The Americas: A Region of ExtremesThe Americas: A Region of ExtremesSocial Inequalities: A Barrier to Exercising the Right to HealthSocial Inequalities: A Barrier to Exercising the Right to Health

Dr. Mirta Roses PeriagoDr. Mirta Roses Periago, , PAHO DirectorPAHO Director

[Bethesda, MD. 16 September 2010.]

ContentContent

• Wide gaps among and within the Region of the Wide gaps among and within the Region of the AmericasAmericas

• The weight of social determinants: health and The weight of social determinants: health and environment environment

• PAHO’s Role to tackle health inequities PAHO’s Role to tackle health inequities – Make them visibleMake them visible– Go beyond national averagesGo beyond national averages– Strengthen health information systemsStrengthen health information systems– Empower the most unfavoredEmpower the most unfavored

Wide gaps among and within the Region of Wide gaps among and within the Region of the Americasthe Americas

Demographic Transition in the AmericasDemographic Transition in the Americas

Age (gr..80-84 yrs75-79 yrs70-74 yrs65-69 yrs60- 64 y..55-59 yrs50-54 yrs45-49 yrs40-44 yrs35-39 yrs30-34 yrs25-29 yrs20-24 yrs15-19 yrs10-14 yrs

5-9 yrs< 5 yrs

Population Pyramid The Americas, 1950

SexMale

Female

Age (gr..85+ yrs

80-84 yrs75-79 yrs70-74 yrs65-69 yrs60- 64 y..55-59 yrs50-54 yrs45-49 yrs40-44 yrs35-39 yrs30-34 yrs25-29 yrs20-24 yrs15-19 yrs10-14 yrs

5-9 yrs< 5 yrs

Population Pyramid The Americas, 2010

Demographic Transition in the AmericasDemographic Transition in the Americas

Año (a 1 Julio)2010

Fuente: World PopulationProspects 2008, UNPDAutor: Ramon Martinez, m..0 20 40 60 80 100 120

Indice de Envejecimiento

Canada

Cuba

Puerto Rico

Martinique

Barbados

United States of America

Uruguay

Guadeloupe

Netherlands Antilles

Argentina

Chile

Trinidad and Tobago

Bahamas

Brazil

Costa Rica

Jamaica

Saint Lucia

Saint Vincent and the Grena..

Grenada

Panama

Mexico

Suriname

Guyana

El Salvador

Ecuador

Colombia

Venezuela (Bolivarian Repu..

Peru

Dominican Republic

Paraguay

Bolivia

French Guiana

Median 100.0

Indice de Envejecimiento, 2010Seleccione un país para interactuar

15.5 122.4

IntervalosIndice de Envejecimiento

1952195619601964196819721976198019841988199219962000200420082012201620202024202820322036204020442048

0

100

200

300

Ind. Envejecimiento Indice de Envejecimiento en Cuba

1952195619601964196819721976198019841988199219962000200420082012201620202024202820322036204020442048

0K

1K

2K

3K

Población (en miles)

Tendencia de Grupos de Población seleccionados, Cuba

Grupos de población0-4

Pob<15

Pob_60+

Pob_75+

0 50 100 150 200 250 300 350

Indice de Envejecimiento

2000

2025

2050 370.9%

162.9%

0.0%

Indice de Envejecimiento y cambio porcentual respecto al 2000, Cuba

Pob_60+

Pob_75+

Prop Pob 60+

Razon 60+ vs <15

Razon 75+ vs <5 0.49

0.53

13.1

37,897

123,527

Americas, 2010

0-4

Pob<15

Pob_60+

Pob_75+

Prop Pob 60+

Razon 60+ vs <15

Razon 75+ vs <5 0.96

1.00

17.3

555

1,939

1,938

580

Cuba, 2010

The Aging Process in the RegionThe Aging Process in the Region

Source:Source: Regional Health Observatory, PAHO.Regional Health Observatory, PAHO.

Life Expectancy at Birth - Subregions of the AmericasLife Expectancy at Birth - Subregions of the Americas

Key points:Key points:

• Total Fertility Rate (TFR)Total Fertility Rate (TFR) declined from 1995 to 2007. declined from 1995 to 2007.

• Life Expectancy at Birth (LEB)Life Expectancy at Birth (LEB) increased from 1995 to 2007. increased from 1995 to 2007.

