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HeartBeat

PAMSA

Social Determinants on Health and

infectious diseases



Imprint

Editor in Chief Leonel Ayala, El Salvador

ProofreadingHelana Chapman, Dominican RepublicGénesis cañas, El SalvadorLaura Figueiredo, Brazil

DesignLeonel Ayala, El Salvador

Publisher International Federation of

Medical Students’ AssociationsGeneral Secretariat:IFMSA c/o WMAB.P. 6301212 Ferney-Voltaire, FrancePhone: +33 450 404 759Fax: +33 450 405 937Email: [email protected]

Homepage: www.ifmsa.org

Contacts

[email protected]


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PuBlications team and tHe future

tHe ifmsa gloBal HealtH equity initiative

advocating for a rational use of PrescriPtion drugs tHrougH medical education

Rio political declaRation on social deteRminants of health.

from our rc

HealtH systems and medical Practice in venezuela

HealtH determinants

sdH and reProductive HealtH

17

1614

12

108

7

6

contents

introduction5

18 WHat We Plan!

PAMSA HeartBeat 3



GabrielaNolesRegional CoordinatorIFMSA - Perú[email protected]

alhelí CalderóNDA for NMO DevelopmentIFMSA - Mé[email protected]

MardelaNGel ZapataAmericas Regional ProjectsAssistant

[email protected]

FrédériCMoriNSCOPE RAIFMSA - [email protected]

tessy CerróNSCOPH [email protected]

Javiera brierley DA for NMO Development

IFMSA - [email protected]

eriCkMeléNdeZSCORA RAIFMSA - El [email protected]

leoNel ayala

DA for Publications and MediaIFMSA - El Salvadorda.pubsmedia.pamsa@gmail.

com

elías orteGaSCOME RA

IFMSA - Argentina

[email protected]

roberto GarCíaSCORE RA

IFMSA - Mé[email protected]

paola aGuirreSCORA RA

IFMSA - Perú[email protected]

riCardo

Zules

SCORP RAIFMSA - Ecuador

[email protected]

pamsa team



fRom ouR Rc

Dear PAMSA riends,

I am honored to write in this, the ourth RM special edition o the PAMSA

Heartbeat “Social Determinants o Health and Inectious diseases”

Why inectious diseases and social determinants o health? Mainly, or

two reasons. First, it is the theme elected by our Regional Meeting 2012

OC as theme event or the RM and; Secondly, because even though non

communicable diseases are nowadays one o the main health issue o

our region, the inectious diseases are still important thus determinate

uture health but, most importantly, are the most afected by the social

environment o the people.

This is the reality that we see every day or must see. Beore this, the big

question is: what are we doing about it? Our members are sharing in these

lines their thoughts, wishes and actions to tackle this topic.

We cordially invite our readers to enjoy our publication and that every

page encourage you to act.

Yours,

Gabriela NolesIFMSA Regional Coordinator or the Americas



publications team & the futuRe

Helena Chapman

IFMSA means ABCD: Adventurous

spirit, Beautiful ideas,

Collaborations in health and

Dissemination of newsworthyndings. The adventurous spirit

brings creativity to the table,

as a desire to help fellow

colleagues as well as populationsin need. Beautiful ideas are

required to develop proposals

for sustainable health initiatives.

Interdisciplinary or multidisciplinary

health collaborations are critical

components to effective teamwork

and transmission of the health

message to community members.

Dissemination of health project

ndings at the local, national andinternational levels will permit

further inspiration to health

professional students across the

globe. Since IFMSA means ABCD,

the future of medicine and public

health appears more creative,

dedicated and collaborative in the

development, implementation and

reporting of program results.

How does IFMSA change your perspective of the future?

Laura A. Figueiredo

In the midst of our dazed lives of

academic medicine and in moments of

crisis in my course, i’ve found in IFMSA

an endless source of encouragement

to continue this journey. Was in

IFMSA that I realized how to ght for

a cause is extremely rewarding, even

when everything goes against you.

The IFMSA welcomed me and showed

me how our society needs actions

for health prevention, care and an

attention especially. Today we see

brutalities that happen in the Public

Health and we can contemplate the

importantance that IFMSA has to

act on signicant gaps of the state

to provide health care to all, even

though we can not change in large

proportions, they are aware that wetry and at least one person affected

by the action already characterizes

the success of our work.

