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1.
Washington, D.C.; OPS; 2025-01-30. (OPS/DHE/HP/24-0005).
in Spanish | PAHO-IRIS | ID: phr-64272

ABSTRACT

La Primera Reunión Regional sobre Acción Intersectorial para Promover la Equidad en Salud en las Américas se llevó a cabo entre el 21 y 23 de noviembre de 2023 en La Habana, Cuba, y contó con la participación de delegaciones de 17 países de la Región de las Américas, así como expertos de la Organización Mundial de la Salud y de otros organismos internacionales. Este encuentro fue organizado por la Unidad de Promoción de la Salud y Determinantes Sociales de la Salud del Departamento de Determinantes Sociales y Ambientales para la Equidad en la Salud de la Organización Panamericana de la Salud en colaboración con el Gobierno de Canadá y la Agencia Suiza para el Desarrollo y la Cooperación. Esta publicación recoge los temas centrales de lo que ha sido un aporte relevante para el fortalecimiento de competencias y el intercambio de experiencias entre diversos actores en materia de acción intersectorial para alcanzar una mayor equidad en salud. Al finalizar la reunión, los participantes acordaron una declaración de líneas políticas y operativas, que recibió el nombre de Declaración de La Habana sobre la intersectorialidad para promover la equidad en salud, en la cual se reafirma la necesidad de contar con sistemas de bienestar y la importancia de la acción intersectorial y de la participación social como fundamento para la equidad en salud. Asimismo, la reunión dio lugar a la conformación de la Red de Trabajo Intersectorial y Participación Social para la Equidad en Salud de las Américas (Red TIPSESA), la cual convoca a diversos actores de la región interesados en promover la equidad en salud a través de la acción intersectorial.


Subject(s)
Equity , International Health Regulations , Health Promotion , Americas
2.
Washington, D.C.; OPS; 2025-01-24. (OPS/PUB/24-0006).
in Spanish | PAHO-IRIS | ID: phr-64186

ABSTRACT

La Región de las Américas es la que presenta las mayores disparidades socioeconómicas, así como importantes inequidades en materia de la salud, ya sea entre los países o dentro de ellos, en relación con los grupos minoritarios y excluidos. Estas inequidades en la salud se traducen en diferencias en la esperanza de vida; el estado de salud al inicio de la vida y a lo largo de ella; la carga de las enfermedades transmisibles y no transmisibles; los comportamientos relacionados con la salud, como el consumo de tabaco, alcohol y drogas; y los accidentes, la violencia y los conflictos. Los grupos de ingresos bajos, los trabajadores informales, la población con menor nivel de escolaridad, los Pueblos Indígenas, las personas afrodescendientes y otros grupos vulnerables en la Región se encuentran en una situación de enorme desventaja y afrontan inequidades considerables en materia de salud, que se traducen en tasas más elevadas de enfermedades transmisibles y no transmisibles y de mortalidad materna e infantil. La Organización Panamericana de la Salud (OPS) se ha comprometido a trabajar para reducir las inequidades en la salud, lo que se refleja en su Política sobre etnicidad y salud, en su Estrategia y plan de acción sobre la promoción de la salud en el contexto de los Objetivos de Desarrollo Sostenible 2019-2030 y en su Política para recuperar el progreso hacia el logro de los Objetivos de Desarrollo Sostenible con equidad por medio de medidas que aborden los determinantes sociales de la salud y el trabajo intersectorial.


Subject(s)
Health Equity , Healthy Life Expectancy , Communicable Diseases, Emerging , Noncommunicable Diseases , Health of Ethnic Minorities , Sustainable Development , Americas
3.
Washington, D.C.; PAHO; 2024-11-08. (PAHO/EIH/SK-0005).
in English | PAHO-IRIS | ID: phr-62057

ABSTRACT

The Pan American Health Organization (PAHO) hosted the “Social Innovation as a Pathway for Health Equity” meeting from 31 October to 2 November 2023. This meeting brought together social innovators in health recognized by the Social Innovation in Health Initiative in Latin America and the Caribbean (SIHI-LAC), actors from various PAHO entities, and other potential key actors to form strategic alliances. The meeting was convened by PAHO through the departments of Evidence and Intelligence for Action in Health (EIH) and Social and Environmental Determinants for Health Equity (DHE) in coordination with Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM) and the Antonio Vidal Institute of Infectious Diseases and Parasitology as part of the SIHI-LAC program. While PAHO led the organization of the meeting, the SIHI-LAC Hub and participating social innovators contributed to developing the agenda and methodology. The meeting created spaces for dialogue between social innovators, SIHI-LAC Hub, PAHO, and current sponsors and potential allies for participating in social innovations. It significantly contributed to identifying needs and opportunities for social innovations in health, preparing the ground to influence public policy, advancing knowledge exchange, and discussing a framework to institutionalize social innovation in PAHO Member States and the Pan American Sanitary Bureau. Innovators also had the chance to present their initiatives within two critical components aligned with PAHO’s objectives and lines of action: sustainability and health equity. The event at PAHO Headquarters was the culmination of months of preparation with participating stakeholders.


