Rio de Janeiro, january 2014
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Director-General of WHO advocates universal coverage as a strategy for global health The World Health Organisation Executive Board held its 134th Session from 20 to 25 January. The board’s 34 members are appointed for a three-year term by the organisation’s MemberStates. Suriname ,currently occupying the Pro Tempore Presidency of Unasur, Argentina and Brazil occupy three of the six Americas region seats. Prominent agenda items for the meeting were the WHO reform and the financing dialogue. Issues addressed more technically included universal health coverage, Millennium Development Goals, international health regulations, chronic non-communicable diseases, and topics such as antimicrobial drug resistance, hepatitis and vaccines.
“In my view, [health coverage] is one of the most positive and powerful trends in global health” In that context, the Board discussed the global strategy and targets for tuberculosis prevention, care and control after 2015 and the global vaccine action plan. The Board also considered the global disability action plan, which had broad support among the international organisations represented at the event, including Unasur (more on page 2). At the opening ceremony, Margaret Chan, Director-General of WHO, drew attention to the lengthy agenda of 67 items and 17 resolutions, and to the number of participants at the event: ‘I interpret the large number of participants as an indication of the high level of interest in global health’, she added. Chan argued that ‘a lean, effective, and flexible WHO must be strategic and highly selective in the work it undertakes’ and declared she ‘would rather see outstanding performance in a limited number of high-impact areas
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Margaret Chan opened the World Health Organization Executive Board’s 134th session, in Geneva, Switzerland
The Executive Board is composed of 34 members technically qualified in the field of health
than a full menu approach that dilutes energy and resources’. She stressed that ‘one reason for the success of the Millennium Development Goals was their limited number’. The Director-General added that ‘part of the problem stems from the simple fact that the determinants of health have become broader and much more complex in a world where not only countries, but also policy spheres are closely interconnected. We are all aware that some new challenges, especially those driven by the globalisation of unhealthy lifestyles, can only be addressed through collaboration with multiple sectors, including some industries’. ‘For medicines’, Chan declared, ‘only around 20% of our Member States have a well-functioning regulatory authority, 50% have variable regulatory quality, and 30% have virtually no or only very limited capacity. On poverty and access to health, she said that ‘an estimated 2.7 billion people live in countries with no safety net to cover health care costs’. In that light, she spoke enthusiastically of the role of universal health coverage: ‘When I think about these statistics, I also think about people, the many millions of people being left behind
in our highly unequal world. I thank Member States and partner agencies for their strong commitment to universal health coverage. In my view, this is one of the most positive and powerful trends in global health’, she concluded. During the meeting, new regional directors were appointed for Southeast Asia and Western Pacific. The main functions of the WHO Executive Board are to give effect to the decisions and policies of the World Health Assembly (WHA), to advise it and generally to facilitate its work, as well as to provide reports on various aspects of the organisation’s work for consideration by the WHA.
READ MORE • Unasur supports WHO plan for people with disabilities Page 2 • International forum debates universal health coverage and systems Page 3 • “Every Minister is a Health Minister”, Michael Marmot Page 4
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PAHO reveals that alcohol kills 80,000 a year, on average, in the Americas
Unasur reinforces its support for WHO disability action plan The draft plan will be discussed at the 67th World Health Assembly that will be held in May During the 134th Session of the Executive Board of the World Health Organisation, held in Geneva from 20 to 25 January, the Union of South American Nations expressed its support for the WHO global disability action plan 2014-2021. In November 2013, representatives of more than 20 members of the Pan American Health Organisation gathered in Quito, Ecuador, to the Regional Consultation of the Americas to discuss the proposed action plan, which aims to improve the health and wellbeing of people with disabilities The draft action plan is intended to remove barriers and improve access to health services and programmes, and expand and strengthen rehabilitation, assistive technologies and communitybased rehabilitation, besides improving collection of appropriate and internationally comparable disability data to support related research and service development. A WHO newsletter reports that the Member States
“WHO Member States considered the draft ‘clear’, ‘comprehensive’ and ‘measurable’” considered the draft ‘clear’, ‘comprehensive’ and ‘measurable’ and praised the prior consultation process for its efficiency, transparency and inclusiveness. Ecuador sponsored the initiative in favour of adopting the resolution on the subject, which was approved at the World Assembly in May 2013, and will be discussed once again during the 67th World Health Assembly. The plan is based on the WHO World Report on Disability (2011), the UN Convention on the Rights of People with Disabilities and the Outcome Document of the UN General Assembly High-Level Meeting on Disability and Development (2013).
