37. The Challenge of Universal Eye Health in Latin America: distributive inequality of ophthalmologists in 14 countries
Hannah Hong, Oscar J Mújica, José Anaya, Van C Lansingh, Ellery López, Juan Carlos Silva
BMJ Open 2016, Public health
Published online: November 2016
Background No comprehensive study currently exists on the supply of ophthalmologists across Latin America. We explored sociogeographic inequalities in the availability and distribution of ophthalmologists across 14 Latin American countries.
Methods The National Ophthalmologic Societies of Argentina, Bolivia, Brazil, Colombia, Costa Rica, Chile, the Dominican Republic, Ecuador, Guatemala, Mexico, Paraguay, Peru, Uruguay and Venezuela provided data on affiliated ophthalmologists by first-order subnational divisions in 2013. Human Development Index (HDI) estimates at the corresponding subnational division were used as equity stratifiers. Distributional inequality of ophthalmologists within each country was assessed by the health concentration index (HCI) and the index of dissimilarity (ID), along with the mean level of ophthalmologists per population.
Results Across all countries studied, there were 5.2 ophthalmologists per 100 000 population on average (95% CI 5.0 to 5.4) in 2013, with a mean HCI of 0.26 (0.16 to 0.37) and a mean relative ID of 22.7% (20.9% to 24.7%). There was wide inequality in ophthalmologist availability between countries, ranging from 1.2 (1.1 to 1.4) in Ecuador to 8.6 (8.5 to 8.8) in Brazil. All countries had positive (ie, pro-rich) HCI values ranging from 0.68 (0.66 to 0.71) in Guatemala to 0.02 (−0.11 to 0.14) in Venezuela. Correspondingly, redistributive potential to achieve equity was closest in Venezuela (ID: 1.5%) and farthest in Guatemala (ID: 60.3%). Benchmarked against regional averages, most countries had a lower availability of ophthalmologists and higher relative inequality.
Conclusions There is high inequality in the level and distribution of ophthalmologists between and within countries in Latin America, with a disproportionate number concentrated in more developed, socially advantaged areas. More equitable access to ophthalmologists could be achieved by implementing incentivised human resources redistribution programmes and by improving the social determinants of health in underserved areas.
Inequalities in Health; Latin America.
38. New WHO data portal to help track progress towards universal health coverage
World Health Organization
Published online: 12 December 2016
To mark Universal Health Coverage Day, WHO today launched a new data portal to track progress towards universal health coverage (UHC) around the world. The portal shows where countries need to improve access to services, and where they need to improve information.
The portal features the latest data on access to health services globally and in each of WHO’s 194 Member States, along with information about equity of access. Next year WHO will add data on the impact that paying for health services has on household finances.
"Any country seeking to achieve UHC must be able to measure it," said Dr Margaret Chan, Director-General of WHO. "Data on its own won’t prevent disease or save lives, but it shows where governments need to act to strengthen their health systems and protect people from the potentially devastating effects of health care costs."
UHC means that all people and communities can access the health services they need without facing financial hardship. So countries aiming to provide UHC need to build health systems that deliver the quality services and products people need, when and where they need them, through an adequately resourced and well-trained health workforce.
The ability to provide strong primary health care services at community level is essential to make progress towards universal health coverage.
Last year, the world’s governments set themselves a target to achieve UHC by 2030 as part of the Sustainable Development Goals (SDGs). UHC is not only essential to achieving the health-related targets, it will also contribute to other goals such as no poverty (Goal 1), and decent work and economic growth (Goal 8).
The portal shows that:
• Less than half of children with suspected pneumonia in low income countries are taken to an appropriate health provider.
• Of the estimated 10.4 million new cases of tuberculosis in 2015, 6.1 million were detected and officially notified in 2015, leaving a gap of 4.3 million.