Génesis cañas

Every single thing we do from IFMSA

has the potential of becoming

decisive for the future. Some projects

are small efforts an other projects

are just incredibly ambitious and

complex, but either way, all the work

we do just makes me realize that we

really are taking the future in ourhands and we are becoming a new

generation of doctors commited with

excelence, and I just could not be

more proud of being part of this.

PAMSA HeartBeat 7


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health sYstems and

medical pRactice in VeneZuela

Manuel Alejandro Rodríguez, MD. Belkis J. Menoni-

Blanco, MD

(Alumni of FEVESOCEM, IFMSA Venezuela)

The health system in Venezuela consists in clinics and

hospitals, public and private, in rural and urban areas.That system is classied depending on the number of

people in each community and the services in these health

centers. The clinical system is developed to promoteprevention, immunization and outpatient treatment

of diseases. In contrast, the hospital system, which is

classied into levels, is responsible for the assistance

provided to patients with diseases that require rapid

and short hospital stay (level I) and more specialized

care that demands more technology (level IV). The public

system have been made based also on preventive health

programs, for example, breastfeeding, HIV and AIDS,

Diabetes, Cardiovascular diseases, comprehensive care

to children and adolescents, prevention of epidemics,

tropical diseases... One of the most recent health

campaigns is the “No Tobacco National Program”,

which entered into effect on “World No Tobacco Day”

(so decreed by the WHO)

From the early stages of medical school, the student

has contact with Public Health and Health Prevention,

because these matters are included in the curriculum of

all universities of this country. During their training, the

medical student goes to remote communities to develop

research projects and promotes prevention and care fordiseases of these communities.

After obtaining the medical degree, the “Practice of

Medicine of Venezuela Law” says that the graduate

must serve a year of rural practice of medicine. Atthis stage the doctor makes educational and medical

assistance to communities in remote locations. This is the

stage where we are today.

In theory, as envisaged in our Constitution in force since

2000, health services must ensure the health protection

to all inhabitants of the country and work in accordance

with the principles of universality, participation,

quality, complementarily, and even Coordination and

Integration of Health System. In fact, these principles

are not always used by the health administration in our

country; both public and private are questionable.

It is not uncommon that

every day is discussed bythe media the inefciency

of the health service,

where there are no health

habits, inefciency in the

administration of health

systems, inadequate control,lack of quality of service

and lack of resources.

Despite some efforts by the

state to make improvements

in social conditions of life,

in our assistance work,

for example, we have

seen numerous failures

such as illiteracy in some

of rural residents, whichgenerates inability to follow

guidelines for treatment

and prevention.


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One of the main shortcomings is the current intention of

establishing a parallel public health system, which is not

related to the traditional. This new system is far fromsolving the current problems, quite the opposite, actually

increases the clutter and creates a battle between the

two systems. But both strive for similar goals, since they

seek equality and population health and who loses in

this battle are the users, because the administrators of

these systems end up diverting resources from one and

neglecting the other.

At the present time, Venezuela unfortunately has a long

list of problems in the health system, many of which

could be prevented or simply solved. Examples of thatwear are manifested by the constant lack of supplies in

health centers, emergencies and sites of hospitalization,

which are often evidenced by the deterioration of some

buildings, lack of equipment, materials, drugs or bedsto accommodate patients properly, as also not enough

staff to handle the overwhelming number of people

attending daily for health.

In conclusion, the duty of health professionals and

students worldwide, not only in Venezuela, should be

promote health education, preventive campaigns and

social assistance, based on medical ethics and morality.

We found in IFMSA a preparation for entering this world

of possibilities and take the reins, though young, of our

careers, so that, in the future, we will use preventivepolicies and social actions in our communities.



the ifmsa Global

mobiliZinG medical students

By Nilofer Khan Habibullah and Renzo Guinto, on behalf

of the IFMSA SWG on Health Inequalities

We marvel at cutting-edge health care technology, yet

there exists a life-span of 34 years at Sierra Leone

and lack of basic amenities (i.e. drinking water) in other

under-developed and developing regions of the world.

We proudly register progress made by the Millennium

Development Goals (MDGs), yet maternal mortality

-one of the MDG indicators- reveal that as many as

170 for every 1,000 mothers die due to inaccessible

or inadequate maternal care in the Philippines alone,

while only 8 mothers die in Japan.

We weigh our country’s development with a rising

Human Development Index. Sample this: A 2005 United

Nations’ Human Development Report reported that theannual income ow of the richest 500 people in the

world exceeded that of the poorest 416 million people.