Subject(s)
Health Equity , Social Justice , Equity in Access to Health Services , Health Promotion , Social Determinants of Health , Latin America , Caribbean Region
4.
Article in English | MEDLINE | ID: mdl-39363359

ABSTRACT

BACKGROUND: To compare racial and ethnic disparities in HIV diagnosis rates among adults in census tracts with most disadvantaged vs advantaged levels of social determinants of health (SDOH). METHODS: In this ecological analysis, we used the National HIV Surveillance System data in 2021 and SDOH data from 2017-2021 American Community Survey. We measured racial and ethnic disparities stratified by sex in the most disadvantaged quartiles and advantaged quartiles for: 1) Poverty 2) Education level 3) Median household income and 4) Insurance coverage. We calculated 8 relative disparity measures (Black-to-White rate ratio [RR], Hispanic/Latino-to-White RR, Index of Disparity [ID], population-weighted ID, Mean Log Deviation, Theil Index, Population Attributable Proportion, Gini coefficient) and 4 absolute disparity measures (Black-to-White rate difference [RD], Hispanic/Latino-to-White RD, absolute ID, and population-weighted absolute ID). RESULTS: Comparing the most disadvantaged quartiles to the most advantaged quartiles, all four absolute disparity measures decreased, but 7 of the 8 relative disparity measures increased: the median percentage decrease in the absolute measures for males and females respectively was 38.1% and 47.6% for poverty, 12.4% and 42.6% for education level, 43.6% and 44.0% for median household income, and 44.2% and 45.4% for insurance coverage. The median percentage increases for the relative measures for males and females respectively were 44.3% and 61.3% for poverty, 54.9% and 95.3% for education level, 19.6% and 90.0% for median household income, and 32.8% and 46.4% for insurance coverage. CONCLUSION: Racial and ethnic disparities in the most disadvantaged and advantaged quartiles highlight the need for strategies addressing the root causes of disparities.

5.
Front Public Health ; 12: 1397576, 2024.
Article in English | MEDLINE | ID: mdl-39234081

ABSTRACT

Objective: This study systematically reviews evidence of socioeconomic health disparities in Costa Rica, a middle-income country, to elucidate the relationship between socioeconomic status and health outcomes. Methods: Published studies were identified through a systematic review of PubMed (English) and Scielo (Spanish) databases from December 2023 to January 2024, following PRISMA guidelines. Search terms included socioeconomic status, social determinants, social gradient in health, and health inequalities. Results: Of 236 identified references, 55 met the inclusion criteria. Findings were categorized into health inequalities in mortality (among the general population, infants, and older adults), life expectancy, cause-specific mortality, and health determinants or risk factors mediating the association between the social environment and health. The studies indicate higher mortality among the most disadvantaged groups, including deaths from respiratory diseases, violence, and infections. Higher socioeconomic status was associated with lower mortality rates in the 1990s, indicating a positive social gradient in health (RII = 1.3, CI [1.1-1.5]). Disparities were less pronounced among older adults. Urban areas exhibited concentrated wealth and increased risky behaviors, while rural areas, despite greater socioeconomic deprivation, showed a lower prevalence of risky behaviors. Regarding smoking, people living in rural areas smoked significantly less than those in urban areas (7% vs. 10%). Despite the relatively equitable distribution of public primary healthcare, disparities persisted in the timely diagnosis and treatment of chronic diseases. Cancer survival rates post-diagnosis were positively correlated with the wealth of districts (1.23 [1.12-1.35] for all cancers combined). Conclusion: The study highlights the existence of social health inequalities in Costa Rica. However, despite being one of the most unequal OECD countries, Costa Rica shows relatively modest social gradients in health compared to other middle and high-income nations. This phenomenon can be attributed to distinctive social patterns in health behaviors and the equalizing influence of the universal healthcare system.


Subject(s)
Health Status Disparities , Humans , Costa Rica , Socioeconomic Factors , Risk Factors , Life Expectancy , Social Determinants of Health/statistics & numerical data , Social Class
6.
Brasília, D.F.; OPAS; 2024-09-13.
Monography in Portuguese | PAHO-IRIS | ID: phr2-61495

ABSTRACT

O Caderno Promoção da Saúde e Vigilância de Doenças e Agravos Não Transmissíveis Integradas – Parte 1 integra a série de publicações em homenagem aos 15 anos da Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 e revista em 2014. A série, voltada a gestores e profissionais de saúde, busca articular de forma prática os componentes da PNPS com outras políticas, programas e iniciativas implementadas pelo Ministério da Saúde em parceria com outros setores e instituições, demonstrando seu caráter transversal, bem como destacar as possibilidades de fortalecimento mútuo no enfrentamento dos determinantes da saude e na promoção da equidade e da saúde, nos territórios. Este Caderno apresenta uma análise da implementação de estratégias de vigilância das DANT nos últimos anos, à luz da promoção da saúde, dos determinantes e da equidade. A Parte 2, apresentará propostas de articulação entre a PNPS e os processos de desenvolvimento teórico, conceitual e metodológico de implementação da vigilância integrada de DANT. A Política Nacional de Promoção da Saúde (PNPS), baseia-se no conceito ampliado de saúde e no referencial teórico da promoção da saúde como um conjunto de estratégias e formas de produzir saúde, no âmbito individual e coletivo, caracterizando-se pela articulação e cooperação intra e intersetorial e pela formação da Rede de Atenção à Saúde, buscando articular suas ações com as demais redes de proteção social, com ampla participação e controle social. Seu objetivo geral é promover a equidade e a melhoria das condições e dos modos de viver, ampliando a potencialidade da saúde individual e coletiva e reduzindo vulnerabilidades e riscos à saúde decorrentes dos determinantes sociais, econômicos, políticos, culturais e ambientais.