• High blood pressure affects 1.13 billion people [≈ population of India, nation]. Over half of the world's adults with high blood pressure in 2015 lived in Asia. Around 24% of men and 21% of women had uncontrolled blood pressure in 2015.
• About 44% of WHO’s member states report having less than 1 physician per 1000 population. The African Region suffers almost 25% of the global burden of disease but has only 3% of the world’s health workers.
"Expanding access to services will involve increasing spending for most countries," said Dr Marie-Paule Kieny, WHO's Assistant Director-General for Health Systems and Innovation.
"But as important as what is spent is how it’s spent. All countries can make progress towards UHC, even at low spending levels.”"
Some countries have made good progress towards UHC with low spending, while others achieve lower levels of coverage even though they spend more. And among countries with similarly low levels of spending, there are large variations in coverage levels.
Note to the editor about UHC:
• All UN Member States have agreed to aim to achieve universal health coverage (UHC) by 2030, as part of the Sustainable Development Goals.
• UHC provides access to quality essential health services; access to safe, effective and affordable essential medicines and vaccines, and protection from financial risk.
• At least 400 million people globally lack access to one or more essential health services.
• Every year 100 million are pushed into poverty and 150 million people [≈ population of Bangladesh, nation] suffer financial catastrophe because of out-of-pocket expenditure on health services.
• On average, about 32% of each country’s health expenditure comes from out-of-pocket payments.
• Ensuring equitable access requires a transformation in how health services are funded, managed and delivered so that services are centred around the needs of people and communities.
• More than 18 million additional health workers will be needed by 2030 to meet the health workforce requirements of the Sustainable Development Goals and universal health coverage targets, with gaps concentrated in low- and lower middle-income countries.
39. Road Map for the Plan of Action on Health in All Policies = Hoja de Ruta para el Plan de Acción sobre la Salud en todas las Políticas
Pan American Health Organization
Published online: November, 2016
Overview / Panorama:
When the PAHO Directing Council approved the world’s first Plan of Action on Health in All Policies in September 2014, it took the lead on implementing an ambitious and innovative approach to public policy-making. Health in All Policies (HiAP) was first defined in the Adelaide Statement of 2010 and then laid out in a global framework for country action in the 2013 Helsinki Statement. The Pan American Health Organization (PAHO) quick action reveals the promise of this new approach to promoting health and the broad support of its stated goals and objectives. At the same time, HiAP incorporates many elements of health promotion and healthy policy making that have been developed and debated for decades. It is based on the expansive vision of health and well-being defined at Alma Ata (1978), as well as the call for health public policy in the Ottawa Charter (1986). It also acknowledges the important contributions of the movement to address the social determinants of health and health equities identified by the WHO Commission on the Social Determinants of Health (2008) […] The present document summarizes the key recommendations from this group of experts and highlights important considerations for implementing the Plan of Action. These recommendations are followed by a concise outline of concrete actions that should be taken in the Region, the expected time frame for action, and identification of the entities responsible for ensuring that the actions are carried out. The outline follows the format laid out in the Plan of Action on Health in All Policies, based on the six strategic lines of action and their specific objectives, with approved indicators for monitoring and evaluation.
Access the document [English]
40. panorama of health inequalities in Brazil
Celia Landmann-Szwarcwald, James Macinko
International Journal for Equity in Health, (2016) 15:177
Published online: 17 November 2016
“Brazil is well known as a country with extremes in income and other social inequalities. But in recent years, Brazil has made considerable strides in extending a range of social protections to the entire population. Notable accomplishments include achieving nearly universal health coverage, expanding community-based primary care and providing a robust conditional cash transfer program. This special edition of the International Journal for Equity in Health presents an overview of health inequities in contemporary Brazil. It provides a summary of progress made and identifies priority areas that will require additional efforts. The articles contained in the issue vary considerably in their methods and approach, but all make use of data from the most recent Brazilian National Health Survey or Pesquisa Nacional de Saúde (PNS 2013).
