ABSTRACT
Ethnic inequalities are often associated with social determinants of health. This study seeks to identify the latest scientific evidence on inequalities in the health of people of African descent in the Americas. For this, a systematic review of the literature on health and people of African descent in the Americas was carried out in the LILACS, PubMed, MEDLINE, and IBECS databases. Institutional and academic repositories were also consulted. Evidence was obtained on the presence and persistence of health inequalities in the population of African descent in the Americas from the identification of five types of quantitative and qualitative evidence: (1) ethnic/racial concept and variables; (2) relations with other social determinants; (3) health risks; (4) barriers and inequalities in health services; and, (5) morbi-mortality from chronic diseases. Studies with qualitative methods revealed invisibility, stereotypes, and rejection or exclusion as main factors of inequality. This review evidenced the existence of health inequalities, its interconnection with other adverse social determinants and risk factors, and its generation and perpetuation by discrimination, marginalization, and social disadvantage. These conditions make people of African descent a priority population group for action on equity, as demanded by the 2030 Agenda for Sustainable Development.
Subject(s)
Black or African American/statistics & numerical data , Health Status Disparities , Health Services Accessibility , Humans , Risk Factors , Social Determinants of Health , Socioeconomic Factors , StereotypingABSTRACT
Fundamentos: La evidencia pone de manifiesto la importancia de abordar la etnicidad en relación a los determinantes sociales de la salud para el logro progresivo del acceso universal a la salud y la cobertura universal en salud. Esto implica que todas las personas y las comunidades tengan acceso, sin discriminación alguna, a servicios integrales de salud adecuados, oportunos, de calidad, a la vez que se asegura que el uso de esos servicios no expone a los usuarios a dificultades financieras. La Organización Panamericana de la Salud (OPS/OMS) reconoció la necesidad de un compromiso político y marco estratégico consensuado para avanzar hacia la equidad en salud, elaborando la primera política sobre etnicidad y salud para las Américas aprobada por los ministerios de salud en septiembre de 2017 durante la 29ª Conferencia Sanitaria Panamericana. Esta política, impulsada por la OPS/OMS, que incluye la etnicidad como uno de sus cuatro ejes transversales de trabajo, está alineada con importantes compromisos globales, incluida la Agenda 2030 para el Desarrollo Sostenible. El presente artículo presenta la forma como se elaboró esta política, y los desafíos para su implementación. Dicha política tiene en cuenta la necesidad de trabajar en conjunto y reorientar los servicios de salud con un enfoque intercultural para mejorar las condiciones de salud de los pueblos indígenas, los afrodescendientes, los romaníes y otros grupos étnicos que coexisten en la región de las Américas y que, en muchas ocasiones, presentan resultados de salud más desfavorables que el resto de la población. Conclusiones: Con la aprobación de esta política, la región de las Américas se convierte en la primera región de la OMS en dar respuesta a la necesidad de adoptar un abordaje intercultural, en el contexto de los determinantes sociales de la salud, considerando las desigualdades de género que interaccionan con las de etnicidad, las diferencias en acceso a la salud a través del curso de vida, la promoción y el respeto de los derechos individuales y, para los pueblos indígenas, de los derechos colectivos
Background: The evidence highlights the importance of working with ethnicity in relation to the social determinants of health for the progressive achievement of universal access to health and universal health coverage. This implies that all people and communities have access, without any kind of discrimination, to comprehensive, appropriate and timely, quality health services, while ensuring that the use of these services does not expose users to financial hardship. The Pan American Health Organization (PAHO / WHO) recognized the need for a political commitment and a consensual strategic framework to advance towards equity in health. As a result, in a participatory way, the first policy on ethnicity and health was elaborated and approved by the Ministries of Health in September 2017 during the 29th Pan American Sanitary Conference. This policy, promoted by PAHO / WHO, includes ethnicity as one of its four cross cutting themes for work, aligned with important global commitments, including the 2030 Agenda for Sustainable Development. This article presents the way in which this political proposal was elaborated, and the challenges for its implementation. This policy takes into account the need to work together and reorient health services with an intercultural approach in order to improve the health conditions of indigenous peoples, afro-descendants, Roma people and other ethnic groups that coexist in the Americas region, who present health results more unfavorable than the rest of the population. Conclusions: With the approval of the policy, the Americas becomes the first region of WHO to respond to the need to adopt an intercultural approach in the context of the social determinants of health. This is done by taking into account the gender and ethnic inequalities that interact, the differences in access to health throughout the life course, as well as the promotion and respect of individual rights and, in the case of indigenous peoples, collective rights
Subject(s)
Humans , Health Policy/trends , Culturally Competent Care/trends , 50262 , Emigrants and Immigrants/statistics & numerical data , Cross-Cultural Comparison , Health Equity/trends , Patient Rights/trendsSubject(s)
Ethnology , Patient Safety/standards , Quality of Health Care/standards , Health Equity , Humans , Quality ImprovementABSTRACT
OBJECTIVE: Characterize the technical cooperation of Colombia with four bordering countries and determine the training needs of the binational technical groups (BTGs). METHODS: Qualitative investigation based on document review and information provided by key actors in this field. To explore training needs, a survey of Colombia-Ecuador BTGs was conducted. Further information was obtained through discussion groups. Deductive and inductive categorization techniques were applied, as well as convergence using the triangulation method. RESULTS: Eighteen agreements/conventions and the documentation from 12 borderarea health cooperation projects were obtained. The majority of the projects involved multilateral cooperation. The two priority cooperation topics were the International Health Regulations and Millennium Development Goals 6 and 7. The BTGs considered training in management, health diplomacy, and capacity-building necessary for cooperation in border areas. CONCLUSIONS: The border areas exhibited complex intervention scenarios, where international law and foreign policy have defined cooperative actions. In determining the training for BTGs, the national and international regulatory framework and context of the border areas should be taken into account.