Subject(s)
Social Determinants of Health , Health Policy , Health Promotion , Health Equity , Urban Health , Delivery of Health Care , Sustainable Development
7.
Brasília, D.F.; OPAS; 2024-09-13.
Monography in Portuguese | PAHO-IRIS | ID: phr2-61494

ABSTRACT

O Caderno Educação Permanente para a Promoção da Saúde integra a série de publicações em homenagem aos 15 anos da Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 e revista em 2014. A série, voltada a gestores e profissionais de saúde, busca articular de forma prática os componentes da PNPS com outras políticas, programas e iniciativas implementadas pelo Ministério da Saúde em parceria com outros setores e instituições, demonstrando seu caráter transversal, bem como destacar as possibilidades de fortalecimento mútuo no enfrentamento dos determinantes da saude e na promoção da equidade e da saúde, nos territórios. Este Caderno apresenta uma proposta de articulação entre a PNPS e os processos de educação permanente desenvolvidos no âmbito do Sistema Único de Saúde, a partir das lentes da promoção da saúde, dos determinantes e da equidade. A Política Nacional de Promoção da Saúde (PNPS), baseia-se no conceito ampliado de saúde e no referencial teórico da promoção da saúde como um conjunto de estratégias e formas de produzir saúde, no âmbito individual e coletivo, caracterizando-se pela articulação e cooperação intra e intersetorial e pela formação da Rede de Atenção à Saúde, buscando articular suas ações com as demais redes de proteção social, com ampla participação e controle social. Seu objetivo geral é promover a equidade e a melhoria das condições e dos modos de viver, ampliando a potencialidade da saúde individual e coletiva e reduzindo vulnerabilidades e riscos à saúde decorrentes dos determinantes sociais, econômicos, políticos, culturais e ambientais.


Subject(s)
Education, Continuing , Social Determinants of Health , Health Promotion , Health Policy , Health Equity , Delivery of Health Care , Sustainable Development
8.
Brasília, D.F.; OPAS; 2024-09-12.
Monography in Portuguese | PAHO-IRIS | ID: phr2-61493

ABSTRACT

O Caderno Promoção da saúde e as cidades integra a série de publicações em homenagem aos 15 anos da Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 e revista em 2014. A série, voltada a gestores e profissionais de saúde, busca articular de forma prática os componentes da PNPS com outras políticas, programas e iniciativas implementadas pelo Ministério da Saúde em parceria com outros setores e instituições, demonstrando seu caráter transversal, bem como destacar as possibilidades de fortalecimento mútuo no enfrentamento dos determinantes da saude e na promoção da equidade e da saúde, nos territórios. Este Caderno apresenta uma proposta de articulação entre a PNPS e o contexto da vida nas cidades, a partir das lentes da promoção da saúde, dos determinantes e da equidade. A Política Nacional de Promoção da Saúde (PNPS), baseia-se no conceito ampliado de saúde e no referencial teórico da promoção da saúde como um conjunto de estratégias e formas de produzir saúde, no âmbito individual e coletivo, caracterizando-se pela articulação e cooperação intra e intersetorial e pela formação da Rede de Atenção à Saúde, buscando articular suas ações com as demais redes de proteção, com ampla participação e controle social. Seu objetivo geral é promover a equidade e a melhoria das condições e dos modos de viver, ampliando a potencialidade da saúde individual e coletiva e reduzindo vulnerabilidades e riscos à saúde decorrentes dos determinantes sociais, econômicos, políticos, culturais e ambientais.


Subject(s)
Social Determinants of Health , Health Policy , Health Promotion , Sustainable Development , Health Equity , Urban Health , Delivery of Health Care
9.
Brasília, D.F.; OPAS; 2024-09-09.
Monography in Portuguese | PAHO-IRIS | ID: phr2-61434

ABSTRACT

O Caderno Monitoramento e Avaliação em Promoção da Saúde integra a série de publicações em homenagem aos 15 anos da Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 e revista em 2014. A série, voltada a gestores e profissionais de saúde, busca articular de forma prática os componentes da PNPS com outras políticas, programas e iniciativas implementadas pelo Ministério da Saúde em parceria com outras instituições, demonstrando seu caráter transversal, bem como destacar as possibilidades de fortalecimento mútuo no enfrentamento dos determinantes da saude e na promoção da equidade e da saúde, nos territórios. A PNPS, baseia-se no conceito ampliado de saúde e no referencial teórico da promoção da saúde como um conjunto de estratégias e formas de produzir saúde, no âmbito individual e coletivo, caracterizando-se pela articulação e cooperação intra e intersetorial e pela formação da Rede de Atenção à Saúde, buscando articular suas ações com as demais redes de proteção social, com ampla participação e controle social. Seu objetivo geral é promover a equidade e a melhoria das condições e dos modos de viver, ampliando a potencialidade da saúde individual e coletiva e reduzindo vulnerabilidades e riscos à saúde decorrentes dos determinantes sociais, econômicos, políticos, culturais e ambientais. Políticas, programas, projetos de promoção da saúde inscrevem-se no campo das intervenções complexas, que impactam o monitoramento e a avaliação pela necessidade de incluir a análise do contexto material, político, social e cultural dos determinantes da saúde e das desigualdades. O monitoramento e a avaliação em promoção da saúde devem fortalecer a capacidade de criar e sustentar processos de mudança, enriquecer a teoria e a prática, qualificar a tomada de decisões promovendo o uso de enfoques metodológicos em consonância com a natureza complexa das intervenções em promoção da saúde. Neste sentido, deve considerar os modos de vida, opiniões e percepções sobre os processos de saúde/doença produzidos nos territórios, reforçando a importância da participação social no monitoramento e avaliação das ações de promoção da saúde.


