Dr. Sofialeticia MoralesSenior Advisor

Millennium Development Goals & Health Targets

AG/RES. 2307 (XXXVII-O/07)POVERTY, EQUITY, AND SOCIAL INCLUSION:

FOLLOW-UP TO THE DECLARATION OF MARGARITA

What is PAHO’s stance on the MDGs?

Global

Responding to Global Commitments, harnessing international aid, Inter-Agency alliances and collaboration as part of the UN System

Regional

Commitment, monitoring regional progress, evidence based knowledge sharing. Go beyond the national average to highlighting the most vulnerable people and communities

NationalSupport the development of national policies and programs to improve health and development through intersectorial strategies.

Local

Support mayors, empower the most vulnerable communities, work with grassroots and civil society to develop key interventions to bring change under the framework of health and development.

What has happened since the Millennium Summit

…and productivity increases

And poverty & extreme poverty reduced

Latin America: Poverty & Extreme Poverty (Change 1990-2006)

Percentage People Population Volume

Extreme Poverty Poverty

Per

cen

tag

e

M

illio

ns

Over the last two decades there has only been a 2% decrease

in the percentage of the population living in

poverty & extreme poverty

Our countries have added 69 million

new poor in the last 26 years

Gini Coefficient: Inequity among Regions 1990, 2000 & 2015

Prospective studies using the Gini

coefficient forecast that in 2015 Latin

America will continue being the most inequitable

region on the planet

LATIN AMERICA AND THE CARIBBEAN (25 COUNTRIES):

SOURCE: ECLAC

UNDERWEIGHT CHILDREN UNDER 5, 1995-2002 a/ (In percentages)

MDG 1 HUNGER

While sufficient foodstuffs are produced in the region to fulfill the caloric requirements of three times the current population, 53 million people have inadequate access to food.

MDG 1 HUNGER

Malnutrition begins in utero: About 17% of newborns in developing countries are born with low birth weight (UNICEF, 2006)

Category of public health significance(anaemia prevalence)

Mild (5.0-19.9%)

Moderate (20.0 - 39.9%)

Severe (>40.0%)

No data

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal statusof any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

© WHO 2005. All rights reserved

Pregnant Women

Pregnant

Category of public health significance(anaemia prevalence)

Mild (5.0-19.9%)

Moderate (20.0 - 39.9%)

Severe (>40.0%)

No data

Category of public health significance(anaemia prevalence)

Normal (<5.0%)

Mild (5.0 - 19.9%)

Moderate (20.0 - 39.9%)

Severe >40.0%

No data

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal statusof any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

© WHO 2005. All rights reserved

Not Pregnant

Category of public health significance(anaemia prevalence)

Normal (<5.0%)

Mild (5.0 - 19.9%)

Moderate (20.0 - 39.9%)

Severe >40.0%

No data

Anaemia Prevalence in Pre-SAC

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal statusof any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

© WHO 2005. All rights reserved

Category of public health significance(anaemia prevalence)

Mild (5.0 - 19.9%)

Moderate (20.0 - 39.9%)

Severe >40.0%

No data

Less than 5 years

Category of public health significance(anaemia prevalence)

Mild (5.0 - 19.9%)

Moderate (20.0 - 39.9%)

Severe >40.0%

No data

Anemic Populations in Latin America

Last reported or estimated data 1995-2005

27% 24% 18%

MDG 1 HUNGER

MDG 1 HUNGER

Responding to the commitments and priorities of the national public agenda to reduce chronic malnutrition in children with coordination between the national government and the Callao region.