More appallingly, it also estimated the cost of ending

extreme poverty at $300 billion, which equates to lessthan 2% of the income of the richest 10% of the world’s

population.

Even today, 1/3rd of the world’s 7 billion habitants lives

in slum shelters.

People affected by these health disparities are notmerely faceless statistical gures. They live among us

and once dreamed of a better future and fair means

to live. Their only ‘misfortune’ is that they were born

in under-developed regions of the world, where health

disparities are still prevalent. These inequalities will

continue to exist, unless we commit our collaborative

efforts to ght these barriers in global health.

What are the social determinants of health?

According to World Health Organization (WHO), social

determinants of health are “the conditions in which

people are born, grow, live, work and age, including

Illustration from: Dahlgren, G. and Whitehead, M. (1991). Policies and Strategies to Promote

Social Equity in Health. Stockholm: Institute for Futures Studies.



health equitY initiatiVe

o close the Gap in health dispaRities

the health system. These circumstances are shaped

by the distribution of money, power and resources atglobal, national and local levels, which are themselves

inuenced by policy choices. The social determinants of

health are mostly responsible for health inequities - the

unfair and avoidable differences in health status seen

within and between countries” (1). One can infer that

the social determinants of health are a result of unjust

distribution of resources, money and power, which all

factor into health inequity.

Health inequity results from a medley of unfair policies,

which do nothing to ensure just and uniform distributionof money, power and resources. People live in different

communities, each with unique characteristics, governance,

structures and policies. Due to these differences, some

people might have closer access to healthy food than

others, or a subdivision may have safer roads than a

village in the rural areas. Since these differences are

shaped by social, economic and political forces that

work in the municipal, national or international level,

we must address these forces through collective action

across all sectors.

IFMSA Global Health Equity Initiative

The IFMSA Global Health Equity Initiative represents a

unique vision and mission to motivate young leadership in

global health matters. The vision describes: To mobilize

youth towards the achievement of “health for all” (Alma

Ata Declaration) and “closing the gap in a generation”

(WHO Commission on Social Determinants of Health).

The mission states: To lead the world’s medical studentsand future physicians in advocating for health for all,

fullling Rudolf Virchow’s vision that physicians are

“natural attorneys of the poor.”

The IFMSA Global Health Equity Initiative will serve four

main purposes. First, it will act as an Institutional voice

for global health equity within IFMSA, especially in

regards to global health equity and social determinants

of health. Second, it will serve as a Clearinghouse of

information, advocacy tools, and technical guidance on

global health equity for IFMSA members. Third, it willact as a Dynamic forum for intellectual exchange and

dialogue on health equity between IFMSA members and

external partners. Lastly, it will be a Cornerstone of

health equity advocacy and campaign within the IFMSA

and the global health community.

Key areas of programming of the Initiative will focus

on, but not limited to, advocacy with grassroots action,

education and training, policy dialogue and legislative

action, media and publications, and building external

networks and coalition for the IFMSA. The Initiative team

structure will also involve lead contacts on each of these

domains of action.

Care enough about health inequity? Join us!

Show your solidarity for the Global Health Equity

Initiative at the upcoming IFMSA March Meeting in

Ghana! After its formal adoption, this Initiative will

serve as a premier platform to join IFMSA medical

students on the call to action for health equality and

social determinants of health. Come be an active part

of this cause!

If you would like to join this cause or have any further

questions, please contact Nilofer Khan Habibullah ([email protected]).

Let us investigate the causes of health inequity and

reach out to the poor, marginalized, vulnerable and

underserved populations! As medical students, we can

make a difference in our local and global community!

References:

(1) World Health Organization. (2011). Socialdeterminants of health. Available from: http://www.

who.int/social_determinants/en/.

PAMSA HeartBeat 11



“Holding life” by Ramón Llorente, FEVESOCEM Venezuela

health deteRminants:

Kevin Stephen Acosta Velásquez *, Martha

Liliana Ospina Gutiérrez **

*3rd year Medical Student, School of Medicine, University of Tolima. Ibagué

-Tolima- Colombia

**5th year Medical Student, School of

Medicine, University of Tolima. Ibagué-

Tolima-Colombia

As the youth represent agents of change,

they have an important future role in

developing countries. Although only a

small percentage of Colombian youth

have access to super education, they

are the innovators that have united their

voices toward a better society. Within

this population, the medical students have

created strength in their presence, where

they have developed various opportunities

for students in their early medical education

to have direct contact with community members. These

individuals represent decisive agents that will direct the

focus on the principal health determinants in the rural

and urban communities: Education.

