Globalization and injuries in the context of the Americas

1. 9thWorld Conference on Injury Prevention and Security Promotion 15 TO 18 MARCH, MERIDA, MEXICO Globalization and injuries in the context of the Americas Dr. Mirta Roses Periago Director, Pan American Health Organization (PAHO)

2. Health Determinants Education Nutrition Water & Sanitation Housing Work Occupation Employment New challenges: Aggresiveness-Violence; public domestic, community and road safety; substance abuse Family income Salary Social development and economic Well-being and Health System and health services Inclusion and coverage Opportunity- Access-Quality 4. Users satisfaction Social networks Life conditions Identity and culture Family integration Urbanization Aging Age Gender Genetics Adapted from WHO

3. RISK FACTORS Ecological Model • Family and friends relationship • Social • Community • Individual • Inequities • Norms that support violence • Guns availability • Police weakness/ criminal justice • Violence in the media • Social status of women • Unequal distribution of wealth • Social isolation • Illegal drug traffic • Conflictive relationship with parents • Conflicts between couple • Pressure from peers involved in violence • Demographic features • Psychological and personality alterations • Abuse history

4. EXPANSION OF DISPARITIES INCREASE IN THE EXCLUSION GLOBALIZATION and new economic order DEMOCRACYand descentralization Economic and State Reforms Health Sector Reforms Welfare state and social security crisis MDG HFA 2000 1975 1990 2015 DEMOGRAPHIC TRANSITION: population growth, urbanization and aging EPIDEMIOLOGICAL POLARIZATION: profile coexistence of opposed risk and disease Overwhelming Environmental and Ecological Impact Health for All – Millennium Declaration

5. 0,40 1,6 Acute diarrheal diseases 1,4 0,30 1,2 Acute respiratory infections 0,20 1,0 residuals Vaccine-preventable diseases 0,8 violence 0,10 perinatal Gained years of life expectancy from 1980 to 2000 (Regional average) Nutritional deficiencies 0,6 cardiovascular cancer 0,4 0,00 <1 1-4 5-9 10-14 15-19 20-24 communicable Age (Years) 0,2 0,0 -0,2 -0,4 The legacy of HFA to the population of the Americas (Decomposition of changes in the life expectancy from 1980 to 2000 for cause and age)

6. Superior tercile 14.000 12.000 10.000 8.000 Average GDP per capita adjusted by PPP (int. $) 6.000 Average tercile 4.000 Lower tercile 2.000 0 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 Disparities of the Economic Growth in the Americas [PAHO/WHO: Health in the Americas, 2002 Edition]

7. 1,0 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0,0 0,3 0,0 0,1 0,2 0,4 0,5 0,6 0,7 0,8 0,9 1,0 The poorer The richest Magnitude of Inequality of Income in the Americas 2003 Perfect equity line ingresos (proporción acumulativa) [ CD145/7; PAHO Program Budget Policy ] Population classified according to its income (Cumulative proportion)

8. Unemployment continues to be high Increase of the informality CEPAL-2005

9. The Inequity Impact on the Global Health • Less developed countries concentrate 84% of the world population… • They consume less than 11% of the world health expenditures • However, they bear 93% of the overall disease burden

10. Ethic Evolution/ Ideology/Values that guide the Social Protection Systems Public Assistance And Charity for the poor and indigenous UNIVERSAL SOCIAL PROTECTION AS A CITIZENS RIGHT STATE BENEFACTOR Segmented Systems according to payment capacity Formal social Security for industrial workers 20’s/40’s Century XXI 50’s/70’s 80’s/90’s Century XX

11. Incidence of DiseasesAVISAs per 100 inhabitants Group I (communicable) Group II (non communicable) Group III (accidents, violence) OMS-2005

12. Expected effect in crime rate according to changes in macroeconomic indicators Source: Fajnzylber P, Lederman D, Loaiza N, BM, 2001