Work is being carried out at the inter-sectoral and interagency level in Ventanilla to tackle the social determinants of health, promoting interagency work with UNICEF and UNEP

Ventanilla, PeruWorking at the Local Level

Unite forces: Poverty-Hunger-Malnutrition

Nutritional and Food Safety – PRESANCA in Central America

Evidence and Lessons Learned

• CHILE – JUNAEB, BRAZIL – Bolsa Familia, MEXICO - OportunidadesPerú – Crecer, Uruguay PANES alfabetización y salud El Salvador: Red Solidaridad Bolivia, Colombia

• Early Childhood Development Network, Commission of Social Determinants of Health,

• CANADA: “Putting Science into action”: Fraser Mustard & Stuart Shaniker

• V Inter-American Meeting of Ministers of Education (CIDI) • Inter Agency Collaboration (OAS, PAHO/WHO, UNICEF, UNESCO-

OREALC) with the leadership of Canada, Chile and Colombia.

MDG 1 HUNGERAreas of Collaboration

Gwatkin DR, Rutstein S, Johnson K, Suliman E, Wagstaff A, Amouzou A. Socio-Economic Differences in Health, Nutrition and Population within Developing Countries. An Overview. The World Bank, 2007; Washington DC.

School completion among women School completion among women Selected countriesSelected countries

MDG 2 EDUCATION

At the national level, Uruguay promotes MDG achievement through Faces, Voices and Places Initiative under the Healthy and Productive communities framework.

Community empowerment through health promoting schools and productiveInitiatives prove its impact on reducing poverty and promote development.

Canelones, UruguayWorking at the Local Level

MDG 2 EDUCATION

Strategic Alliance Health Education• Inter-American Contest of Best Practices for the Promotion of Health

in the ambit 130 experiences, 10 winning experiences / Nicaragua, Brazil, Chile, Colombia, Honduras, Argentina etc/ PAHO/WHO, UNESCO-OREALC, UNICEF, CAB, Brazil: Facendo Escola

• Health Promoting Schools Network – Friendly and Healthy Schools

Evidence and Lessons Learned:• Chile: Intersectorial Alliance, Brazil: Technical Ministerial Meeting, • Trinidad & Tobago, • The 1rst Caribbean Regional Curriculum Framework for Health and

Family Education• EDUCN/Caribbean Education Sector: HIV and AIDS Coordination

Network/ UNESCO – EDC – PAHO/WHO – St. Lucia

MDG 2 EDUCATION Areas of Collaboration

MDG 2 EDUCATION

PROPORTION OF THE POPULATION AND INCOME THAT CORRESPONDS TO EACH SEX PER QUINTILIL

in Percentages

Fuente: Comisión Económica para América Latina y el Caribe (CEPAL), sobre la base de tabulaciones especiales de las encuestas de hogares.

MDG 3 GENDER EQUALITY

PROPORTION OF FEMALES HEADS OF HOUSEHOLD BY INCOME LEVELLatin America (simple average 12 countries A/),Urban Areas 1990, 2002 & 2005

MDG 3 GENDER EQUALITY

53

4239

31 30 29

22

12 10 12 12 10

17

6

0

10

20

30

40

50

60

Bolivia (2003) P erú (2004) Colombia(2005)

Ecuador (2004) Nicaragua (1998) Haití (2000) RepúblicaDominicana

(2002)

Violencia física Violencia sexual

% of women that sometime between 15 and 49 years of age that have been victims of violence by their

husband or partner

MDG 3 GENDER EQUALITY

In the Canton of Corredores an initiative has been developed to strengthen the capacity of women for decision making and enhaced economic standing.

This has been done through a sustainable food production projects within the framework of nutrition and food security and healthy settings. These give an important focus on priorities such as safe drinking water and solid waste collection and management.

Canton Corredores, CRWorking at the Local Level

MDG 3 GENDER EQUALITY

• Consolidated Alliance CIM and PAHO’s Gender and Ethnicity Team• Promotion of the adoption of the Vaccine Human Papilloma Virus

(HPV)/ Cervical Cancer measures• Best Practices Contest for Health and Gender Equality: Let’s Get Real

Evidence and Lessons Learned

• Bolivia: Building bridges between the community and health services with a gender and culturally sensitive approach