Based on strong evidence of the association between an individual’s (and even a society’s) social and economic circumstances and their health, monitoring health inequalities has become an essential feature of measuring national health progress and development. Such monitoring has shown not only that health inequalities are present in nearly every nation, but that their magnitude represents a social gradient that extends from the most to the least privileged in society. This implies that policies and programs must be assessed not only in terms of changes they may make in the aggregate, but also to the extent to which they reduce social inequalities among different population groups. Given the many types of health outcomes and the many factors by which different populations can be compared, such monitoring and evaluation is a daunting task that must be based on relevant, reliable, and frequent data collection and analysis…”
41. WHO release’s Innov8 Approach for Reviewing National Health Programmes to Leave No One Behind: Technical Handbook =
World Health Organization
Published online: 21 November 2016
EN - “Leaving no one behind” is at the forefront of discussions on the 2030 Sustainable Development Agenda. Yet stakeholders at all levels are grappling with the question of how to concretely do just that. The Innov8 Approach for Reviewing National Health Programmes to Leave No One Behind is an eight-step review process geared towards this very aim. Innov8 is a resource that supports operationalization of the SDGs and the progressive realization of universal health coverage and the right to health. It does this by identifying ways to make concrete, meaningful and evidence-based programmatic action to make health programmes more equity-oriented, rights-based and gender responsive, while addressing critical so¬cial determinants of health influencing programme effectiveness and outcomes.
The Innov8 Technical Handbook is a user-friendly resource that includes background readings, country examples and analytical activities to support a programmatic review process. The Technical Handbook will be complemented by the release of wider set of materials currently under development by WHO as part of the Innov8 resource package.
Innov8 es un recurso que apoya la operacionalización de los Objetivos de Desarrollo Sostenible (ODS) y la realización progresiva de la cobertura sanitaria universal y el derecho a la salud. Para ello, identifica maneras de hacer acciones programáticas concretas, significativas y basadas en evidencia para hacer que los programas de salud estén más orientados hacia la equidad, los derechos y las cuestiones de género, al tiempo que se abordan determinantes sociales críticos de la salud que influyen en la eficacia y los resultados del programa. El Manual Técnico de Innov8 es un recurso fácil de usar que incluye lecturas de base, ejemplos de países y actividades analíticas para apoyar un proceso de revisión programática. El Manual Técnico se complementará con la publicación de un conjunto más amplio de materiales actualmente en desarrollo por la OMS como parte del paquete de recursos Innov8.
Sustainable Development Goals; Health Equity; Gender; Human Rights; Social Determinants of Health; Global Health
42. Inequalities in full immunization coverage: trends in low- and middle-income countries
María Clara Restrepo-Méndez, Aluísio JD Barros, Kerry LM Wong, Hope L Johnson, George Pariyo, Giovanny VA França, Fernando C Wehrmeister, Cesar G Victora
Bull World Health Organ 2016;94:794–805A
Published online: November 2016
Objective: To investigate disparities in full immunization coverage across and within 86 low- and middle-income countries.
Methods: In May 2015, using data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we investigated inequalities in full immunization coverage – i.e. one dose of bacille Calmette-Guérin vaccine, one dose of measles vaccine, three doses of vaccine against diphtheria, pertussis and tetanus and three doses of polio vaccine – in 86 low- or middle-income countries. We then investigated temporal trends in the level and inequality of such coverage in eight of the countries.
Findings: In each of the World Health Organization’s regions, it appeared that about 56–69% of eligible children in the low- and middle-income countries had received full immunization. However, within each region, the mean recorded level of such coverage varied greatly. In the African Region, for example, it varied from 11.4% in Chad to 90.3% in Rwanda. We detected pro-rich inequality in such coverage in 45 of the 83 countries for which the relevant data were available and pro-urban inequality in 35 of the 86 study countries. Among the countries in which we investigated coverage trends, Madagascar and Mozambique appeared to have made the greatest progress in improving levels of full immunization coverage over the last two decades, particularly among the poorest quintiles of their populations.
