Leading causes of death and disease burden in the Americas: Noncommunicable diseases and external causes. Executive summary

The health status of its population is a key determinant of a country’s social and economic development. Understanding disease morbidity, mortality, disability, and the related impact on life expectancy is a fundamental pillar for building resilient health systems and more equitable societies. Such knowledge informs strategic planning and optimal resource allocation to effectively address health challenges, making health systems more responsive to the needs of the populations they serve. This is the executive summary of the report Leading causes of death and disease burden in the Americas: Noncommunicable diseases and external causes, which presents an in-depth analysis on life expectancy and mortality in the Americas, exploring the burden of disease throughout the life course. It focuses on noncommunicable diseases (NCDs), encompassing mental and substance use disorders, neurological conditions, and external causes during the period 2000–2019. Despite a trend to overall increased life expectancy, NCDs and external causes remain a major challenge to social and economic development in the Region of the Americas, requiring public health solutions, health systems innovations, and political interventions to bring about the required changes. Rapidly aging populations and related demographic shifts, increasing disease burdens, and widening gaps in equity demand accelerated actions to tackle NCDs and mental health conditions. This report provides evidence urgently needed for decisive actions, so that the Sustainable Development Goals can be achieved by the countries of the Americas.

Strategy for accelerating maternal mortality reduction in the Region of the Americas based on Primary Health Care

In Latin America and the Caribbean (LAC), one maternal death was registered every hour in 2020. That same year, the trend in the maternal mortality ratio (MMR) for the Region of the Americas regressed alarmingly and unprecedentedly to the levels seen two decades ago. In addition to indicating a worsening of health outcomes, these figures also signal a deepening of inequalities, representing thousands of individual, unacceptable tragedies that in most cases could have been preventable. Maternal death is the result of a multifactorial process in which structural elements such as the economic system, environmental conditions, and culture interact. Other factors related to social inequality are also present, such as racism, poverty, gender inequality, and lack of access to the education system. The current situation calls for urgent mobilization of the health systems of LAC countries in order to strengthen efforts to combat maternal mortality, especially in countries that are still far from achieving the SHAA2030 regional target. For this reason, a preventive, health-promoting, life-course-based approach is needed, with models of care centered on women, families, and the community Scientific evidence shows that health systems with a solid foundation in primary health care (PHC) achieve better outcomes, greater equity, and reduced health expenditures. To address this, PAHO proposes a strategy, aimed primarily at women who are in the most vulnerable situation, who are the ones who represent the greatest burden of maternal mortality, to accelerate the reduction of maternal mortality in the Region of the Americas, based on the expansion and strengthening of PHC.

Strengthening care for noncommunicable diseases in the Americas

Noncommunicable diseases (NCDs), such as cardiovascular diseases, cancer, respiratory diseases and diabetes, account for 81% of lives lost in the Americas. An estimated 240 million adults in the Region live with at least one NCD, requiring access to continuous support, delivered through Primary Health Care. Successful implementation of NCD policies and interventions can result in significant cost savings, alleviating the economic burden on healthcare systems, individuals, and society, while effective NCD management at the Primary Health Care level reduces premature deaths and disabilities. Strengthening integration of NCDs into Primary Health Care represents a key milestone in a country’s health system response to the Sustainable Development Agenda, with the aim of leaving no-one behind.

Healthy Municipalities, Cities, and Communities Movement of the Americas. Local Governance for Health and Well-being

This brochure presents the Movement of Healthy Municipalities, Cities and Communities (MCCS) of the Americas, a regional platform of local governments in the Region, committed to local governance for health and well-being. Aimed at mayors and women mayors, it shows how the MCCS Movement is organized, how to join, and what opportunities it offers.