• Mexico: Campaign for the prevention and control of diabetes in women• Declaration of Ministers of the Americas at the Meeting on Prevention

of Violence and Injuries, México, March, 2008. • MDGs Report 2006: A look at gender equity and women self-

determination in Latin America and the Caribbean/ CEPAL with Inter- Agency Collaboration 2006

Areas of Collaboration

MDG 3 GENDER EQUALITY

35 COUNTRIES& TERRITORIES IN LAC: Infant Mortalilty per 1000lb, 2007

MDG 4 INFANT MORTALITY

0.0 10.0 20.0 30.0 40.0 50.0 60.0

Cuba

Martinica

Guadalupe

Chile

Puerto Rico

Islas Ví rgenes de los Estados Unidos

Costa Rica

Barbados

Trinidad y Tobago

Santa Lucía

Uruguay

Guyana Francesa

Argentina

J amica

Bahamas

Antillas Neerlandesas

Belice

México

Aruba

Venezuela (Rep. Boliviariana de)

Panamá

Colombia

Ecuador

América Latina y el Caribe

El Salvador

Nigaragua

Perú

San Vicente y las Granadinas

Brasil

Suriname

Honduras

República Dominicana

Guatamala

Paraguay

Grenada

Guyana

Bolivia

Haití

Aruba

Antillas Neerlandesas

Trinidad y Tobago

Suriname

Grenada

San Vicente y las Granadinas

Paraguay

Santa Lucía

Venezuela (Rep. Boliviariana de)

Barbados

Martinica

Guyana

Panamá

J amica

Costa Rica

Uruguay

Colombia

Bahamas

Guyana Francesa

América Latina y el Caribe

Honduras

Puerto Rico

Bolivia

Islas Vírgenes de los Estados Unidos

República Dominicana

Haití

Argentina

Belice

Guatamala

Brasil

México

El Salvador

Chile

Guadalupe

Ecuador

Nigaragua

Perú

Cuba

Reducción relativa 1990-2007 (respecto de 1990) Cuánto falta para lograr la meta en 2015

Progresos en la reducción de la mortalidad infantil entre 1990-2007 y reducción pendiente hasta 2015 a (Indicador 14, ODM)

•Seven countries have a child mortality rate in children less than five years of age of 30 or more per 1000 live births;

Mortality in children less than five years of age has decreased from 31.7 to 27.0 per 1000 births (postnatal)Despite the decrease, every year 450,000 children die in hour hemisphere and 92% of the death occur in LA and the Caribbean

MDG 4 INFANT MORTALITY

Inequities are more pronounced at the local level (NBI – Infant Mortality)

99.77 to 100%

BOLIVIA 2001, Municipalities by Infant Mortality Rate

BOLIVIA 2001, Municipalities by percentage of the population with unmet basic needs (NBI)

There is a strong correlation between the infant mortality rate in a municipality & the

% of the population with unmet basic needs

BOLIVIA 2001, Municipalities by Infant Mortality Rate & Percentageof the population witn unmet basic needs (NBI)

MDG 4 INFANT MORTALITY

Has chosen the Healthy and Productive Communities Network to promoting changes in the quality of life in Chacaltaya through productive projects that generate employment and income.

Using this experience as a model, the goal is to replicate the approach in other communities of the Altiplano (Pampas Aullaga) and Chaco (Yapiroa) regions.

There is also support for the national Zero Malnutrition Program promoted by the Ministry of Health.

Chalcataya, BoliviaWorking at the Local Level

MDG 5 MATERNAL HEALTH

Haiti & Guatemala

Honduras, Nicaragua, Peru, Bolivia, Paraguay, Guyana, & Suriname

Fuente: DHS

Percentage of youth (15-19 year) that are already mothers or are pregnant by educational level

