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)

European Statement on Migrants’ Health

The following statement on migrants’ health was signed by 20 National Member Organisations of the IFMSA, and was read during the European Regional Meeting 2015, held in Aalborg, Denmark, April 24-28th 2015.

On Sunday the 19th of April 2015 a ship carrying migrants from Libya to Lampedusa capsized, resulting in the loss of over 700 lives. An emergency summit of European Union leaders convened on the 23rd of April in response to this disaster and resulted in commitments to increase funding for search-and-rescue missions in the Mediterranean and to ‘identify, capture and destroy’ vessels used in human trafficking.

Since the start of 2015, the International Organization of Migration estimates that more than 1700 migrants have perished on the crossing from Africa to Europe. In April 2015, twice as many migrants are estimated to have died attempting this crossing than in the whole of 2013.

Article 14 of the International Declaration of Human Rights states that ‘everyone has the right to seek and to enjoy in other countries asylum from persecution’. A person can only claim asylum in some European countries once they have crossed the border, so migrants making the journey from their countries of origin are vulnerable due to their lack of state protection.

The IFMSA has acknowledged governments’ “obligation under international law to protect the human rights of migrants” in the Access to Healthcare for Undocumented Persons policy statement adopted at the August Meeting of 2014.

We, the undersigned National Member Organisations of the European Region of the International Federation of Medical Students’ Associations, condemn:

  1. The response of our governments to the current situation, such as the destruction of vessels, which does not address the root causes of migration and will not prevent migrants fleeing desperate situations.
  2. Our governments’ role in the root causes of migration and the lack of political will to remedy this.

We reaffirm that human life should be equally valued regardless of origin or nationality. As National Member Organisations of IFMSA, we commit to raise this issue in our countries where appropriate and continue to support work within our institution on this issue.

We applaud the European Governments who have pledged to increase funding for search and rescue missions in the Mediterranean as a short term strategy to mitigate the threat to life caused by this crossing. In the longer term, we call for a commitment from European governments to make safer options for migrants to enter Europe to apply for asylum. We call for a commitment from European governments to address their role in root causes of unsafe migration, such as financing of conflicts and discriminatory immigration policies.

We task European leaders with increasing the number of resettlement places available in European countries. Finally, we call for acknowledgement of the responsibility of the European governments to protect the human rights of vulnerable people above immigration policy.

“We can’t deter people fleeing for their lives. They will come. The choice we have is how well we manage their arrival, and how humanely” – António Guterres, United Nations High Commissioner for Refugees and former Prime Minister of Portugal.

The following National Member Organizations of the IFMSA signed and supports this statement: Medsin-UK, SISM-Italy, TurkMSIC-Turkey, IFMSA-Spain, MMSA-Malta, HelMSIC-Greece, ANEMF-France, NMSA-Norway, AMSA-Austria, FASMR-Romania, FiMSIC-Finland, IFMSA-Sweden, IMCC-Denmark, AMSB-Bulgaria, AECS-Catalonia, MMSA-Macedonia, CroMSIC-Croatia, SloMSA-Slovakia, IFMSA-Serbia and HumSIRC-Hungary. 

WHA 67: Sir Michael Marmot stops by IFMSA

Not only did Sir Michael Marmot (Director of UCL Institute of Health Equity) give an engaging speech at the “Doctors addressing violence against women and girls through social determinants of health” luncheon organised by IFMSA and WMA, where one of the most important statements was how equity has to be taken into consideration for education for women, and where education is relevant to health, he also dedicated a bulk of his valuable time at the World Health Assembly to join the IFMSA delegation at our daily briefing.

“IFMSA, I tell you the same every time I see you, you as medical students inspire us.”

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We also used our time with him to discuss some crucial topics, such as asking him his view on the Post-2015 discussion, where several sharp questions were asked.

“What I would have as a goal for Post 2015? A health goal! We’re resurrecting the confusion between the definitions of health and health care. Rich countries are not interested in Universal Health Coverage if they already have it. Why have a goal some countries wouldn’t do anything about? Such a goal doesn’t bind countries.
There are healthcare workers all over the world working together, it’s heartwarming. Yes, we should be addressing Social Determinants of Health. But what if your goal was Premature Mortality as an example: it applies to every country and makes you focussed on what you need to do, including ensuring Universal Health Care, but also for example to decrease levels of smoking. Ideally, we wouldn’t even need the movement on Social Determinants of Health, it would be included from the beginning”.

He ended his visit in addressing the IFMSA members present. “Some colleagues approached me for having a meeting with them, but I told them I was going to talk to the students. The students? Yes, what can be more fun? I’m continuously amazed by both your enthusiasm as well as your organizing skills in bringing people together”.

Our utmost gratitude goes out to Sir Michael Marmot for his time, support and inspiring words during our briefing and side event. From a personal perspective, his words both in thanks to medical students worldwide as well as in his views on the SDH/MDG discussion have truly inspired me and have changed my perspective on this discussion. I look forward to following its future developments

All the best,

Stijntje Dijk

IFMSA Standing Committee on Medical Education Director