Conclusion: Most low- and middle-income countries are affected by pro-rich and pro-urban inequalities in full immunization coverage that are not apparent when only national mean values of such coverage are reported.
Immunization Coverage; Inequalities; Low- and Middle-Income Countries; Global Health.
43. Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study
Annette J. Browne, Colleen Varcoe, Josée Lavoie, Victoria Smye, Sabrina T. Wong, Murry Krause, David Tu, Olive Godwin, Koushambhi Khan and Alycia Fridkin
BMC Health Services Research (2016) 16:544
Published online: 4 October 2016
Background: Structural violence shapes the health of Indigenous peoples globally, and is deeply embedded in history, individual and institutional racism, and inequitable social policies and practices. Many Indigenous communities have flourished, however, the impact of colonialism continues to have profound health effects for Indigenous peoples in Canada and internationally. Despite increasing evidence of health status inequities affecting Indigenous populations, health services often fail to address health and social inequities as routine aspects of health care delivery. In this paper, we discuss an evidence-based framework and specific strategies for promoting health care equity for Indigenous populations.
Methods: Using an ethnographic design and mixed methods, this study was conducted at two Urban Aboriginal Health Centres located in two inner cities in Canada, which serve a combined patient population of 5,500. Data collection included in-depth interviews with a total of 114 patients and staff (n = 73 patients; n = 41 staff), and over 900 h of participant observation focused on staff members’ interactions and patterns of relating with patients.
Results: Four key dimensions of equity-oriented health services are foundational to supporting the health and well-being of Indigenous peoples: inequity-responsive care, culturally safe care, trauma- and violence-informed care, and contextually tailored care. Partnerships with Indigenous leaders, agencies, and communities are required to operationalize and tailor these key dimensions to local contexts. We discuss 10 strategies that intersect to optimize effectiveness of health care services for Indigenous peoples, and provide examples of how they can be implemented in a variety of health care settings.
Conclusions: While the key dimensions of equity-oriented care and 10 strategies may be most optimally operationalized in the context of interdisciplinary teamwork, they also serve as health equity guidelines for organizations and providers working in various settings, including individual primary care practices. These strategies provide a basis for organizational-level interventions to promote the provision of more equitable, responsive, and respectful PHC services for Indigenous populations. Given the similarities in colonizing processes and Indigenous peoples’ experiences of such processes in many countries, these strategies have international applicability.
Indigenous People; Health Services; Health Equity; Health Disparities
44. Violence against children in Latin America and Caribbean countries: a comprehensive review of national health sector efforts in prevention and response
Andrea L. Wirtz, Carmen Alvarez, Alessandra C. Guedes, Luisa Brumana, Cecilie Modvar, Nancy Glass
BMC Public Health
BMC series – open, inclusive and trusted 2016 16:1006
Published online: 22 September 2016
Background: Violence against children (VAC) remains a global problem. The health sector has an opportunity and responsibility to be part of the multi-sector collaboration to prevent and respond to VAC. This review aimed to assess the health sector’s response to VAC among Latin American & Caribbean (LAC) countries, particularly as it relates to physical violence, sexual violence, and neglect.
Method: National protocols for the identification and provision of health care to child survivors of violence, abuse and neglect were solicited in partnership with UNICEF and PAHO/WHO country offices within the LAC region. A parallel systematic review was undertaken in January 2015 to review studies published in the last 10 years that describe the regional health sector response to VAC.
Results: We obtained health sectors guidelines/protocols related to VAC from 22 of 43 (51 %) countries and reviewed 97 published articles/reports that met the review inclusion criteria. Country protocols were presented in Spanish (n = 12), Portuguese (n = 1), and English (n = 9). Thematic areas of country protocols included: 1) identifying signs and symptoms of VAC, 2) providing patient-centered care to the victim, and 3) immediate treatment of injuries related to VAC. The systematic review revealed that health professionals are often unaware of national protocols and lack training, resources, and support to respond to cases of VAC. Further, there is limited coordination between health and social protection services.