%

60.7

52.4

47.2

46.3

44.6

40.5

36.9

34.2

42.3

25.2

32.4

18.8

25.6

26.5

14.1

16.4

9.8

16.3

10.7

9.1

9.2

23.3

20.5

15.7

24.7

18.0

21.6

13.0

0 10 20 30 40 50 60 70

Rep. Dominicana 2002

Colombia 2005

Bolivia 2003

Nicaragua 2001

Haití 2000

Guatemala 1998/99

P erú 2000

Sin educación P rimaria Secundaria o más Total nacional

MDG 5 MATERNAL HEALTH

40% of unsafe abortions are done to women between the ages of 15 and 24

40% of young mothers are anemic

Adolescent mothers are 2x as likely to die as a result of pregnancy related complications, this is higher among those under 15

MDG 5 MATERNAL HEALTH

Cuba has joined the initiative with the Cotorro community. This community was selected because of the innovative way in which the socioeconomic vulnerability challenges have been address.

The community is a suburban area and sets an example for its high coverage of health services and low morbidity and mortality rates.

El Cotorro, HabanaWorking at the Local Level

MDGs 4 & 5

• UNDP/PAHO/WHO/CEPAL/UNICEF are focusing their work to collaboratively help advance in the reduction of infant mortality and the improvement of maternal health. We ask the OAS to join this effort

• Meeting of United Nations Regional Directors and the Inter American System (June 24-25, 2008)

Evidence and Best Practices– Casas Hogar for Mothers (ambulatory)– Centros de Desarrollo – Unidades Moviles– Barrio Adentro / Misiones

Maternal Health Infant Mortality

MDG 6 HIV/AIDS

It is stimated that 1.6% of women & 0.7% of men are infected with HIV/AIDS in the Caribbean, and that 0.3% of women and 0.5% of man in Latin America

Steep increase of new cases (adolescent, MSM, SW, IDU women and others)

Country Classification according to HIV and Tuberculosis epidemiologyCountry Classification according to HIV and Tuberculosis epidemiology

Countries with Generalized HIV Epidemic

Countries with Concentrated or Low Level HIV Epidemic

High TB Incidence*

Low&Medium TB Incidence a

High TB Incidence *

Low and Medium TB Incidencea

HaitiDominican Republic HondurasGuatemalaGuyanaSuriname

JamaicaTrinidad y TobagoBarbadosBahamasBelize

BrazilMéxicoEl SalvadorPeruBoliviaNicaraguaParaguayEcuador

CubaCosta RicaChileUruguayArgentinaVenezuelaPanamáPuerto RicoCanada ColombiaUnited States of America

* Estimated TB incidence over 50 per 100,000; a Estimated TB incidence below 50 per 100,000 population

MDG 6 HIV/AIDS

MDG 6 HIV/AIDS

Has launched an integrated strategy for municipal health development.

The strategy employs an intersectoral, multiprogrammatic approach toinfluence health determinants through participatory activities

These are centered on situation analysis, the identification of problems, and support for the design of local health plans grounded in the renewed PHC, reducing inequities, and extending social protection through a family health model.

Rosario de Mora, Santiago Texacuangos, San Salvador

Working at the Local Level

MDG 6 HIV/AIDS

Areas of Collaboration• Support the promotion and protection of Human Rights• Strengthen inter-sectorial action (health-education-

labour- finance-social development) as a means to reduce the number of new cases, particularly in the school ambit

• Political Advocacy to revitalize the HIV/AIDS prevention agenda

• Mexico City’s International HIV/AIDS Conference August 3-7 2008

New Reported TB Cases New Reported TB Cases Americas, 2006Americas, 2006

80%80%

HaitíHaití

Dom. Rep.Dom. Rep.

MéxicoMéxico

HondurasHonduras

EcuadorEcuador

Perú Perú

Bolivia Bolivia

BrasilBrasil

NicaraguaNicaragua

GuyanaGuyana

ColombiaColombia

GuatemalaGuatemala

PeruPeru

BrazilBrazil

50% 50%

Total: 224.548Total: 224.548

Source: Global Tuberculosis Control. WHO Report 2008.