• Decreasing trend of family sizeDecreasing trend of family size and increased years of life and increased years of life expectancy of the population. expectancy of the population.

• Countries are reducing their Countries are reducing their gaps in both indicators due to gaps in both indicators due to the intervention of maternal the intervention of maternal and child care and family and child care and family planning programs. planning programs.

Countries lagging far behindCountries lagging far behind: : Haiti, Haiti, Bolivia, Bolivia, Honduras, Honduras, Guatemala, Guatemala, Paraguay Paraguay

Source: Source: Basic Indicators Information System. PAHO/WHO; 2010Basic Indicators Information System. PAHO/WHO; 2010

Pan AmericanHealthOrganization

The reality check: Life Expectancy vs. SpendingThe reality check: Life Expectancy vs. Spending

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

Asia delEste y

Pacífico

Europa yAsia Central

OCDE AméricaLatina y El

Caribe

OrienteMedio y

África delNorte

Asia Sur África sub-sahariana

Percentil 25MáximoMínimoPercentil 75

The most unequal Region in the worldThe most unequal Region in the world

Pan AmericanHealthOrganization

BO

NI

EC

MX

UY

CR

VE

SV

PA

AR

PY

BRCO

RD

GT

CL

PE

HN

Latin America

0.40

0.45

0.50

0.55

0.60

0.65

0.40 0.45 0.50 0.55 0.60 0.652002

2008

Countries in which inequality decreased

Countries in which inequality Increased

Inequities in health: Towards a working definitionInequities in health: Towards a working definition

The term inequity as used in WHO documentsrefers to:

• Differences in health which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust.

Source: The concepts and principles of equity and health by Margaret Whitehead.2000. WHO.

Pan AmericanHealthOrganization

Source:Source: ECLAC, Indigenous and Afro-descendent Peoples of Latin America and the Caribbean: ECLAC, Indigenous and Afro-descendent Peoples of Latin America and the Caribbean: Socio-demographic Data for Policies and Programs Socio-demographic Data for Policies and Programs.. Santiago, Chile, 2006 Santiago, Chile, 2006

Inequalities in Life Expectancy at Birth Inequalities in Life Expectancy at Birth Indigenous and non-indigenous populations, Indigenous and non-indigenous populations,

by sex, Panama, 2000 censusby sex, Panama, 2000 census

SEXSEXETHNIC ORIGINETHNIC ORIGIN

Indigenous peoplesIndigenous peoples Non-indigenous peoplesNon-indigenous peoples

MaleMale 61.161.1 69.669.6

FemaleFemale 63.663.6 75.175.1

Pan AmericanHealthOrganization

Total fertility rate, indigenous and non-indigenous population Total fertility rate, indigenous and non-indigenous population Selected countries of the Americas, ~2000Selected countries of the Americas, ~2000

6.66.1

5.45.0 4.8

2.52.9

3.9

3.0 3.23.7

2.2

0

1

2

3

4

5

6

7

Panama2000

Guatemala2002

Ecuador2001

Mexico 2000 Bolivia 2001 Chile 2002

Ave

rage

chi

ldre

n pe

r wom

en

Indigenous population Non-indigenous population

Note:Note: The countries are shown in descending order of the TFR in the indigenous population. The countries are shown in descending order of the TFR in the indigenous population.

SourceSource: ECLAC. Indigenous and Afro-descendent Peoples of Latin America and the Caribbean: : ECLAC. Indigenous and Afro-descendent Peoples of Latin America and the Caribbean: Socio-demographic Data for Policies and Programs Socio-demographic Data for Policies and Programs.. Santiago, Chile: 2006. Santiago, Chile: 2006.