Health financing and access to medicines in the Caribbean

For millions of people, including those in the Caribbean region, accessing affordable and high-quality medicines poses significant challenges. These include affordability issues, concerns over the quality and safety of medicines, and inadequate financing for health care, as well as the inappropriate use of essential medicines, weak or limited regulatory systems, and complex procurement and supply chain management processes. The Caribbean region also faces a unique set of challenges, including high levels of public debt and significant informal economies. These factors constrain the capacity of governments to invest in social programs and agendas, including the provision of universal health coverage. At present, public spending on health care in the region is only 3.9% of gross domestic product, well below the 6% target. Consequently, many people must rely on out-of-pocket payments for health care, including medicines. This financial burden creates barriers to accessing health care and can lead to the irrational use of prescription drugs and other medicines. This report offers an initial and concise evaluation of certain health financing aspects that are crucial for accessing medicines in the Caribbean. It also provides a preliminary set of recommendations to guide national and regional efforts to improve the region’s current organization, financing, and provision of medicines. These recommendations aim to tackle the significant challenges highlighted in the report, including those related to system financing, barriers to access, and the financial burden of out-of-pocket costs. Envisioned as an integral part of a broader series of initiatives, this study aims to promote equitable, affordable, and sustainable access to medicines and health technologies by strengthening regulatory frameworks and production capacities, as well as by promoting the rational use of medicines. The publication also aims to be a useful resource for policymakers, health professionals, and other stakeholders in the region and beyond, as they work toward ensuring that everyone in the Caribbean has access to the medicines they need to lead healthy and productive lives, and that the region can achieve sustainable and equitable health financing.

Age-friendly Environments: Baseline Assessment in Latin America with reference to Costa Rica

Consolidating age-friendly environments is a goal of the Decade of Healthy Ageing (2021–2030). Under the World Health Organization (WHO) Age-Friendly Cities and Communities Framework the first step is to carry out a baseline assessment, with the active participation of older people, in order to determine the areas in which cities and communities must work to remove the barriers experienced by older people and create increasingly friendly environments adapted to their requirements. The WHO program recommends using the Vancouver Protocol to conduct this assessment. Due to particular complications, many Latin American countries have adapted it for local implementation in order to overcome difficulties that arose. Outlining the current knowledge available in Latin America and noting the experiences of cities and communities in the subregion, this document compiles examples and case studies of these adaptations, such as the program implemented in Costa Rica, which will guide policy actions that foster people's full development throughout the life course. In order to respond to the challenges posed by demographic transitions, it is essential to create tools that allow environments to be adapted in ways that promote healthy ageing. This requires accurate, up-to-date, and effective information. The Decade of Healthy Ageing establishes a period of focused action aimed at producing and monitoring information. This is the strategy that serves as the framework for this report.

The economic impact of eliminating industrially produced trans fatty acids in Barbados

The fact sheet facilitates the dissemination of evidence in Barbados on the potential impact of industrially produced trans-fatty acids elimination best practice policies in mortality, productivity and reducing the incidence of noncommunicable diseases. This information may help inform Member States' policy formulation in advancing food labeling regulations in the Region.

Evaluation of the Pan American Health Organization results-based management framework implementation. Volume II Annexes

As a specialized agency for global health in the Americas, the Pan American Health Organization (PAHO) is at the center of efforts to combat diseases, respond to emergencies and disasters, and strengthen regional health systems. To underscore efforts and amplify regional results in these areas, PAHO adopted an Organization-wide Results-Based Management (RBM) Framework in 2010. Given these strides towards a more comprehensive RBM of PAHO’s portfolio of work, the Organization conducted an assessment of its efforts to determine its achievements thus far. This publication complements the original report, which is the first of its kind – a comprehensive external evaluation of the RBM Framework for PAHO. It was commissioned to examine the implementation of RBM including its functioning, value added to the work of PAHO, and details around any improvements that could be made. The evaluation covered all four components of the RBM framework: Strategic and Operational Planning; Implementation, Performance Monitoring, and Assessment; Independent Evaluation and Learning; and Accountability; and considered the period from January 2008 to December 2022 within all levels of PAHO entities (regional, subregional, and country offices).

