HUMAN SECURITY: A Public Health Perspective

1. HUMAN SECURITY:   A Public Health Perspective Dr. Mirta Roses Periago Director Pan American Health Organization (PAHO/WHO) LXVII Annual Meeting USMBHA /AFMES Human Security: A New Border Response El Paso, Texas, USA. June 3-5, 2009

2. . Content • Human Security: • Its origins, development, and concept • The contribution of human security to health •   National examples of human security and its • usefulness for the MEX-US border

3. Introduction • Three current topics that exemplify human security: • Influenza A (H1N1) epidemic • MEX-U.S. border violence • Global economic crisis

4. Background • Mandatory References: • Human Development Report. New Dimensions of Human Security. UNDP (1994) • Millennium Summit - UN (2000) • Human Security Now.Intergovernmental Commission on Human Security – UN. S. Ogata & A. Sen (2003)

5. A less violent world, but … Number of armedconflicts, 1946-2003 Source: Human Security Report 2005. Uppsala/PRIO, 2004.

6. Number of armedconflicts, 1946-2003 Source: Human Security Report 2005. Uppsala/PRIO, 2004.

7. Number of armedconflicts, 1946-2003 Source: Human Security Report 2005. Uppsala/PRIO, 2004.

8. What is new in the concept of human security? • Different from the concept of national security or state security. Emerges post-cold war • Paradigm shift: state-centered security to people-centered security • Need to address the human right to live without fear or want • The key issue is to protect people from threats, risks, dangers, and want

9. HUMAN SECURITY MEANS: • Security against chronic threats such as hunger, disease, and repression • Protection against sudden and harmful changes in everyday life, whether at home, in the job market, or at the community level.

10. Why human security? • A world with fewer conflicts between countries but … • Transnationalorganized crime (drug trafficking; human trafficking; weapons smuggling; money laundering) • Interpersonal violence have become a visible phenomenon

11. Human Security is: “ Protecting the vital core of all human beings in ways thatenhance human freedom and fulfillment. ” “ Protecting fundamental freedoms - those which are the essence of life. It means protecting people from critical (severe) and pervasive threats. ” “ Creating political, social,environmental, economic, military and cultural systems that give people more reasons to live and enjoy a life with dignity. ” Human Security Now. UN Commission on Human Security. NewYork, 2003.

12. Relations and differences

13. Seven major categories of threats to Human Security • Economic security • Food security • Health security • Environmental security • Personal security • Community security • Political security

14. It attempts to address • daily threats related to: • Poverty • Pandemics • Environmental degradation • Lack of access to drinking water • Natural or man-made disasters • Maternal and child health risks • Unemployment • Violence • Lack of road safety

15. Six areas linking poverty and conflict

16. H e a l t h D e r t e r m i n a n t s Education Agriculture - Food Potable Water/Sewerage Housing Work Environment Employment Social and Economic Development Violence & insecurity Addiction to narcotics Health and Well-being Health care 1. Resources 2. Administration and management 3. Opportunities Access Quality Users’ perception Social Network Condition of Life Family size Age Gender Genetics Lifestyle Adapted from WHO

17. Relationship between Human Security and Social Determinants of Health: three levels of action Structural conditions that affect health at the global, national, and local level Conditions in which people are born, grow, live, work, and age Research, Monitoring, Training

18. HUMAN SECURITY AND HEALTH Concept of Public Health “ Public Health is joint action by the State and civil society to protect and improve the health of the people. It is an interdisciplinary social practice. ” PAHO. Public Health in the Americas. Conceptual Renewal, Performance Assessment, and Bases for Action. Washington, D.C. 2002.

19. Relationship between Human Security and Health • Two questions: • How does human insecurity affect health? • How do disease and adverse health conditions affect people’s security?

20. Gaps to fill in Human Security and Public Health

21. HUMAN SECURITY AND HEALTH Human security is reflected in a child who doesn’t die, a disease that doesn’t spread, a job that isn’t eliminated, ethnic tension that doesn’t explode into violence, a dissenter who isn’t silenced. Human security doesn’t involve concern about arms, but concern about human life and dignity.

