Introduction: Regional Outlook

This chapter presents an analysis of the general health situation in the Region of the Americas in the last 5 years, with three subtopics: (1) Socioeconomic inequalities in health in the Region of the Americas; (2) Health status of the population; and (3) The quest for universal health: summary of indicators on health systems performance.

Socioeconomic Inequalities in Health in the Region of the Americas

The section on socioeconomic inequalities in the Region of the Americas considers the following public health issues: (1) maternal and child health; (2) communicable and noncommunicable diseases; (3) health of adolescents; and (4) public health expenditure by the countries. The socioeconomic stratification variables were gross domestic product, percentage rural population, percentage access of the population to improved sanitation facilities, and mean years of schooling received by people ages 25 and older.

Simple measurements of socioeconomic inequalities in health were calculated, making it possible to describe the magnitude of inequalities in the most recent year (2013) and their trends between 2004 and 2013. An analysis is also presented, for reference purposes, comparing the subregions of the Americas.

An ecological study design was adopted, with the following units of analysis: (i) countries of the Region of the Americas; (ii) countries of the subregions of the Americas; and (iii) subnational levels of the countries of the Americas. This analysis highlighted socioeconomic inequalities in health among countries of the Region, among countries of the subregions, and among subnational levels within countries.

Health status of the population

The section on the health status of the population of the Americas presents the most important issues related to health and disease observed in the Region between 2010 and 2015. This information is grouped as follows: (1) Population characteristics and trends; (2) Mortality situation and trends; (3) Critical issues of health and disease; (4) Noncommunicable chronic diseases and external causes of mortality; and (5) Health status throughout the life course.

“Population characteristics and trends” describes the interaction of fertility, mortality, and migration as key drivers and basic components of the demographic changes in a population’s size, structure, and distribution.

The quality of mortality data is addressed in an analysis of underreporting and garbage ICD-10 codes (International Classification of Diseases, 10th edition). This section also includes a study of causes of death according to the global burden of disease (communicable diseases, noncommunicable diseases, and external causes). The leading causes of death by age group (10 to 24 years, 25 to 64, and over 65) for the period 2010-2013 are also presented. Maternal mortality and infant mortality are analyzed for three time periods (2002-2005, 2006-2009, and 2010-2013) and by subregion.

In this next section, the reader will find information on critical problems that impact health and contribute to disease in the Region of the Americas. These include emerging diseases, vector-borne diseases (malaria, dengue, Zika, and chikungunya), neglected diseases, vaccine-preventable diseases, communicable chronic diseases such as tuberculosis and leprosy, sexually transmitted diseases, and zoonoses such as rabies and leptospirosis.

Information is presented on the status of four main chronic diseases (cardiovascular disease, diabetes, malignant neoplasms, and respiratory disease) that cause four out of five deaths in the Region. Also discussed is the status of the main risk factors to which people are exposed, such as tobacco use, harmful consumption of alcohol, insufficient physical activity, unhealthy eating habits, and unhealthy diet. Information is included on mental and neurological disorders, as well as disorders associated with substance use that are factors leading to morbidity, disability, injuries, premature mortality, and increased risk of other health conditions. Attention is given to the situation in the Region with respect to road traffic deaths and the importance of implementing and enforcing road safety legislation with a view to reducing the number of deaths. This chapter addresses the issue of violence in general and against women, children, and young people in particular, as well as its consequences. Workers’ health, working conditions, social determinants, risk factors, workers’ access to health services, and occupational health are also discussed in this section.

The chapter includes information on the specific situation of certain population groups from the life course perspective. Children’s and adolescent health, maternal health, and the health of older adults are addressed in depth, in the context of the confluence of situations that affect the life course.

The quest for universal health: summary of indicators on health systems performance

This section summarizes the progress made in the last 5 to 10 years in terms of the performance of health systems and the impact this has had on universal health indicators in 34 countries of the Region of the Americas. Access to health is measured using indirect indicators such as use of health services, likelihood of reporting unsatisfied medical needs, and perceived access barriers. Health coverage is measured using several metrics, including population coverage, availability and distribution of human and material resources, essential technologies and drugs, and information systems. Three key aspects of health systems are analyzed in terms of how they have changed in recent years: 1) universal access to and universal coverage of quality health services; 2) financing of health services and elimination of direct payments; and 3) health services capacities and activities. These measurements are considered from the perspective of equity in order to present results that go beyond averages, establishing linkages with the social determinants of health.

This section also offers a more detailed look at health system indicators aimed at improving the health and well-being of the entire population through the progressive attainment of universal access to health and universal health coverage. Furthermore, this section provides an analysis of governance, human resources, and financing that ensure the health system’s capacity and readiness to offer treatment, prevention, rehabilitation, and palliative care services to the entire population.