Due to the local and global activities promoted by the

governments and different organizations, including the

Association of Medical Students, education has been

successful in many areas. In particular, the initiative

of the International Week of Maternal Breastfeeding

was founded by the World Alliance for Breastfeeding

Action (WABA). By forming strategies for annual

implementation between August 1-7, future physicians

have become critical and active agent of change forthis health topic.

Considered by the World Health Organization (WHO)

as a natural act and behavior to learn, maternal

breastfeeding is an important topic, especially due tothe offered benets in the biopsychosocial environment

of the individual. Currently, the Hospital Federico Lleras

Acosta (HFLLA) is considered one of the most important

Colombian institutions that offer health services, where

an initiative (1992) between the WHO and UNICEF,

established the Institution “Amiga de la Mujer y la

Infancia” (IAMI).

This focus on the rights of this social and vulnerable group

is an advantage for the remaining hospital functions,

as a University Hospital and principal rotation site for

the medical students at the Faculty of Health Sciences

of Tolima. In promotion of this program, at the start ofthe latter half of this year, the Scientic Association of

Medical Students of the University of Tolima (ACEMED

UT) (Local Committee of ASCEMCOL) and the respective

Hospital, created and implemented the “First Week for

Collaboration: The IAMI HFLLA and the ACEMED UT.”

The implemented strategy was to create a collective and

equal work environment between the IAMI Hospital and

the public university, where both would act as a social,

education and health base of the relevant community,from an epidemiologic and geographic perspective. Thehospital roles were dened and permitted the Tolima

medical students to become involved in the planning,

organization and development of education activities

and promotion of maternal breastfeeding. In this

manner, this educative center can combine the directed

objectives of the maternal and infantile population with

the group members and leaders of the project, where

health determinants would be considered.



actinG locallY, thinkinG GloballY duRinG the inteRnational

Week of mateRnal bReastfeedinG in colombia.

3. World Health Organization. (2011). Child

and adolescent health and development: World

breastfeeding week. Available at: http://www.who. in t/ch i ld_adolescent_heal th/news/

archive/2011/03_08_2011/en/index.html.

4. Hospital Federico Lleras Acosta de Ibagué- Tolima

E.S.E. (2011). Homepage. Available at: http://www.

hleras.gov.co/.

5. World Alliance for Breastfeeding Action. (2011).

World Breastfeeding Week. Available at: http://

worldbreastfeedingweek.org/.

6. World Health Organization. (2004). Estrategia

mundial: Lactancia materna, fundamental para la

supervivencia infantil. Available at: http://www.who.

int/mediacentre/news/releases/2004/pr19/es/.

These strategies are proposed for a direct intervention

between the community and public hospitals as a

solution for the actual health problem. The time-space-communication triangle can be implemented in

the search for the appropriate promotion of maternal

breastfeeding with the media. It is important that

all members of each association of medical students

implement concrete actions for these initiatives, which

would permit a strong collaboration between hospital

and university as well as offer solutions for the public

health problems that affect the local, national and

global community.

References:

1. Zambrano, A. Determinantes del estado de salud

en Colombia y su impacto según área urbana y rural:

Una comparación entre 1997 y 2003. Available at:

http://www.asivamosensalud.org/descargas/lecturas/

Zambrano_estado_de_salud.pdf.

2. Alvarez, L. (2009). Los determinantes sociales de la

salud: Más allá de los factores de riesgo. (2009). Rev

Gerenc Polit Salud, Bogotá (Colombia), 8 (17): 69-79.

PAMSA HeartBeat 13



adVocatinG foR a Rational use of pRescRiption

dRuGs thRouGh medical education

Prescription drugs constitute one of the main tools

in the art and science of medical practice. They givethe physician an enormous power in the recuperation

process of the patient, where the medication mayproduce benecial or deleterious effects in the human

body. Reecting on the common phrase, “great power

comes with a great responsibility,” we must emphasize

proper use of prescription drugs in the best interest of

our patient.

The increasing numbers of pharmaceutical products

and marketing names are also a major challenge in

developing countries. Why? The answer may exist in the

variation of regional drug regulators. In Argentina, like

in other countries in the Americas, once a new drug is

discovered, it must go through a research process thatconsiders drug efcacy and safety, prior to approval

for general market sales. Although both criteria are

essential, this evaluation does not take into account other

factors. For example, in Norway, the drug evaluation

process considers necessity. If an existing drug with

proven mechanism of action has been successful, then the

regulators forbid any similar drugs to be approved forthe general market sales. In this way, they prevent themarket from overowing with the same pharmaceutical

products.1 Of course, this is a result of the lobbying

performed by the pharmaceutical industry to healthcare

professionals, which eventually reaches the academic

environment.

