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Brief analytical summaries or syntheses #53

Health in the Americas. 2012 edition


In Health in the Americas 2012, the Pan American Sanitary Bureau presents and analyzes health data and information from every country in the Region of the Americas. In drafting the publication, it has used data from many domestic and international, as well as unofficial, sources, trying as much as possible to identify and eliminate any discrepancies.


Chapter 1: A Century of Public Health in the Americas

In the last 110 years, Latin America and the Caribbean have experienced great transformations, from the independence of the Caribbean countries to the construction of modern states, from authoritarian regimes and dictatorships to democracy and the rule of law, and from cycles of economic growth and high productivity to financial crises, economic slow-downs, and massive foreign debt. The Region also has achieved a notable increase in life expectancy and a substantial reduction in poverty, as well as major improvements in the health and living conditions of the majority of the population. Around the world, and especially in the Americas, there is also an ongoing shift to a new paradigm and a comprehensive approach that considers health as the result of a complex interaction of biological factors, the physical environment, and a series of social, political, and economic determinants.

Finally, the new reality associated with rapid economic, social, and cultural globalization has highlighted the close associations between health and the development of societies, public policy management, foreign policies of countries, and interactions with multiple actors at the regional and global levels. Similarly, advances in scientific research, technology, and access to information have moved forward at dizzying speed and have gone further than ever envisioned. This has made possible, on the one hand, wide and immediate dissemination of new knowledge, ideas, and methods, and on the other, an unprecedented increase in social demand, growing capacity for change, and ultimately a more democratic distribution of power.

Analysis and results

Chapter 2: Health Determinants and Inequalities

Today it is well known that breaking the cycle of poverty depends on investments by governments, civil society, and families themselves in children’s rights and well-being, and in women’s rights and well-being. Spending on a child’s health, nutrition, and education; on his or her social, emotional, and cognitive development; and on achieving gender equality is not only an investment in a more democratic and a more equitable society, it is also an investment in a healthier, more literate, and, ultimately, more productive population.

Policies that promote equity can boost social cohesion and reduce political conflict. To be effective, most policies require broad political support, which is more likely to be forthcoming when the distribution of income is seen as fair. Many necessary policies for action on social determinants require intersectoral action. Successful implementation of such action requires a range of conditions, including the creation of a conducive policy framework and approach to health; an emphasis on shared values, interests, and objectives among partners; the ability to ensure political support and to build on positive factors in the policy environment; the engagement of key partners at the outset, with a commitment to inclusiveness; sharing of leadership, accountability, and rewards among partners; and facilitation of public participation.

Chapter 3: The Environment and Human Security

The vast Region of the Americas is home to diverse but highly vulnerable ecosystems; the Region’s large reserves of natural habitats have been strained on many fronts. The Americas is also the world’s most urbanized region: more than three-quarters of Latin Americans live in cities, a figure that is projected to reach 85% by 2030. While cities may provide better work opportunities and conditions and richer cultural and social circumstances for their residents than do rural areas, many urban environments can be stressed by unplanned and unchecked growth, unsafe roads and streets, housing deficits, an aging and inefficient public service infrastructure, and increasing inequities in access to goods and to public health services.

Chapter 4: Health Conditions and Trends

The quality of mortality data in the Region of the Americas has improved in recent years, as national vital statistics systems have been strengthened. Noteworthy improvements include: 1. the availability of more timely information that reflects more recent data; 2. higher-quality information with better coverage and fewer deaths attributed to ill-defined causes; and 3. better dissemination of information as a result of the adoption in many countries of policies on transparency in data availability. However, progress has not been even across the Region, and inequalities among countries have deepened in terms of the quality of mortality statistics.

Chapter 5: Health Systems and Social Protection in Health

This chapter describes and analyzes the situation and trends of the Region of the Americas’ health systems and social protection in health mechanisms during 2006–2010. It examines a range of issues, including governance in health, public policies, and national plans; the strengthening of sectoral capacity; and health system reforms with a primary care approach. It also reviews recent legislative trends toward a guarantee of the right to health, the legal framework that bolsters the role of the national health authority, and the countries’ challenges and achievements in social protection in health. The chapter also presents data on health expenditure and health financing—including household expenditure—and analyzes the impact of economic policy and the financial crises on the health systems. Finally, it explores issues dealing with access to and quality of the services, technology, and the situation and trends of human resources for health.

Chapter 6: Knowledge, Technology, Information, and Resource Management

Knowledge management and information technology are powerful tools for decision-making and for strengthening health systems. During 2006–2010, the Americas made significant progress in the development and use of new health technologies, as well as in information and resource management. The Virtual Health Library (VHL) is a prime example: available in 30 of the Region’s countries, the VHL serves as a clearinghouse for technical and scientific information in the countries’ health research, education, promotion, and care delivery systems. The Region also advanced in the development of national research policies and the consolidation of virtual collaboration as a cost-effective and time-saving tool. But, despite its recent achievements in this area, the Region has yet to overcome weaknesses that undermine technology and knowledge processes, such as a lack of global education strategies and limited investment in research, which accounts for less than 2% of the gross domestic product (GDP).


Chapter 7: Synthesis and Prospects

This chapter summarizes some of the leading health gains, gaps, and trends in the Region of the Americas. The aim here is not to present alternative scenarios, whose methodology would go beyond this publication’s objectives, but rather, to address issues related to the political, economic, and social contexts that have affected health in recent years. The chapter also touches on demographic and epidemiological changes, as well as certain transformations involving technology, culture, and risks. These have either a direct or an indirect impact on health and well-being that is both concomitant and concurrent and determines the health services’ response capacity. Finally, the chapter examines other relevant topics, such as those related to managing disasters and health alerts, as well as the ongoing evolution of ethics, human rights, and global health. The intention is to identify the predominant health trends during the period under review, along with their associated and determining factors, and to present some thoughts on future prospects for health in the Region.


Health in the Americas. 2012 edition

Gouvernement du Québec
© Gouvernement du Québec, 2018