Latin America and the Caribbean Show Uneven Progress on Millennium Health Goals

The Americas as a whole are mostly on track to achieve the Millennium Development Goals (MDGs) related to health. But continuing efforts are needed to bridge gaps in progress across countries and population groups, said the Pan American Health Organization/World Health Organization (PAHO/WHO) in reports presented to PAHO’s 51st Directing Council this week.

The MDGs were set in 2000 by the 189 United Nations member countries that signed the Millennium Declaration. Three of the goals (4, 5 and 6) are directly related to health and at least five other goals and targets are inextricably linked to health.

With support from PAHO/WHO, ministries of health throughout Latin American and the Caribbean have implemented policies and programs to improve maternal and child health, fight HIV/AIDS and other infectious diseases, and improve living and social conditions that affect people’s health.

“In doing so, they have strengthened long-standing programs such as those in maternal-child care, while also creating new initiatives specifically aimed at advancing the MDGs,” said PAHO Director Dr. Mirta Roses. “As a result of these commitments and actions, our fegion is as a whole on track today to meet most of the MDG health-related targets, including those on hunger, child mortality, and water and sanitation.”

The reports presented to the 51st Directing Council this week examine progress on MDG-4, reducing child mortality; MDG-5, improving maternal health; and MDG-6, fighting HIV/AIDS, malaria and other diseases. One of the reports, the Annual Report of the Director 2011, describes PAHO/WHO technical cooperation as well as countries’ progress in the areas of hunger reduction, environmental sustainability, access to medicines, and partnerships for development as well.

MDG-4 Reduce child mortality

The countries of the Americas have made significant progress in reducing both infant (under-1) and child (under-5) mortality. Infant mortality has declined 55 percent in Latin America and the Caribbean since 1990, according to PAHO data, down from 42 to 19 deaths per 1,000 live births as of 2009.

However, countries have not all progressed at the same speed and currently have widely varying indicators. The lowest rates—under 10 deaths per 1,000 live births—are found in Anguilla, Chile, Costa Rica, Cuba, French Guiana, Guadeloupe, Martinique, and Uruguay. The highest rates are in Bolivia and Haiti, with 50 to 80 deaths per 1,000 live births, depending on the data source.

PAHO/WHO credits improvements in child mortality to “high-impact, low-cost” primary health care strategies, free and universal immunization programs, oral rehydration therapy, child growth and development monitoring, improved levels of education (particularly for women), declining fertility, poverty reduction, and increased access to clean water and sanitation services.

MDG-5 Improve maternal health

Estimating changes in maternal mortality is difficult due to problems with data quality and coverage. Different estimates show that pregnancy-related deaths in Latin America and the Caribbean have declined between 29 percent and 40 percent since 1990. Despite this progress, some 10,000 women continue to die of pregnancy-related causes in the hemisphere each year.

As with child mortality, progress on maternal mortality varies markedly from one country to another. Fifteen countries have had declines ranging from -3 percent to -44 percent. Some countries have shown increases that may be partly due to improved monitoring. Data are not yet available for 2009, but PAHO/WHO notes than an increase in maternal mortality is likely for that year as a result of the 2009 influenza A (H1N1) epidemic, which disproportionately affected pregnant women.

The declines in maternal deaths in many countries are due to expanded prenatal care coverage, more deliveries by skilled birth attendants, increased contraceptive access and use, and improved surveillance. Nevertheless, the report notes that “most of the countries in the region will not succeed in meeting the target” on maternal mortality by 2015.

MDG-6 Combat HIV/AIDS, malaria and other diseases

The goal of “halting and reversing” the HIV epidemic appears clearly out of reach for the Americas, as for other regions. However, new HIV infections declined 15 percent in the Caribbean between 2001 and 2009 (from 20,000 to 17,000) and 7 percent in Central and South America (from 99,000 to 92,000). During the same period, new HIV cases increased 6 percent in North America (from 66,000 to 70,000).

Several countries—including Argentina, Brazil, Chile and Costa Rica—have significantly reduced deaths from HIV/AIDS through expanded access to antiretroviral treatment (ART). Indeed, Latin America and the Caribbean have wider access to ART than any other developing region, with an estimated 50 percent coverage as of 2009.

Other indicators of progress on the MDGs in the region include:

  • More than half of Latin American and Caribbean countries and territories for which data are available seem to be on track at the national level to achieve the MDG-1 targets on hunger. Chronic malnutrition remains a problem in many countries and populations groups.
  • In the 21 malaria-endemic countries of the Americas, coordinated control and treatment efforts have contributed to a 52 percent reduction in total malaria cases since 2000 and a 69 percent decline in deaths. In nine countries, malaria incidence declined more than 75 percent, meeting this MDG-6 target well ahead of the 2015 deadline.
  • The prevalence of tuberculosis in the Americas has declined some 60 percent since 1990 and TB deaths have declined 75 percent, representing sufficient progress to meet the MDG targets.
  • The Region of the Americas has significantly expanded access to drinking water and sanitation since 1990 and is on track to meet the MDG targets. However, some 40 million people still lack access to improved sources of drinking water, and some 115 million lack improved sanitation facilities, leaving room for progress even after the MDGs are met.

Despite such progress, PAHO Director Mirta Roses noted that “some of our Member States are unlikely to meet targets that the region as a whole is on track to achieve. And in nearly all countries, there are vulnerable communities and vulnerable population groups that have not benefitted as they should from national progress on the MDGs.” The need to focus efforts on these vulnerable groups has been and will continue to be “a central tenet” of PAHO/WHO’s technical cooperation, she said.

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