Financial Report of the Director and Report of the External Auditor. 1 January – 1 December 2023

This publication presents the Financial Report of the Pan American Health Organization (PAHO) for 2023. Certified and approved for publication by the Director of the Organization, the financial statements have been prepared on the accrual basis of accounting in accordance with the International Public Sector Accounting Standards. In addition to the financial statements and notes thereto, the report presents an analysis of PAHO’s financial performance in 2023. Sections on revenue, voluntary contributions, procurement, expenses, financial position, reserves, investments, foreign exchange, and employee liabilities are accompanied by figures and tables. However, this report goes beyond the financial information to also highlight selected achievements of the Organization in 2023. These achievements relate to PAHO’s ongoing efforts to spearhead innovative initiatives in the Region of the Americas to scale up health action and its work to help countries to protect public health gains, recover better from the impact of the COVID-19 pandemic, and build stronger. In 2023, PAHO also sought to foster commitment, enable cooperation, shed light on solutions, and focus efforts on reducing inequality gaps across the Region. The selected achievements concern, for example, PAHO’s efforts to strengthen primary health care, help respond to health emergencies and disasters, increase health system resilience and preparedness, tackle preventable communicable diseases, address the growing burden of noncommunicable diseases, raise the flag for mental health, bring immunization rates back on track, and accelerate the digital transformation of public health. Also mentioned is the ongoing work to streamline internal systems and processes through the initiation of PAHO Forward.

Leading causes of death and disease burden in the Americas: Noncommunicable diseases and external causes

The health status of its population is a key determinant of a country’s social and economic development. Understanding disease morbidity, mortality, disability, and the related impact on life expectancy is a fundamental pillar for building resilient health systems and more equitable societies. Such knowledge informs strategic planning and optimal resource allocation to effectively address health challenges, making health systems more responsive to the needs of the populations they serve. This report presents an in-depth analysis on life expectancy and mortality in the Americas, exploring the burden of disease throughout the life course. It focuses on NCDs, encompassing mental and substance use disorders, neurological conditions, and external causes during the period 2000–2019. Despite a trend to overall increased life expectancy, NCDs and external causes remain a major challenge to social and economic development in the Region of the Americas, requiring public health solutions, health systems innovations, and political interventions to bring about the required changes. Rapidly aging populations and related demographic shifts, increasing disease burdens, and widening gaps in equity demand accelerated actions to tackle NCDs and mental health conditions. This report provides evidence urgently needed for decisive actions, so that the Sustainable Development Goals can be achieved by the countries of the Americas.

Notes on COVID-19 Health Accounts

The COVID-19 pandemic led health systems to implement a treatment and preventive strategy for a previously unknown challenge. The sharing of experiences and formulation of interventions was accelerated and the usual financial management rules had to be modified to facilitate quick reactions. Moreover, the health accounts process also needed a reflection and discussion on how it should proceed under such circumstances. Thus, this document details the most recent international agreements on health accounting of COVID-19 health spending.

Evaluation of the Pan American Health Organization results-based management framework implementation. Volume 1. Final Report

As a specialized agency for global health in the Americas, the Pan American Health Organization (PAHO) is at the center of efforts to combat diseases, respond to emergencies and disasters, and strengthen regional health systems. To underscore efforts and amplify regional results in these areas, PAHO adopted an Organization-wide Results-Based Management (RBM) Framework in 2010. Given these strides towards a more comprehensive RBM of PAHO’s portfolio of work, the Organization conducted an assessment of its efforts to determine its achievements thus far. This report is the first of its kind – a comprehensive external evaluation of the RBM Framework for PAHO. It was commissioned to examine the implementation of RBM including its functioning, value added to the work of PAHO, and details around any improvements that could be made. The evaluation covered all four components of the RBM framework: Strategic and Operational Planning; Implementation, Performance Monitoring, and Assessment; Independent Evaluation and Learning; and Accountability; and considered the period from January 2008 to December 2022 within all levels of PAHO entities (regional, subregional, and country offices).

Criteria for Healthy Municipalities, Cities, and Communities in the Region of the Americas

The regional criteria for healthy municipalities, cities and communities (MCCS) of the Americas, adopted at the Meeting of Mayors for MCCS of the Region of the Americas in 2022, present a set of reference guidelines to strengthen public policies, plans and programs aimed at improving the health and well-being of the populations served by local governments. It is based on the recognition of the key role of municipalities in promoting healthy public policies, taking into account that these transcend the health sector and the role that other sectors have, given the impact of all public policies on health. These criteria are the result of collaborative and interdisciplinary work with the participation of different people and institutions in the Region, including local governments. Some key considerations for the development of these criteria were the experiences of national and subnational networks of healthy municipalities, the existing criteria in several countries in the Region and the World Health Organization guidelines for healthy cities. The criteria are grouped into six areas of political action and for the implementation of each one a group of recommended actions is included, as well as a proposal for means of verification and compliance indicators. They are addressed to municipal management teams, networks and associations of municipalities in the Region, and ministries of Health, as support for policies that strengthen the inclusion of health promotion as a priority of local management. The existing heterogeneity among local governments is expressly recognized, where different organizational forms, competencies and availability of resources address diverse realities. For this reason, the criteria are conceived with a purposeful nature to adapt to this diversity and must be contextualized and prioritized in each territory. Undoubtedly, the application of these guidelines will lead to the identification of different challenges and opportunities that will enrich this proposal.

Health in the Americas: Potentially avoidable premature mortality

In recent decades, a significant improvement in people’s general health conditions has occurred, leading to an increase in life expectancy at birth in most countries in the Region of the Americas. This progress has been the result of both health technology advances – antibiotics, vaccines, and other treatments – and improvements in the conditions in which people live, including increased access to improved drinking water and sanitation, and health services. Nevertheless, progress has slowed in recent years, and achievements have varied among countries and territories, as well as within them. In the journey toward universal health, it is essential to have the ability to monitor and assess progress in terms of the ultimate goal of health systems: improving the health and well-being of populations. To this end, this edition of Health in the Americas analyzes the standardized rate of potentially avoidable premature mortality as an indicator of health system performance, considering both its preventable component through public and intersectoral health interventions, as well as the treatable component, related to the effectiveness of health services, that is, the quality of health care. The analysis of potentially avoidable premature mortality provides a metric for comparing and tracking performance over time. This analytical tool plays a crucial role in holding health systems accountable in the Region of the Americas. Furthermore, the analysis of potentially avoidable premature mortality highlights the importance of investing not only in healthcare services but also in addressing the broader social and environmental determinants of health. This approach is fundamental to ensuring equity in health outcomes across countries. By recognizing the significance of these determinants, countries can develop comprehensive strategies that encompass not only health care but also social policies aimed at reducing inequalities and improving overall population health.

Aging in Latin America and the Caribbean from the Perspective of National Transfer Accounts

This report is the result of collaboration between the Pan American Health Organization (PAHO) and the Economic Commission for Latin America and the Caribbean (ECLAC), It describes aging based on the socioeconomic profiles of older people in the subregion, from the perspective of national transfer accounts. The report analyzes the profiles of labor income and consumption; the life cycle deficit; financing the system for older people; the interactions between consumption, health, and population aging; the economic support ratio; and public policies that provide transfers to older people. It also explains how public transfers and accumulated assets are the main sources of financing for older people, and how older people often help to finance other groups of people through private transfers. This publication provides evidence that draws attention to the importance of pension systems for the income of older people, and to the low rates of social security contributions resulting from informal and precarious labor conditions, as well as the impact of non-contributory programs.

