Health Inequalities in the Americas

In the past decade, most economies in Latin America and the Caribbean have undergone rapid growth, allowing approximately 70 million people to rise out of poverty. Sadly, this growth has not benefited everyone equally. In turn, it has resulted in major variations in health indicator data, both between and within countries in the Americas region.

About inequality:
The Gini coefficient is a measure of the inequality of a distribution, a Gini coefficient of 0 represents exact equality—that is, every person in the society has the same amount of income and a Gini coefficient of 1 represents total inequality—that is, one person has all the income and the rest of the society has none. The average Gini coefficient of Latin America is 0.52 although this average hides a deep variation between countries, for example Bolivia, Haiti and Jamaica have Gini coefficients around 0.60 and Uruguay close to 0.45; but taking a look in the Americas’ region the gap becomes bigger and bigger with two developed countries like US and Canada, that have Gini coefficients of 0.45 and 0.32 respectively.

On the 22nd of June, 2015, the World Health Organization (WHO) State of Inequality Report was presented to the Americas’ Region at the Pan American Health Organization (PAHO) Headquarters in Washington, DC, USA.

With the knowledge that the Latin American region faces the greatest socioeconomic and health inequalities in the world, national Health Ministers, department heads of the PAHO, non-governmental organizations (among these, the International Federation of Medical Students Associations’) and many others, were anxiously awaiting the release of this report.

The objective of this report was to showcase best practices in inequality reporting in low- and middle-income countries (LMICs) using high-quality data, robust analysis methods, and user-friendly reporting methodologies.

The publication focuses on inequalities pertaining to reproductive, maternal, newborn, and child health (RMNCH), and has been compiled using public data from 86 LMICs. Using 23 RMNCH indicators, inequality status and its evolution over the last few decades has been assessed.  All data has been disaggregated according to four dimensions of inequality: education, economic status, education, sex, and place of residence.

A simultaneously promising and disappointing message permeated the report. Within-country inequalities have narrowed, with improvements in the poor subgroups driving the national decreases in disparities. However, significant inequalities in the RMNCH indicators continue to be present worldwide. Women, infants, and children who are the most socioeconomically disadvantaged, least educated and living in rural regions are the most vulnerable to health inequalities.

Maternal health intervention indicators were found to be the most disparate across inequality dimensions. The percentage of births attended by skilled birth health personnel, for instance, was 80 percentage points higher in the richer subgroups compared to the poor subgroups. A similar trend was discerned in antenatal care coverage (at least 4 visits), wherein the poor and less educated experienced at least a 25 percentage point difference in coverage.

On a positive note, coverage gaps in immunization (specifically BCG, measles, polio, and DTP3) were noted to be very minimal to virtually non-existent across inequality dimensions. Additionally, the under-five mortality rate has significantly decreased in poorer subgroups within the last decade, indicative of narrowing inequalities in child mortality.

On the whole, in many nations reported improvements in health coverage have been driven by select subgroups, failing to capture the true status of all citizens. Health inequality monitoring is thereby integral to the promotion and attainment of health equity, and without a designated regard for and analysis of disadvantaged subgroups, nations risk blinding themselves to the true state of health coverage in the face of improving national averages.  As Dr. Carissa Etienne, Director of the Pan American Health Organization remarked on June 22nd, “We need to go beyond the averages. Because beyond the averages is human suffering of immense proportions.”

As we enter the post-2015 era, we must continue to strive for access to essential health interventions for all who need them, without financial hardship. And in the words of Dr. Etienne, it must be ensured that “we leave no one behind.”

The full report can be accessed at: http://apps.who.int/iris/bitstream/10665/164590/1/9789241564908_eng.pdf?ua=1&ua=1

Entry written by Claudia Frankfurter (IFMSA-CFMS) and Maria Jose Cisneros Caceres (IFMSA Regional Coordinator for the Americas)

IFMSA Global Surgery Day

Welcome to IFMSA’s Global Surgery Day 2015!

