ISAGS Report March/2016

Rio de Janeiro, March 2016

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Carina Vance appointed new executive director of ISAGS

Personal archive

José Gomes Temporão will transfer his position on July 26, in Rio de Janeiro

Graduated in Political Science and History, Vance holds a Public Health master degree from the University of California - Berkeley

After a meeting on March 30, the South American Health Council, which is formed by the ministers of health of the 12 countries of the continent, announced the name of ISAGS’ new executive director, the Ecuadorian Carina Vance. Considering her distinguished experience as head of the health ministry in her country, the election of Vance for a two-year term of office, as established by ISAGS’ Bylaws, was defined by consensus, in compliance with the regulations approved by the ministers last year.

Vance holds a degree in History and Political Sciences, and became closer to public health issues after working with HIV patients in the poorest regions of the city of San Francisco, in the United States. “Since school, I have always tried to get involved in issues related to social change. My country, as well as the whole region, lives with great inequality; but this experience allowed me to understand the social determinants of health and also opened this area for me”, she said during an interview to ISAGS Report, in which she added that, after this period, she went to the University of California - Berkeley, for a master’s degree in public health.

Back to Ecuador, in 2004, she was an activist of LGBT rights and director of the Causana Foundation, until being appointed minister, at the age of 34. “My greatest challenge at that time was to restructure the Ministry, which was

skeletal in comparison with the magnitude of the work we had to develop. We then incorporated more efficiency and transparency in service delivery, while increasing our presence in territories, which helped us with planning, the identification of needs and shortages regarding human resources and infrastructure”, she commented. Based on this diagnosis, there were 52 health centers and 10 hospitals created during her management, from 2012 to 2015.

“Other important achievements were processed food labeling, which was part of a health promotion policy, and a dramatic reduction in marternal mortality. It is one of the highlights of the last few years in my country”.

Dr. Temporão’s term of office as ISAGS’ director started in July 2011, and was exceptionally extended until 2016. During the meeting on March 30, all ministers and representatives acknowledged the work developed by him, with emphasis on the challenge of starting the structuration of an Institute from zero. Temporão, in return, acknowledged the fundamental support given by countries to this process. “I would also like to thank Carina for accepting the challenge of taking our history forward”.

At the moment, the Institute is working on arrangements for transition, which shall occur on July 26, in a ceremony in Rio de Janeiro.

According to Vance, there is a connection between her work as minister, in Ecuador,

and as ISAGS’ director. “If we consider the advancements in Ecuador and in most of the countries of the region over the last years, there are several national experiences that deserve to be shared and implemented regionally”.

She also affirmed that the context of global economic crisis and, particularly, the crisis in South American countries require creativity and innovation in order to deepen the work that is already being developed by ISAGS, technical groups and networks of the Health Council.

Her plans include the consolidation of the Institute’s structure by recruiting experts from all over the continent, which would “support the appropriation, by countries of the region, of the work developed by ISAGS”, and the intensification of communication strategies.

“All of us, and that includes the population in general, must understand the added value of UNASUR and ISAGS”.

READ MORE Poverty tends to increase in Latin America, says ECLAC Page. 2 ISAGS launches report on flexibilities in the TRIPS agreement Page. 3 Interview - Davide Rasella, researcher at Fiocruz and Wellcome Trust Page. 4

Poverty tends to increase in Latin America, according to ECLAC In spite of the crisis, South American countries present satisfactory rates in the reduction of poverty and inequality The Latin American poverty indicator may have exceeded 29% in 2015, according to the “Social Panorama” published by the Economic Commission for Latin America and the Caribbean (ECLAC) in the beginning of the month. The result is 1 percent higher than the last one, which represents an increase in 7 million to the 168 million people registered in 2014.

However, after an analysis of national rates, it was identified that poverty was reduced in most UNASUR member countries during the first four years of this decade (2010-2014), especially in Uruguay (-14.9%), Peru (-9.8%), Chile (-9.1%), Brazil (-7.9%) and Ecuador (-6.6%).

“South America had relatively positive results in a period of international recession. This success is a consequence of the social policies implemented all

over the region, with special emphasis on employment generation and cash transfer policies. Nevertheless, the deepening of the crisis in 2014/2015 is already negatively impacting this virtuous circle, as shown by ECLAC’s estimations”, observed Alessandra Ninis, ISAGS’ technical advisor for social determinants of health.