Fertility Rate: Indigenous population and Fertility Rate: Indigenous population and non-indigenous populationnon-indigenous population

Pan AmericanHealthOrganization

Adolescent Birth Rate- Region of the AmericasAdolescent Birth Rate- Region of the Americas

Adolescent birth rate - 2005-2006

21.5

108.5

0 20 40 60 80 100 120

MartiniqueTurks and Caicos Islands

Netherlands AntillesCuba

AnguillaAruba

BahamasDominica

United States Virgin IslandsChile

BrazilPuerto Rico

SurinameJamaicaUruguay

Costa RicaArgentina

El SalvadorPanamaMexico

French GuianaBolivia

GuatemalaColombia

Dominican RepublicVenezuelaNicaragua

(per 1000 women)

Nicaragua is 2.5 times higher Nicaragua is 2.5 times higher compared with Cubacompared with Cuba

The difference between the The difference between the extremes is 5 timesextremes is 5 times

Source:Source: PAHO Basic Indicators PAHO Basic IndicatorsPan AmericanHealthOrganization

International Aid for Population Activities by Components of International Aid for Population Activities by Components of ICPD* ICPD*

Latin American and Caribbean, 1997-2007Latin American and Caribbean, 1997-2007

-En Millones de Dólares US-Los Datos de 2007 son Provisionales

Family Planning Services

- In US$ Million

- 2007 provisional data

Data Analysis and Collection

Reproductive Health Services

HIV/AIDS and STD

*ICPD: International Conference on Population and Development

Proportion of deaths by age groups and cause of death in Proportion of deaths by age groups and cause of death in Country groups according to income Country groups according to income

Classification of countries according World Bank income criteria

wb_income (group) / agegroup

Low, Lower-middle Upper-middle High

year 1 < years 4 -1 years 9 -5 ..yea 29 -10 ..yea 49 -30 ..yea 69 -50 and over 70year 1 < years 4 -1 years 9 -5 ..yea 29 -10 ..yea 49 -30 ..yea 69 -50 and over 70

year 1 < years 4 -1 years 9 -5 ..yea 29 -10 ..yea 49 -30 ..yea 69 -50 and over 70

0%

10%

20%

30%

40%

50%

60%

Proportion of deaths

cause (group)Sign symptoms ill-defined

Chronic non-communicable diseases

Communicable, maternal, perinatal, nutritional diseases

External causes

Source: PAHO Basic Indicators

Diabetes Mortality Rates * Age group (50 to 69) Diabetes Mortality Rates * Age group (50 to 69) Selected countries of the Americas. (2004, 2005 and 2006 lad)Selected countries of the Americas. (2004, 2005 and 2006 lad)

Source:Source: Mortality Database. PAHO/HSD/HAMortality Database. PAHO/HSD/HA * per 100.000 pop* per 100.000 pop

0 50 100 150 200

VenezuelaUruguay

United StatesPuerto Rico

PeruParaguay

PanamaMexico

EcuadorCuba

Costa RicaColombia

ChileCanada

BrazilBolivia

ArgentinaMexico and Paraguay Mexico and Paraguay have a higher risk of have a higher risk of death from Diabetes death from Diabetes compared to otherscompared to others

Mortality rates 50-69

Source:Source: Mortality Database, PAHO/HSD/HA and World BankMortality Database, PAHO/HSD/HA and World Bank

0

10,000

20,000

30,000

40,000

50,000

0 5 10 15 20 25 30 35 40

proportional premature deaths due to cerebrovascular disease (%)

gros

s na

tiona

l inc

ome

per c

apita

(ppp

$)

Figure 1

USA

BAR

CAN

SKNURU

DOMPANSLU

SVG

CHI

COL

GRE

ARG

MEX

BLZ COL ELSNIC

TRT

VENBRA SUR

ECUPER

DORPAR

GUT

GUYHAI

BOL

Premature mortality due to Cerebrovascular Disease by Premature mortality due to Cerebrovascular Disease by Gross National Income in the Americas (Circa 2006)Gross National Income in the Americas (Circa 2006)

** OccurrenceOccurrence of death in age ≤ 64 years oldof death in age ≤ 64 years old

* Per 100.000 pop* Per 100.000 pop

0 20 40 60 80

Mortality Rate 50 - 69

VenezuelaUruguay

United StatesPuerto Rico

PeruParaguay

PanamaMexico

EcuadorCuba

Costa RicaColombia

ChileCanada

BrazilBolivia

Argentina

Cervical Cancer Rates * Age group 50-69 Cervical Cancer Rates * Age group 50-69 Selected countries of the Americas (2004, 2005 and 2006 lad)Selected countries of the Americas (2004, 2005 and 2006 lad)

Cervical Cancer still a problem in the Region. Cervical Cancer still a problem in the Region. We have to look at the quality of the dataWe have to look at the quality of the data

