First Word
A call to close the gaps
In 2000, 189 countries of the world signed the United Nations Millennium Declaration. This historic call to action—at the dawn of the new century—set forth an ambitious agenda for improving the lives of the world's poorest citizens by 2015, through a joint effort of both developed and developing countries. The key goals outlined in the declaration have since been expanded, refined and operationalized as the Millennium Development Goals. They include concrete targets and a specific timetable, with accountability at all levels: international, regional and country, as well as municipal and community. The millennium goals show that the countries of the world consider yawning gaps in development to be unacceptable and dangerous for the future of humanity. They affirm that we can and must be the generation that sets things right.
The Millennium Development Goals represent a special challenge for the Americas. While not the poorest, our region is the most unequal in the world. Data on income distribution show that on average in Latin America, the richest 10 percent of the population earns 36.1 percent of all household income, while the poorest 40 percent receives just 13.6 percent. In 2002, the per capita income of the wealthiest 20 percent of the population exceeded that of the poorest 20 percent by a factor of 24.6 in the Dominican Republic, 29.6 in Colombia, and 44.2 in Bolivia.
These economic inequalities have a major impact on health. In the late 1990s, the gap in life expectancy between the wealthiest and poorest population groups in the Americas was 9.8 years. A newborn in the lowest income quintile faced a three times greater risk of dying before the age of 1 than a newborn in the highest quintile. Factors such as gender, ethnicity, race and geographical situation exacerbate such health inequalities. These disparities, unacceptable in themselves, also contribute to a lack of social cohesion and endanger the democratic process in the Americas.
Addressing these inequalities will require a clear commitment on the part of the region's countries to the principles of equity and solidarity. For its part, the Pan American Health Organization (PAHO) is focusing special efforts on five of the region's neediest countries: Bolivia, Guyana, Haiti, Honduras, and Nicaragua. In this and other work, PAHO has put the United Nations Millennium Development Goals at the center of its strategic approach.
One of the major contributions of the millennium goals is a new vision of development that gives health a central role. Three of the eight goals and seven of the 18 targets fall within the responsibility of the health sector, and all the millennium targets can be viewed as determinants that have a major impact on the health of the world's populations. This emphasis on health and its role in development, together with the millennium goals' call for a more equitable world, gives new urgency and legitimacy to the fight against health inequalities and a greater voice to neglected groups and concerns.
The millennium goals call for action that is intersectoral, integrated, and focused on equity. With this in mind, PAHO has developed a strategy to support its member countries in their pursuit of the millennium goals, emphasizing those that are explicitly related to health but also with a view to strengthening the contribution of health to overall development. PAHO is committed to playing its part, together with its Member States and its many partners, to ensure that by 2015 the region has attained all the millennium goals and become a significantly more equitable hemisphere. Our emphasis will be on the region's marginalized population groups and on the countries with the least favorable health indicators. If conditions for these can be improved, all of us will benefit. The overarching goal—of better health and better quality of life for all the people of the Americas—has been PAHO's primary goal since its founding more than a century ago.
Mirta Roses Periago
Director