Forum debates coverage and health systems
Approximately 150 policy makers and academics will attend the event The 1st International Forum on Universal Coverage and Health Systems is to take place on 1-2 February at the Brazil Office of the Pan American Health Organisation (PAHO/WHO) in Brasilia. The event is called to pursue discussion of universal coverage and health systems, sharing conceptions and examining the challenges, with a view to strengthening national health systems and guaranteeing the right to health. Brazil´s National Coordinator at the Unasur Health Council and Director of the Fiocruz Centre for International Relations in Health, Paulo Buss, will
moderate the round table “Universal systems and universal coverage: innovation and challenges”. The forum continues with four sessions On the second day the round table “Pathways to universal coverage and universal health systems – Goals beyond 2015” will be held. The forum precedes the 2nd National Presentation of Experiences in Strategic and Participatory Management (Segunda Mostra Nacional de Experiências em Gestão Estratégica e Participativa, EXPOGEP), organised by Brazil’s Ministry of Health, which will be held at the same venue, on 2-6 February.
Alcohol causes an average of 80,000 deaths every year in the Americas. The figure appears in a Pan American Health Organisation (PAHO) report published in the scientific journal Addiction. The study “Mortality from diseases, conditions and injuries where alcohol is a necessary cause in the Americas, 2007-09” notes that alcohol is a determinant cause of death in at least 79,456 cases per year. The authors, Vilma Gawryszewski, a PAHO advisor on health information and analysis, and Maristela Monteiro, a substance abuse specialist, assert that these deaths represent only “the tip of the iceberg of a larger problem”, because alcohol is associated with other diseases, such as cardiac insufficiency and cancer, as well as to traffic and firearm accidents. The highest rates were found in El Salvador (27.4 cases per 100,000 deaths), followed by Guatemala (22.3), Nicaragua (21.3), Mexico (17.8) and Brazil (12.2). The problem is least acute in Colombia (1.8), Argentina (4.0) and Venezuela (5.5). In all the countries studied, most alcoholrelated deaths (84%) involved men, although the numbers for women varied by country. The hazard also differed by age group. In Argentina, Canada, Costa Rica, Cuba, Paraguay and the United States, the highest alcohol-related death rates were among 50-69 year olds. In Brazil, Ecuador and Venezuela, the rates were highest in the 40-49 year age group. The authors state that alcohol-related deaths can be prevented by policies and interventions, including restrictions on availability, increases of price and taxes, and market and advertising controls. “As these high rates have shown a major public health problem, countries should increase their efforts to improve the quality of information, monitor the problem and implement more effective policies to reduce alcohol availability and consumption at national levels”, they conclude.
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Health experts map primary care in South America
HEALTH CONECTION Pharmaceuticals Act in Chile
ISAGS will hold a workshop on the subject in May
The six experts retained as consultants by ISAGS to map models of primary health care (PHC) in South America are now at the country technical visit stage. The project, which started in November 2013, fulfils the decisions of ISAGS Annual Operating Plan, approved last year by the South American Health Council, and underlines the importance of exploring this subject in depth, as emphasised in the guidelines of Unasur’s Fiveyear Plan.
“The research’s material will be consolidated in a book to be published by the Institute” The consultants are distributed among the following regions: 1-Brazil; 2-Argentina, Paraguay and Uruguay; 3-Bolivia, Ecuador and Venezuela; 4-Chile, Colombia and Peru; and 5-Guyana and Suriname. During this stage, in January and February, they will be collecting information and reviewing the specialised literature on the countries PHC. The aim is to complete the mapping and analytical matrix prepared by the project’s coordinator, Lígia Giovanella, an ISAGS consultant who holds a PhD in Public Health from ENSP/Fiocruz. The matrix guides the research in terms of the conception of primary health care, governmental assignments
and competencies, funding, participation of PHC spending in total public spending on health, coordination and integration of services in the network, workforce, training and intersectoral activities, besides strategies for the retention of health professionals in remote and more vulnerable areas.The study is supported by the focal points of the Unasur Technical Group on Universal Health Systems. As provided for in the ISAGS 2014 Annual Operating Plan, one of the outcomes of the mapping will be the workshop “Approaches to Primary Health Care and strategies to fix personnel in remote, underserved areas of South American countries”, to be held by ISAGS from 13 to 15 May. There, the project consultants will present the vision of PHC in the regions where they conducted their survey, so as to share experience and identify innovative practices and strategies for strengthening PHC in South America. More than producing knowledge, ISAGS aims that governments use the mapping to formulate strategic action policies at local, national and regional levels, representing another cooperation joint effort, which is an important milestone in consolidating the region’s universal health systems. The research’s material will be consolidated in a book to be published by the Institute. The mapping will also have an interactive version to be featured in ISAGS website.
Visit from the University of Scranton
Professors from the Master of Health Administration programme at the University of Scranton, in Pennsylvania, visited ISAGS in January to learn more about the Institute’s work on health governance. With support from ISAGS, the professors also visited the FIOCRUZ Centre for International Relations in Health (CRIS) and the Network of National Cancer Institutes and Institutions (RINC). On 14 February, a group of students from the same Master’s programme will be coming to visit the Institute.
Conference in Peru
On 20 and 21 February, Peru’s Ministry of Health will be holding the conference “Towards universal health coverage” in Lima. The event will be attended by Margaret Chan, DirectorGeneral of the World Health Organisation, and Carissa Etienne, Director of the Pan American Health Organisation. José Gomes Temporão, Executive Director of ISAGS, will present the conference “Universal health coverage: the South American experience”.