Pan AmericanHealthOrganization

The weight of social determinantsThe weight of social determinants

Population of Latin America and Population of Latin America and the Caribbean: 582 million (2009)the Caribbean: 582 million (2009)

27% without regular access to 27% without regular access to basic health services: 135 millionbasic health services: 135 million

46% without health insurance, 46% without health insurance, public or private: 230 millionpublic or private: 230 million

USA: 44 million without social USA: 44 million without social protection in health protection in health

685,000 children without a 685,000 children without a complete vaccination scheme complete vaccination scheme

17% of births in LAC attended by 17% of births in LAC attended by unskilled health personnelunskilled health personnel

Social Exclusion in Latin America and the CaribeanSocial Exclusion in Latin America and the Caribean

Pan AmericanHealthOrganization

Social exclusion in health and environmentSocial exclusion in health and environment

Source: Source: PAHO Basic IndicatorsPAHO Basic Indicators

Pan AmericanHealthOrganization

Coefficient of linear correlation= -Coefficient of linear correlation= -0.630.63

0

10

20

30

40

50

60

0 20 40 60 80 100

Infa

nt m

orta

lity

rate

[per

1,0

00 lb

] (E

stim

ated

less

than

1 y

ear)

-200

6

Proportion of population with access to improved sanitation [%] -2004 to 2006

More access to improved sanitation, less Infant More access to improved sanitation, less Infant MortalityMortality

Source: Source: PAHO Basic IndicatorsPAHO Basic Indicators

%

69.8

38.132.8

57.7

31.426.332.535.6

0

20

40

60

80

Indígena Otro Mestizo Blanco Indígena Ladino

Ecuador 2004 Guatemala 2002Women aged 30-49 years

Source:Source: ENDEMAIN, Ecuador-INEC 2004 ; DHS -2002 Guatemala ENDEMAIN, Ecuador-INEC 2004 ; DHS -2002 Guatemala

Proportion of Women never screened for Cervical Cancer Proportion of Women never screened for Cervical Cancer Ecuador and Guatemala Ecuador and Guatemala

Women aged 15-49 years

Indigenous Other Mestizo White Indigenous Ladino

0

10

20

30

40

50

60

0 10 20 30 40

Infa

nt m

orta

lity

rate

[per

1,0

00 lb

] (E

stim

ated

less

than

1 y

ear)

200

6

Highest 20%/Lowest 20% income ratio [Ratio] 2002-2006

In Bolivia the highest 20% income isIn Bolivia the highest 20% income is36 times the lowest 20%36 times the lowest 20%

More inequality is related to higher infant More inequality is related to higher infant and maternal mortality ratesand maternal mortality rates

0

50

100

150

200

250

0 10 20 30 40

Mat

erna

l mor

talit

y ra

tio, r

epor

ted

[per

10

0,00

0 lb

] 200

2-20

06

Highest 20%/Lowest 20% income ratio [Ratio] 2002-2006

Maternal MortalityMaternal Mortality RatioRatio

Infant and Maternal Mortality Rates are higher in more unequal Infant and Maternal Mortality Rates are higher in more unequal countriescountries

Infant MortalityInfant Mortality RatioRatio

Source: Source: PAHO Basic IndicatorsPAHO Basic Indicators

0

20

40

60

80

100

120

Bolivia (1989-2008)

Brasil (1991-2006)

Colombia(1990-2005)

Ecuador(1987-2004)

El Salvador(1993-2002)

Guatemala(1987-2002)

Haití (1994-2005/2006)

Honduras(1990-

2005/2006)

Perú(1991/1992-2004/2005)

RepúblicaDominicana (1991-2007)

Sin instrucción -valor inicial Sin instrucción -valor final Primaria -valor inicial

Primaria -valor final Secundaria - valor inicial Secundaria - valor final

Some countries have progressed

Some countries have progressed

decreasing the IMR in low level

decreasing the IMR in low level

social economic groups

social economic groups

Latin America and Caribbean: Infant Mortality RatesLatin America and Caribbean: Infant Mortality RatesEducational level of mothers. Circa 1990 and 2005. (Selected Educational level of mothers. Circa 1990 and 2005. (Selected

countries)countries)

SourceSource: ECLAC, based on data from the database of Indicators for the Action Plan of the “ICPD”, : ECLAC, based on data from the database of Indicators for the Action Plan of the “ICPD”, www.cepal.org/celadewww.cepal.org/celade and and national reports on demographics and health for Bolivia (DHS 2008) and Brazil (PNDS 2006) ECLAC 2007. national reports on demographics and health for Bolivia (DHS 2008) and Brazil (PNDS 2006) ECLAC 2007.