13. HOMICIDE RATES x 100.000 pop. (ADJUSTED) MALE SELECTED COUNTRIES, 1996- 2005 We have to share experiences and help each other Fuente: OPS, Datos básicos

14. HOMICIDE RATE x 100.000 pop. (Adjusted) female Selected countries, 1996- 2005 Fuente: OPS, Datos básicos Female homicide rates are lower than those of men: ratio 1:10 More cases are detected as gender based (feminicide)

15. Type of road user in proportion to all the deaths by trafficin the countries of the Americas + Road user categories were not uniform across all country data. * Data for Mexico and the United States did not differentiate between drivers and passengers. “Drivers” bar for these two countries corresponds to the total of drivers and passenger fatalities. Sources: Data compiled from the following sources. Canada, 2002—Canadian Motor Vehicle Traffic Collision Statistics 2002, http://www.tc.gc.ca/roadsafety/tp/tp3322/2002/page3.htm; Colombia, 2002—Instituto Nacional de Medicina Legal; Costa Rica, 2003—INEC; El Salvador, 2003—National Police; Jamaica, 2003—Ministry of Health (original figures from National Police Headquarters); Mexico, 2000—Consejo Nacional de Prevención de Accidentes; Saint Lucia, 2001—Royal St. Lucia Police Force (Traffic Department); Trinidad and Tobago, Office of the Commissioner of Police; United States, 2002—NHTSA.

16. Deaths by traffic accidents in Bogota, Colombia1991-2005 Civic Culture Change of policemen Closing of night establishments Source: Instituto de Medicina Legal y Ciencias Forense. Fiscalia General de la Nación

17. Women (%) 15 to 49 years, sometime living in union, that say to have been victims of violence by their husband or partner Physical violence Sexual violence Source: Measure DHS, ORC Macro, Encuestas Demográficas y de Salud (DHS). Ecuador: CEPAR, ENDEMAIN. ORC Macro: procesamientos especiales de las DHS. (Países seleccionados)

18. Model to address comprehensively family violence (VIF) • Regional Level: • International Forums • Replication and exchanges • Lessons learned • National coalitions • Legislation, monitoring systems • Prevalence/advocacy study National • Training, University curricula s • Policies, standards and protocols • Surveillance and reference systems • Prevention Sector Community • Networks, support groups, men groups • Evaluation of needs: Critical Path

19. CoaliciónInteramericanapara la Prevención de la Violencia BM, BID, OEA, CDC, USAID, UNESCO, OPS Face Together the New Challenges Violence Prevention Inter American Coalition WB, IDB, OAS, CDC, USAID, UNESCO, PAHO

20. Focus in needier, vulnerable Sectors, and territories Emphasis on prevention Interpersonal, gender , juvenile, and self-inflicted violence Road safety: pedestrians, motrocyclist, the elderly, migrants Strenghtening of networks and joint effort in road safety: work together Strategic Plan 2008-2012 OUR PROPOSALS AND COMMITMENTS 132º CE - OPS/OMS

21. Health Agenda for the Americas • Human Rights, universality, • access and inclusion • Pan American Solidarity • Equity in Health • Social Participation 2008 - 2017 • Strengthening National Health Authority • Tackling Health Determinants • Harnessing knowledge, science, and technology • Strengthen Health Security • Diminishing health inequalities among countries and inequities within them • Reducing the risk and burden of disease • Increasing social protection and access to quality health services • Strengthening the management and development of health workers

22. Challenges for 2015:MDG Achievements and other Priority Agendas HEALTH SYSTEMS BASED ON PRIMARY HEALTH CARE HEALTH PROMOTION DETERMINANTES Healthy public policies Environment Social Exclusion MDG Achievements by 2015 Faces, voices and places for MDGs Family Community Healthy environments Community Action Individual Inequity Municipality State Country Región Inequalities Personal skills Health services reorientation

23. … there are many challenges ahead CountryPublic Policy Change in the economic performance Member capacity UN Mandates Integration System External Resources Available Inter American Systems Socio-determinant Factors UN Changes