Washington, D.C., 25 September 2017 (PAHO/WHO) - Members of the Commission on Equity and Health Inequalities in the Americas, launched last year by the Pan American Health Organization (PAHO), today described the importance of identifying and addressing the social, economic, and cultural factors that underlie health inequalities, during a special event on the sidelines of the 29th Pan American Sanitary Conference.
Sir Michael Marmot, chairman of the regional commission and former chair of a similar global commission created by the World Health Organization (WHO), noted that the Region of the Americas has shown major health gains in recent years, but not all people or countries have shared those gains equally.
"The gap between countries with the highest and lowest life expectancy is 18 years for women and 19 years for men," Marmot observed. "That should not be the case. There is no biological necessity for that gap in the region."
Marmot and his fellow commissioners are reviewing data and research on health inequities and social determinants in the Americas. Based on those reviews and deliberations, said Marmot, the commission will propose "conceptual and practical approaches for Member States, international organizations, local organizations and civil society" to use in tackling health inequalities related to social determinants.
Some of the evidence gathered so far by the commission shows, among other things, strong correlations between preschool enrollment and life expectancy, between mothers' education and their children's health, and between social insurance coverage and child survival rates. This evidence points to the need for more public spending on preschool education, more efforts to achieve gender parity in secondary education, and continued efforts to expand social insurance coverage, said Marmot.
Marmot also said the evidence so far supports conditional transfer programs, such as those in Argentina, Brazil, Mexico, and Peru. "Conditional transfers work. These programs reduce poverty and have an impact on school enrollment and the like."
Luis Fernando Correa, vice minister of health and social protection of Colombia, described his country's efforts to address social determinants, efforts that have been examined by the Equity Commission. He said Colombia has significantly expanded health coverage and has substantially reduced out-of-pocket spending on health. Nevertheless, access to health services remains difficult for rural populations, since health services remain concentrated in more populated areas.
To tackle these and other challenges, Colombia developed a 10-year national health plan through a participatory, intersectoral process designed to engage a wide range of actors in addressing the social determinants of health.
"Intersectoriality is key to addressing these issues," said Correa, "although it's equally clear that the health sector must play a leadership role in bringing other sectors together."
Nila Heredia, executive secretary of the Andean Regional Health Organization and co-chair of the Equity Commission, said that too many countries lack data on the health of indigenous and native peoples. "My request is that countries collect data that will give visibility to what is happening with these groups. It's easier to find data broken down by territory or gender, but not based on cultural matters."
Paulo Buss, another commission member, said the kind of evidence being collected by the commission was essential to inform and spur public policies to reduce poverty and improve equity. "In places like Latin America, you have to have public policies, because the market will never change the situation of inequity. This is the reason for health in all policies. But the health sector must play the leadership role in bringing other sectors together."
The final report of the Commission on Equity and Health Inequalities in the Americas is expected to be available by September 2018.