Infant Mortality Rate: Indigenous, Afro and other Infant Mortality Rate: Indigenous, Afro and other Populations Populations

Selected Countries of the Americas. Census 2000Selected Countries of the Americas. Census 2000

Source:Source: PAHO/ECLAC/CELADE. Special census micro-data process. 2000. PAHO/ECLAC/CELADE. Special census micro-data process. 2000.

Indigenous

Total

Afro

Other

Countries

IMR

Source:Source: Wilkinson & Pickett, The Spirit Level (2009) Wilkinson & Pickett, The Spirit Level (2009)

The Prevalence of Mental Illness is Higher in More Unequal Rich The Prevalence of Mental Illness is Higher in More Unequal Rich CountriesCountries

National health expenditure on health in LAC: magnitude and trendsNational health expenditure on health in LAC: magnitude and trends

Source: Source: National Health Expenditure Data base. HSS/PAHO.National Health Expenditure Data base. HSS/PAHO.

Changes in the composition of the National Health Expenditure. Latin America and the Caribbean, 1980 – 2005

Central GovernmentOut of pocket expenditure

Local Government Public InsurancePrivate Insurance

1980 1995 1990 1995 1998-2000 2004-05

Nati

onal

hea

lth e

xpen

ditu

re

as p

erce

ntag

e of

the

GDP

Trends in Public Expenditures in Health as % of GDP in Canada, Latin America and the Caribbean (LAC) and the United States of America; Selected periods 1960-2006

1.2% 1.3%1.7%

2.4%

3.6%

4.3%

5.0%

6.4%

7.6%8.1%

2.4% 2.6%

3.7%

4.9%

6.0%

7.2%7.5% 7.6%

2.8% 2.8%3.2% 3.4% 3.5% 3.5% 3.4%

7.1%7.4%7.2%

7.2%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

11%

12%

1960 1960-65 1965-70 1970-75 1975-80 1980-85 1985-90 1990-95 1995-2000 2000-05 2006

Years

Publ

ic E

xpen

ditu

re in

Hea

lth -

% G

DP

US CAN LAC

Public source health expenditure as % of GDP Public source health expenditure as % of GDP Canada, LAC and USA. Selected periods 1960-2006Canada, LAC and USA. Selected periods 1960-2006

PAHO’s Role to tackle health inequitiesPAHO’s Role to tackle health inequities

We are an Organization with:We are an Organization with:

• Vision of Health in the AmericasVision of Health in the Americas

• Values of Equity and Pan-AmericanismValues of Equity and Pan-Americanism

• Focus on: Focus on: • Key CountriesKey Countries• Special PopulationsSpecial Populations• Technical PrioritiesTechnical Priorities

Our Core CommitmentsOur Core Commitments

Special PopulationsSpecial Populations

Key Key CountriesCountries

PAHOPAHOVisionVision

EquityEquity

Pan-AmericanismPan-Americanism

Technical Technical PrioritiesPriorities

Facing new challengesFacing new challenges

Addressing the Addressing the unfinished agendaunfinished agenda

Protecting Protecting achievementsachievements

PAHO Framework for ActionPAHO Framework for Action

• Reducing the GapReducing the Gap• Ensuring AccessEnsuring Access• Achieving Results Achieving Results

We have to think in:We have to think in:

SimilarSimilar situations situations amongamong countries countries

SpecificSpecific situations in situations in eacheach country country

Focu

sFo

cus Priority CountryPriority Country

Intermediate CountryIntermediate Country

Highly Developed Highly Developed CountryCountry

Addressing the Addressing the unfinished agendaunfinished agenda

Protecting Protecting achievementsachievements

Facing new Facing new challengeschallenges

Framework for Technical CooperationFramework for Technical Cooperation

Each Country has a specific situation in the FrameworkEach Country has a specific situation in the Framework

PAHO’s Commitment with the MDGsPAHO’s Commitment with the MDGs

Goal:Goal:

It was launched to address the dangerous & unjust illusion resulting from averages in health statistics

To make the most neglectedTo make the most neglected communities communities seen and heardseen and heard as we as we attempt to meet the targets of the MDGs attempt to meet the targets of the MDGs

Working with the Ministries of Health and national and local governments, we are calling for intersectoral action for participatory local development.

