Health in the Americas [2012 edition] is the official updated report that the Pan American Sanitary Bureau presents to the 28th Pan American Sanitary Conference on the health situation, its determinants, and trends in the Region of the Americas during the period 2006-2010.
This edition is the most recent in a long line of similar Bureau reports that have been published without interruption since 1956. That year, the first assessment of the health situation of the population of the Americas, prepared for the XIV Pan American Sanitary Conference in Santiago, Chile, in 1954, was published under the title Summary of Reports on the Health Conditions in the Americas, 1950-1953. In 1966, the title was changed to Health Conditions in the Americas, and the report continued to be published under this title every four years. The 1998 and 2002 editions bore the title Health in the Americas, and in the following 2007 edition, the periodicity of the publication was changed to every five years.
Health in the Americas is the most important publication of the Pan American Health Organization in terms of performing its function of generating, compiling, analyzing, and disseminating health information for use by the Member States.
As on other occasions, this publication consists of two equally important and complementary parts: a description and analysis of health conditions in the 48 countries and territories of the Western Hemisphere, and an integrated approach to the most important health issues in the Region as a whole.
Unlike previous editions, this 15th edition is being presented as an e-publication, thus increasing the opportunities for it to reach a wider public. In addition to targeting health authorities, academics, professionals, students, and health workers, as well as technical and financial cooperation agencies and other international audiences, the 2012 edition has been designed for the general public—especially readers interested in learning about the health situation in a specific country or exploring any of the major health related issues in the Region.
The online format will also enable us to periodically update the data and information and, in the future, to interact with readers and enrich and fine-tune the content for subsequent editions.
One of the greatest challenges for the publication’s more than 600 contributors has been limiting the chapters to one third of their length in earlier editions. The effort involved in selecting and condensing the most important information is compensated for by the innovation of using hyperlinks that take the reader to other sites, publications, and databases that complement the search for information, analysis, and learning.
This official report also includes the publication of a printed volume containing a summary of each country report and the regional volume—the latter of which is the subject of Chapter 7 of the electronic version. The printed volume will be presented at the same time as the Quinquennial Report of the Director, which succinctly describes the main achievements and results of PAHO’s technical cooperation during the first decade of the 2000s, with emphasis on the past five years.
The content of Health in the Americas closely follows the eight lines of action agreed upon by the ministers of health and described in the Health Agenda for the Americas, 2008-2017 and, therefore, provides information that is unquestionably useful for documenting progress and challenges involved in implementing the Agenda. This content is complemented with Chapter 1, which offers a historical account of the advances in public health in the Region, in whose achievement the Pan American Health Organization has actively participated during its 110 years of providing technical cooperation to the countries of the Americas.
The regional volume, which consists of seven chapters, and the country volume, which contains reports on each of the 48 countries and territories of the Hemisphere, together form the complete Health in the Americas, 2012. In this publication, interested readers will find a description and analysis of the main issues linked with the health situation and trends in the Region.
Chapter 1, “A Century of Public Health in the Americas,” presents a concise historical overview of the major advances in public health in the Americas from the dawn of the 20th century to the present and serves as an introduction to the succeeding chapters. This chapter introduces the message and challenge echoed throughout the work: that despite the undeniable progress in extending life and improving the health of the peoples of the Americas, inequities persist, and in some cases, have increased—inequities, that impact and distinguish the countries, both individually at the subnational level and comparatively, in relation to other countries in the Region.
Chapter 2, “Health Determinants and Inequalities,” discusses the social determinants—that is, the “causes of the causes” of good or ill health—and examines three megatrends: demographic transition and the gradient; migration, and urban growth. This chapter focuses on group and societal inequities and vulnerabilities, as well as poverty-reduction efforts in the Region, including initiatives in other sectors that have improved the health of populations in the Americas. It also provides specific examples of how progress has been made in tackling the social determinants of health through inter- and extrasectoral initiatives, such as efforts to promote children’s health care, education, and better housing and working conditions.
