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

Membercapacity

… there are many challenges ahead

CountryPublic Policy

Change in the economic

performanceExternal

Resources Available

Socio-determinant Factors

UNMandates

UN

Changes

Integration System

Inter American Systems