PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the

1. . • PAN AMERICAN HEALTH ORGANIZATION • Pan American Sanitary Bureau, Regional Office of the • WORLD HEALTH ORGANIZATION SCHOOLS AS ENGINE FOR DEVELOPMENT AND HEALTH, A NEW WAY TO PROMOTE COMMUNITY DEVELOPMENT WITHIN THE FRAMEWORK OF THE SOCIAL DETERMINANTS OF HEALTH FOR THE ACHIEVEMENT OF THE MDGs Dr. Sofialeticia Morales Senior Advisor Millennium Development Goals Team Leader Education and Health Unit of Health Determinants and Public Policies

2. MILLENNIUM DEVELOPMENT GOALS HIGHEST LEVEL POLITICAL CONSENSUS ON MEASURES TO COMBAT POVERTY 1 ¿WHY ARE THE MDGs IMPORTANT? 2 HEALTH OCCUPIES A CENTRAL PLACE OF IMPORTANCE FOR DEVELOPMENT • Commitment to Action • Consolidate progress, resolve problems • Position health as a top public priority • Reduce inequities • Respond to national and regional needs • Inequity and Poverty • HIV/AIDS • Environmental Protection GOALS, TARGETS AND INDICATORS ARE QUANTIFIABLE AND AMBITIOUS / MEASURE THE PROGRESS AND DEMAND PROGRESS 3 IT IS POSSIBLE TO CALCULATE THE COST OF ACHIEVING THEM, WHAT IS AVAILABLE VERSUS WHAT IS NECESSARY 4 GLOBAL PARTNERSHIP FOR DEVELOPMENT EMPHASIZES HUMAN SECURITY AND GLOBAL PROSPERITY SAFETY AND WORLD PROPOSPERITY 5

3. Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality and empower women Reduce child mortality Improve maternal health Combat HIV/AIDS, malaria, and other diseases Ensure environmental sustainability Develop a global partnership for development The Millennium Development Goals • A set targets & indicators bound by a specific time frame for completion (1990 2015) • A synergic and indivisible unit that requires intersectorial action for their completion

4. OBJETIVOS DE DESARROLLO DEL MILENIO PAHO’s STAND ON THE MDGs • Highlight the challenge of inequity in the world’s most inequitable region. • Go beyond advocacy and monitoring to become directly involved on interventions at the municipal level. • Carry out a regional mapping exercises of the most vulnerable municipalities, based on MDG related local level indicators derived from National Censuses and Population. (ECLAC/CELADE/PAHO Agreement) • Consider the social, economic, political, environmental and cultural determinants and their impact on health. • Analyze and respond to the multi-dimensionality and multi-causality of the poverty particularly. • Work at the municipal level to work on all the MDGs respecting their indivisibility and synergy. • Launch the initiative Faces and Places of the MDGs

5. The Social Determinants, Health Promotion and the MDGs “The social determinants refer to the social conditions in which people live, study, work, and develop” The MDGs recognize the interdependence of health and social conditions, and offer an opportunity to develop health policies that address the social roots of avoidable human suffering arising from unjust social conditions.

6. SOCIAL DETERMINANTS OF HEALTH HEALTH PROMOTION PROTECTING & RISK FACTORS MILLENNIUM DEVELOPMENT GOALS SCHOOLS ENGINES FOR DEVELOPMENT TWO WAY INTERACTION WITH THE MUNICIPALITY

7. THE SOCIAL NATURE OF HEALTH Health is not exclusively a bio-natural occurrence related to the individual, but the result of complex and changing relations and interactions between biological, individual, environmental, and living conditions of economic, environmental, cultural, and political order. We get sick and we die in relation to the way we live, eat, reproduce, work, relate to others, educate, develop our capacities and face ours limitations . This is the focus of SOCIAL DETERMINANTS OF HEALTH

8. Declaration on the New Orientations for Primary Health Care (Declaration of Montevideo) • Commitment to facilitate social inclusion and equity in health. • Recognition of critical roles of both the individual and community in the development of PHC-based systems. • Orientation toward health promotion and comprehensive and integrated care. • Development of intersectoral work.