AmazoniaAmazonia

AltiplanoAltiplano

El ChacoEl Chaco

La MosquitiaLa Mosquitia

Transnational Transnational TerritoriesTerritories

Monitoring Regional ProgressMonitoring Regional Progress

Vital and Health Statistics Data in the Vital and Health Statistics Data in the Americas Coverage and QualityAmericas Coverage and Quality

In the Region there are:In the Region there are:

data with data with goodgood quality and quality and data with data with very poorvery poor quality quality

The regional report lists the countries according to their The regional report lists the countries according to their vital and health statistics situation, revealing vital and health statistics situation, revealing wide disparities among countries and even within themwide disparities among countries and even within them. .

These findings make it possible to pinpoint the These findings make it possible to pinpoint the areas requiring greater attentionareas requiring greater attention and targeting and targeting (at geographical and sectoral level) processes associated with (at geographical and sectoral level) processes associated with health care, vital records systems, etc.health care, vital records systems, etc.

CoverageCoverage. Vital statistics (VS) situation was relatively better in . Vital statistics (VS) situation was relatively better in 7 of 26 countries, which exhibited broad coverage (over 85%) 7 of 26 countries, which exhibited broad coverage (over 85%) throughout their national territory. throughout their national territory. At the other extreme, however, At the other extreme, however, 7 countries recorded barely 50%7 countries recorded barely 50% of these events. This means: only of these events. This means: only one out of every two births or deathsone out of every two births or deaths are recorded. (under recording affects special groups of population)are recorded. (under recording affects special groups of population)

Health and Vital Statistics: Regional Situation

Quality of VSQuality of VS. Affect the countries in a more homogeneous manner, . Affect the countries in a more homogeneous manner, specially at the local level. Lack of information on mother’s age, specially at the local level. Lack of information on mother’s age, child’s birthweight, place of residence, socioeconomic child’s birthweight, place of residence, socioeconomic characteristics of people involved in events, the attribution of characteristics of people involved in events, the attribution of ill-defined cause of death or failure to state the cause, make it ill-defined cause of death or failure to state the cause, make it difficult for countries to know the true levels of risk and burden of difficult for countries to know the true levels of risk and burden of disease or to determine the epidemiogical profiles of mortalitydisease or to determine the epidemiogical profiles of mortality. .

In the area of In the area of morbidity, resources and health services statisticsmorbidity, resources and health services statistics, , countries also exhibit wide disparities.countries also exhibit wide disparities.

Health and Vital Statistics: Regional Situation

0

10

20

30

40

50

60

70

80

90

100

Situation of Vital and Health Statistics in the countries

Health and Vital Statistics: Regional SituationHealth and Vital Statistics: Regional Situation

Source:Source: Health and Vital Statistics Regional Evaluation Health and Vital Statistics Regional Evaluation

32 countries studied32 countries studied19 (59%) - good quality and 19 (59%) - good quality and coverage data coverage data

6 (19%) - medium data quality6 (19%) - medium data quality

7 (22%) - poor or very poor 7 (22%) - poor or very poor data quality data quality

Mortality DataMortality Data

Mortality Data has improvedMortality Data has improved

Proportion of certified deaths due to ill-defined and unknown conditions

0

5

10

15

20

25

30

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

%

Brazil

ChileDominican RepublicPeru

Source: Source: Regional Health Observatory / PAHORegional Health Observatory / PAHO

The proportion of

The proportion of

unknown cause of

unknown cause of

death are decreasing

death are decreasing

Without good data for monitoring the MDGs, Without good data for monitoring the MDGs, different agencies or researchers are different agencies or researchers are

making estimates for the Regionmaking estimates for the Region

What is the problem with estimates?What is the problem with estimates?