A global issue2…

•Two-thirds of global antibiotic sales occur without anyprescription.•90% of injections are estimated to be unnecessary.

•Adverse drug events rank among the top 10 causes of

death in the USA, where it is estimated to cost between

US$ 30 and US$ 130 billion each year.

Globally, there is a large quantity of prescriptions written

by physicians every single day. If we could analyze

each individual prescription, we would observe that a

considerable percentage is completely unnecessary or

incorrect for the patient. This may be a consequence of

multiple factors, including inadequate knowledge about

Elias Jesus Ortega Chahla.

Universidad Nacional de Tucuman. San Miguel de

Tucuman, Tucuman, Argentina. 2011.



For this reason, we are at the best moment to improve this

educational process in early medical education, before

medical students become certied health professionals.

As medical students, how can we advocate for a Rational

Use of Prescription Drugs? We can:

•Demand that our professors and mentors base their

drug prescribing practices on evidence-based medicine.

•Participate in curriculum changes that improve the

teaching of rational practice in medical education.•Participate and organize courses, workshops and other

activities to promote the rational use of prescription

drugs.

•Develop independent criteria when reviewing treatmentguidelines while following WHO standards in selection

of the appropriate medication.

As future healthcare professionals, it is our sacred duty

and privilege to promote the best quality of attention to

our patients. We have the responsibility to advocate for

the rational use of prescription drugs. Within our reach,

we have organizations (i.e. IFMSA) that offer the unique

and wonderful opportunity to work as one global team,

gathering the appropriate resources and tools to ghtfor improved prescription practices.

“The power of a doctor’s pen is mightier than the deadliest

disease…”

References:

1. National Therapeutic Form. (2011). Medical

Confederation of the Argentine Republic, 11th ed.

Argentina.

2. De Vries, T.P.G.M, Henning, R.H., Hogerzeil, H.V.,

Fresle, D.A. (1994). Guide to the good prescribing: A

practical manual. Geneva: World Health Organization,

Action Programme on Essential Drugs.

3. Mordujovich, P., Buschiazzo, H. (2006).

Rationalized approach on therapeutics. Argentina:

National University of La Plata.

prescription drugs. At the same time, just as not all disease

conditions require prescription drugs, some medications

produce deleterious effects in the human body. This mayconstitute a frequent form of poor medical practice.3

Common examples of Irrational Use of Prescription

Drugs2…

•Too many medications are prescribed per patient

(polypharmacy).•Injections are used where oral formulations would be

more appropriate.•Antimicrobial medications are prescribed in inadequate

doses or duration or for non-bacterial infections, therebycontributing to the alarming problem of antimicrobial

resistance.

•Prescriptions do not follow clinical guidelines.

•Patients self-medicate inappropriately or do not

adhere to prescribed treatment.

Across the world, there are countless examples of

incorrect and unnecessary use of prescription drugs.

Although the motive for these prescriptions may bebased on many factors, the most important reason is

inadequate education on prescribing practices among

medical students and health professionals. So the

question arises, why are medical students not taught

how to use prescription drugs correctly? The answer is

complicated, although one possibility is that medical

school professors are not aware of the Rational Use of

Prescription Drugs.

Why does it happen?•Studies in Canada, Australia, Kuwait and the USA, as

well as in middle-income countries, such as South Africa

and Thailand, have revealed that inappropriate use of

medications is widespread in teaching hospitals.3

•The high cost of medications contributes to low adherence

levels by patients. In some studies, an estimated 90%

of consumers buy antibiotics for three or less days,

which makes compliance with the recommended dosage

impossible.2

If we do not start to educate the healthcare professionalsabout the Rational Use of Prescription Drugs, how can

we expect that they will be responsible prescribers?

PAMSA HeartBeat 15


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sdh and RepRoductiVe health

By Erick Melendez & Paola Aguirre Camino

SCORA Regional Co-Assistants for Americas 2011/2012

During the last year we were hearing about something

that is revolutionizing the global health and is making

a new era on health work: the social determinants of

health (SDH). They are described as “the conditions

in which people are born, grow, live, work and age,

including the health system”(1) and, there is no need to

say that they affect the people’s health in every aspect.

