Rio de Janeiro, August 2016
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The Rio Olympics and Health Surveillance
ISAGS
The games in the Brazilian city presented opportunities and challenges for the health surveillance, one of the most debated topics in ISAGS since its foundation
Between August 5th and 21st, the city of Rio de Janeiro received nearly one million visitors from around the world, among tourists, athletes, coaches and journalists, according to official statistics. Besides these people, countless microorganisms circulated in means of transport, arenas, hotels and restaurants, which demanded not only the need to carefully organize the provision of health services, but also a robust health surveillance because, according to the report “Communicable disease alert and response for mass gatherings” of the World Health Organization (WHO), there is the “potential for increased risk of importation of infectious diseases”. This scenario has allowed two important partners of the ISAGS to develop their activities. On the side of scientific research, the novel microbial diversity in the city transformed the subway in a laboratory for researchers of the Oswaldo Cruz Institute (IOC/Fiocruz). Part of the MetaSUB International Consortium, this work included the analysis of the transformation caused by the mega event in the microbiome of Rio de Janeiro from samples collected at local subway stations and trains. Although similar surveys are being conducted in 50 other cities in the world, this is the first time it takes place in the context of a mass event. “This information can help in the surveillance process. It is
possible that in the future we can identify, for example, the entry of a new virus, the influenza strains that are circulating or the detection of a species of bacteria that has never been identified in Brazil”, said Milton Ozorio Moraes, Chief of the Institute’s Leprosy Laboratory and coordinator of the project. “All the information is being monitored in an open and shared way with the other cities of the consortium”. Meanwhile, the Health Surveillance Agency of Brazil (ANVISA) was responsible for preventing this microbial diversity from becoming a risk to the local population and visitors. With 17 years of experience in organizing regular mass events in Rio in January at a smaller scale, such as the celebration of New Year and Carnival, as well as the organization of the Football World Cup in 2014 with events in 12 host cities scattered along the country, ANVISA has been sharing its know-how with other South American countries in several events and workshops in ISAGS, including the publication of the Institute “Health Surveillance in South America – epidemiological, sanitary and environmental”. In preparation for the Games, two guides for Health Surveillance Performance in Mass Events were published, one on risk management and the other on the regulation of the provision of food and health services, as well as various resolutions and an integrated plan to guide its operations.
Including actions of three governmental levels – the Union, the state and the municipality of Rio de Janeiro – and the Rio 2016 Committee, the Integrated Operational Plan for Sanitary Vigilance defined the actions to be performed during the preparation period and during the event. “Among the actions listed in the Plan, those considered essential in ensuring the health safety of the event were highlighted in a Responsibility Matrix”, said Daniela Gomes, ANVISA Commission coordinator for the Olympic and Paralympic Games Rio 2016. “In such a model, after conducting workshops, the Operational Plans for the other five locations that hosted the Olympic football were elaborated, with emphasis on the planning of public health laboratories in forecasting and conducting analysis of products subject to sanitary surveillance”. ANVISA also participated in the activities developed in the Integrated Centre for Joint Health Operations (CIOCS). “It is a specialized structure that aims to institutionally coordinate the detection, assessment, monitoring and response to health claims related to the Games”, explained Daniela. Among the CIOCS initiatives that had the support of ANVISA are the monitoring of public health events primarily related to food services and health services, support for municipal health surveillance of Rio de Janeiro in obtaining and consolidating inspection data in health services, food services, ambulances, sanitary facilities and water supply.