Bioethics Committee in Ecuador
In January, Ecuador’s Ministry of Health set up the National Bioethics Committee to advise the National Health Authority. The committee will work in coordination with the Vice-minister for Health Governance and Surveillance and with the other Ministry of Public Health bodies responsible for health research, human rights and gender. The Ministry placed special emphasis on bioethics as an instrument to safeguard the quality of research and respect for human dignity, as well as the application of ethics in public health decision making.
MIN SALUD ECUADOR
min salud chile
Early this year, the chamber of deputies of Chile’s Congress approved the National Pharmaceuticals Law, which broadens access to medicines in Chile. The new law requires pharmacies to supply the generic drugs approved by the Institute of Public Health, permits the sale of unit doses and increases oversight of pharmaceutical products. Cecília Perez, Secretary-General to the Chilean Government, says the project indicates that “the government is meeting its commitment to guarantee Chileans timely, effective access to drugs of guaranteed quality and at fair prices”.
Members of the National Bioethics Committee of Ecuador
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Michael Marmot at the international auditorium of the Fiocruz´s National School of Public Health
“Every Minister is a Health Minister”
Marmot reinforces the words of Norway’s Minister of Foreign Affairs during interview to ISAGS Michael Marmot is Professor of Epidemiology and Public Health at University College London, England, and was Director of the WHO Commission on Social Determinants of Health from 2005 to 2008. On 20 February, he will be participating in the conference “The equity dimension of universal coverage” during the International Conference “Towards universal health coverage”, organised by the Ministry of Health of Peru. In an interview for ISAGS Report, Marmot stressed the importance of acting on social determinants to reduce inequities in health. How do you see the role of the State in implementing health policies to reduce inequities? Firstly, the State has a huge role to play, because the general assumption that I make and it’s not just an assumption, there’s good evidence, that social and economic inequalities in society relate to health inequalities. So the State has a key role to play in reducing social and economic inequalities. But the State is, to some extent, determined by the culture and the history. So it’s not just that governments do things. They do, but the nature of the governments we get relates to the kind of culture and society we have. So, it’s a two-way
relationship. The State’s very important, but it is in its turn a reflection of the attitudes of the population. The social determinants of health are addressed in the five-year plan of Unasur. What is the importance of international cooperation for action on social determinants? I think the international cooperation can work at different levels. At the simplest level, countries can support each other. That can be done diplomatically. So, I think the first is that countries can learn from each other. There are good examples of countries taking action on social determinants of health then its supportive for other countries. Second, there are global forces that impact on the social and economic conditions: patterns of trade, international agreements, movements of labour and migration of populations, all have an impact on the social determinants of health. If you think about Latin American States , and we’ve seen this with the European Commission , that it’s a much stronger voice in global political circles if you’ve got a union, than if you’ve got a single country. It’s a much stronger voice. Considering
that
social
position
precedes health, what is the importance of the intersectoral approach to act on the social determinants of health? In the WHO commission, we said that health and health equity are determined by the conditions in which people are born, grow, live, work and age. And the inequities in power, money and resources that give rise to those conditions of daily life are outside the health sector. So, you can’t take action on those conditions by working within the health sector alone. We do need to work across sectors. It’s absolutely vital. I’ve been quoting the Norwegian Minister of Foreign Affairs, who said at a meeting that I was at: ‘I am a Health Minister. Every minister is a Health Minister’. So, I’ve been quoting him, because it makes the point that we need action in all the key domains of government. And I got a phone call from a senior official in the Norwegian Ministry of Health who said ‘You know you’ve been quoting our Minister of Foreign Affairs. He now is our Health Minister and he would like to meet you’. So, I went to Oslo to meet him – and it’s good, because the perspective he brought to becoming a Health Minister was the perspective of ‘All ministers impact on health’. How do you evaluate the critical aspect of the social determinants of health in the context of the Millennium Development Goals? The Millennium Development Goals did not say enough about equity. They talked about poverty, which was good, but not enough about equity. It was more about averages: reducing maternal mortality and child mortality and so on. So, I’d like to see a much more explicit focus on social determinants, on the one hand, and equity in health, on the other. How much that will feature in the post-2015 process, I’m not sure, but I’d certainly like to see it.
SCHEDULE
• 04/02 - World Cancer Day • 10/02 - UNASUR Meeting of Authorities for International Cooperation, Paramaribo, Suriname. • 20 e 21/02 - International Conference: “Towards Universal Health Coverage”, Lima, Peru.
INSTITUTIONAL
ISAGS-UNASUL Executive Director: José Gomes Temporão Head of office: Mariana Faria Technical Coordinator: Henri Jouval Information and Knowledge Management Coordinator: Camilla Ibiapina Report Editor: Mariana Moreno Team: Daniel Pondé, Felippe Amarante, Flávia Bueno, Maíra Mathias and Nanci Miranda
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.
Contact: comunicacao@isags-unasur.org Telephone: +55 21 2505-4400
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