In 1998 a group at University College London

summarized the evidence on the social determinants of

health, and published it as The Solid Facts.(2)It had ten

messages on the social determinants of health based

on: the social gradient, stress, early life, social exclusion,

work, unemployment, social support, addiction, food,transport; making the big rst review on the topic, in that

opportunity based on evidence on their region, Europe.

Even with all that revolution about the social

determinants on health there is not much informationabout their inuence in the reproductive health; to

try to understand better the topic we will give u thedenition of reproductive health according to the WHO:

“Reproductive health, therefore, implies that people are

able to have a responsible, satisfying and safe sex life

and that they have the capability to reproduce and the

freedom to decide if, when and how often to do so. Implicit

in this are the right of men and women to be informed

of and to have access to safe, effective, affordable

and acceptable methods of fertility regulation of theirchoice, and the right of access to appropriate health

care services that will enable women to go safely

through pregnancy and childbirth and provide couples

with the best chance of having a healthy infant”. (3)

While the last two decades have seen improvements

in access to and utilization of sexual and reproductive

health services, progress in many countries has been

slow and, after decades of investments, disappointing.

On a global scale, women living in low and middle

income countries experience higher levels of morbidity

and mortality attributed to sexual and reproductive

health than do women living in wealthier countries. (4)

The relationship between poverty and poor reproductive

health is well established. Greene and Merrick conducteda thorough review of the social, nancial and health

consequences of key reproductive health indicators

including maternal survival, early childbearing and

unintended pregnancy. The report concluded that large

family size was associated with increased risk of maternal

mortality and less investment in children’s education.

Unwanted pregnancy was positively correlated with

health risks of unsafe abortion. Short birth intervals

were found to negatively inuence child survival, and

early pregnancy was associated with lifelong risk of

morbidities. (5)

Social Determinants of Health inuencing the sexual and

reproductive health is a reality, but additional research

is needed to better understand how exactly they are

interfering on the topic, we as medical students have the

tools and the energy to perform amazing research, to

advocate on the topic and to change this. This is brief

review on the topic but there are a lot of information to

look out, to inspire you to work on it; the course of the

world is in our hands and we have to be sure that we do

not disappoint next generations.

References

(1)WHO. Social Determinants of Health. Available in:

http://www.who.int/social_determinants/en/

(2)The Regional Ofce for Europe of the World Health

Organization. Social Determinants of Health: The Solid

Facts. 1st Edition. WHO. Copenhagen, Denmark; 1998.

(3) WHO. Reproductive Health. Available in: http://www.who.int/topics/reproductive_health/en/

(4) Shawn Malarcher. A view of sexual and

reproductive health through the equity lens. Department

of Reproductive Health and Research World Health

Organization. Geneva, Switzerland; 2010.

(5) Green ME, Merrick T. Poverty reduction: does

reproductive health matter? Washington, DC: The

International Bank for Reconstruction and Development /

The World Bank; 2005 (Health, Nutrition and Population

(HNP) Discussion Paper)


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Rio political declaRation on social

deteRminants of health.

Some of the support policies, strategies, programmes

and action plans the plan to develop as a way to ghtagainst the inquieties on health are:

-To adopt better governance for health and development

-To promote participation in policy-making and

implementation

-To further reorient the health sector towards reducing

health inequities: Acknowledging that accessibility,

availability, acceptability, affordability and quality

of health care and public health services are essentialto the enjoyment of the highest attainable standard of

health, one of the fundamental rights of every human

being, and that the health sector should rmly act to

reduce health inequities

-To strengthen global governance and collaboration

-To monitor progress and increase accountability:

Establish, strengthen and maintain monitoring systems

that provide disaggregated data to assess inequitiesin health outcomes as well as in allocations and use of

resources

-Call for global action

If you’d like to read the whole article you can visit the

following link: http://www.who.int/sdhconference/

declaration/Rio_political_declaration.pdf

Invited by the World Health Organization, the Heads of

Government, Ministers and government representativescame together on the 21st day of October 2011

in Rio de Janeiro to express their determination to

achieve social and health equity through action on

social determinants of health and well-being by a

comprehensive intersectoral approach.