READ MORE Distribution of medicines in Venezuela Page. 2 ISAGS provides overview on nutritional health in South America Page. 3 INTERVIEW: Enrique Jacoby Page. 4
Rational use of medicines and a strengthened distribution system are the strategies of Venezuela for ensuring supply
ISAGS
Actions have been strengthened to ensure equitable access by all the Venezuelan population
Venez ue la ’s Minis ter of He alt h L u isan a M elo
On a global level, a proper supply of medicines is a priority in many countries, as well as it is affected by various factors that may translate into barriers to equal access to medical products. The medicines supply shortage issue is rather complex, as it may be a result of mechanisms to promote research and development to regulatory and intellectual property barriers, which are reflected in high prices and even the very physical unavailability of a medicine due to the industry’s lack of interest in producing it. Across South America, countries are implementing measures to strengthen medicine supply process in order to boost universal access policies. In Venezuela, the Ministry of Popular Power for Health has adopted measures and reached agreements with regional directors to consolidate the drug distribution system in the country, as well as to strengthen the national pharmaceutical system. According to the country’s Health Minister, Luisana Melo, the rational use of drugs is essential to ensure access to the entire
population. In an official statement, the head of the Ministry reported that medicines supply will be carried out under strict rules and according to the real needs of the population. Furthermore, she added that it is necessary to “abandon the practice of favouring brandname over active principle imposed by large multinational companies”, reinforcing the need for prescriptions and procurements under scientific basis. In this sense, the general director of the Autonomous Service of Pharmaceutical Elaborations (SEFAR), Gerardo Biceño in an interview with journalist Francisco Solórzano, reinforced the idea that the country’s policy consist of a list of essential medicines, reaffirmed in 2015, with drugs that meet most of the diseases that affect the country’s population. “We do not allow innovative medicines that fail to demonstrate a significant costeffectiveness on the patient, resulting in an economic cost for the National Public Health System”, he added. According to the Minister, the country has an installed capacity to produce 75% of the
medicines needed to fight diseases that affect Venezuelans and has been systematically working to strengthen the national productive system. In addition, the government is applying logistical improvements through point-to-point distribution, eliminating warehouses and making medicines directly available for health centres in the communities. Universal access to medicines is one of the areas that underlies the actions of the Health Council of UNASUR since its foundation. In 2014, the bloc’s Health Ministers agreed to continue strengthening regional mechanisms to monitor and characterize supply shortage in order to prevent and mitigate problems of access, rational use and financial sustainability of health systems in the region. This issue was at the heart of one of the common interventions of the Council before the World Health Assembly this year, which reaffirmed that equitable access to medicines is a necessary condition for achieving the highest possible level of health, an indispensable requirement in order to make progress in ensuring the right to health.
ISAGS provides overview of nutritional health in South America in International Conference on Nutrition
HEALTH CONNECTION
The event took place for the first time on the eve of the opening of the London Olympic Games in 2012 and will also take place in Tokyo in four years
DIRECTOR CARINA VANCE MET WITH THE GENERAL DIRECTOR OF INCA On August 12 th, the Executive Director of ISAGS Carina Vance met with Luiz Fernando Bouzas, General Director of the National Cancer Institute of Brazil (INCA) that holds the Executive Secretariat of the Network of Institutes and National Institutions of Cancer (RINC-UNASUR) since its formation. During the meeting, future joint actions for the control and treatment of cancer in the continent were raised, highlighting the progress made in the project “South America Free of Cervical Cancer” funded by UNASUR, coordinated by the RINC. ISAGS is its executing agency.
ISAGS
RISKS & DISASTERS
A day before the 2012 Olympic Games opening ceremony, Rio de Janeiro hosted the summit Nutrition for Growth (N4G), organized by the Ministry of Health of Brazil, the United Kingdom Cooperation Agency (UKaid) and the government of Japan. Under the motto “Accelerating progress against malnutrition with actions to promote access to health food for all”, the event was attended by the Minister of Health of Brazil, Ricardo Barros, the head of the World Health Organization, Margaret Chan, the director of the Food and Agriculture Organization of the United Nations (FAO), José Graziano da Silva, and the executive director of ISAGS, Carina Vance. During the meeting, Vance provided an overview of the South American current context on the issue, with positive data on reducing malnutrition, but at the same time with striking inequality between countries and a growing concern with the increase in obesity. “About 60% of the population is overweight in Latin America, the highest rate in the world”, she explained, with successful food labelling policies initially implemented in Ecuador by Vance when she was Minister of Health. Currently, similar initiatives have been replicated in other countries such as Bolivia and Chile. Before that, the WHO Director Margaret Chan opened the event by thanking the host countries of the Olympics for
holding the meeting before the games, since nutrition and sport overlap. Chan praised Brazil’s efforts in reducing malnutrition. “The country is a leader on the issue”, she said citing the reduction of child growth problems by 80% and the increase in breastfeeding. One of the people responsible for such progress was present at the event. Current FAO director José Graziano da Silva coordinated the Zero Hunger program and designed the Bolsa Família Program that, between 2003 and 2015, lifted 36 million people out of extreme poverty. He noted that 13 of the 17 Sustainable Development Goals (SDGs) lay out targets related to nutrition and that it is necessary to transform the fight against malnutrition into state policy. The Brazilian Minister of Health, Ricardo Barros, said that after leaving the Hunger Map elaborated by the UN, the country will launch a campaign to improve the eating habits of citizens with campaigns of awareness and salt and sugar reduction on processed products. The issue of nutrition has been gaining ground in the health and social development integration agenda of UNASUR. In November, partnering with Brazil’s National Health Surveillance Agency (ANVISA), will hold a Workshop on Nutrition and Food Labelling in the countries of South America.
On September 20th and 21st, the ISAGS will host a workshop to develop a South American plan for disaster risk that includes a basic manual for responses on health risks and disasters in member countries of UNASUR. The event articulates with the guidelines issued by the meeting “Transversal Disaster Risk Management”, held at the headquarters of UNASUR in Ecuador, which aimed to advance the construction of a coordinated and shared agenda between the bodies working in the area in the bloc.
