Portfolio: Evidence-based Programs for a Person-centered, Integrated Care for Older People at the Primary Health-care Level

A great challenge for public policies is to transform the current demographic transition into opportunity. Longer lives call for new paradigms and concepts in the field of healthcare. This publication, Portfolio: Evidence-based programs for a person-centered, integrated care for older people at the primary health-care level, presents several interventions/programs that are evidence-based and enable healthy aging. To improve older person’s health is crucial to access older adult's needs as well as provide timely identification and action on losses in their physical and mental capacities, that is the intrinsic capacity. The selected programs presented in this document have the objective to improve or maintain older adults’ intrinsic capacity at the community level, focusing on one or more of its main domains. The portfolio focuses mainly on locomotor, psychological and cognitive capacity, as well as self-care and caregiver support. Through the identification of declines in the intrinsic capacity it is possible to create a personal care plan, which will help to prevent or ameliorate declines, support disease management, as well as promote one's active participation in their own care, as supported by the WHO Integrated Care for Older People (ICOPE). With the ICOPE model, older adults not only have knowledge of what to do to improve their own health, but they also feel empowered to achieve specific goals. The portfolio programs have been proven to deliver positive outcomes in improving older adults’ capacities, as well as on their adherence to self-care; therefore, it should become part of any primary care toolkit designed to promote and improve healthy aging in the community, accompanying the ICOPE model. Older adults require an integrated approach and a continuum of care with adequate support and transitions from one level to another, depending on their specific needs. Strengthening primary care is one strategy to prepare and align health systems to an aging society.

Mitigating the Indirect Impacts of COVID-19 on Maternal, Newborn, Child and Adolescent, and Ageing Health Services: Lessons Learned from the Experience of Brazil

The COVID-19 pandemic disrupted daily lives in several dimensions. One of them was the disruption of health services. During the first two years of the pandemic, the rapid increase in severe cases and hospitalizations inevitably led to a greater focus on hospital care and less on non-COVID-19 services, in particular those services provided at the first level of care. The result was a decrease in coverage of critical health interventions. As governments gained more experience in responding to the changes of the pandemic and the knowledge on the transmissibility of the virus and effective control and treatment measures was readily available, national and local actions to ensure the continuity of health services gradually increased, in particular those for women, mothers, children, adolescents and older people. The experience of three municipalities in Brazil provide a special insight from the perspective of the local response to the pandemic. There are several lessons learned on how municipal authorities, program managers, and health care workers were able to find creative ways to keep providing services and support. The rapid increased use of telemedicine, follow-up contacts and counselling by phone or WhatsApp, the expansion of hotlines and the use of social media platforms to disseminate a wide range of health related information, the definition of new roles to community health workers or home visitors, and the increase use of partnerships with a variety of sectors and local actors are few examples of the efforts made to mitigate the effects of the pandemic on health services. After more than two years of pandemic, this is the right time to reflect on those lessons learned and start working on the preparedness for future crisis. This report aims to serve as an input to those discussions within Brazil and in Latin America and the Caribbean.

Health in the Americas 2022: Overview of the Region of the Americas in the Context of the COVID-19 Pandemic

The Region of the Americas is one of the most affected by COVID-19. More than 175 770 000 cases of the disease were recorded between the beginning of the pandemic and 31 August 2022. The pandemic has also highlighted the challenges faced by the Region's health systems in ensuring universal access to health and universal health coverage and has slowed progress towards achieving the Sustainable Development Goals (SDGs) and the 2030 Agenda for Sustainable Development. Among other devastating consequences, life expectancy in 2021 fell to levels comparable to those of 2004; since 2020, the number of vaccines administered to children has fallen dramatically; the prevalence of depression has increased by 27.6%, and anxiety by 25.7%, relative to pre-pandemic levels; and the targets for tuberculosis, HIV, and malaria have suffered major setbacks on the road to achieving SDG 3. The Region, like the rest of the world, is facing not only a public health crisis but also an economic and social crisis that has especially affected populations in conditions of vulnerability, such as older people, lower-income groups, ethnic groups, migrants, and homeless people. This publication by the Pan American Health Organization presents an overview of the impact of COVID-19 in the Region and offers a forward-looking vision to build resilient and sustainable health systems and ensure universal health as a tool to address current and future public health emergencies.