Subject(s)
Social Determinants of Health , Health Policy , Health Promotion , Sustainable Development , Health Equity , Delivery of Health Care
10.
Brasília, D.F.; OPAS; 2024-09-05.
Monography in Portuguese | PAHO-IRIS | ID: phr2-61365

ABSTRACT

O Caderno Promoção da Saúde e Objetivos de Desenvolvimento Sustentável integra a série de publicações em homenagem aos 15 anos da Política Nacional de Promoção da Saúde (PNPS), publicada em 2006 e revista em 2014. A série, voltada a gestores e profissionais de saúde, busca articular de forma prática os componentes da PNPS com outras políticas, programas e iniciativas implementadas pelo Ministério da Saúde em parceria com outras instituições, demonstrando seu caráter transversal, bem como destacar as possibilidades de fortalecimento mútuo no enfrentamento dos determinantes da saúde e na promoção da equidade e da saúde. Este Caderno apresenta uma proposta de articulação entre a PNPS e as estratégias utilizadas para a implementação e alcance dos Objetivos de Desenvolvimento Sustentável no âmbito dos territórios, a partir das lentes da promoção da saúde, dos determinantes sociais e ambientais e da equidade. A Política Nacional de Promoção da Saúde (PNPS), baseia-se no conceito ampliado de saúde e no referencial teórico da promoção da saúde como um conjunto de estratégias e formas de produzir saúde, no âmbito individual e coletivo, caracterizando-se pela articulação e cooperação intra e intersetorial e pela formação da Rede de Atenção à Saúde, buscando articular suas ações com as demais redes de proteção social, com ampla participação e controle social. Seu objetivo geral é promover a equidade e a melhoria das condições e dos modos de viver, ampliando a potencialidade da saúde individual e coletiva e reduzindo vulnerabilidades e riscos à saúde decorrentes dos determinantes sociais, econômicos, políticos, culturais e ambientais.


Subject(s)
Social Determinants of Health , Health Policy , Health Promotion , Sustainable Development , Health Equity , Delivery of Health Care
11.
Washington, D.C.; PAHO; 2024-09-19. (PAHO/PUB/24-0006).
in English | PAHO-IRIS | ID: phr-61592

ABSTRACT

The Americas is the region where the largest socioeconomical disparities are found, as well as health inequities between countries and within countries among minority and excluded population groups. These health inequities are refl ected in diff erences in life expectancy; health at the start of life and over the life course; burden of infectious as well as noncommunicable diseases; health behaviors such as smoking, alcohol and drug use; and accidents, violence, and confl ict. Low-income groups, informal workers, lower educational level population, indigenous peoples, people of African descent, and other groups in situations of vulnerability in the Americas are at an enormous disadvantage and face considerable health inequities, reflected in higher rates of both communicable and noncommunicable diseases and maternal and infant mortality. PAHO has committed to work toward reducing health inequities, refl ected in its Policy on Ethnicity and Health, the Strategy and Plan of Action on Health Promotion within the context of the Sustainable Development Goals 2019–2030, and the Policy for Recovering Progress toward the Sustainable Development Goals with Equity through Action on the Social Determinants of Health and Intersectoral Work.


Subject(s)
Health Equity , Life Expectancy , Communicable Diseases , Noncommunicable Diseases , Health of Ethnic Minorities , Sustainable Development , Americas
12.
Article in Spanish | PAHO-IRIS | ID: phr-61437

ABSTRACT

[RESUMEN]. La Región de las Américas ha experimentado históricamente desigualdades sociales enraizadas en el colonialismo, las cuales se reflejan y reproducen en el ámbito de la salud. La incursión de la pandemia de COVID-19 afectó a toda la Región, pero golpeó con mayor fuerza a los grupos socialmente más desaventajados, y agravó las inequidades en salud. Bajo la premisa que las pandemias no son fenómenos socialmente neutrales, en este informe especial se analizan los impactos desiguales de la pandemia desde distintas perspectivas –histórica, epidemiológica, política, social, económica, ambiental y poblacional. Se ofrecen aquí reflexiones críticas sobre las implicaciones negativas de las desigualdades para el bienestar, no solo de las poblaciones más afectadas, sino de la sociedad en su conjunto. Se concluye con recomendaciones estratégicas para progresar hacia la equidad en salud en el escenario pospandémico. Se destaca la importancia de avanzar en la madurez de los sistemas de información para el monitoreo de la equidad en salud, la resiliencia de los sistemas de salud, y la implementación de políticas y prácticas explícitas dirigidas a eliminar las inequidades en salud. Se espera que todo lo anterior allane el camino hacia la prosperidad y el desarrollo sostenible en la Región.


[ABSTRACT]. The Region of the Americas has historically experienced social inequalities rooted in colonialism, which are reflected and reproduced in the area of health. The COVID-19 pandemic affected the entire Region, but the most socially disadvantaged groups were hit hardest, intensifying health inequities. Under the premise that pandemics are not socially neutral phenomena, this special report analyzes the unequal impacts of the pandemic from different perspectives: historical, epidemiological, political, social, economic, environmental, and population-related. Critical reflections are offered here on the negative impacts of inequalities on well-being, not only in the most affected populations, but across society as a whole. Strategic recommendations are made for progress toward health equity in the post-pandemic context. This report highlights the importance of advancing toward mature information systems to monitor health equity, developing more resilient health systems, and implementing explicit policies and practices aimed at eliminating health inequities. All of this should pave the way for prosperity and sustainable development in the Region.