They quoted “We underscore the principles and

provisions set out in the World Health Organization

Constitution and in the 1978 Declaration of Alma-Ata

as well as in the 1986 Ottawa Charter and in the series

of international health promotion conferences, whichreafrmed the essential value of equity in health and

recognized that ‘the enjoyment of the highest attainable

standard of health is one of the fundamental rights of

every human being without distinction of race, religion,

political belief, economic or social condition’. We

recognize that governments have a responsibility for thehealth of their peoples, which can be fullled only by

the provision of adequate health and social measures

and that national efforts need to be supported by an

enabling international environment.” as well as “Wereiterate our determination to take action on social

determinants of health as collectively agreed by the

World Health Assembly and reected in resolution

WHA62.14 (“Reducing health inequities through action

on the social determinants of health”), which notes the

three overarching recommendations of the Commission

on Social Determinants of Health: to improve daily living

conditions; to tackle the inequitable distribution of power,

money and resources; and to measure and understand

the problem and assess the impact of action.”

We can all have clear, thanks to the statements above,

that the authorities are taking a bigger consideration

regarding the growing problems in health, setting as

objective to treat the very reason of all these problems,

the social determinants on health.



What We plan!

“Hello IFMSA!

As NMO DAs we want to improve the communication between

NMOs, and ensure that the region develops to it’s fullest potential.

We believe that PAMSA can take IFMSA very far, and we want to contribute to this by working with our beautiful RC, the PAMSA

NMO Presidents and all PAMSA members. So, let’s do this! Llama

Hugs. Alheli and Javiera”

As a family, we wanted all PAMSA to know what each of us is planning on doing

on this amazing journey waiting ahead for us! So here is a little message fromall of us to our dearest PAMSA.

Dear PAMSA family, as you know my name is Gabriela Noles but almost all people call me

Coti. I am glad and honored to be the IFMSA Regional Coordinator of the amazing Region

of the Americas.

This year as IFMSA RC Americas I will be focused mainly in supporting, updating and linking

NMOs by being in close contact with each one of them. Also, I will organize the procedures inthe region by updating/creating our Internal Operating Guidelines and all the attachments to

it.

Finally, I will assure a well organized and enjoyable RM2013 by working closely with the OC.

“Dear PAMSAeans,

It is with great honor and satisfaction that I introduce myself as the person in charge of the

projects of our beloved region. I am really motivated to make our region bigger than ever

through our projects. Initially, we have to work on our data base and strengthen the Project Support Division (PSD) in each NMO, developing and supporting them.

Getting an IFMSA ofcial status for most of the projects of our region is one of my goals. I will

work constantly with the national projects coordinators and each project coordinator in order

to give them support to present their projects during the MM and AM.

To summarize, the constant evaluation, communication and motivation of the people of our

region will be important things to consider in my period.

We are hardworking and full of energy. That is one of the reasons why I feel really proud of

being PAMSAean. On the other hand, projects are connected with all the committees and the

NMOs, we considered them as the heart of our federation. I’m sure that with our hard work,

everybody will get to know that PAMSA has the BIGGEST heart of the world! Do not hesitate

to contact me if you have any doubt related to projects. Lots of hugs

Mardelangel Zapata Ponze de Leon (Maggie )

Regional Projects Assistant”



“Hi! We are Paola and Erick, SCORA Regional Co-Assistants!

During this term we are going to work towards ensuring that

SCORA keeps its growth within the region, have a great team

with all the NORAs in the region and encourage the PAMSA

SCORAngels to develop more projects according to the reality of

our region.

To us, teamwork and mutual cooperation is a priority when

developing and growing as a unit. We are sure it is the only way

we can achieve the goals we have and make SCORA, the PAMSA

region and its NMOs grow and develop.”

“Hey my awesome SCOMEdians! It is with great pleasure that I write to you in the frame of

the Regional Meeting of PAMSA!

Since my appointment as Regional Assistant I’ve been working really hard Integrating and

developing SCOME in PAMSA. In this sense, I am working closely with the NOMEs of

the region to improve communication and collaboration between NMOs in creating and maintaining Transnational regional Projects and SWGs that attend to PAMSA’s needs and

priorities.

I deeply believe in the involvement of students in medical education, since we are the

recipients I think it is only fair that we have input on it, and SCOME gives us a space for

that purpose, making us one single voice in advocating for a better, modern and wholesome

medical education. It is this very voice I want to see roar in the Americas!

Let’s Rock SCOME in PAMSA! Elias Ortega. SCOME RA”

“Hi Dear PAMSA members

As SCORP Regional Assistant for PAMSA during these months I have experienced big

positive feelings and I can`t nd the exact words to describe them. I have used all of them

to inspire myself and all PAMSA SCORPions to continue working as hard as we can for

Human Rights and Peace all over the Americas and in each NMOs.