Subject(s)
Emigration and Immigration , Global Health , Health Promotion/organization & administration , International Cooperation , Public Health , Colombia/epidemiology , Data Collection , Goals , Humans , International Agencies/organization & administration , Models, Theoretical , Pan American Health Organization , Population Surveillance , Public Health Administration , South America/epidemiologyABSTRACT
OBJETIVO: Caracterizar la cooperación técnica de Colombia con cuatro de sus países fronterizos y determinar las necesidades de formación de sus grupos técnicos binacionales (GTB). MÉTODOS: Investigación cualitativa basada en la revisión documental y en información suministrada por actores clave de este campo. Para explorar las necesidades de capacitación se aplicó una encuesta con los GTB de Colombia y Ecuador, la cual fue profundizada a través de grupos de discusión; se aplicaron técnicas de categorización deductiva e inductiva, y de triangulación por convergencia. RESULTADOS: Se obtuvieron 18 acuerdos/convenios y documentación de 12 proyectos de cooperación sanitaria en zona de frontera. La mayoría de los proyectos encontrados correspondían a cooperación multilateral. Los dos temas de cooperación priorizados fueron el Reglamento Sanitario Internacional y los Objetivos de Desarrollo del Milenio 6 y 7. Los GTB consideraron necesario un proceso de capacitación en gestión, diplomacia en salud y desarrollo de capacidades para la cooperación en ámbitos fronterizos. CONCLUSIONES: Las fronteras se exhibieron como escenarios complejos de intervención, donde el derecho internacional y la política exterior han delimitado las acciones de cooperación. Al definir la capacitación de los GTB, se sugiere considerar el marco normativo nacional e internacional y el contexto de las áreas fronterizas.
OBJECTIVE: Characterize the technical cooperation of Colombia with four bordering countries and determine the training needs of the binational technical groups (BTGs). METHODS: Qualitative investigation based on document review and information provided by key actors in this field. To explore training needs, a survey of Colombia-Ecuador BTGs was conducted. Further information was obtained through discussion groups. Deductive and inductive categorization techniques were applied, as well as convergence using the triangulation method. RESULTS: Eighteen agreements/conventions and the documentation from 12 borderarea health cooperation projects were obtained. The majority of the projects involved multilateral cooperation. The two priority cooperation topics were the International Health Regulations and Millennium Development Goals 6 and 7. The BTGs considered training in management, health diplomacy, and capacity-building necessary for cooperation in border areas. CONCLUSIONS: The border areas exhibited complex intervention scenarios, where international law and foreign policy have defined cooperative actions. In determining the training for BTGs, the national and international regulatory framework and context of the border areas should be taken into account.
Subject(s)
Humans , Emigration and Immigration , Health Promotion/organization & administration , International Cooperation , Public Health , Global Health , Colombia/epidemiology , Data Collection , Goals , International Agencies/organization & administration , Models, Theoretical , Pan American Health Organization , Population Surveillance , Public Health Administration , South America/epidemiologySubject(s)
Technical Cooperation , Technical Cooperation , Border Areas , Global Health , Global Health Strategies , Health Surveillance , Colombia , International Cooperation , Technical Cooperation , Border Areas , Global Health , Global Health Strategies , Colombia , Data Collection , International Agencies , Models, Theoretical , Health Surveillance , Emigration and Immigration , Health Promotion , International Cooperation , Public Health , Global Health , Pan American Health Organization , Population Surveillance , Public Health Administration , South AmericaSubject(s)
Intersectoral Collaboration , Ethnicity , Health Equity , Policy Making , Public Policy , Vulnerable Populations , ColombiaABSTRACT
[Extraído de la Introducción]. El estudio que se presenta a continuación examina dos experiencias de acción intersectorial (AI) en Colombia, ambas resultantes de la combinación de estrategias orientadas al mejoramiento de la equidad en salud. Para ello, se adopta la definición de la acción intersectorial (AI) como una relación reconocida entre diferentes sectores para actuar sobre asuntos que mejoren la salud y la equidad en salud.