9. Values Right to the highest attainable level of health Equity Solidarity Principles Responsiveness to people‘s health needs. Quality – oriented Government accountability Sustainability Participation Intersectoriality Renewing Primary Health Care in the Americas

10. The Causes of the Causes SOCIAL CONTEXT CULTURE, RELIGION, SOCIAL SYSTEM HUMAN RIGHTS, LABOUR MARKET, EDUCATIONAL SYSTEM STRUCTURAL DETERMINANTS PRODUCE SOCIAL STRATIFICATION AND INCLUDE TRADITIONAL FACTORS SUCH AS EDUCATION AND INCOME, AS WELL AS GENDER, ETHNIC ORIGIN AND SEXULITY HEALTH PROMOTION PRIMARY HEALTH CARE SOCIAL PROTECTION HEALTH SYSTEMS GLOBALIZATION INTERMIDIATE DETERMINANTS ARISE FROM THE CONFIGURATION OF THE SOCIAL ESTRATIFICATION AND DETERMINE THE DIFFERENCES OF EXPOSITION AND VULNERABILITY TO THE CONDITIONS UNHEALTHY CONDITIONS BIOLOGICAL PROCESSES HEALTH/ILLNESS

11. Negative Impacts On Health Structural Determinants Intermediate Determinants Risk Factors Results in the Health + + = Hunger & Malnutrition Limited Access to health Services & Education Quality Unemployment Contamination and Climate Change Addictions Obesity Morbidity Mortality Reduce Life Expectancy Low Quality of Life Vulnerability Maternal and Child` Diseases Communicable Diseases Chronicles Mental HealthProblems HIV-AIDS Social Poverty and Inequality Economic Political Environmental Degradation Environmental Styles of Life not Healthy Technological Biological Reduction of Factors of Risk Better Results in the Health ( - ) Negative On Health Structural Determinants Intermediate Determinants + = Impact Positive in the Health and the Quality of Life Millennium Development Goals 1990-2015 Determinants of Health and the Millennium Development Goals

12. DETERMINANTES SOCIALES DE LA SALUD Y SU IMPACTO EN LA ESCUELA Y EN LA COMUNIDAD • Access to education and health services • Social Security and Protection Programs • Health and Education as a right ECONOMIC POLITICAL • Bad Quality Education • Bad Quality Health Services • Morbidity and Mortality • Materno-Adolescent Mortality POVERTY MARGINATION MINIUMUM WAGE INCOME COMPENSATIONS COMMITMENT TO HEALTH, SOCIAL POLICYL, LAWS REGULATIONS FACES, VOICES & PLACES SCHOOLS SOCIALES Y CULTURALES AMBIENTALES • Discrimination • Obesity • Prevention Culture • Stress • Sedentarism • Cardio Vascular and metobolic pathologies • Violence STRATIFICATION FACTORS ETHNIC GROUP, GENDER, SEXUAL ORIENTATION. HEALTH HABITS PERCEPTIONS HEALTH/ ILLNESS AIR AND WATER QUALITY SANITATION CHEMICAL SUBSTANCES CONTAMINATION OZONE LAYER DEPLETION, CLIMATE CHANGE • Poor basic sanitation • Parasites • Enfermedades infecciosas • Respiratory Infections • Diahreal Diseases • Malaria, Dengue • Skin Cancer • Lead Poisoning

13. SOCIAL DETERMINANTS OF HEALTH AND EDUCATIONDiagnosis and Context • ECONOMIC • To what socioeconomic group the students belong to? • What economic problems have and how these affect their education and health? • SOCIAL • Are their parents are illiterate or university graduates? • Do they have access to culture at home? • CULTURAL • What is the value that their culture assigns to the education and health? • ENVIRONMENTAL • Where is the school located? • What are the environmental problems in the municipality? • How do these problems affect their health?