As regards income distribution, the report indicated that, from 2002 to 2014, most of the countries of the region have made progresses in relation to the “Gini index”, in which zero corresponds to full equality and 1 to maximum inequality.

The index reached 0.491 in 2014, whilst in 2010 it was 0.507. To Alessandra, this process of social and economic insertion and citizen participation is also threatened by the recession scenario.

“If we wish to give South America sustainability and aim at poverty eradication goals of the 2030 Agenda, governments and regional organisms – such as UNASUR and ECLAC – must strengthen cash transfer strategies, regardless of tensions with external actors and interest groups”, she concluded. facebook.com/isags.unasursalud Channel on Youtube: Isags Unasur twitter.com/isagsunasur

ISAGS’ new Annual Report features the Institute’s actions in 2015 The English and Spanish versions of the report can be downloaded from ISAGS’ website Since 2013, ISAGS publishes an Annual Report to share with other structures of the Health Council and of UNASUR, similar institutions and the general public, the highlights of its activities, with emphasis on issues related to regional integration, support to training, production of knowledge,

communication and institutionalization, among others. The elaboration of an annual activity report is foreseen in ISAGS Bylaws.

The Annual Report 2015 features texts and images, in a retrospective overview of the events organized by the Institute, such as the Course “Public Intersectoral Policies

and Social Determinants of Health” and the workshop “Border Health Policies in UNASUR”, besides publications and activities involving health diplomacy.

The Annual Report 2015, as well as the editions of the two previous years, can be downloaded from ISAGS’ website.

ISAGS launches report on flexibilities in the TRIPS agreement

HEALTH CONNECTION SUBSCRIBE TO ISAGS CALENDAR!

The publication aims to identify potentialities for the implementation of policies towards the access to medicines in UNASUR member countries

ISAGS has a special area in its website for monitoring regional and global public health events in accordance with the strategic guidelines of UNASUR’s South American Health Council. You can also receive e-mails with news and updates on the calendar. Go to: http://goo.gl/PX89Yz

ISAGS

ISAGS LAUNCHES REPORT ON BORDER HEALTH

Monica Sutton, ISAGS’ consultant and head coordinator of the project

To discuss flexibilities in the TradeRelated Aspects of Intellectual Property Rights (TRIPS) Agreement, with emphasis on the potentialities for the implementation of policies towards the access to medicines in UNASUR countries. This is the objective of “TRIPS Flexibilities on Intellectual Property”, a report recently launched by ISAGS in English, Spanish and Portuguese versions.

Produced by the professor of the Institute of Economy of the Federal University of Rio de Janeiro (UFRJ), Ronaldo Fiani, the document presents “gaps” in the agreement in relation to issues such as the harmonization of patent protection, compulsory licenses, local manufacturing capacity and freetrade agreements. The idea – according to the general coordinator of the project and ISAGS’ technical advisor for the Health Industrial Complex and Regulation, Mônica Sutton – is to enable each country to understand the flexibilities of the TRIPS and to apply them to their own health systems.

“We realized this was an interesting topic during the meetings of the

Technical Group on Universal Access to Medicines (GAUMU) and based on demands from UNASUR members.

This report was elaborated not only to update countries on the TRIPS, but also to show possible ways for the use of these flexibilities”, she commented.

Among the several case studies included in the document, there is the compulsory licensing adopted by the Brazilian government for Efavirenz, a medicine for the treatment of HIV/AIDS, whose patent belonged to Merck Sharp & Dohme. It was the first negotiation of this sort in Latin America; at that time, the Minister of Health of the country was ISAGS’ current executive director, José Gomes Temporão.

“Brazil’s example is internationally recognized, but it is important to observe that we have great local manufacturing capacity. This would not be the most suitable flexibility for countries without public laboratories, considering that they would not be able to produce the medicine after granting the license. It is essential to thoroughly analyze each one of the flexibilities”, Mônica remarked.

The English and Spanish versions of the report “Border Health Policies in UNASUR” are already available online.

Named after the event organized by the Institute in November 2015, the material presents a general panorama of health in South American borders, with emphasis on the exchange of experiences and lessons learned among countries of the Bloc. http://goo.gl/Jco94I

IADB PUBLISHES RESEARCH ON INTEGRATION IN LATIN AMERICA The Inter-American Development Bank (IADB) published the report “Objective and Subjective Dimensions of Regional and Global Integration in Latin America” through the INTAL - Latinbarometer initiative.

