatin
America and the
CaribbeanOCDE, Low income
World average
Group I (communicable)Group II (non communicable)Group III (accidents, violence)
Expected effect in crime rate according to changes in macroeconomic indicators
1% Increase
Homicides Rate
Thefts rate
G.D.P.
Falls on 2.4%
Falls on 13.7%
Coefficient GINI
Increases a 1.5%
Increases a 2.6%
Source: Fajnzylber P, Lederman D, Loaiza N, BM, 2001
HOMICIDE RATES x 100.000 pop. (ADJUSTED) MALE
SELECTED COUNTRIES, 1996- 2005
Fuente: OPS, Datos básicos
We have to share experiences and help each other
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
96 97 98 99 00 01 02 03 04 05
Year
Rate
/100,0
00
Argentina
Brazil
Canada
Colombia
El Salvador
Mexico
Paraguay
USA
HOMICIDE RATE x 100.000 pop. (Adjusted) female
Selected countries, 1996- 2005 Fuente: OPS, Datos básicos
Female homicide rates are lower than those of men: ratio 1:10
More cases are detected as gender based (feminicide)
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
96 97 98 99 00 01 02 03 04 05
Year
Rate
/100,0
00
Argentina
Brazil
Canada
Colombia
El Salvador
Mexico
Paraguay
USA
Type of road user in proportion to all the deaths by trafficin the countries of the Americas
0% 20% 40% 60% 80% 100%
United States*
Trinidad and Tobago
Saint Lucia
Mexico*
Jamaica
El Salvador
Costa Rica
Colombia
Canada
Pedestrians Drivers Passengers
Cyclists Motorcyclists Other/Not specified
+ Road user categories were not uniform across all country data. * Data for Mexico and the United States did not differentiate between drivers and passengers. “Drivers” bar for these two countries corresponds to the total of drivers and passenger fatalities.Sources: Data compiled from the following sources. Canada, 2002—Canadian Motor Vehicle Traffic Collision Statistics 2002, http://www.tc.gc.ca/roadsafety/tp/tp3322/2002/page3.htm; Colombia, 2002—Instituto Nacional de Medicina Legal; Costa Rica, 2003—INEC; El Salvador, 2003—National Police; Jamaica, 2003—Ministry of Health (original figures from National Police Headquarters); Mexico, 2000—Consejo Nacional de Prevención de Accidentes; Saint Lucia, 2001—Royal St. Lucia Police Force (Traffic Department); Trinidad and Tobago, Office of the Commissioner of Police; United States, 2002—NHTSA.
Deaths by traffic accidents in Bogota, Colombia1991-2005
Source: Instituto de Medicina Legal y Ciencias Forense. Fiscalia General de la Nación
546655
585697745
834878914931
1301
1387
13411260
1284
1089
0
200
400
600
800
1000
1200
1400
1600
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Years
Nu
mb
er o
f d
eath
s
Change of policemen
Closing of night establishments
Civic Culture
Women (%) 15 to 49 years, sometime living in union, that say to have been victims of violence by their husband or partner
%
53
41 39
31
22
15 141510 12 12
6 4
11
0
10
20
30
40
50
60
Bolivia(2003)
Perú (2004-2005)
Colombia(2005)
Ecuador(2004)
RepúblicaDominicana
(2002)
Honduras(2005-2006)
Haití (2005-2006)
Violencia físicaViolencia sexual
Source: Measure DHS, ORC Macro, Encuestas Demográficas y de Salud (DHS). Ecuador: CEPAR, ENDEMAIN. ORC Macro: procesamientos especiales de las DHS. (Países seleccionados)
Physical violence
Sexual violence
Model to address comprehensively family violence (VIF)
Regional Level: International Forums Replication and exchanges Lessons learned
National
Sector
Community
National coalitions Legislation, monitoring systemsPrevalence/advocacy study
Training, University curricula sPolicies, standards and protocols Surveillance and reference systemsPrevention
Networks, support groups, men groups Evaluation of needs: Critical Path
Face Together the New ChallengesFace Together the New Challenges
Violence Prevention Inter American Coalition
WB, IDB, OAS, CDC, USAID, UNESCO, PAHO
• Focus in needier, vulnerable Sectors, and territories
• Emphasis on prevention– Interpersonal, gender , juvenile, and self-inflicted
violence – Road safety: pedestrians, motrocyclist, the elderly,
migrants
• Strenghtening of networks and joint effort in road safety: work together
• Strategic Plan 2008-2012
132º CE - OPS/OMS
OUR PROPOSALS AND COMMITMENTS
Health Agenda for the Americas
• Strengthening National Health Authority• Tackling Health Determinants • Harnessing knowledge, science, and technology• Strengthen Health Security• Diminishing health inequalities among countries
and inequities within them• Reducing the risk and burden of disease• Increasing social protection and access to quality
health services • Strengthening the management and development
of health workers
• Human Rights, universality, access and inclusion• Pan American Solidarity• Equity in Health• Social Participation
2008 - 20172008 - 20172008 - 20172008 - 2017
HEALTH PROMOTION
Social Exclusion
Inequity
Inequalities
DETERMINANTES
Challenges for 2015:MDG Achievements and other Priority Agendas
Healthy public policies
Healthy environments
Community Action
Personal skills
Health services reorientation
Faces, voices
and places
for MDGs
MDGAchievements
by 2015
Environment
Family Community
Mu
nic
ipal
ity
Sta
te
Co
un
try R
egió
n
Individual
HEALTH SYSTEMS BASED ON PRIMARY HEALTH CARE