[RESUMO]. Historicamente, a Região das Américas vivencia desigualdades sociais enraizadas no colonialismo, que estão refletidas e se reproduzem no campo da saúde. A pandemia de COVID-19 afetou toda a Região, mas atingiu com mais força os grupos mais desfavorecidos do ponto de vista social, agravando as iniquidades em saúde. Sob a premissa de que as pandemias não são fenômenos neutros em termos sociais, este relatório especial analisa os impactos desiguais da pandemia a partir de diferentes perspectivas: histórica, epidemiológica, política, social, econômica, ambiental e populacional. São apresentadas reflexões críticas sobre as implicações negativas das desigualdades para o bem-estar, não apenas das populações mais afetadas, mas da sociedade como um todo. Conclui-se com recomendações estratégicas para avançar em direção à equidade em saúde no cenário pós-pandemia. Destaca-se a importância de avançar na maturidade dos sistemas de informação para monitorar a equidade em saúde, a resiliência dos sistemas de saúde e a implementação de políticas e práticas explícitas voltadas para a eliminação das iniquidades em saúde. Espera-se que os pontos mencionados abram caminho para a prosperidade e o desenvolvimento sustentável na Região.


Subject(s)
Health Equity , Health Status Disparities , Social Determinants of Health , COVID-19 , Americas , Health Equity , Health Status Disparities , Social Determinants of Health , Americas , Health Equity , Health Status Disparities , Social Determinants of Health
13.
Article in English | MEDLINE | ID: mdl-39200702

ABSTRACT

In the 21st century, climate change has emerged as a critical global public health challenge. Women experience the most severe impacts of climate change, intensifying pre-existing gender inequalities. This scoping review aims to explore the intersection of climate change, health, and gender, considering the social determinants of health. The methods for this review follow the Arksey and O'Malley framework for a scoping review and the PRISMA-ScR checklist. The review, covering January 2019 to February 2024, included PubMed, LILACS, and SciELO databases. We identified 71 studies with 19 meeting the inclusion criteria. The results revealed the differential effects of climate change on health according to gender in areas such as mental health, reproductive health, gender-based violence, occupational health, and health issues associated with heat and air pollution. Our findings also elucidated how socio-economic and gender inequities intersect, exacerbating the risk of experiencing these effects. In conclusion, the study highlights a clear need for gender-sensitive climate policies and interventions to address these disparities and protect vulnerable populations from the health impacts of climate change.


Subject(s)
Climate Change , Humans , Female , Male , Sex Factors , Socioeconomic Factors
14.
Horiz. sanitario (en linea) ; 23(2): 337-343, may.-ago. 2024.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1582424

ABSTRACT

Resumen Objetivo: Analizar los factores condicionantes al pie diabético de las personas hospitalizadas, del 2017 al 2020, en el hospital San Juan de Dios, desde el marco de los Determinantes Sociales de la Salud de la Organización Mundial de la Salud (OMS). Materiales y métodos: Investigación mixta, con una muestra de 243 pacientes, un muestreo no aleatorio, con dos momentos metodológicos, con posterior triangulación de datos. El primer momento metodológico fue cuantitativo, se tomó el universo de 243 pacientes, se realizó un análisis descriptivo de la base de datos con el programa estadístico SPSS. El segundo fue cualitativo, se tomó una muestra por conveniencia de 30 personas, se les aplicó una entrevista semiestructurada. Resultados: Se evidenciaron los determinantes sociales de la salud de la población en estudio, a saber, que las personas más afectadas por pie diabético son hombres entre 50 a 59 años, con analfabetismo o primaria incompleta, con actividades económicas dentro de los quintiles más bajos, con prevalencia de trastornos psicoafectivos; además disponen de ausencia de acciones preventivas de los establecimientos de salud. Adicionalmente, el impacto de esta enfermedad es aún mayor dado que se evidenció la falta de una política de educación para la salud, el desempleo e informalidad, la no participación comunitaria, más la transición demográfica de Costa Rica. Conclusiones: Las condiciones sociales y económicas como baja escolaridad, género, bajo ingresos económicos, desempleo e informalidad, pobres redes de apoyo y la no participación social inciden negativamente en las personas con factores de riegos para padecer pie diabético. Aunado a lo anterior, las personas no reciben una atención integral e integrada, con un autocuidado deficiente y poco conocimiento y empoderamiento sobre la enfermedad, son factores que permiten que las personas con Diabetes puedan tener un riesgo mayor de padecer Pie diabético.


Abstract Objective: Analyze the related factors from the structural determinants, establish their intermediate determinants and determine precipitating risk factors in the study population. Materials and methods: Mixed research, collection of quantitative and qualitative data, with subsequent triangulation of data, with quantitative descriptive analysis of the database of the Diabetic Foot Clinic of the San Juan de Dios hospital of people hospitalized in the established period, and a semi-structured interview with thirty subjects with a history of hospitalization. Results: It was evident that the people most affected by diabetic foot are men between 50 and 59 years old, with illiteracy or incomplete primary school, with economic activities within the lowest quintiles, with a prevalence of psycho-affective disorder. They also have an absence of preventive actions by health establishments. The lack of a health education policy, unemployment and informality, lack of community participation, added to the demographic transition of Costa Rica, has a greater impact of this disease on the population. Conclusions: Social and economic conditions such as low schooling, gender, low income, unemployment and informality, poor support networks and lack of social participation negatively affect people with risk factors for suffering from Diabetes. In addition to the above, people do not receive comprehensive and integrated care, with poor self-care and little knowledge and empowerment about the disease, these are factors that allow people with Diabetes to have a higher risk of suffering from diabetic foot.

