New Life for Primary Health Care: the Social Determinants of Health

1. New Life for Primary Health Care: the Social Determinants of Health Dr. Mirta Roses Periago PAHO/WHO Presentation to the WHO Commission on the Social Determinants of Health Vancouver, Canada June 2007

2. The Social Determinants of Health in the Americas The Region is characterized by a demographic transition with high population growth, and rapid and unplanned urbanization. Research has shown the complex relationships between the social, economic, environmental, political and culture conditions – known as the social determinants of health – in the health of the population and communities. The Americas is the most unequal region of the World: 220 million people living in poverty

3. The Social Determinants of Health (SDH) and Primary Health Care (PHC) New focus on the SDH and human development recognizes that health should be central to the development agenda because: • Health is a basic human need • It is indispensable in the establishment of democratic societies • It is a fundamental human right Any approach to improve health should be linked within a broader economic, social and political context, and should allow for the inclusion of multiple actors and sectors

4. Achievements of PHC in the Americas include: For the past 30 years, PHC has been recognized worldwide as a key component of effective health systems.

5. Primary Health Care in the Region of the Americas There are still challenges and inequities to overcome in the countries of the Americas • Need to address exclusion in issues related to health. • Need to broaden social protection as a central element of sectoral reforms. • Definition of new strategic and programmatic orientations to improve health outcomes. • Integrate and incorporate the Millennium Development Goals (MDG)

6. The Social Determinants of Health and Primary Health Care PHC is a useful approach for equitable health and human development since it requires that more attention is placed on the operational and structural needs of health systems(access, sustainability of resources, political commitment, guarantee of high quality care, etc.).

7. Core Values, Principles and Elements in a PHC-Based Health System Universal coverage and access First Contact Intersectorial actions Comprehensive, integrated and continuing care Responsiveness to peoples’ health needs Adequate and Sustainable resources Family and community based Intersectoriality Quality-oriented Right to the highest attainable level of health Appropriate human resources Emphasis on promotion and prevention Equity Government accountability Participation Solidarity Optimal organization & management Sustainability Appropriate care Social justice Pro-equity policies & programs Active participation mechanisms Sound policy, legal & institutional framework

8. PAHO Technical Cooperation in PHC PAHO understands PHC as an integral part of the development of health systems and that the most appropriate path to produce equitable and sustainable improvements in the health of the people of the Americas is to build health systems based on PHC.

9. Main PHC Principles for Technical Cooperation • Responsiveness to people’s health needs • Government accountability • Quality-oriented services • Social justice

10. Main PHC Principles for Technical Cooperation • Sustainability • Intersectoriality • Social and individual participation

11. Social and Environmental Aspects of Primary Health Care In the Americas, the principles of PHC have been adopted and adapted by each country according to its own reality and needs. In the past few years, the Region has faced considerable changes: • Rapid and unplanned urbanization • Structural changes in health systems • Climate changes • Demographic transitions • Increased inequity and poverty

12. Social and Environmental Aspects of Primary Health Care The emphasis on the environmental aspects of PHC has been highlighted with the definition of “primary environmental care” (Borrini, 1990) that includes a focus on community-based development to achieve sustainable lifestyles with 3 elements: • Fulfill basic human needs • Strengthen people and community • Optimal and sustainable use and management of community resources

13. Social and Environmental Aspects of Primary Health Care One of the most effective answers is to consider PHC in its most broader form, emphasizing health promotion and prevention, as well as active citizen and community participation to achieve better health.

14. Community Active Selected Movement Faces, Voices, and Places of the MDGs is a regional initiative that targets the poorest and most vulnerable communities in Latin America and the Caribbean to help them achieve the MDGs from the perspective of health. Communities are chosen by national Ministers of Health in collaboration with PAHO/WHO Representatives (PWRs). Selection is based on their extreme conditions of vulnerability and poverty. To date there are in 26 communities in 13 countries participating. Reviews the experiences of work done since Alma Ata and re-energizes them through local work with a concrete objective; advancing towards the MDGs. "Our greatest concern must always rest with disadvantaged and vulnerable groups. These groups are often hidden, live in remote rural areas or shantytowns and have little political voice." Dr Margaret ChanWHO Director-General This initiative’s contribution to the Region is to shift from the analysis of MDG indicators to participatory, action-oriented research that fosters local empowerment. The initiative analyzes local realities, develops critical interventions, and provides targeted technical assistance with the support of PAHO/WHO technical units and other UN system agencies. We don't have to re-invent the wheel but make it spin faster! Puts the emphasis on improving conditions of peoples and their territories through the community self-management model. It is a catalyst for change, that coordinates actions to allow political leaders, the leaders and inhabitants of the communities, NGOs, IOs, and the international cooperation community work together at the local level. Empowers individuals and the community via a horizontal exchange partnership between local communities and providers of technical assistance. Is designed to foster a citizenry that exercises its capacity for change through their collective and individual power.

15. WHO Commission on Social Determinants of Health / Knowledge Networks and Faces, Voices and Places Social Exclusion The initiative is aimed at addressing the most vulnerable, neglected and economically deprived communities. In Ventanilla, Peru, through participatory action research methodology exercises the community and its citizens are being empowered to reduced social exclusion. Measurement and EvidenceThe initiative’s initial diagnosis includes a thorough study of available data on the community, setting of baselines and targeting and monitoring of advances. Through the PAHO - CEPAL-CELADE Agreement, census data from 19 LAC countries was analyzed and sub-national poverty maps were created to facilitate targeting of the most vulnerable communities. Women and Gender Equity In the Chiquimula and El Estor regions of Guatemala multi-cultural and gender perspectives have driven the work. This will lead to the development of healthy mechanisms, processes and actions to be taken at the local level to reduce gender-based inequities in health. Priority Public Health Conditions In Santa Fe de Veraguas in Panama, malaria control has been approached with a focus on socially and economically disadvantaged groups. Interventions and actions to improve the situation will address the social determinants causing inequities in health outcomes, barriers and will facilitate access to health care. Urban Settings In four communities in the Greater San Salvador area in El Salvador work is underway to address the most vulnerable and marginalized communities. The strategy employs an intersectorial, multi-programmatic, approach to influence health determinants through participatory activities centered on situation analysis. Early Child DevelopmentInYuty, Caazapa, Paraguay, efforts involving the community component ofthe IMCI strategy are underway through participatory planning exercises with local leaders. These have led to disease prevention and health promotion activities under MDGs 1, 4 and 5. These provideopportunities to young children and their mothers in shaping sound lifelong health and development status.