TALLER SOBRE GOBERNANZA DE LA SALUD, DEL AMBIENTE Y DEL DESARROLLOSUSTENTABLE EN UN CONTEXTO INTER SECTORIAL - ISAGSAborda...
Relevancia de la Salud Publica como lider delnuevo proceso global de desarrollo sostenible Los determinantes ambientales y...
Transición Rural-Urbana en las                                               Américas, 1950-2010                          ...
Pirámides de población de lassubregiones principales de las Américas;              1900 - 2010
Ejemplos de protección social en saludArgentina        “Plan Nacer”                 “Asignación Familiar por HIjo”Brasil  ...
PORTO ALEGRE COHORT, BRAZIL                                Source: Bassanesi et al. Arq Bra Card 90(6) 2008               ...
Mexico Enfermedades cronicas atribuibles a                                      obesidad                                  ...
Global inequalities: energy rich, energy poor                                                A. Per capita                ...
GLOBAL ESTIMATES: NCDS HARVARD WEF STUDY ESTIMATES IN 47 TRILLION USD THE $ BURDEN                               http://m....
Brasil: redistributional effect on infant mortality inequality, 1997-2008            Equity in health‐the backbone for the...
maternal mortality inequalities by female years of schooling, The Americas                                             700...
concentration of social inequalities in mortality; The Americas, 2008                                                     ...
urban-rural inequalities in progress towards MDG7                        urban                           ruraldrinking  wa...
el mayor riesgo de muerte materna se concentra sistemáticamente en la              población con menor acceso a agua potab...
infant mortality by quartile of access to sanitation; The Americas, 2008                                                  ...
maternal mortality by quartile of access to water; The Americas, 2008                                                     ...
human development inequalities in mortality; The Americas, 2008                                                           ...
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,            ...
“The Future we Want”Preamble:•   We recognize that health is a precondition for, an outcome of, and an     indicator of al...
The Future We WantParagraphs on Health and population Chapter:‐ Universal health coverage ‐ equitable universal coverage;–...
Thematic Consultations Themes    In addition to the country consultations, a number of thematic consultations are being   ...
Procesos para los ODS (rojo), marco de desarrollo post-2015 (azul), consultas         (naranja) Implementacion y revision ...
What priority themes should     SDGs address?
Esquema dee conceptos que serviran para definir el nuevomarco de desarrollo global para los ODMs despues del 2015
A COMMON AGENDA, AND ONLY       SO MANY TO ACT ON IT
COMMON ELEMENTS IN THE AGENDA                          PHC SDH NCDs     DEVELOPMENT    HEALTH                             ...
Common Inherent elements
New responsibilities of Ministriesof Health, will need to include atleast:• understand the political requirements of theot...
Position and Find the Synergies
Luiz Galvão - Abordaje conjunto de los determinantes sociales y ambientales de la salud.
Luiz Galvão - Abordaje conjunto de los determinantes sociales y ambientales de la salud.
Luiz Galvão - Abordaje conjunto de los determinantes sociales y ambientales de la salud.
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Luiz Galvão - Abordaje conjunto de los determinantes sociales y ambientales de la salud.

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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.

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Luiz Galvão - Abordaje conjunto de los determinantes sociales y ambientales de la salud.

