Democracy and health: from paper to reality
Washington, DC, 2 May 2002 (PAHO)-- The gap between rich and poor in Latin America and the Caribbean is starkly evident through differences in access to health services and, consequently, in health and living standards of the low-income population. This has the effect of weakening basic democratic principles, according to the Pan American Health Organization (PAHO).
"In our countries, no matter how much the health systems are called public systems, what is most common is that the services do not reach the poorest people. Whether for political, economic, social, or ethnic reasons, in fact, the higher income sectors end up absorbing a large portion of public health resources," explains Dr. Cesar Vieira, coordinator of the program on public policy and health at PAHO.
Today PAHO is supporting democratization of health systems, a task linked to the struggle for equity that transcends the written word, legislation and speeches. "For health services to get to the people who most need them," says Dr. Vieira, "it is not enough to have some legislation or to have a given service that in principle is supposedly accessible to all for free. There are many factors to coordinate, since everything is often reduced to a problem of information. People with more education -generally, those with more money-can access those services because they know how to look for it, how to request it, and where to find it, while needier people perhaps don't even know it exists", he adds.
"That is the heart of the work of PAHO in the linkage of democracy and health; that the poorest and the weakest, who need the most access to health, actively participate in absorbing public resources allocated to the health sector," Dr. Vieira says.
Democratization of political systems in Latin America in the 1980s and 1990s prompted revitalization of democratic institutions, and "PAHO began collaborating with the parliaments of the region, since these had been neglected institutions during decades of military dictatorships," said Dr. Cristina Torres, regional adviser in health policies in the PAHO's program on public policy and health.
The parliaments of the region lacked the necessary technical updating in order to carry out their task. According to Dr. Torres, PAHO carried out a quick diagnosis, which concluded that parliaments dealt with health matters through committees but needed some improvements to do their work effectively.
"These commissions lacked technical advisers, access to information on the health situation, the organization of the sector and access to services. PAHO began working to facilitate access to information on crucial subjects that required the participation of the lawmakers," she explained.
These limitations in the legislative bodies created a series of practical problems, "Although almost all the countries and the new governments knew that health matters were key in democratic systems," the technical and legal instruments for responding to this did not exist. "Good proposals were lost and the gap between the legislative and the executive was a serious problem", Dr. Vieira explained.
The work of PAHO consisted of helping to break what Dr. Vieira called a "bottleneck" in legislation, since existing laws were antiquated and had not kept up with developments in business and technology in the health sector. "Latin American countries did not have modernized institutions to regulate the health sector, insurance, pharmacists, and hospital care. PAHO is working to increase the regulatory capacity of the state, to elevate its ability to protect the neediest people," he said.
"Legislation is one of the results of the democracy and health program", Dr. Vieira noted, citing new laws such those for safe motherhood in Bolivia; natural disasters in Costa Rica; disaster prevention in Ecuador, and anti-tobacco legislation to protect young people, in Mexico. These have bee passed with advisory services from PAHO, in joint efforts with the countries individually, and with inter-parliamentary regional agencies, such as the Latin American Parliament (PARLATINO), the Andean Parliament, the Central American Parliament, the Indigenous Parliament and the Parliamentary Conference of the Americas.
Among the topics lawmakers dealt with, PAHO cites reorganization of the health systems, disaster prevention and mitigation, control of blood banks, the regulation of sale of breast milk substitutes, generic drugs, prevention and control of smoking, healthy municipalities, protection of older adults, reduction of violence against women, communicable disease networks, especially AIDS, and insurance, especially for mothers and children.
PAHO, which also serves as the Regional Office for the Americas of the World Health Organization, was established officially in 1902 and is the oldest health organization in the world. It works with all the countries of the Americas in order to improve health and raise living standards.
Related Information:
PAHO BOOKS:
Equity and Health: Views from the Pan American Sanitary Bureau
Investment in Health: Social and Economic Returns
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