We need good informationWe need good information

Variability is observed more often in small populationsVariability is observed more often in small populations

MDG Infant Mortality Rate: MDG Infant Mortality Rate: Forecasting is difficult for countries with a small Forecasting is difficult for countries with a small

populationpopulation

Country 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008Belize 21.2 17.9 14.3 18.4 19.6 17.2Grenada 19.5 14.3 17.6 19.6 11.1 7.3Cayman Islands 9.1 1.6 13.7 4.8 6.4 7.0 8.7 8.3 1.3Turks and Caicos 9.7 8.2 7.3 0.0 14.5 4.3 1.8Virigin Islands (RU) 10.8 9.5 9.2 31.3 11.2 28.3 7.2 22.7 25.1 22.4Saint Kitts & Nevis 13.9 14.3 17.6 15.3 13.5 21.7 14.1Saint Vincent and the Grenadines 17.2 24.2 15.7 19.2 18.1 17.8 15.7 26.2Saint Lucia 15.0 12.0 16.7 13.5 16.2 15.0Trinidad and Tobago 16.2 17.1 18.5 21.1 18.5 24.2 24.0 16.5

red: repetitions

red: repetitions

Forecasting is difficult for countries with limited dataForecasting is difficult for countries with limited data

blue: too few observations

blue: too few observations

Country 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008Anguilla 35.5 5.2 0 0Netherlands Antilles 12.6 12.3Aruba 6.5 1.5Bermuda 3.6 0 0Jamaica 19.9 21.09Bolivia 67 54 54 54 54 54El Salvador 35 35 35 25 25 25 25 21.5Guatemala 48 39 39 39 39 39 39Haiti 80.3 80.3 80.3 80.3 80.3 57 57Honduras 34 34 34 34 34 23 23 23 23 23 23Montserrat 0 0 25.0 0 0 0 23.8 0Nicaragua 45.2 31 31 31 31 31 33Peru 33.3 33.3 33.3 33.3 33.4 33.4 33.4 21 21 21 21

The analysis described has led to the consideration of lines of action in the following areas:

(a)(a) Preparation or expansion of situation analyses in each country.Preparation or expansion of situation analyses in each country.

(b)(b) Creation of an interinstitutional team to make a diagnosis and devise a Creation of an interinstitutional team to make a diagnosis and devise a plan in each country.plan in each country.

(c)(c) The priorization of greater coverage (thematic, geographical, sectoral), The priorization of greater coverage (thematic, geographical, sectoral), and improvements in quality and timeliness of availability and and improvements in quality and timeliness of availability and dissemination of data.dissemination of data.

(d)(d) To prepare a national plan in countries (POA)To prepare a national plan in countries (POA)

(e)(e) To harmonize the national plan in a regional plan (PSVHS)To harmonize the national plan in a regional plan (PSVHS)

Way forwardWay forward

For the technical point of view:For the technical point of view:

(a)(a) Develop uniform standards, procedures, and classifications;Develop uniform standards, procedures, and classifications;

(b)(b) Develop methodologies for the analysis and dissemination of data;Develop methodologies for the analysis and dissemination of data;

(c)(c) Train and upgrade the skills of personnel;Train and upgrade the skills of personnel;

(d)(d) Utilize appropriate, up-to-date computer technology for the production, processing, Utilize appropriate, up-to-date computer technology for the production, processing, and dissemination of data;and dissemination of data;

(e)(e) Promote horizontal cooperation and a clear definition of best practices and strategies Promote horizontal cooperation and a clear definition of best practices and strategies for providing the most appropriate technical assistance, based on available budgets for providing the most appropriate technical assistance, based on available budgets and the national and international capacity to mobilize resources. and the national and international capacity to mobilize resources.

Way forwardWay forward

National Basic Indicators pamphletsNational Basic Indicators pamphlets

Special PopulationsSpecial Populations

Key Key CountriesCountries

PAHOPAHOVisionVision

EquityEquity

Pan-AmericanismPan-Americanism

Technical Technical PrioritiesPriorities

Consensus and coordination has Consensus and coordination has increasedincreased

NGO’sNGO’s

Organization of Organization of Americas StatesAmericas States

(OAS)(OAS)

Bi/Multi-Bi/Multi-LateralsLaterals

Foundations/ Foundations/ Private sectorPrivate sector

We Are Not Alone On Our Journey...We Are Not Alone On Our Journey...

Thank youThank you