15.
Eur J Investig Health Psychol Educ ; 14(7): 2029-2046, 2024 Jul 11.
Article in English | MEDLINE | ID: mdl-39056650

ABSTRACT

The occurrence of multiple risk behaviors among adolescents imposes challenges in the context of public policies of health, particularly in low- and middle-income countries. Evidence on the conditions leading to the exposure to and adoption of multiple risk behaviors allows the identification of vulnerable groups of adolescents, and may support the proposition of targeted strategies directed to individuals at risk. Therefore, the aim of this study was to perform a quantitative analysis to identify recent trends in the exposure to and adoption of multiple health risk behaviors among Brazilian adolescents, highlighting individual-, household-, and school-level characteristics linked to inequalities among social groups. The analysis was based on cross-sectional data from the National Student Health Survey (PeNSE), conducted by the Brazilian Institute for Geography and Statistics in 2009, 2012, 2015, and 2019. The trends in the occurrence of multiple risk behaviors among adolescents were estimated according to social strata, allowing the calculation of concentration indexes and their disaggregation into major determinants of inequalities in the exposure and adoption of risk behaviors. The analyses were conducted using a complex survey design to allow representativeness at the population level. The results showed a rise in the incidence of multiple risk behaviors among youngsters in Brazil from 2009 to 2019. Factors influencing inequalities in the exposure to multiple risk behaviors were socioeconomic status and the characteristics of the household and school environments, whilst the adoption of multiple risk behaviors was also influenced by early exposure to multiple risk behaviors. Furthermore, trends in inequalities in the exposure to and adoption of multiple risk behaviors showed an intensification from 2009 to 2019, being initially concentrated among wealthier adolescents, followed by a transition to higher incidence in the lower socioeconomic strata in 2012 and 2015, respectively. The findings underscore the role of support systems for adolescents at risk within the familial and school contexts, whereas strategies of public policies of health based on the strengthening of community ties may require improvements to tackle socioeconomic inequalities in the occurrence of risk behaviors among youngsters.

16.
PLoS One ; 19(7): e0305955, 2024.
Article in English | MEDLINE | ID: mdl-39046943

ABSTRACT

This study delves into the global evolution of 43 Sustainable Development Goals (SDG) indicators, spanning 7 major health themes across 185 countries to evaluate the potential progress loss due to the COVID-19 pandemic. Both the cross-country and temporal variability of the dataset are employed to estimate an empirical model based on an extended version of the Preston curve, which links well-being to income levels and other key socioeconomic health determinants. The approach reveals significant global evolution trends operating in each SDG indicator assessed. We extrapolate the model yearly between 2020 and 2030 using the IMF's pre-COVID-19 economic growth projections to show how each country in the dataset are expected to evolve in these health topics throughout the decade, assuming no other external shocks. The results of this baseline scenario are contrasted with a post-COVID-19 scenario, where most of the pandemic costs were already known. The study reveals that economic growth losses are, on average, estimated as 42% and 28% for low- and lower middle-income countries, and of 15% and 7% in high- and upper middle-income countries, respectively, according to the IMF's projections. These disproportional figures are shown to exacerbate global health inequalities revealed by the curves. The expected progress loss in infectious diseases in low-income countries, for instance, is an average of 34%, against a mean of 6% in high-income countries. The theme of Infectious diseases is followed by injuries and violence; maternal and reproductive health; health systems coverage; and neonatal and infant health as those with worse performance. Low-income countries can expect an average progress loss of 16% across all health indicators assessed, whereas in high-income countries the estimated loss is as low as 3%. The disparity across countries is even more pronounced, with cases where the estimated progress loss is as high as nine times worse than the average loss of 8%. Conversely, countries with greater fiscal capacity are likely to fare much better under the circumstances, despite their worse death count, in many cases. Overall, these findings support the critical importance of integrating the fight against inequalities into the global development agendas.


Subject(s)
COVID-19 , Global Health , Sustainable Development , Humans , COVID-19/epidemiology , COVID-19/economics , Sustainable Development/trends , SARS-CoV-2/isolation & purification , Pandemics/economics , Socioeconomic Factors , Health Status Disparities
17.
Article in English | PAHO-IRIS | ID: phr-59634