14. With themselves CREAT AND SUSTAIN RELATIONSHIPS SEXUAL RELATIONS HANDLING STRESS TRANSFORMING THEIR SORROUNDINGS EMOTION CONTROL EMPATHY DECISION TAKING PROBLEM SOLVING CRITICAL THINKING CREATIVE THINKING SELF UNDERSTANDING How to educate to create and sustain healthy relationships? How to help students to understand themselves better? How to educate them to control their emotions? Providing relevant information and respect for themselves and others? How to commit students to improving their social sorroundings? How to teach them to control their stress? How to make students empathetic? With others With the community Education for freedom Quality Education and teaching capacities for life Skills for Life

15. What is the role of Schools in community development? School Engines for Development play a key role in community transformation. • They promote health through knowledge, understanding, and re-assessing the students immediate context. • The educational community is certain of the context where its everyday life takes place and can describe it by identifying the social determinants of health and analyzing how these social determinants play a key role in school life • An initial analysis takes place from the school and about the school to identify the interplay of the school and community and how its location limits or promotes educational quality and the school as motor for community transformation beyond classroom walls.

16. What is the role of Schools in development, health promotion and addressing the determinants • The initial context analysis exercises is endogenous and centered around the school and mindful of the elements that promote or limit the provision of quality education.   • The secondary level analysis is exogenous in nature and centered on the municipality as a geographical, jurisdictional and political entity. The analysis is based on the history, its peculiarities, and its cycles; sources of employment, economy, politics, and environment

17. Social Policy SCHOOLS AS AN ENGINE FOR DEVELOPMENT Human Development: Sustainable / Equitable Millennium Development Goals & other relevant national agendas Health Promotion, Renewed Primary Health Care Classroom ~> School ~> Family ~> Comunity ~> Municipality ~> TARGET Children, Teenagers, Young Adults, Social Determinants of Health

18. The Pedagogy of Development • Schools and Engines for Development base their strength in the pedagogy of development that has as its axiological foundation the value of human life as a fundamental right. • Takes on the paradigm of Education for Freedom, where education occurs through dialogue. This approach requires the development of alternatives and critical visions. Where the analysis of various points of view is essential for evaluating, transforming conceptions, attitudes, substantiate beliefs, and worldviews.   

19. The Pedagogy for Development and Education • The pedagogy of the development in the classroom where the educational act allows the transformation of the student’s understanding of community’s reality through dialogue and an analysis of the problems being faced. • The pedagogy of the development in the school implies a collegiate action that leads the students and the educator to develop a school project that involves the whole school. • Learning will take place by doing and the transformation of an aspect of the school. • The pedagogy of the development in the community through an action of co responsibility between the educational community and the key actors of the community.

20. Schools Engines for Development and Health • Arises from the analysis of the social determinants of health and aims advancing toward the achievement the Millennium Development Goals and other pertinent agendas with the understanding that schools are the engine for development. • The commitment implies first creating or consolidating the national, provincial and local networks of schools and later to promote the international networks. • The national Networks become solid foundations for the sharing of experiences, success stories and challenges in making that schools become promoters of development. It is necessary to link the schools with the first level of care within the framework of Primary Health Care to ensure that the local development is consolidated through the partnerships between schools and health services.

21. SUPPORTING TECHNICAL PARTNERSHIPS EDUCATION • Health Promoting Schools(1995), • Programs Responding to Violence in Schools settings • HIV/AIDS prevention Social Protection and Education Workers Health UNESCO/OREALC/ PAHO/ILO Health and Occupational Health Virtual Network Educational Environments Healthy and Violence Free Network of Healthy Environment For Children LABOR ENVIRONMENT Health Promotion and Prevention Primary Health Care Provision of Health Services Training and Education Strategies HEALTH

22. Other methods to promote health within the framework of the determinants The promising introduction of programs that combine financial assistance with the human resources development and the improvement of health and living conditions • Bolsa Familia - Brasil • Oportunidades - México • Chile Solidario/ Chile Puente • Barrio Adentro - Venezuela • Familias en Acción - Colombia • Bono de Salud - Bolivia • Beca escolar - Ecuador • Programa de Asignación Escolar - Honduras • Bono Alimentario y Escolar -Nicaragua. • Red de solidaridad y oportunidades - El Salvador • Plan Familia - Argentina

23. EMPHASIS: