Recolección de datos durante la pandemia por la COVID-19 y la inclusión de la población con discapacidad en América Latina y el Caribe / Data collection and inclusion of the population with disabilities during the COVID-19 pandemic in Latin America and the Caribbean / Coleta de dados na pandemia de COVID-19 e a inclusão de pessoas com deficiência na América Latina e no Caribe

RESUMEN Objetivo. Identificar las encuestas que incluyeron preguntas sobre discapacidad durante la pandemia por la COVID-19, en el periodo 2020-2021; y a partir de esto, estudiar qué acciones han implementado los países de América Latina y el Caribe en aspectos educativos, de salud y protección social que han incluido explícitamente a la población con discapacidad. Métodos. Se revisaron los documentos de los Institutos Nacionales de Estadística de los países de la región, al igual que la plataforma de Socioeconomic Impact Assessment y páginas de instituciones internacionales como el Banco Mundial, el Programa de las Naciones Unidas para el Desarrollo y la Comisión Económica para América Latina y el Caribe, buscando identificar las encuestas nacionales o regionales implementadas durante el 2020 y primer semestre de 2021. Adicionalmente, se realizó un análisis documental de las normas que implementaron medidas en los sectores de salud, educación y protección social como respuesta a la pandemia por la COVID-19. En estos documentos se buscó identificar si de manera explícita se mencionaba a la población con discapacidad. Resultados. De los países de América Latina y el Caribe, 23 recolectaron información estadística tipo encuesta durante el 2020 -2021. De estos, tan solo cuatro (Colombia, Costa Rica, Perú y México) incluyeron preguntas de discapacidad dentro de las encuestas nacionales y aunque se realizaron algunas encuestas específicas para la población con discapacidad, en general, en la región existe una falta de datos asociados de esta población durante la pandemia. Solo diez incluyeron explícitamente a la población con discapacidad en las medidas de salud, doce en educación y trece en protección social Conclusiones. La falta de datos sobre la población con discapacidad en los países de América Latina y el Caribe durante la pandemia por la COVID-19, muestra que esta población está invisibilizada dentro de los procesos de recolección de información, lo cual se asocia con el bajo número de países que implementaron políticas para mitigar el impacto de la pandemia que explícitamente incluyeron a la población con discapacidad.

ABSTRACT Objective. To identify surveys that included questions about disability during the COVID-19 pandemic, in the period 2020-2021; and based on this, to determine what actions the countries of Latin America and the Caribbean implemented in the areas of education, health, and social protection that explicitly included the population with disabilities. Methods. Documents from the national statistics institutes of the countries of the region were reviewed, as well as the Socioeconomic Impact Assessment platform and webpages of international institutions such as the World Bank, the United Nations Development Program, and the Economic Commission for Latin America and the Caribbean, seeking to identify national or regional surveys implemented during 2020 and the first half of 2021. Additionally, a documentary analysis was conducted of the measures implemented in the health, education, and social protection sectors in response to the COVID-19 pandemic. These documents were studied to determine whether the population with disabilities was explicitly mentioned. Results. Twenty-three countries in Latin America and the Caribbean collected information from statistical surveys during 2020-2021. Of these, only four (Colombia, Costa Rica, Mexico, and Peru) included questions on disability in their national surveys and although some specific surveys were conducted for the population with disabilities, in the region there is a general lack of associated data on this population during the pandemic. Only 10 countries explicitly included the population with disabilities in health measures, 12 in education, and 13 in social protection. Conclusions. The lack of data on the population with disabilities in the countries of Latin America and the Caribbean during the COVID-19 pandemic shows that this population remains invisible in information collection processes. This is associated with the low number of countries that explicitly included the population with disabilities in policies implemented to mitigate the impact of the pandemic.

RESUMO Objetivo. Identificar pesquisas que incluíram perguntas sobre deficiência realizadas no período de 2020-2021 da pandemia de COVID-19 e, a partir dessa informação, determinar as ações em saúde, educação e assistência social empreendidas nos países da América Latina e do Caribe e que incluíram explicitamente pessoas com deficiência. Métodos. Documentação obtida dos institutos nacionais de estatística dos países da Região, da plataforma Socioeconomic Impact Assessment (avaliação do impacto socioeconômico) e de sites de organismos internacionais (como Banco Mundial, Programa das Nações Unidas para o Desenvolvimento e Comissão Econômica para a América Latina e o Caribe) foi analisada com o objetivo de identificar as pesquisas nacionais ou regionais realizadas em 2020 e no primeiro semestre de 2021. Também foi realizada uma pesquisa documental da regulamentação para ações em saúde, educação e assistência social destinadas a enfrentar a pandemia de COVID-19, com vistas a identificar a menção explícita de pessoas com deficiência. Resultados. Vinte e três países da América Latina e do Caribe fizeram a coleta de dados estatísticos em pesquisas realizadas no período 2020-2021. Apenas quatro países incluíram perguntas sobre deficiência em pesquisas nacionais: Colômbia, Costa Rica, México e Peru. Apesar de ter havido pesquisas direcionadas para pessoas com deficiência, a Região em geral carece de dados relativos à situação dessa população na pandemia. Somente 10 países empreenderam ações em saúde com a inclusão explícita de pessoas com deficiência, 12 em educação e 13 em assistência social. Conclusões. A falta de dados sobre a situação das pessoas com deficiência nos países da América Latina e do Caribe durante a pandemia de COVID-19 demonstra a invisibilidade deste segmento populacional nos processos de coleta de dados. Como resultado, um número reduzido de países incluiu explicitamente as pessoas com deficiência nas políticas implementadas para o enfrentamento da pandemia.

Association Between Social Pensions With Depression, Social, and Health Behaviors Among Poor Older Individuals in Colombia.

OBJECTIVES: Many low- and middle-income countries have introduced social pensions to alleviate extreme poverty and improve the well-being of older individuals. However, evidence remains inconclusive about the potential effects of such programs on mental health, social, and health behaviors. METHODS: Data for individuals aged 60 or older came from the nationally representative Encuesta Nacional de Salud, Bienestar y Envejeciamiento survey in Colombia 2015 (N = 9,456). We used propensity score matching to estimate the association between the country's social pension program (Colombia Mayor) with depression, self-rated health, food insecurity, alcohol consumption, social participation, and labor force participation. RESULTS: Results show that receiving the program does not significantly affect the likelihood of suffering from depression or self-rated health among either men or women. However, receiving the program is associated with significant reductions in the likelihood of experiencing food insecurity and significant increases in the likelihood of participating socially. Among women, receiving the program is associated with significant reduction in the likelihood of participating in the labor force. DISCUSSION: The absence of a measurable effect on depression and self-rated health may be explained, at least partly, by the program's comparatively small cash benefit and the sharing of resources with other family members. Policymakers should assess possibilities to maximize the health and social benefits of social pensions.

Use of the six core surgical indicators from the Lancet Commission on Global Surgery in Colombia: a situational analysis.

