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9 th World Conference on Injury Prevention and Security Promotion. 15 TO 18 MARCH, MERIDA, MEXICO . Globalization and injuries in the context of the Americas. Dr. Mirta Roses Periago Director, Pan American Health Organization (PAHO). Health Determinants. Education Nutrition

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9thWorld Conference on Injury Prevention and Security Promotion

15 TO 18 MARCH, MERIDA, MEXICO

Globalization and injuries in the context of the Americas

Dr. Mirta Roses Periago

Director, Pan American Health Organization (PAHO)


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Health Determinants

Education

Nutrition

Water & Sanitation

Housing

Work

Occupation

Employment

New challenges:

Aggresiveness-Violence; public domestic, community and road safety; substance abuse

Family income

Salary

Social development

and economic

Well-being and Health

System and health services

Inclusion and coverage

Opportunity-

Access-Quality

4. Users satisfaction

Social networks

Life conditions

Identity and culture

Family integration

Urbanization

Aging

Age

Gender

Genetics

Adapted from WHO


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RISK FACTORS

Ecological Model

  • Family and friends relationship

  • Social

  • Community

  • Individual

  • Inequities

  • Norms that support violence

  • Guns availability

  • Police weakness/ criminal justice

  • Violence in the media

  • Social status of women

  • Unequal distribution of wealth

  • Social isolation

  • Illegal drug traffic

  • Conflictive relationship with parents

  • Conflicts between couple

  • Pressure from peers involved in violence

  • Demographic features

  • Psychological and personality alterations

  • Abuse history


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EXPANSION OF DISPARITIES

INCREASE IN THE EXCLUSION

GLOBALIZATION

and new economic order

DEMOCRACYand descentralization

Economic and State Reforms

Health Sector Reforms

Welfare state and social security crisis

MDG

HFA

2000

1975

1990

2015

DEMOGRAPHIC TRANSITION: population growth, urbanization and aging

EPIDEMIOLOGICAL POLARIZATION: profile coexistence of opposed risk and disease

Overwhelming Environmental and Ecological Impact

Health for All – Millennium Declaration


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0,40

1,6

Acute diarrheal diseases

1,4

0,30

1,2

Acute respiratory infections

0,20

1,0

residuals

Vaccine-preventable diseases

0,8

violence

0,10

perinatal

Gained years of life expectancy from 1980 to 2000 (Regional average)

Nutritional deficiencies

0,6

cardiovascular

cancer

0,4

0,00

<1

1-4

5-9

10-14

15-19

20-24

communicable

Age (Years)

0,2

0,0

-0,2

-0,4

The legacy of HFA to the population

of the Americas

(Decomposition of changes in the life expectancy from 1980 to 2000 for cause and age)


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Superior tercile

14.000

12.000

10.000

8.000

Average GDP per capita adjusted by PPP (int. $)

6.000

Average tercile

4.000

Lower tercile

2.000

0

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

Disparities of the Economic Growth in the Americas

[PAHO/WHO: Health in the Americas, 2002 Edition]


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1,0

0,9

0,8

0,7

0,6

0,5

0,4

0,3

0,2

0,1

0,0

0,3

0,0

0,1

0,2

0,4

0,5

0,6

0,7

0,8

0,9

1,0

The poorer

The richest

Magnitude of Inequality of Income in the Americas 2003

Perfect equity line

ingresos (proporción acumulativa)

[ CD145/7; PAHO Program Budget Policy ]

Population classified according to its income

(Cumulative proportion)


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Unemployment continues to be high

Increase of the informality

CEPAL-2005


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The Inequity Impact on the Global Health

  • Less developed countries concentrate 84% of the world population…

  • They consume less than 11% of the world health expenditures

  • However, they bear 93% of the overall disease burden


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Ethic Evolution/ Ideology/Values that guide the Social Protection Systems

Public Assistance

And Charity for

the poor and

indigenous

UNIVERSAL SOCIAL PROTECTION AS A CITIZENS RIGHT

STATE

BENEFACTOR

Segmented Systems according to payment capacity

Formal social

Security for

industrial

workers

20’s/40’s

Century XXI

50’s/70’s

80’s/90’s

Century XX


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Incidence of DiseasesAVISAs per 100 inhabitants

Group I (communicable)

Group II (non communicable)

Group III (accidents, violence)

OMS-2005


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Expected effect in crime rate according to changes in macroeconomic indicators

Source: Fajnzylber P, Lederman D, Loaiza N, BM, 2001


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HOMICIDE RATES x 100.000 pop.