  1. 1. TALLER SOBRE GOBERNANZA DE LA SALUD, DEL AMBIENTE Y DEL DESARROLLOSUSTENTABLE 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
  2. 2. Relevancia de la Salud Publica como lider delnuevo 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.
  3. 3. Transición Rural-Urbana en las Américas, 1950-2010 100 80proporción poblacional (%) 60 ALC  urbano NA  urbano ALC  rural NA  rural 40 20 0 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010
  4. 4. Pirámides de población de lassubregiones principales de las Américas; 1900 - 2010
  5. 5. Ejemplos de protección social en saludArgentina “Plan Nacer” “Asignación Familiar por HIjo”Brasil “Bolsa Familia” “Programa Salud de la Familia”Chile “Chile Solidario” “Acceso Universal con GarantíasExplícitas” (AUGE)Colombia “Familias en Acción”Haiti “Servicios Obstétricos Gratuitos” (SOG) “Servicios Infantiles Gratuitos” (SIG)México “Seguro Popular de Salud”
  6. 6. PORTO ALEGRE COHORT, BRAZIL Source: Bassanesi et al. Arq Bra Card 90(6) 2008 •LOWER STATUS 2.6 TIMES HIGHER RISK OF CVD DISEASE •Area relatively wealthy • In productive age group • Cerebrovascular 3 time higher than in USA in the younger age group COST TOSOCIAL CARDIOVASCULAR LABOR &GRADIENT UNSUSTAINABLE CONDITION PRODUCTIVITY
  7. 7. Mexico Enfermedades cronicas atribuibles a obesidad Source: Estrategia de Salud Alimentaria, 2010 Para 2010, el costo atribuible para sobrepeso y obesidad fue equivalente al total de recursos del “Seguro Popular” para roveer aceso universalLas intervenciones incluidas en el cálculo son: diagnóstico y tratamiento farmacológico de diabetes mellitus tipo 2; diagnóstico y tratamiento de la neuropatíaperiféricasecundaria 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,osteoartritisGradiente EnfermedadesSocial Riesgos Costo al sistema Insostenible cronicas y familias
  8. 8. Global inequalities: energy rich, energy poor A. Per capita Carbon emissions A. Health impacts from climate change: higher on those with lower emissions B. 2.4 billion exposed to pollution from solid fuels: B. Biomass use health impacts (% of all energy at remain with the national level) users Source: Wilkinson et al, Lancet 2007Globally, 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).
  9. 9. GLOBAL ESTIMATES: NCDS HARVARD WEF STUDY ESTIMATES IN 47 TRILLION USD THE $ BURDEN http://m.ibtimes.com/gallup-u-s-workers-86-percent-u-s-GLOBAL ESTIMATES: GALLUP workers-have-chronic-conditions-chronic-conditions-cost- 153-billio-233376.html 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 MEDICAL COSTSOCIAL &GRADIENT CHRONIC DISEASES UNSUSTAINABLE PRODUCTIVITY
  10. 10. Brasil: redistributional effect on infant mortality inequality, 1997-2008 Equity in health‐the backbone for the post 2015 Development  A d
  11. 11. maternal mortality inequalities by female years of schooling, The Americas 700 1.0 1990 2010 0.9 600 0.8maternal mortality (x 1 0 5   live births) 500 maternal deaths (c umm %) 0.7 0.6 400 0.5 300 0.4 0.3 200 0.2 100 0.1 1990 2010 0 0.0 0 2 4 6 8 10 12 14 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 schooling (years) population gradient by years of schooling (cumm %) health concentration index in 1990 = - 0.44 health concentration index in 2010 = - 0.27 Equity in health‐the backbone for the post 2015 Development  A d
  12. 12. concentration of social inequalities in mortality; The Americas, 2008 diabetes deaths, by gender 1.0 0.9 0.8 0.7 diabetes deaths (cum m  % ) 0.6 0.5 0.4 0.3 0.2 HCI males = -0.117 0.1 female male HCI females = -0.184 0.0 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 %) Equity in health‐the backbone for the post 2015 Development  A d
  13. 13. urban-rural inequalities in progress towards MDG7 urban ruraldrinking  watersanitation Equity in health‐the backbone for the post 2015 Development  A d
  14. 14. 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 750 1.0 1990 675 2000 0.9 2010 600 0.8mortalidad materna (tasa x 100,000 nv) muertes maternas (% acum) 525 0.7 450 0.6 375 0.5 300 0.4 225 0.3 150 0.2 1990 75 0.1 2000 2010 0 0.0 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 domiciliar gradiente social de acceso a agua con conexión domiciliar mortalidad materna (por 100,000 nv) 1990 2000 2010 valor promedio regional 86.66 67.31 58.92 índice de desigualdad de la pendiente (desigualdad absoluta) ‐171.75 ‐125.01 ‐52.81 índice de concentración de la desigualdad (desigualdad relativa) ‐0.42 ‐0.38 ‐0.18 Equity in health‐the backbone for the post 2015 Development  A d
  15. 15. infant mortality by quartile of access to sanitation; The Americas, 2008 24.9 25 infant mortality rate (xr 1,000 live births) 20 18.8 15 12.9 10 6.6 5 0 lowest second third highest quartile of improved access to sanitation Equity in health‐the backbone for the post 2015 Development  A d
  16. 16. maternal mortality by quartile of access to water; The Americas, 2008 138.6 140 maternal mortality ratio (x 1,000 live births) 120 100 88.4 80 57.9 60 40 23.2 20 0 lowest second third highest quartile of improved access to water Equity in health‐the backbone for the post 2015 Development  A d
  17. 17. human development inequalities in mortality; The Americas, 2008 external causes, by gender mortality, external causes (rate x 10  pop) female 200 179.3 male 5 160 143.6 120 109.0 106.4 86.4 73.7 80 65.5 37.1 50.8 40 31.0 28.5 23.7 0 lowest second third highest human development quartile Equity in health‐the backbone for the post 2015 Development  A d
  18. 18. Eventos globales de relevancia en desarrollo
  19. 19. The Future We Want
  20. 20. 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%201230p m.pdf
  21. 21. “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.
  22. 22. The Future We WantParagraphs 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.
  23. 23. 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
  24. 24. Procesos para los ODS (rojo), marco de desarrollo post-2015 (azul), consultas (naranja) Implementacion y revision de los ODMs (verde)
  25. 25. What priority themes should SDGs address?
  26. 26. Esquema dee conceptos que serviran para definir el nuevomarco de desarrollo global para los ODMs despues del 2015
  27. 27. A COMMON AGENDA, AND ONLY SO MANY TO ACT ON IT
  28. 28. COMMON ELEMENTS IN THE AGENDA PHC SDH NCDs DEVELOPMENT HEALTH MDGs SUSTAINABLE PROMOTIONGovernance / StewardshipHealth system actionCommunity / social participationInformation for monitoringAllignement of stakeholdersHealth in All Policies / Healthy PoliciesHealth StewarshipEquity goalSpecific Concern for NCDsRequire efective Health PromotionImpact of NCDs on Development
  29. 29. Common Inherent elements
  30. 30. New responsibilities of Ministriesof Health, will need to include atleast:• understand the political requirements of theother sectors and agendas• build the knowledge base of policy options•Assess the comparative health consequencesof options• create regular platforms for dialogue and work• evaluate and monitor Modified from Adelaide statement on HiAP, 2010
  31. 31. Position and Find the Synergies

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