But our work as SCORP can`t stop right there; we need to continue the improvement in our

region to create a solid structure all over PAMSA. If we achieve this main goal, our regional

communication and projects will develop in an efcient mode.

Personally, as a motivated SCORP member I will put my best to give all my dear SCORPions

the mechanisms and tools to increase the amazing job they are developing in their NMOs and also being an integral participant of all SCORP PAMSA projects; hopefully to accomplish

a TRANSANATIONAL SCORP PAMSA PROJECT for all NMOs. Yeah!

I wish everybody an amazing RM and remember that motivation is the best way to change

the world positively.

Ricardo Gabriel Zules Oña

SCORP Regional Assistant for PAMSA 2011-2012”

PAMSA HeartBeat 19



“Hey PAMSA, my name is Roberto Garcia and I’m the SCORE RA

As RA this year, the rst activity will be the RM and Pre-RM, where I’ll meet all the NOREs of the

assisting NMOs, and together we will work as close as possible. We have to analyze the actual

situation of SCORE in PAMSA, seek which NMOs aren’t active and support them so they can

achieve the activation of SCORE in their NMOs. I think SCORE is a highly important committee

to the medical students, because it gives us the opportunity to involve ourselves deeper into the

investigation eld, and not only locally but internationally. I’ll work as well with the Exchange

Workshop along the SCOPE RA where we will give the National ofcers the tools to coordinate

the committee that they represent. I wish as well, by this mean, to tell every NMO that they count

with my total unconditional support for the development of SCORE in their country.

We will be working as well, with collaboration of other committees, in seeking the common

strengthen and the growth of PAMSA.

I hope that at the end of this year, many of the NMOs that don’t have SCORE active in them,

will be able to do so, and that in our region IFMSA continues to grow so we can keep creating

leaders for a society that needs them so much.”

“Hi my dear PAMSA family

This year I want to improve the SCOPH exchange in PAMSA, because we have a lot of good

projects that can be useful for this and we have a lot of people that have so many good ideas

about this topic.

Also I want to do online trainings about the topics you’d like, helping this way to capacitate

LPOs and NPOs in all the SCOPH related matters.

For me, it’s important to do more online meetings, where we can talk about all the problems we

have, as well as projects (already implemented or new ones).

I want to motivate you to participate more in [email protected], IFMSA- SCOPHin facebook and [email protected], there you can write all you want, share

photos, videos, and any other thing you’d like to share of a project.

I would like to be your friend, someone that is near you when you need.

Kisses and love”

GianinaTessyCerron Calderon

RA SCOPH PAMSA



“Dear PAMSAmigos and SCOPEans,

My name is Frédéric Morin, I am a 3rd year medical medical student at University of

Montreal and the SCOPE Regional Assistant (RA) within PAMSA. SCOPE, as you may

know, is the oldest Standing Committee (SC). One of IFMSA main goals is to give medicalstudents around the world a better understanding of what is global health and its inuences.

Regarding this specic goal, SCOPE is denitly reaching this goal by giving a practical

example of how a health system can inuence a population’s health and by creating reexions

and discussions among medical students. We will have the chance during the following days,

of what I already consider as a successful Regional Meeting (RM), to share our ideas and

visions of SCOPE, to gather our energy and enthousiasm to show the rest of the world how

proactive we can be in PAMSA and how fruitful our sessions can be. To me, this Regional

Meeting rhymes with tools development. I truly believe that such meetings allow us to share

our problems, our solutions, our ideas, through group discussions, activites, reexions and

projects. I really want all of us to leave this meeting with more IFMSA/SCOPE knowledgeand concrete ideas on how to improve your standing committee in YOUR NMO. To make

this possible, I would suggest all PAMSAmigos, not just SCOPEans, to write down a list of

goals they want achieve during RM. It looks a bit childish but I promise you will not regret

the outcomes of any meeting if you do so. I also invite you to see the potential in every

activities. We have a very packed agenda but I also encourage you to take advantage

of lunch times and other free time to learn more about IFMSA’s potential and to NEVER

stop sharing your ideas/problems/solutions with other delegates. I will be easily reachable

during the whole RM so don’t hesitate to talk to me at any moment during sessions, lunch,

free time or on the danceoor, why not? ;) Your questions, ideas and comments are always

welcome.

After 3 RMs, I can assure that: We are a family!

Frederic alias Fico/Fede/Fred”

PAMSA HeartBeat 21

heartbeat+ +sdh

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