Conclusions: VAC remains an international, public health priority. Health professionals are well-positioned to identify, treat and refer cases of VAC to appropriate institutions and community-based partners. However, poor protocol dissemination and training, limited infrastructure, and inadequate human resources challenge adherence to VAC guidelines.
Violence Against Children, Health System, Latin America, Caribbean.
45. Flagship Report
Leaving no one behind. A critical path for the first 1,000 days of the Sustainable Development Goals
Elizabeth Stuart, Kate Bird, Tanvi Bhatkal, Romilly Greenhill, Steven Lally, Gideon Rabinowitz, Emma Samman and Moizza Binat Sarwar, with Alainna Lynch
Overseas Development Institute 2016
Published online: July 2016
• The Sustainable Development Goals (SDGs) will not be met if the poorest and most marginalised people continue to be left behind by progress. Efforts to ensure that no one is left behind are vital in the first 1,000 days – or three years – of the SDGs: the longer governments take to act, the harder it will be to deliver on their promises by 2030.
• If sub–Saharan Africa (SSA) is to eliminate ultra poverty, for example – that is people living on less than just $1 a day (2011 PPP), an estimate of the minimum survival level – by 2030, its current progress needs to be nearly twice as fast, rising to over three times as fast if no action is taken in the next six years. If nothing happens until 2024 or 2027, the region will need to speed up progress by factors of 4.5 and nearly 8 respectively – a formidable task.
• There is clear alignment between the leave no one behind agenda and what marginalised people say they want from their governments: better services such as universal health coverage and rural electrification; greater public awareness, such as creating environments where all girls are expected to go to school; and institutional and legal reform, including the extension of a minimum wage to informal workers, or the introduction of women’s land rights.
• The total cost of leaving no one behind in health, education and social protection across the 75 countries for which we have data is an annual average of $739 billion [≈ cost of US-Iraq War in 2011]. Of these, the 30 low-income countries (LICs) will require an additional $70 billion [≈ all real estate in Staten Island, NYC, 2010] each year to meet these costs. In the case of the 45 middle-income countries (MICs), governments are generating enough public revenues to meet these costs: the challenge is their allocation.
• The benefits of leaving no one behind include solid returns. Evidence suggests an additional dollar invested in high-quality pre-schools delivers a return of anywhere between $6 and $17 (Engle et al., 2011). Recent research by the World Bank (Olinto et al., 2014) and the International Monetary Fund (IMF) (Dabla-Norris et al., 2015) suggests a pro-poor growth agenda helps to improve overall growth levels.
Sustainable Development Goals; Low-income Countries; Social Impact Indicators; Social Inequity; Global Health.
46. A Strategic Framework for Utilizing Late-Stage (T4) Translation Research to Address Health Inequities
Maria Lopez-Class; Emmanuel Peprah; Xinzhi Zhang; Peter G. Kaufmann; Michael M. Engelgau
Ethn Dis. 2016;26(3): 387-394
Published online: July 2016
Achieving health equity requires that every person has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances. Inequity experienced by populations of lower socioeconomic status is reflected in differences in health status and mortality rates, as well as in the distribution of disease, disability and illness across these population groups. This article gives an overview of the health inequities literature associated with heart, lung, blood and sleep (HLBS) disorders. We present an ecological framework that provides a theoretical foundation to study late-stage T4 translation research that studies implementation strategies for proven effective interventions to address health inequities.
Health Inequalities; Health Equity; Research.