ABSTRACT

[ABSTRACT]. The G20, representing the world’s largest economies, plays a critical role in shaping global health policies, initiatives and innovative solutions. As these nations navigate the complexities of digital transformation in the health sector, engagement with the Global Initiative on Digital Health (2), aligned with the Pan American Health Organization ́s (PAHO) eight guiding principles for the digital transformation of the health sector (3), becomes imperative not only for advancing technology adoption but also for promoting health equity and universal access to health and universal health coverage. The inclusion of telehealth in the G20 agenda, championed by Brazil’s presidency, underscores the group’s commitment to leveraging digital innovations to improve health outcomes in G20 countries and globally, as telehealth is a key area of the digital transformation of the health sector. Because countries worldwide vary widely in the capacity of their digital health infrastructure and their development stages, there lies a unique opportunity to foster international collaboration, share knowledge and drive global standards that support the widespread adoption of telehealth solutions for leaving no one behind. This strategic focus is predicated on the understand- ing that telehealth serves as both a catalyst for health equity and a critical tool for reinforcing health systems grounded in primary health care (PHC). The scientific rationale behind this concerted effort is clear: by enhancing digital infrastructure and fostering the adoption of telehealth solutions, there is potential to bridge the global digital divide and democratize access to health services. The G20, representing the world’s largest economies, plays a critical role in shaping global health policies, initiatives and innovative solutions (1). As these nations navigate the complexities of digital transformation in the health sector, engagement with the Global Initiative on Digital Health (2), aligned with the Pan American Health Organization ́s (PAHO) eight guiding principles for the digital transformation of the health sector (3), becomes imperative not only for advancing technology adoption but also for promoting health equity and universal access to health and universal health coverage. The inclusion of telehealth in the G20 agenda, championed by Brazil’s presidency, underscores the group’s commitment to leveraging digital innovations to improve health outcomes in G20 countries and globally, as telehealth is a key area of the digital transformation of the health sector. Because countries worldwide vary widely in the capacity of their digital health infrastructure and their development stages, there lies a unique opportunity to foster international collaboration, share knowledge and drive global standards that support the widespread adoption of telehealth solutions for leaving no one behind. This strategic focus is predicated on the understand- ing that telehealth serves as both a catalyst for health equity and a critical tool for reinforcing health systems grounded in primary health care (PHC). The scientific rationale behind this concerted effort is clear: by enhancing digital infrastructure and fostering the adoption of telehealth solutions, there is potential to bridge the global digital divide and democratize access to health services. In envisioning the future of global health, the fourth pillar of the vision of PAHO’s Director emerges with critical importance: the construction of resilient national health systems is firmly rooted in the implementation of the PHC strategy. This vision is not just an aspiration but a necessary evolution, with PAHO standing ready to guide countries towards achieving this goal. PAHO’s commitment involves supporting countries in the organization of health services networks based on PHC, targeting public financing to foster universal access and coverage, and bolstering governance in health under the leadership of health ministries. Moreover, it calls for the rapid deployment of technological innovations such as telehealth and also broader digital transformation initiatives (4). Digital transformation, emerging as a key innovative strategy, offers significant improvements to the strengthening of PHC. Through the adoption of inclusive digital health solutions, it is possible to enhance the delivery of health services, ensuring they become more accessible, efficient and equitable for everyone, everywhere (5, 6). Among the priorities leading this transformation, telehealth emerged at the G20 as a key opportunity in the mission to leave no one behind and as a cornerstone of the digital transformation of the health sector. Telehealth improves access to care and health information, thereby empowering individuals and communities (7). It effectively extends health services to underserved populations, encourages collaborative practices among health professionals, and broadens access to health for the wider community. It can support reduced waiting times and costs through efficiencies in care management. Through telehealth, the transition to a new era of PHC can be accelerated through technological advancements that drive us towards a more inclusive and accessible health care system for all. Concrete efforts should be focused on modernizing normative and legislative frameworks, investment in digital infrastructure, prioritizing the development of robust digital health infrastructures while ensuring that reliable internet access and digital tools are available across urban and rural areas alike. Enhancing digital literacy and telehealth competencies among health professionals and the population will maximize the utilization and effectiveness of digital health services. However, the lack of standardized policies and frameworks for telehealth is a significant barrier to its global adoption and, therefore, G20 nations can lead by example, working towards (a) developing international telehealth guidelines that consider ethical, privacy and security standards for telehealth services to facilitate cross-border healthcare delivery and secure data exchange; and (b) promoting interoperable telehealth platforms that can seamlessly exchange information, thus enhancing the continuity and quality of care. The G20’s leadership and commitment to integrating telehealth into the global health agenda can set an unprecedented opportunity for international cooperation in digital health. G20 countries can significantly impact global health outcomes by integrating telehealth at all levels of care and health service delivery networks, impacting the lives of billions around the world. Equity must remain central to our efforts as telehealth services are integrated into the model of care. This means ensuring the adoption of differentiated approaches in digital health based on (a) the characteristics of a territory (geographical dis- persion, status of infrastructure), (b) the beneficiary population to be served (their health needs, and cultural, racial and ethnic considerations) and (c) the health system capacities and organization (the health services network, coverage capacity and availability of multiprofessional teams). Health outcomes can be significantly positively impacted by undertaking bottom-up planning processes that take into account the latter considerations and by adapting the model of care to leverage the capacity of digital health. Embracing the Regional Roadmap for the Digital Transformation of the Health Sector in the Region of the Americas is imperative for countries aiming to develop expansive, resilient and inclusive health systems based on PHC (8,9). This comprehensive framework, backed by lessons learned and suc- cessful experiences, underscores the significant potential that digital transformation holds for improving health outcomes. Brazil's commitment to the consolidation of the Unified Health System (the Sistema Único de Saúde, or SUS) and its well-established Family Health Strategy as the foundation for the health and well-being of its population is being expressed through the rapid deployment of telehealth, and serves as a model of innovation and effectiveness, showcasing the transformative impact of digital health solutions on accessibility, efficiency and quality of care (10). This editorial, jointly prepared by rep- resentatives of the government of Brazil and PAHO advocates for global standardization of telehealth practices that ensures the scalability and sustainability of health interventions while addressing the core determinants of health equity.