Communicating with a Focus on Equity, Gender, and Cultural Diversity in the Context of COVID-19 Vaccination. Practical Guide

Incorporating a perspective that takes into account considerations of equity, gender and cultural diversity is the first step towards a form of communication that responds to the multiple and complex realities of the different countries in the Region of the Americas. This practical guide aims to help the communication teams of the Pan American Health Organization to integrate this approach into their daily work and to develop materials that adapt to the particularities of each type of audience. It calls for promoting outreach to beneficiary communities and includes practical examples of inclusive use of language, guidelines for the representation of sociocultural diversity, checklists to evaluate relevance, and specific recommendations within the context of anti-virus vaccines.

Latin America and the Caribbean Code against Cancer. Learn how to help prevent cancer in yourself and your family

The International Agency for Research on Cancer of the World Health Organization and the Pan American Health Organization convened a group of specialists and representatives of civil society from Latin America and the Caribbean to formulate a series of prevention measures for cancer, based on the most recent scientific evidence and adapted to common scenarios in the subregion. As a result of this initiative, this code presents 17 actions to help prevent cancer, as well as public policy recommendations aimed at guaranteeing its effective application.

Meeting Report of the PAHO Strategic and Technical Advisory Group on Disease Elimination. Meeting Report and Recommendations. 29–30 November 2022

In September 2019, the 57th Pan American Health Organization (PAHO) Directing Council endorsed the PAHO Disease Elimination Initiative (EI), an innovative policy that promotes an integrated, sustainable approach to accelerate countries’ progress toward the elimination of communicable diseases and related conditions. The EI builds on the successful track record of disease elimination in the Americas and aims to catalyze political will and leverage the needed technical capacity to achieve a future that is free from the burden of 35 communicable diseases and/or related conditions in the Americas by 2030 and contribute to progress towards the Sustainable Development Goals. As countries recover from the impact of COVID-19 and adapt to the evolving public health context in the region, PAHO recognized the importance of convening the external Strategic and Technical Advisory Group (STAG) on Disease Elimination to take stock of the new public health landscape and recent developments in the EI and seek orientation and recommendations on priority topics to sustain the disease elimination agenda in the Americas. This report provides a summary of the proceedings, conclusions, and recommendations from the second meeting of the PAHO STAG on Disease Elimination, which took place on 29-30 November 2022.

Front-of-package warning labels save lives and resources: results from a modeling study in Barbados

Unhealthy eating has been driven largely by the widespread availability, affordability, and promotion of ultra-processed and processed food products that are excessive in sugars, fats, and sodium. As such, an essential part of the solution requires the use of laws and regulations to reduce the demand for and offer of products that contain excessive amounts of critical nutrients. One of the key policy tools to regulate such products to prevent them from unbalancing diets is the use of front-of-package labeling (FOPL) to indicate to consumers which products contain excessive amounts of sugars, total fats, saturated fats, trans fats, and/or sodium. This publication presents evidence on the expected impact of the adoption of octagonal warning labels on health and economy of a country. It features results from Barbados, showing warning labels have the potential to avert 16% of the deaths caused by noncommunicable diseases and save the country USD 732.8 million.

STAR-H: Strategic Toolkit for Assessing Risks in Health Facilities

Health facilities in the Region of the Americas frequently suffer the effects of health emergencies and disasters, which jeopardize their ability to provide services to the population. The STAR-H methodology helps staff responsible for health emergency and disaster risk management to identify and assess risks as part of strategic planning to improve facility preparedness. It is intended to help them develop, with a multi-hazard approach, a response framework with operating procedures to deal with hazards of any type, scale, or frequency; determine roles and responsibilities; facilitate the effective use of resources; undertake strategic planning exercises, and improve the preparedness of facilities to effectively respond to and recover from impacts. This methodology is designed for use in health facilities of any size and capacity, and makes it possible to generate historical reports and national or subnational risk profiles. This information can be used to develop an effective health emergency and disaster risk management program.