47. Greece. Profile of health and well-being (2016)
English (PDF, 2.9 MB)
Pусский (PDF, 2.9 MB)
2016, ix + 29 pages
ISBN 978 92 890 5143 9
CHF 15.00/US$ 18.00
In developing countries: CHF 10.50/US$ 12.60
Order no. 13400172
This publication, the first in a new series of profiles of health and well-being, presents an analysis of the state of and trends in health in Greece. Although Greece had been among the countries with the best health status in the WHO European Region, health improvements were falling behind those in other countries that belonged to the European Union before May 2004 (EU15) well before the current economic crisis, and progress towards the targets of the Health 2020 policy framework is mixed. Historically, the Greek population has been one of the healthiest in Europe. As a result of the continuing economic crisis, the widening gap in health status and the absence of national health policies aligned with Health 2020, inequalities are likely to increase and progress towards and achievement of Health 2020 goals might be jeopardized unless decisive proactive measures are taken soon.
Profiles of health and well-being give an overview of a country's health status, providing data on mortality, morbidity and exposure to key risk factors and showing trends over time. The WHO Regional Office for Europe develops them in collaboration with European Member States. When possible, each report also compares a country to reference groups: the WHO European Region as a whole and the EU15. To make the comparisons as valid as possible, data are as a rule taken from one source to ensure reasonably consistent harmonization. The data in the report are drawn from the Regional Office's European Health for All (HFA) database. These are collected from Member States annually and include metadata that specify the original source of data for specific indicators. The findings in the profiles are summarized in brief highlights publications.
48. Greece. Highlights on health and well-being (2016)
English (PDF, 782.5 KB)
Pусский (PDF, 849.6 KB)
2016, iv + ix pages
ISBN 978 92 890 5144 6
This publication is only available online.
Although Greece had been among the countries with the best health status in the WHO European Region, health improvements were falling behind those in other countries well before the current economic crisis, and progress towards the Health 2020 targets is mixed. While Greece faces particular challenges owing to its continuing economic crisis, these pressures have also generated the momentum to address some long-standing issues, especially with the health system. This summary highlights some key challenges for health in the country that should be addressed if it is to regain its position among the healthiest in Europe.
Highlights on health and well-being give an overview of a country's health status, describing mortality, morbidity, exposure to key risk factors and trends. The WHO Regional Office for Europe develops the highlights in collaboration with European countries. When possible, each report also compares a country to reference groups: in this report, the WHO European Region as a whole and the 15 countries that belonged to the European Union before 1 May 2004. To make the comparisons as valid as possible, data as a rule are taken from one source to ensure that they have been harmonized in a reasonably consistent way. Whenever possible, the data in the report are drawn from the Regional Office's European Health for All database. These are collected from Member States on an annual basis and include metadata that specify the original source of data for specific indicators. Longer profiles accompany the highlights.
49. Voluntary health insurance in Europe: country experience
English (PDF, 2.5 MB)
Edited by: Anna Sagan and Sarah Thomson
Observatory Studies Series No. 42
2016, xiv + 161 pages
ISBN 978 92 890 5037 1
CHF 40.00/US$ 48.00
Order no. 13400168
No two markets for voluntary health insurance (VHI) are identical. All differ in some way because they are heavily shaped by the nature and performance of publicly financed health systems and by the contexts in which they have evolved.
This volume contains short, structured profiles of markets for VHI in 34 countries in the WHO European Region. These are drawn from European Union Member States plus Armenia, Iceland, Georgia, Norway, the Russian Federation, Switzerland and Ukraine. The book is aimed at policy-makers and researchers interested in knowing more about how VHI works in practice in a wide range of contexts.
Each profile, written by one or more local experts, identifies gaps in publicly financed health coverage, describes the role VHI plays, outlines how the market for VHI operates, summarizes public policy towards VHI, including major developments over time, and highlights national debates and challenges.
The book is part of a study on VHI in Europe prepared jointly by the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe. A companion volume, "An introduction to voluntary health insurance in Europe", provides an analytical overview of VHI markets across the 34 countries.