[RESUMEN]. Sin resumen disponible Texto completo en inglés


[RESUMO]. Não existe resumo disponível Texto completo em inglês


Subject(s)
Digital Health , Health Status Disparities , Americas
18.
Braz Oral Res ; 38: e023, 2024.
Article in English | MEDLINE | ID: mdl-38597543

ABSTRACT

The present study aimed to investigate the contextual inequalities of specialized public dental care (SPDC) in Brazil. The outcome was the trajectory of dental specialized production in municipalities with SPDC (from 2015 to 2017) obtained by group-based trajectory modeling. A Poisson regression model was used to analyze the factors associated with the high trajectory of SPDC production. The inequality indicators for SPDC production were the slope index and the concentration index according to contextual factors. The study included 954 SPDC units distributed across 893 municipalities. Among the municipalities evaluated, 62.9% had a low trajectory of SPDC. Large-sized municipalities had the highest production (IRR = 2.84, 95%CI: 1.94-4.14) and the southern region had the lowest production (IRR = 0.73, 95%CI: 0.58-0.92). Municipalities presenting a very high human development index (HDI) showed the greatest SPDC production (IRR = 3.34, 95%CI: 1.09-10.24), as well as municipalities with the highest tertile of schooling rate (IRR = 1.23, 95%CI: 1.00-1.50). The absolute inequality was 52.1 percentage points for the average monthly wage (p < 0.001), 61.0 percentage points for the HDI (p < 0.001), -22.1 for infant mortality rate (p <0.001), and 14.8 for the schooling rate (p = 0.012). Thus, there are contextual inequalities in the Brazilian SPDC. Higher scores for social indicators were associated with better SPDC performance.


Subject(s)
Dental Health Surveys , Public Health , Humans , Socioeconomic Factors , Brazil , Cities , Dental Care
19.
Cancer Control ; 31: 10732748241244928, 2024.
Article in English | MEDLINE | ID: mdl-38557156

ABSTRACT

OBJECTIVE: To obtain breast cancer survival estimates in Manizales, Colombia, considering socioeconomic level, health insurance regime and residential area, while adjusting for age, histology and stage at diagnosis. METHODS: Analytical cohort study based on breast cancer incident cases recorded by the Population-based Manizales Cancer Registry between 2008-2015. Patients were followed-up for 60 months. Cause-specific survival was calculated using the Kaplan-Meier method for variables of interest, with the Wilcoxon-Breslow-Gehan test for differences. Cox multivariate regression models were fitted. RESULTS: 856 breast cancer cases were included. The 5-year cause-specific survival for the entire cohort was 78.2%. It was higher in women with special/exception health insurance, high socioeconomic level, <50 years old, ductal carcinoma, and stages I and II. Residential area did not impact survival. In Cox models, the subsidized health insurance regime (HR: 4.87 vs contributory) and low socioeconomic level (HR: 2.45 vs high) were predictors of the hazard of death in women with breast cancer, adjusted for age, histology, stage and interactions age-stage and insurance-stage. A positive interaction (synergistic effect modification) between health insurance regime and stage regarding to survival was observed. CONCLUSION: Socioeconomic factors significantly contribute to the inequities in breast cancer survival, independent of the stage at diagnosis. This suggests the need for comprehensive interventions to remove barriers to accessing the health system. This research provides evidence of survival gaps mediated by certain social determinants of health and generates data on the overall performance of the Colombian health system.


Subject(s)
Breast Neoplasms , Humans , Female , Middle Aged , Breast Neoplasms/epidemiology , Breast Neoplasms/therapy , Breast Neoplasms/diagnosis , Colombia/epidemiology , Cohort Studies , Breast , Health Inequities
20.
Int J Equity Health ; 23(1): 48, 2024 Mar 11.
Article in English | MEDLINE | ID: mdl-38462637

ABSTRACT

BACKGROUND: Life-long health inequalities exert enduring impacts and are governed by social determinants crucial for achieving healthy aging. A fundamental aspect of healthy aging, intrinsic capacity, is the primary focus of this study. Our objective is to evaluate the social inequalities connected with the trajectories of intrinsic capacity, shedding light on the impacts of socioeconomic position, gender, and ethnicity. METHODS: Our dynamic cohort study was rooted in three waves (2009, 2014, 2017) of the World Health Organization's Study on Global AGEing and Adult Health in Mexico. We incorporated a nationally representative sample comprising 2722 older Mexican adults aged 50 years and over. Baseline measurements of socioeconomic position, gender, and ethnicity acted as the exposure variables. We evaluated intrinsic capacity across five domains: cognition, psychological, sensory, vitality, and locomotion. The Relative Index of Inequality and Slope Index of Inequality were used to quantify socioeconomic disparities. RESULTS: We discerned three distinct intrinsic capacity trajectories: steep decline, moderate decline, and slight increase. Significant disparities based on wealth, educational level, gender, and ethnicity were observed. Older adults with higher wealth and education typically exhibited a trajectory of moderate decrease or slight increase in intrinsic capacity. In stark contrast, women and indigenous individuals were more likely to experience a steeply declining trajectory. CONCLUSIONS: These findings underscore the pressing need to address social determinants, minimize gender and ethnic discrimination to ensure equal access to resources and opportunities across the lifespan. It is imperative for policies and interventions to prioritize these social determinants in order to promote healthy aging and alleviate health disparities. This approach will ensure that specific demographic groups receive customized support to sustain their intrinsic capacity during their elder years.


Subject(s)
Aging , Ethnicity , Humans , Female , Middle Aged , Aged , Cohort Studies , Educational Status , Socioeconomic Factors
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