MDG 6 TUBERCULOSIS

Malaria Situation in the Americas 2000-2006

18 Malaria-free countries

4 Countries with 50 - 74% decrease in total cases 7 Countries with <50% decrease in total cases

6 Countries with increases

•Decrease P. falciparum fatality rate from 13 to 4 per 10,000•20% decrease in malaria cases for the entire Region

4 Countries with >75% decrease in total cases

•18 countries transmission-free

•21 endemic countries•11 countries South America (73% cases P. vivax)•8 countries Central America (94% cases P. vivax)•2 countries in Hispaniola (almost 100% P. falciparum)

• 70% cases in the Region P. vivax• 29% P.falciparum• <1% P. malariae (Brazil,Guyana & Suriname)

MDG 6 MALARIA

Increased migration of people makes epidemiologic surveillance and monitoring increasingly difficult

Active participation of many sectors, particularly civil society and communities, remains lacking in many countries.

MDG 6 MALARIA

ObjectiveTo prevent the reintroduction of DDT for malaria control through the demonstration and evaluation of alternative and integrated methods of vector control that are cost effective, replicable, and sustainable.

BeneficiariesRural populations affected by malaria, public institutions that have to face the problem of malaria control, populations affected by the use of the DDT in the past, workers of vector control who have been exposed to DDT, women, and children who live in unhealthy settings close to vector breeding sites.

V Sanitary RegionWorking at the Local Level

MDG 7 ENVIRONMENT

0

100

200

300

400

500

600

Acceso a fuentes mejoradas de agua potable en América Latina y el Caribe

Millones de habitantes 2004

Urbana 404 16.8 420.8

Rural 97 35.9 132.9

Total 501 52.7 553.7

Con Acceso* Sin Acceso Total

Con Acceso*: Hogares y otros accesos a través de pilas, fuentes públicas y pozos protegidos.

Fuente: Evaluación de Medio Término del Programa Conjunto de Monitoreo (PCM) del abastecimiento de agua y saneamiento de OMS y UNICEF (2006)

52.7 million of people without access to safe drinking water

MDG 7 ENVIRONMENT

• Scarcity of safe and reliable sources of safe drinking water is one of the main problems in these communities.

• Sanitation is also a key problem causes increased prevalence of preventable diseases

• Of the main obstacles for resolving these issues is the construction and community management of aqueducts to channel water sources available but currently out of reach.

MDG 7 ENVIRONMENT

El Bongo Pencalá Los EncuentrosGuatemala

Working at the Local Level

Areas of Collaboration

• Meeting of Ministers of Health and Environment OAS-PAHO/WHO-UNEP to strengthen the alliance Health Environment

• Working with the Department of Sustainable Development in the water and sanitation initiative. (OAS, PAHO,UNEP.

MDG 7 ENVIRONMENT

MDG 8 PARTNERSHIPS

Work is being carried out in the municipality of Nabón in Azuay Province, which has a database, maps, social indicators, and an intersectoral, interagency intervention proposal with political backing and localinvestment.

National and international partnerships for development and inter-agency and intersectoral collaboration have been key for the achievements. Although progress has been made these partnerships need to be strengthened and shared with other communities through out the region

Nabon, Azuay

Working at the Local Level

MDG 8 PARTNERSHIPSFrom The Millennium Declaration to Local Action:

• Pool political will, technical expertise and targeted financial resources to extend the Faces, Voices and Places initiative to the poorest communities in each country. That no country is left out of this initiative

• To work in the Caribbean a new strategy for FVP with the MDGs Plus Strategy

• To work together to reinforce the role of the Inter American system in empowering Haiti.

• Address poverty and social inclusion in areas that are predominantly populated by indigenous populations, transcend borders and are marked by biodiversity and are chronically neglected. La Mosquitia in Central America, the Andean Antiplano, the South American Chaco and the Amazon Region.

POVERTY, EQUITY, AND SOCIAL INCLUSION

MDG 8 PARTNERSHIPS

Inter Agency – Inter Sectorial

Collaboration Mechanism:

• For advocacy & commitment

• To include pro-tempore presidents of ministerial meetings