BACKGROUND: Surgical, anaesthetic, and obstetric (SAO) health-care system strengthening is needed to address the emergency and essential surgical care that approximately 5 billion individuals lack globally. To our knowledge, a complete, non-modelled national situational analysis based on the Lancet Commission on Global Surgery surgical indicators has not been done. We aimed to undertake a complete situation analysis of SAO system preparedness, service delivery, and financial risk protection using the core surgical indicators proposed by the Commission in Colombia, an upper-middle-income country. METHODS: Data to inform the six core surgical system indicators were abstracted from the Colombian national health information system and the most recent national health survey done in 2007. Geographical access to a Bellwether hospital (defined as a hospital capable of providing essential and emergency surgery) within 2 h was assessed by determining 2 h drive time boundaries around Bellwether facilities and the population within and outside these boundaries. Physical 2 h access to a Bellwether was determined by the presence of a motor vehicle suitable for individual transportation. The Department Administrativo Nacional de Estadística population projection for 2016 and 2018 was used to calculate the SAO provider density. Total operative volume was calculated for 2016 and expressed nationally per 100 000 population. The total number of postoperative deaths that occurred within 30 days of a procedure was divided by the total operative volume to calculate the all-cause, non-risk-adjusted postoperative mortality. The proportion of the population subject to impoverishing costs was calculated by subtracting the baseline number of impoverished individuals from those who fell below the poverty line once out-of-pocket payments were accounted for. Individuals who incurred out-of-pocket payments that were more than 10% of their annual household income were considered to have experienced catastrophic expenditure. Using GIS mapping, SAO system preparedness, service delivery, and cost protection were also contextualised by socioeconomic status. FINDINGS: In 2016, at least 7·1 million people (15·1% of the population) in Colombia did not have geographical access to SAO services within a 2 h driving distance. SAO provider density falls short of the Commission's minimum target of 20 providers per 100 000 population, at an estimated density of 13·7 essential SAO health-care providers per 100 000 population in 2018. Lower socioeconomic status of a municipality, as indicated by proportion of people enrolled in the subsidised insurance regime, was associated with a smaller proportion of the population in the municipality being within 2 h of a Bellwether facility, and the most socioeconomically disadvantaged municipalities often had no SAO providers. Furthermore, Colombian providers appear to be working at or beyond capacity, doing 2690-3090 procedures per 100 000 population annually, but they have maintained a relatively low median postoperative mortality of 0·74% (IQR 0·48-0·84). Finally, out-of-pocket expenses for indirect health-care costs were a key barrier to accessing surgical care, prompting 3·1 million (6·4% of the population) individuals to become impoverished and 9·5 million (19·4% of the population) individuals to incur catastrophic expenditures in 2007. INTERPRETATION: We did a non-modelled, indicator-based situation analysis of the Colombian SAO system, finding that it has not yet met, but is working towards achieving, the targets set by the Lancet Commission on Global Surgery. The observed interdependence of these indicators and correlation with socioeconomic status are consistent with well recognised factors and outcomes of social, health, and health-care inequity. The internal consistency observed in Colombia's situation analysis validates the use of the indicators and has now informed development of an early national SAO plan in Colombia, to set a data-informed stage for implementation and evaluation of timely, safe, and affordable SAO health care, within the National Public Health Decennial Plan, which is due in 2022. FUNDING: Zoll Medical.

Do the determinants of self-rated health vary among older people with disability, chronic diseases or both conditions in urban Colombia? / ¿Varían los determinantes de la salud autoevaluada entre las personas ancianas con discapacidad, enfermedades crónicas o ambas condiciones en áreas urbanas de Colombia? / Os determinantes da autopercepção da saúde variam entre idosos com deficiência, com doenças crônicas não transmissíveis ou com ambas condições nas áreas urbanas da Colômbia?

Abstract: Our study aimed to identify the main determinants of self-rated health for individuals aged 60 years or older in Bogotá, Colombia, and if those determinants vary between groups. Data was obtained from the Demographic Health Survey 2011 for Bogotá. Logistic regression models were estimated to identify the determinants of excellent/good self-rated health among people aged 60 years or older living in Bogotá. Moreover, a subgroup analysis was conducted seeking to identify if the determinants changed between groups (men, women, persons with disability, with chronic disease(s), and persons with both disability and chronic disease(s)). The likelihood of reporting an excellent/good self-rated health health decreases when the individual has a disability, a chronic disease or reports that their household income is not enough to cover the basic needs. On the other hand, the odds of reporting excellent/good self-rated health increase when the individual is more educated and reports to receive family support. The subgroup analysis showed that although some determinants are only associated with one group (age with chronic diseases), in general, three main determinants stood out: years of education, socioeconomic status variables and receiving family support. The determinants of self-rated health for older adults in Bogotá differ according to the disability and the chronic disease status. Thus, public policies aiming to improve the levels of health and quality must consider the impacts of those characteristics on individuals' perceptions of their own health.

