Article Index

Prefacio

The Secretariat of the Pan American Health Organization has a constitutional responsibility to report to the Pan American Sanitary Conference on health conditions and trends in the Region. Such is the principal purpose of this 2007 edition of Health in the Americas. It offers an updated, comprehensive presentation of the health situation throughout the hemisphere generally and specifically in the 46 countries and territories of the Americas,and it describes and analyzes the progress, constraints, and challenges of PAHO Member States in their efforts to improve the health of the peoples of the Region.

As a health agency, our core discipline is epidemiology, which enables us to measure, define, and compare health problems and conditions and their distribution from the perspectives of population, geography, and time.This publication addresses the issue of health as a human right, taking into account both the individual and community contexts, and examines various critical determinants of health, including those of a biological, social, cultural, economic, and political nature. That examination reveals the existence of gaps, disparities, and inequities that persist in our Region, especially those related to access to basic services, health, nutrition, housing, and adequate living conditions as well as to the lack of opportunities for human development—all of which contribute to the greater vulnerability to diseases and health risks of some population groups.

Therefore, in addition to the Secretariat’s institutionally specific remit to describe and analyze health problems and the response of the health sector to those problems, we have chosen to frame our analysis in the context of the universal commitment to the Millennium Development Goals of reducing hunger and poverty, promoting gender equity in opportunities for education, preventing and controlling diseases, managing and furthering cooperation among countries, and creating and strengthening subregional and intersectoral partnerships between governments and civil society as necessary conditions to achieve better health for the peoples of the Americas.

Production of this publication has been a major and complex undertaking of more than 500 of the Secretariat’s staff members. In the course of their work, they have consulted countless sources, both official and unofficial, to compile this compendium of information; consequently, some discrepancies in the presentation of data may have occurred. It bears noting, moreover, that the quality of information from the countries varies considerably and that it was impossible to obtain from some of them within-country disaggregations of data that would enable measurement of disparities in the health status of specific population groups. Nonetheless, this regional panorama expresses our commitment to work with the countries to address the unfinished agenda of unnecessary, preventable deaths of mothers, children, and other vulnerable population groups; to continue and renew efforts to sustain achievements in health, such as the elimination of diseases preventable by immunization;and to tackle ongoing and future challenges such as,among others, HIV/AIDS, multiresistant tuberculosis, juvenile violence, and new forms of bioterrorism.

In our determination to add value to the information we provide our readers, this edition of Health in the Americas offers some new features such as individual highlights of each country’s efforts to deal with a specific national health problem,and several other features described in the note to our readers. And, in our continuing attempts to broaden the reach of our information and to capitalize on changing technologies for the benefit of our readers, we are publishing this edition of Health in the Americas in print,online,and other digital platforms.

Along with the description and analysis of regional health conditions, this edition provides the perspectives of 10 internationally renowned experts regarding the “Health Agenda for the Americas, 2008-2017,” an initiative of the countries of the Region launched on the occasion of the XXXVII General Assembly of the Organization of American States (Panama City, 3 June 2007), the aim of which is to pursue over the coming decade an integrated, collective enterprise to attain the health goals of the Region.

In closing, we aver that this latest in a series of 14 editions of our flagship publication gathers facts and presents intelligence with regard to health in the Americas, by providing analysis, perspec- tives, and context as accurately, fairly, and authoritatively as possible. We hope that our readers will bear in mind that behind every number and every statistic in this publication is the life of a girl, a boy, a woman, or a man living in some corner of the Region. We further hope that the 2012 edition of the publication will bring news of the countries’ great progress in their common covenant to attain better health and longer, fuller, more fruitful lives for all the peoples of the Americas, especially those who thus far have been excluded from the benefits of development.

Mirta Roses Periago
Director

Note to our Readers

This edition of Health in the Americas introduces a number of changes to previous editions.

The Regional Volume includes an opening chapter that provides an overview of health in terms of the Millennium Development Goals; of the health status continuum—the unfinished agenda, the protection of health gains, and the confrontation of emerging threats; and of the national and international health sector response to that health status. Also added is a final chapter that contemplates a vision of the future of public health in the Region in the context of the Health Agenda for the Americas, 2008 - 2017, with commentaries from a number of distinguished international experts. Each of the intervening chapters commences with an introductory summary, which is set off from the main text with a different format. Color is used throughout the volume to assure the clarity of graphic material. Finally,as one of the main purposes of the series Health in the Americasis to trace regional trends in health conditions and health systems over time, complementing this edition are quotations from the Directors of the Organization—from Hugh S.Cumming in the 1920s to Mirta Roses Periago in the 21st century— that are germane to the subjects of the various chapters.

The Country Volume presents maps of each country and territory, as well as short notices that highlight a specific health challenge and the response of the national health sector to that challenge.

Throughout both volumes,text boxes are introduced to provide additional material; figures and tables are inserted as close as possible to their in-text mention; and bibliographic references are included.

We hope that these editorial enhancements will serve both to interest and to enlighten you, our readers.