Chapter 3, “The Environment and Human Security,” explores in detail another major factor in human health, ecological determinants, and describes the risks that the environment, in its broadest sense, poses for health throughout the life course. Specifically, the chapter discusses changes in ecosystems and health, describing the impact of the long-used persistent pollutants, the result of human activity; air and water pollution; and sanitation. The second part of the chapter, which deals with human security, considers factors that sporadically and unpredictably cause harm to individuals and communities (earthquakes, hurricanes, floods, etc.), as well as the culture of violence; safety in food production and food handling, food security; and the workplace environment and its risks.
Chapter 4, “Health Conditions and Trends,” which has always been the core of this publication, presents the health situation through its principal indicators and provides a description and analysis of the epidemiological and demographic changes in the Region since the publication of the last edition in 2007. The chapter also describes the trends in infant and maternal mortality and shows age-specific mortality, with a breakdown by sex, groups of causes, and some specific causes. Concerning morbidity, this chapter includes the main diseases and health problems in the Americas, describing the situation, changes, and trends with respect to each. It also addresses the most significant risk factors that increase the population’s predisposition to health problems. This chapter highlights inequalities in the distribution of disease, the breadth of the prevailing pathology, and the serious challenges posed by the new obesity, violence, and smoking epidemics that are impacting the Region.
Chapter 5, “Health Systems and Social Protection in Health,” describes problems and solutions in the different areas of action in the Health Agenda for the Americas, 2008-2017 connected with this topic. It describes the features of the health systems and services and their impact on the health of the population, especially, in terms of inequities in the response to demand. It discusses the trends in health governance, intersectoral coordination and collaboration, and the strengthening of sectoral capacity in the Region. The chapter also looks at the characteristics and challenges of legislation designed to guarantee the right to health; country trends in the achievement of universal health coverage and its financing; social protection in health, health service expenditure and financing, and the impact of economic policies and financial crises on health systems. Finally, it describes the human resources situation and the allocation of those resources, as well as policies and plans for managing human resources, including staff retention strategies in areas with underserved populations, means of addressing the emigration of health workers, and the development of public health career paths in the Americas.
Chapter 6, “Knowledge, Technology, Information, and Resource Management,” is horizontally aligned manner with the areas of action found in the Health Agenda for the Americas, 2008-2017. This chapter describes how knowledge, technology, information, and resource management in this area aids decision-making and strengthens the Region’s health systems, in addition to fostering improvements in the quality of life of citizens. It focuses especially on the development of knowledge from its beginnings up to its analysis and application in public health through an analysis of the national health science information systems as the basis of a governance model; a description of the knowledge management situation and trends; and inclusion of the changes in health and education wrought by the use of information and communication technology.
Finally, Chapter 7, “Synthesis and Prospects,” is an original annotated summary of the topics explored in the regional volume, and it also appears in the print version of Health in the Americas, 2012. This chapter describes demographic and epidemiological trends in the Americas in the context of the economic, political, environmental, and social determinants of health and offers commentary and thoughts on the regional health situation and outlook in the next five years.
The main theme of the publication is the inequality in resources and in the distribution of health and well-being among and within countries. The Americas is a region of contrasts and similarities; of persistent inequities and growing social justice; of old diseases and the serious health, disease, and risk situations of recent decades; of unfinished agendas, achievements that must be protected, and enormous new and unpredictable challenges.
In Health in the Americas, 2012 the Pan American Sanitary Bureau presents and analyzes the data and information from every country in the Region of the Americas. In drafting the publication, it has used data from many domestic and international, as well as unofficial, sources, trying as much as possible to identify and eliminate any discrepancies.
The basic message of the publication is that each country is a mosaic of situations, places, and communities, and that every number, every piece of information, and every statistic represents the face, life, health, and hopes of a single, unique individual; that each face represents a voice, each voice expresses a need, and each need requires action.
Convinced of the importance of this information, we are certain that its extensive use will be the best incentive for the generation, processing, and analysis of ever-more relevant, valid, and timely data to benefit health in the Americas.