Resumen: El objetivo fue identificar los determinantes principales de salud autoevaluada en individuos con edades comprendidas entre los 60 años o más en Bogotá, Colombia y si esos determinantes varían entre grupos. Los datos se recabaron de la Encuesta Demográfica sobre Salud de 2011 en Bogotá. Los modelos de regresión logística se estimaron para identificar los determinantes de una excelente/buena salud autoevaluada entre personas con 60 años o mayores, viviendo en Bogotá. Asimismo, se realizó un análisis subgrupo, con el fin de identificar si los determinantes cambiaron entre grupos (hombres, mujeres, personas con discapacidad, con enfermedades crónicas, y personas viviendo con discapacidad y enfermedades crónicas. La probabilidad de informar de una excelente/buena salud autoevaluada decrece cuando la persona sufre una discapacidad, una enfermedad crónica o informa que sus ingresos no son suficientes para cubrir las necesidades básicas. En cambio, las probabilidades de informar sobre una excelente/buena salud autoevaluada se incrementan cuando la persona tiene más formación educacional e informa recibir apoyo familiar. El subgrupo de análisis revela que pese a que algunos determinantes están sólo asociados a un grupo (edad con enfermedades crónicas), en general, fueron importantes tres determinantes: años de educación, variables status socieconómico y recibir apoyo familiar. Los determinantes de salud autoevaluada para las personas mayores en Bogotá varían, dependiendo de la discapacidad y estatus de las enfermedades crónicas. Por tanto, las políticas públicas con el fin de mejorar los niveles de salud y calidad deben considerar los efectos de aquellas características sobre las percepciones individuales de su propia salud.

Resumo: O estudo teve como objetivos identificar os principais determinantes da autopercepção da saúde entre indivíduos com 60 anos ou mais em Bogotá, Colômbia, e averiguar se esses determinantes variam entre grupos. A fonte de dados foi a Pesquisa Nacional de Demografia e Saúde de 2011, para a cidade de Bogotá. Foram estimados modelos de regressão logística para identificar os determinantes da autopercepção da saúde excelente/boa entre pessoas com 60 anos de idade ou mais, residindo em Bogotá. Além disso, foi realizada uma análise de subgrupos com o objetivo de identificar se os determinantes mudaram entre os grupos (homens, mulheres, pessoas com deficiência, com doenças crônicas e pessoas vivendo simultaneamente com deficiência e com doenças crônicas). A probabilidade de relatar autopercepção da saúde excelente/boa diminui quando a pessoa é portadora de deficiência ou doença crônica ou quando a renda domiciliar é insuficiente para atender as necessidades básicas. Enquanto isso, as chances de relatar autopercepção da saúde excelente/boa aumentam quando a pessoa tem maior escolaridade e recebe apoio da família. A análise de subgrupos revelou que, embora alguns determinantes só estejam associados a um grupo (idade e doenças crônicas), de maneira geral, três principais determinantes foram importantes: anos de ensino, condição socioeconômica e apoio familiar. Os determinantes da autopercepção da saúde em idosos residentes em Bogotá variam de acordo com a presença ou ausência de deficiência e doenças crônicas. Portanto, as políticas públicas que procuram melhorar os níveis de saúde e qualidade de vida devem considerar os efeitos dessas características sobre a percepção dos indivíduos em relação à própria saúde.

Disability and poverty: two related conditions. A review of the literature / Discapacidad y pobreza: dos condiciones relacionadas. Una revisión de la literatura

The relationship between disability and poverty has been recognised in the literature since the 1990s. Empirical evidence supporting the existence of this relationship has increased in the last decade; however, there is still a lack of knowledge of how these two conditions interact and what the causal mechanisms that participate in the creation of this relationship are. This article aims to explore how the concepts of disability and poverty are related and it analyses the bidirectional relationship between these two conditions, how it is mediated by social exclusion and what empirical evidence supports this relationship around the world and in Latin America (LA).

La relación entre discapacidad y pobreza ha sido reconocida en la literatura desde los años noventa. La evidencia empírica que soporta la existencia de esta relación ha crecido en la última década, sin embargo, todavía no se ha determinado cuáles son los mecanismos que facilitan y participan en la creación de la correspondencia entre discapacidad y pobreza. El propósito de este artículo es explorar cómo los conceptos de discapacidad y pobreza se relacionan; igualmente analizar la bidireccionalidad de la relación entre estas dos condiciones, cómo esta mediada por la existencia de procesos de exclusión social y qué evidencia empírica existe en países en vía de desarrollo en Latinoamérica.