SAMPER SUGGESTED A REGIONAL SUMMIT FOR PEACE AND INTEGRATION During a press conference, the SecretaryGeneral of the Union of South American Nations Ernesto Samper Pizano proposed a regional summit for peace and integration. In this context, he recalled the idea of organizing a meeting of Heads of State of various regional blocs such as the Bolivarian Alliance for the Peoples of Our America (ALBA), the Southern Common Market (Mercosur), the Andean Community of Nations and the Pacific Alliance, so that they are “under the common umbrella of UNASUR”.
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being carried out by Chile and Ecuador is the implementation of a decision taken unanimously by the Directing Committee of PAHO. But all the regulatory efforts are being scrutinized with pretexts ranging from ‘give more information to consumers’ to ‘it is harmful for business‘. We are not saying that the production of soft drinks or foods that have no nutritional value is prohibited, what we are saying is that the public must be well informed, as in the case of the cigarettes. Like cigarettes, junk food is a commercial product that is legal and, at the same time, lethal. Therefore, there is a public health reason to regulate their marketing.
Interview: Enrique Jacoby
ISAGS
Like cigarrettes, junk food is a commercial product that is legal and, at the same time lethal. Therefore, there is a public health reason to regulate their marketing
In recent years, three member countries of UNASUR, Bolivia, Chile and Ecuador, adopted labelling models of processed foods with easy visual identification to alert consumers about the levels of critical nutrients, such as sugar, salt and saturated fats. Former Peruvian Vice Minister of Health and Regional Advisor on Healthy Nutrition and Active Living of the Pan American Health Organization, Enrique Jacoby spoke to Report ISAGS on the negative reaction of representatives of the food industry. 1) What are the advantages of easy visual identification systems, such as those related to traffic signals, compared to more complex or only the traditional indication ‘recommended daily intake’ (GDA) on the labels of food products? First, these daily values are not established by the Public Health authorities, but rather by criteria of the food industry. It is very different from the front-of-pack labelling for quick information, such as those currently used in Ecuador and Chile. Ecuadorian labelling information, for example, were based on the criteria used by a public consultation on the advertising of junk food that the Pan-American Health
Organization (PAHO) convened in 2010. I was in charge of this expert consultation in which it was said “no more sugar, no more salt, no more fat”. We borrow the criteria developed by the British food agency. In turn, Chile created its own scheme. Given that each country had its own internal processes and to ensure that those processes were not influenced by negotiations with industry, PAHO stepped forward and published a scientifically based profile of nutrients for guidance. 2) This year, the food industry representatives in Ecuador proposed to alter the nutritional traffic lights, adding to its visual identity GDA data and a new strip with protein values. What is the impact this may have on the progress already achieved? After thirty years of work in this field, I can say firmly that the industry seeks to mislead the consumer. In Chile, the industry also says the law is excessive. The truth is that they have no reason at all. These measures, along with a fiscal policy to discourage the consumption of processed food that damages health, are validated by an Action Plan for the prevention of obesity in childhood and adolescence signed by all Health Ministers of the Americas in 2014. That is, what is
3) What other measures can be taken to curb the alarming increase of overweight and obesity in South America? First I would emphasize taxes. It is necessary to raise the price of products and hinder the accessibility to them at school, avoid advertising for children and ensure that the product bears a label that reasonably explains in a few seconds how dangerous is its excessive consumption when a child or an adult buys it. These actions combined are necessary, but not sufficient. Governments need to boost promotional activities encouraging the production and consumption of natural foods. It is a lie that natural foods are more expensive. You have to invest time in cooking, but it is also the responsibility of governments to return time to people with a better transportation system in large cities. The fact that there are people who travel three, four hours a day without being able to cook their food is an expropriation of time to citizens. The poorest are those who obviously pay the most because of this. 4) Which countries or places may be taken as reference in dealing with obesity? Those who advanced in the proposal of establishing a tax, such as Mexico, some US cities and now Chile. In all these places, you can hear many complaints from the processed food industry, often replicated by industry-friendly media. This is positive because it means that the measures are effective.
INSTITUTIONAL ISAGS-UNASUR Executive Director: Carina Vance Mafla Technical Coordinator: Henri Jouval Head of Office: Luana Bermudez INFORMATION AND KNOWLEDGE MANAGEMENT Coordinator: Flávia Bueno ISAGS Report Editor: Manoel Giffoni Report: Manoel Giffoni and Karla Menezes Team: Bruno Macabú and Felippe Amarante Contact: comunicacao@isags-unasur.org Phone: +55 21 2505 4400
This is the report from the South American Institute of Government in Health (ISAGS), the think tank on health of the Union of South American Nations (UNASUR) that aims to contribute to improving South America government quality in health by means of leadership training, knowledge management and technical support to health systems.