(ADJUSTED) MALE

SELECTED COUNTRIES, 1996- 2005

We have to share experiences and help each other

Fuente: OPS, Datos básicos


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HOMICIDE RATE x 100.000 pop.

(Adjusted) female

Selected countries, 1996- 2005

Fuente: OPS, Datos básicos

Female homicide rates are lower than those of men:

ratio 1:10

More cases are detected as gender based (feminicide)


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Type of road user in proportion to all the deaths by trafficin the countries of the Americas

+ Road user categories were not uniform across all country data.

* Data for Mexico and the United States did not differentiate between drivers and passengers. “Drivers” bar for these two countries corresponds to the total of drivers and passenger fatalities.

Sources: Data compiled from the following sources. Canada, 2002—Canadian Motor Vehicle Traffic Collision Statistics 2002, http://www.tc.gc.ca/roadsafety/tp/tp3322/2002/page3.htm; Colombia, 2002—Instituto Nacional de Medicina Legal; Costa Rica, 2003—INEC; El Salvador, 2003—National Police; Jamaica, 2003—Ministry of Health (original figures from National Police Headquarters); Mexico, 2000—Consejo Nacional de Prevención de Accidentes; Saint Lucia, 2001—Royal St. Lucia Police Force (Traffic Department); Trinidad and Tobago, Office of the Commissioner of Police; United States, 2002—NHTSA.


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Deaths by traffic accidents in Bogota, Colombia traffic1991-2005

Civic

Culture

Change of policemen

Closing of night

establishments

Source: Instituto de Medicina Legal y Ciencias Forense. Fiscalia General de la Nación


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Women (%) 15 to 49 years, trafficsometime living in union, that say to have been victims of violence by their husband or partner

Physical violence

Sexual violence

Source: Measure DHS, ORC Macro, Encuestas Demográficas y de Salud (DHS). Ecuador: CEPAR, ENDEMAIN. ORC Macro: procesamientos especiales de las DHS. (Países seleccionados)


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Model to address comprehensively family violence (VIF) traffic

  • Regional Level:

    • International Forums

    • Replication and exchanges

    • Lessons learned

  • National coalitions

  • Legislation, monitoring systems

  • Prevalence/advocacy study

National

  • Training, University curricula s

  • Policies, standards and protocols

  • Surveillance and reference systems

  • Prevention

Sector

Community

  • Networks, support groups, men groups

  • Evaluation of needs: Critical Path


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CoaliciónInteramericanapara traffic la Prevención de la Violencia

BM, BID, OEA, CDC, USAID, UNESCO, OPS

Face Together the New Challenges

Violence Prevention Inter American Coalition

WB, IDB, OAS, CDC, USAID, UNESCO, PAHO


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Focus in needier, vulnerable Sectors, and territories traffic

Emphasis on prevention

Interpersonal, gender , juvenile, and self-inflicted

violence

Road safety: pedestrians, motrocyclist, the elderly, migrants

Strenghtening of networks and joint effort in road safety: work together

Strategic Plan 2008-2012

OUR PROPOSALS AND COMMITMENTS

132º CE - OPS/OMS


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Health Agenda for the Americas traffic

  • Human Rights, universality,

  • access and inclusion

  • Pan American Solidarity

  • Equity in Health

  • Social Participation

2008 - 2017

  • Strengthening National Health Authority

  • Tackling Health Determinants

  • Harnessing knowledge, science, and technology

  • Strengthen Health Security

  • Diminishing health inequalities among countries and inequities within them

  • Reducing the risk and burden of disease

  • Increasing social protection and access to quality health services

  • Strengthening the management and development of health workers


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Challenges for 2015: trafficMDG Achievements and other Priority Agendas

HEALTH SYSTEMS BASED ON PRIMARY HEALTH CARE

HEALTH PROMOTION

DETERMINANTES

Healthy public policies

Environment

Social Exclusion

MDG

Achievements

by 2015

Faces, voices and places for MDGs

Family Community

Healthy environments

Community Action

Individual

Inequity

Municipality State

Country Región

Inequalities

Personal skills

Health services reorientation


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… there are many challenges ahead traffic

CountryPublic Policy

Change in the economic performance

Member

capacity

UN

Mandates

Integration

System

External Resources Available

Inter American Systems

Socio-determinant Factors

UN

Changes


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