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New Life for Primary Health Care: the Social Determinants of Health


Title: Red Iberoamericana de Ciudades Patrimonio Cultural de la Humanidad, Universitarias y Saludables Author: Ing. Ana Isabel Quan Last modified by – PowerPoint PPT presentation

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Title: New Life for Primary Health Care: the Social Determinants of Health

New Life for Primary Health Care the Social
Determinants of Health
  • Dr. Mirta Roses Periago
  • Presentation to the WHO Commission on the Social
    Determinants of Health

  • Vancouver, Canada

  • June 2007

The Social Determinants of Health in the Americas
The Region is characterized by a demographic
transition with high population growth, and rapid
and unplanned urbanization. Research has shown
the complex relationships between the social,
economic, environmental, political and culture
conditions known as the social determinants of
health in the health of the population and
The Americas is the most unequal region of the
World 220 million people living in poverty
The Social Determinants of Health (SDH) and
Primary Health Care (PHC)
  • New focus on the SDH and human development
    recognizes that health should be central to the
    development agenda because
  • Health is a basic human need
  • It is indispensable in the establishment of
    democratic societies
  • It is a fundamental human right

Any approach to improve health should be linked
within a broader economic, social and political
context, and should allow for the inclusion of
multiple actors and sectors
Achievements of PHC in the Americas include
For the past 30 years, PHC has been recognized
worldwide as a key component of effective health
1970 Lalonde Report establishing the concept of the non-medical determinants of health.
1980 Health for All expansion of PHC and vertical programs in selected countries SILOS renewal of community participation.
1990 Establishment of the concepts of sustainable human development health sector reforms elimination of polio in the Americas.
2000 Commission on Macroeconomics and Health focus on equity in health MDGs WHO Commission on the Social Determinants of Health.
Primary Health Care in the Region of the Americas
  • Need to address exclusion in issues related to
  • Need to broaden social protection as a central
    element of sectoral reforms.
  • Definition of new strategic and programmatic
    orientations to improve health outcomes.
  • Integrate and incorporate the Millennium
    Development Goals (MDG)

There are still challenges and inequities to
overcome in the countries of the Americas
The Social Determinants of Health and Primary
Health Care
  • PHC is a useful approach for equitable health
    and human development since it requires that more
    attention is placed on the operational and
    structural needs of health systems (access,
    sustainability of resources, political
    commitment, guarantee of high quality care,

Core Values, Principles and Elements in a
PHC-Based Health System
Universal coverage and access
First Contact
Comprehensive, integrated and continuing care
Intersectorial actions
Responsiveness to peoples health needs
Adequate and Sustainable resources
Family and community based
Right to the highest attainable level of health
Appropriate human resources
Emphasis on promotion and prevention
Government accountability
Optimal organization management
Appropriate care
Social justice
Pro-equity policies programs
Active participation mechanisms
Sound policy, legal institutional framework
PAHO Technical Cooperation in PHC
  • PAHO understands PHC as an integral part of the
    development of health systems and that the most
    appropriate path to produce equitable and
    sustainable improvements in the health of the
    people of the Americas is to build health systems
    based on PHC.

Main PHC Principles for Technical Cooperation
  1. Responsiveness to peoples health needs
  2. Government accountability
  3. Quality-oriented services
  4. Social justice

Main PHC Principles for Technical Cooperation
  1. Sustainability
  2. Intersectoriality
  3. Social and individual participation

Social and Environmental Aspects of Primary
Health Care
  • In the past few years, the Region has faced
    considerable changes
  • Rapid and unplanned urbanization
  • Structural changes in health systems
  • Climate changes
  • Demographic transitions
  • Increased inequity and poverty

In the Americas, the principles of PHC have
been adopted and adapted by each country
according to its own reality and needs.
Social and Environmental Aspects of Primary
Health Care
  • The emphasis on the environmental aspects of PHC
    has been highlighted with the definition of
    primary environmental care (Borrini, 1990) that
    includes a focus on community-based development
    to achieve sustainable lifestyles with 3
  • Fulfill basic human needs
  • Strengthen people and community
  • Optimal and sustainable use and management of
    community resources

Social and Environmental Aspects of Primary
Health Care
  • One of the most effective answers is to consider
    PHC in its most broader form, emphasizing health
    promotion and prevention, as well as active
    citizen and community participation to achieve
    better health.

Faces, Voices, and Places of the MDGs is a
regional initiative that targets the poorest and
most vulnerable communities in Latin America and
the Caribbean to help them achieve the MDGs from
the perspective of health.
Communities are chosen by national Ministers of
Health in collaboration with PAHO/WHO
Representatives (PWRs). Selection is based on
their extreme conditions of vulnerability and
poverty. To date there are in 26 communities in
13 countries participating.
Reviews the experiences of work done since Alma
Ata and re-energizes them through local work with
a concrete objective advancing towards the
"Our greatest concern must always rest with
disadvantaged and vulnerable groups. These groups
are often hidden, live in remote rural areas or
shantytowns and have little political voice." Dr
Margaret ChanWHO Director-General
This initiatives contribution to the Region is
to shift from the analysis of MDG indicators to
participatory, action-oriented research that
fosters local empowerment.
The initiative analyzes local realities, develops
critical interventions, and provides targeted
technical assistance with the support of PAHO/WHO
technical units and other UN system agencies.
We don't have to re-invent the wheel
but make it spin faster!
Puts the emphasis on improving conditions of
peoples and their territories through the
community self-management model.
It is a catalyst for change, that coordinates
actions to allow political leaders, the leaders
and inhabitants of the communities, NGOs, IOs,
and the international cooperation community work
together at the local level.
Empowers individuals and the community via a
horizontal exchange partnership between local
communities and providers of technical
Is designed to foster a citizenry that exercises
its capacity for change through their collective
and individual power.
WHO Commission on Social Determinants of Health /
Knowledge Networks and Faces, Voices and Places
Social Exclusion The initiative is aimed at
addressing the most vulnerable, neglected and
economically deprived communities. In Ventanilla,
Peru, through participatory action research
methodology exercises the community and its
citizens are being empowered to reduced social
Measurement and EvidenceThe initiatives initial
diagnosis includes a thorough study of available
data on the community, setting of baselines and
targeting and monitoring of advances. Through the
PAHO - CEPAL-CELADE Agreement, census data from
19 LAC countries was analyzed and sub-national
poverty maps were created to facilitate targeting
of the most vulnerable communities.
Women and Gender Equity In the Chiquimula and El
Estor regions of Guatemala multi-cultural and
gender perspectives have driven the work. This
will lead to the development of healthy
mechanisms, processes and actions to be taken at
the local level to reduce gender-based inequities
in health.
Priority Public Health Conditions In Santa Fe de
Veraguas in Panama, malaria control has been
approached with a focus on socially and
economically disadvantaged groups. Interventions
and actions to improve the situation will address
the social determinants causing inequities in
health outcomes, barriers and will facilitate
access to health care.
Urban Settings In four communities in the
Greater San Salvador area in El Salvador work is
underway to address the most vulnerable and
marginalized communities. The strategy employs an
intersectorial, multi-programmatic, approach to
influence health determinants through
participatory activities centered on situation
Early Child DevelopmentIn Yuty, Caazapa,
Paraguay, efforts involving the community
component of the IMCI strategy are underway
through participatory planning exercises with
local leaders. These have led to disease
prevention and health promotion activities under
MDGs 1, 4 and 5. These provide opportunities to
young children and their mothers in shaping
sound lifelong health and development status.