Why surgery?
Surgery has long been a neglected part of primary health care; it has been mistakenly considered too expensive to be incorporated into the Millenium Development Goals (MDGs), but research has shown that surgery is in fact more cost – effective than several other widespread health initiatives, including campaigns against malaria and HIV/AIDS. There is a dire need to work towards an equitable distribution of surgeons and surgical resources across the globe, such that access to safe surgery anesthesia becomes accessible to everyone as a basic human right.

Why now?
This year has been a momentous one in the field of surgery and anaesthesia care. With the launch of the Lancet Commission on Global Surgery last month, the burden of surgically preventable diseases  we now know as many as 5 billion people don’t have access to safe and affordable surgical care and as many as 143 million more procedures are needed annually to make up for this deficit. What is more, surgery has been shown to be affordable, to save lives and to promotes economic growth.

The 68th World Health Assembly in Geneva adopted a resolution ‘Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage’ on 22nd May. it marks the start of a new era of surgical inclusion in the Global Health sphere, and marks the start of a long road to ensuring adequate surgical cover to people in all parts of the world. The IFMSA work was appreciated during several side meetings with the stakeholders with WHO GIEESC (our official partner), G4Alliance, The Lancet Global Commission, UNFPA, Fistula Foundation, Zonta International, SICOT, ICS/SIC and many others, included member states from Zambia to US, who congratulated with us.

Why us?
As the surgeons of 2030, we in the IFMSA have been campaigning across the world for Surgery and Anaesthesia for Everyone #SAFE, including campaigns, toolkits, training sessions and research projects. Coming together from our different cultures, health systems and educational backgrounds, we not only learn from each other but are working together to better understand this newly quantified health burden.

What now?
To support this moment when we need health advocates worldwide to be talking about  Surgery, you can be part of this moment, shaping the future of the Global Surgery paradigm. Join our online campaign for Global Surgery Day by following this link: http://tinyurl.com/q7swlq2 and become a part of the change leading towards easy and affordable access to Surgery and Anesthesia For Everyone. #SAFE

On social media, you are invited to use: #GlobalSurgeryDay #globalsurgery #healthsystems #SAFE

For any questions, lorma@ifmsa.org

[WHA68] Statement on Health in Post-2015 Agenda

Statement made on May 20th 2015 during the 68th World Health Assembly on Item 14.2: Health in the post-2015 development agenda

IFMSA welcomes the report A68/14 and underlines the importance for the WHO to ensure this process is a priority in its action plan.

Considering that changing any goals at this point is extremely difficult, we ask the WHO to focus its attention on supporting the development of realistic targets and clear indicators, which will remain a main topic of discussions in the following months.

Considering Goal 3 of the proposed SDG, IFMSA notes the additional work is to be done for the targets to be finalized. We underline the ambitious targets such as eradicating Malaria and AIDS in the next 15 years, which will need the full commitment of WHO.

IFMSA expresses concerns about the risk of health to be siloed in Goal 3, instead of being considered as a transcendent pillar of the SDGs framework. We understand the importance of HiAP to achieve the SDG and the need to recognize health as a driver and outcome of sustainable development, and the underlying importance of the social determinants of health. Cross sectoral targets should be established. Measure progress in health is fundamental to this process, and should not be limited to progress made in Goal 3. 

IFMSA remarks the absence of several important health areas, such as recognizing primary health coverage and the importance of health literacy, patient centered care and patient empowerment. We believe this areas need independent targets.

IFMSA calls for a more active discussion on some of the present targets. As example, the proposed target 3.10.c, continues to underline the need to change from training to education of health workforce. IFMSA favors a change so that this target reflect a global problem, not only one of developing countries.

IFMSA commits to keep being involved in the SDG process, as we were proactively present in previous years event, such as Rio+20 and UN OWGs. This process is one of all of us. As stated in the proposed SDGs, let’s finally ensure healthy lives and promote well-being for all at all ages.