22. HUMAN SECURITY AND HEALTH “ In both developing and industrialized countries, threats to health security tend to be greater for the poorest populations, particularly children and rural dwellers. ”

23. HUMAN SECURITY AND HEALTH “ Although the poor are generally less secure when it comes to health, poor women are in a particularly difficult situation. One of the most serious risks that they face is childbirth... ”

24. HUMAN SECURITY AND HEALTH Human security and health are interdependent… as health improves, so does human security as human security improves, so do health conditions

25. HUMAN SECURITY AND HEALTH The more evident challenges • Infectious diseases: HIV/AIDS, avian flu, influenza A (H1N1), bioterrorism, epidemics, and outbreaks (special impact on fragile states) • Poverty-related threats that impact health: the majority of preventable infectious diseases, nutritional deprivations, maternity-related risks • All forms of violence and lack of road safety

26. SOCIAL EXCLUSION IN HEALTH THREATENS HUMAN SECURITY • 230 million people (46%) lack health insurance • 125 million (25%) lack access to basic health services • 17% of births without the presence of a qualified birth attendant • 152 million people lack access to safe drinking water and basic sanitation

27. OUT OF POCKET EXPENDITURE IN HEALTH THREATENS THE FINANCIAL SECURITY OF HOUSEHOLDS • Household out of pocket expenditure in health represents 37% of total spending in health and in various countries it exceeds 50%. • Health spending is considerably greater among lower income families • Out of pocket spending in health is between 16% and 40% greater in women than in men

28. SOCIAL SECURITY AND HEALTH • Social achievement of workers. • The basis of wellbeing • Human Rights – Right to Health • Public Policy for poverty reduction, economic growth and social development

29. Classic Social Security is not enough to reduce social exclusion and promote human security REDUCED CONTRIBUTIVEBASELINE OF SOCIAL SECURITY High unemployment Increase in informal labor Source: ECLAC, 2004

30. SOCIAL PROTECTION, CHANGING THE FOCUS • In short and medium term, employment cannot be the only mechanism to access social protection • A better balance is required between incentives and solidarity • New pressures due to demographic and epidemiological changes, as well as in the family structure • Synergy of contributive and non contributive mechanisms • Integral and integrating public policy

31. INOVATIVE ALTERNATIVES FOR THE EXTENSION OF SOCIAL PROTECTION IN HEALTH Expansion of classic social security schemes, including the incorporation of informal workers Broadening mechanisms and projects for the extension of coverage of health systems SYNERGY AND COHERENCE Develop links between previous mechanisms and other protection mechanisms and public initiatives (overcome fragmentation, segmentation and improve equity) Promotion and development of innovative protection strategies, including community based initiatives

32. EXTENSION OF SOCIAL PROTECTION IN HEALH PAHO/ILO JOINT INITIATIVE ON THE EXTENSION OF SOCIAL PROTECTION IN HEALTH

33. THE CASE OF INFLUENZA A (H1N1) • Decisions by PAHO/WHO, governments, and the scientific community aimed at: • PROTECTING the population from the risk of contracting the virus • PROVIDING timely quality care for infected people to lower case-fatality • MINIMIZING as much as possible the adverse economic impact

34. RESSCAD Health and Human Security Agreement Guatemala, Sept. 2006 • Priority given to violence and human security with a public health approach; emphasis on comprehensive prevention of youth violence • Improvement of information systems • Development of national and sub regional plans and programs

35. HONDURAS • Human Security Program • UNDP, PAHO, UNICEF (JICA – UNFHS) • Violence prevention (selected municipalities) • Information systems and observatories on violence (at national and local level) • Social Culture • Research

36. COLOMBIA • Project: “Healthy and Safe Environments to ensure a decent and productive life to young people affected by violence” • UNDP, PAHO, UNODC, UNICEF (JICA–UNFHS)5 DEPARTMENTS (Provinces) • Advocacy, dissemination of knowledge • Access to people-friendly health and education services, healthy and safe environments, guarantee of safe maternity services for young women • Opportunities for employment and income generation

37. SÃO PAULO, BRAZIL • Project: “Human Safety in São Paulo” • UN, UNESCO, PAHO, UNFPA, UNICEF (JICA-UNFHS) • Violence reduction and creation of a culture of peace and harmony through education, health, and community participation • Family-friendly hospitals and health centers • Health-promoting schools, reproductive health and sexual education • Violence-free environments, strengthening of community networks-social cohesion

38. SONSONATE, EL SALVADOR • Project: “ Improving Human Security,Social Cohesion, and Public Safety in Three Municipalities” UNDP, PAHO, UNICEF, ILO (JICA-UNFHS) • Information systems and observatories on violence • Community networks • Promotion of employment and income generation for young people

39. GUATEMALA • Project:“ Consolidating Peace in Guatemala through violence • prevention and conflict resolution” • UNDP, PAHO, UNFPA, UNDAF, UNHABITAT, UNESCO, UNICEF • (AECI – MDG Fund) 3 municipalities • Policy and legal framework reviewed and adapted - gender-based violence, youth violence, and violence against children and indigenous people • National capacity to prevent conflict and address social violence: information systems, networks, indigenous communities

40. HUMAN SECURITY AND HEALTH Challenges for PAHO and countries • Raise regional commitment to incorporate the human security approach in health plans • Expand the concept beyond issues related to violence and conflict. • Identify and reduce threats to human security in each country

41. THANK YOU GRACIAS