The publication resulted from researches carried out with the populations of eighteen countries in relation to issues regarding the construction of new regional public policies, such as democracy, regional integration, infrastructure, citizen security, among others. http://goo.gl/5xFelu

YOU CAN STILL REGISTER TO RUN THE UNASUR MARATHON! UNASUR will celebrate its anniversary with a marathon in Quito, Ecuador, where its headquarters is located, on April 17 th . For more details about the course, registry and rules, check out www.unasur12k.unasursg.org.

programme and then cross-referred to tuberculosis databases.

Interview: Davide Rasella

ISAGS

If we are able to improve living conditions of the population, we will see the reduction of several diseases and it is important to quantify these factors scientifically in order to evaluate the cost-benefit ratio of poverty reduction.

On the World Tuberculosis Day, celebrated every year on March 24, the Italian researcher at Fiocruz and Research & Development Fund Wellcome Trust, Davide Rasella, gives details on a study that relates reductions in tuberculosis prevalence in Brazil to the implementation of the cash transfer programme Bolsa Família.

1) What are the social characteristics related to tuberculosis?

In classical epidemiology, based on several studies, tuberculosis is in close connection with poverty. In a very visual manner, we can use charts that demonstrate reductions in mortality from the disease in Europe, according to improvements in social and economic conditions during the 20 th century, despite allegations that these reductions would be a consequence of improvements in treatment over the last fifty years.

Groups that advocate for a biomedical approach are on the frontline of powerful economic interests, and therefore often have a much louder voice than groups that defend an approach to social determinants, but some studies show very consistent results. One of the conclusions of these studies is that an increase in the social and economic level of households avoids what we call overcrowding, that is, many people sharing the same room, for example, which is a risk factor. We could also mention food safety, not only

in terms of quantity but also in terms of quality, which has a direct influence on the immunological system, both at the moment of infection and during the development of the disease. Finally, improvements in social conditions increase the contact of the population with the health system, which is frequently related to costs of transportation for regular visits or, in the case of autonomous workers, the possibility of leaving work for one day a week in order to visit a health professional.

2) What was the methodology used in the study that related the reduction of tuberculosis prevalence to the cash transfer programme Bolsa Família?

We focused on prevalence in the overall population and we used the mathematical model of micro-simulations, which are an innovation. In comparison with behavioral models, which are classical models for infectious diseases and tuberculosis, in particular, they do not only study the average behavior of the disease in the population, that is, treating the population as a whole; micro-simulations, in turn, are able to analyze the impact of an intervention at individual and subpopulation levels and to incorporate behavioral responses that are in constant change. Therefore, it requires access to microdata which, in the case of this study, were extracted from the database of the Single Registry of the Bolsa Família

3) What were the conclusions of the study?

We concluded that the Bolsa Família programme increased the disease survival rate in 7% or more, depending on characteristics of population groups.

The mechanisms mentioned before, that is, more access to the health system or more time dedicated to treatment, enabled this achievement. This study caught the attention of the National Programme for Tuberculosis Control in Brazil and now there is even a draft act for financial support to patients with tuberculosis. It is important to say that we used Bolsa Família in Brazil as a starting point, but probably all cash transfer programmes in South America and in the world have a similar impact.

We can prove the impact of a programme with concrete cases, but there are strong evidences that analyze improvements in social protection in a more comprehensive way, including an approach to primary health care. It also enables more contact with the population, which favors the detection of cases, monitoring treatment and the family so as to avoid transmission.

4) Both the new Social Panorama 2015 of ECLAC and the conclusions of the meeting “Dialogues between Cash Transfer Policies and the Social Determinants of Health”, organized

by ISAGS, highlight the importance of maintaining social policies in times of crisis. In the case of tuberculosis, which would be the impact of weakening these policies due to austerity measures?

The results of our study are very clear: if the Bolsa Família programme were to be extinguished today without being replaced for another policy, the prevalence of tuberculosis would be 6% higher over the next 15 years. But this is only one of the implications. What would be the impact of these programmes in the case of HIV and diarrhea in children, for example? If we are able to improve living conditions of the population, we will see the reduction of several diseases and it is important to quantify these factors scientifically in order to evaluate the cost-benefit ratio of poverty reduction.

INSTITUTIONAL ISAGS-UNASUR Executive Director: José Gomes Temporão 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.