Regulating the Availability of Alcohol

Limiting the access to alcoholic beverages fall partially outside the health sector but they need to be implemented in order to reduce alcohol accessibility, leading to less alcohol consumption, harms, and therefore the health and social costs of alcohol. Despite the widespread use of licensing systems, they continue to be underused as a policy tool, and measures are only partially adopted and are not enforced. It is important to increase public and policy makers understanding of their need and value, so they can be promoted and included in alcohol policy plans in all countries. This fact sheet will describe what they include, how they need to be done to be effective, what is their impact and why they need to be implemented.

Health Inequalities in Latin America and the Caribbean: A Sustainable Development Goal baseline assessment for women, children, and adolescents

The 2030 Agenda for Sustainable Development (2030 Agenda) established in 2015 sets guiding principles to “achieve a better and more sustainable future for all.” The Sustainable Development Goals (SDGs) included in the 2030 Agenda make explicit what this means by specifying relevant statistical indicators and setting clearly defined targets in them to be achieved by 2030. Given the emphasis on the collection and availability of SDG-related data, it is possible to track universal progress towards the SDG targets. One of the SDGs, SDG 3, includes targets to improve health and well-being. In general, SDG health-related indicators measure health outcomes and coverage at the country level by employing averages. However, given the nature of the data, inequalities in health outcomes and the access to health services tend to be masked. Since it is important to strive for gains in health and well-being to be equitably distributed among individuals regardless of their wealth, educational attainment, and other factors relating to their social background, it is essential to first identify and quantify existing social inequalities in health. To this end, this publication provides an overview of social inequalities in several indicators related to the health of women, children, and adolescents in a region deemed as one with high levels of inequality: the Latin America and the Caribbean (LAC) region. In order for it to serve as a baseline for the 2030 Agenda, emphasis is placed on examining these inequalities around year 2014. The analysis suggests that reducing within-country disparities is a priority, as widespread social inequalities in health are identified among LAC countries.

Recommendations for Preparing Policy Briefs based on the System of Health Accounts (SHA 2011)

Monitoring the use and allocation of financial resources ensures they are consistent with policies to improve the equity and efficiency of the health system, while ensuring the long-term sustainability of funding. Health accounts not only show what is going right, they also show gaps and opportunities for improvement in the allocation of resources. However, information must be available in order to be relevant, making the preparation of policy briefs the culmination of the annual process of generating health accounts. This publication offers recommendations to help ensure that policy briefs based on health accounts meet their objective of facilitating a contextualized discussion that can lead to proposals for interventions that translate into more and better health services tailored to people’s needs.

Volksgezondheidsbeleid ten aanzien van het gebruik van psychoactieve middelen: een handleiding voor gezondheidsplanners

Het gebruik van psychoactieve middelen heeft diverse sociale en gezondheidsgevolgen, die vanuit het perspectief van volksgezondheid en maatschappelijk welzijn kunnen worden aangepakt door middel van beleid dat door overheidsinstanties wordt geformuleerd overeenkomstig hun specifieke mandaten. Met een expliciet beleid ten aanzien van de gezondheid en het gebruik van psychoactieve middelen kunnen de benodigde oplossingen worden ontwikkeld ter bescherming en bevordering van het recht op gezondheid van de bevolking in verband met dit complexe probleem. Deze handleiding is een instrument dat is gebaseerd op technieken en methoden voor beleidsanalyse en ontwikkeld met het doel de toepassing van de beginselen van de volksgezondheid te faciliteren bij het vinden van antwoorden op problemen in verband met het gebruik van psychoactieve middelen. Daarom bevat de handleiding voorbeelden en oefeningen die de verschillende fases van het planningsproces illustreren en die kunnen worden gebruikt in workshops en andere opleidingsactiviteiten. Het is bedoeld voor degenen die verantwoordelijk zijn voor het formuleren, uitvoeren en evalueren van beleid, plannen en programma's gericht op het verminderen van de effecten van middelengebruik op de collectieve gezondheid, van volksgezondheidsinstanties en andere relevante sectoren tot de burgermaatschappij.

Recommendations for Establishing a National Maternal Near-miss Surveillance System in Latin America and the Caribbean

From a pathophysiological perspective, death is the end result of a wide spectrum of complications leading to multi-organ dysfunction. However, there is a group of women who survive despite the seriousness of their condition, and is an outcome that depends primarily on the quality of health care services provided by a country or institution. This publication proposes an epidemiological surveillance system for the maternal near-miss (MNM) indicator, which refers to extremely severe maternal morbidity, i.e., cases that bring women very close to the death event, thus making it possible to estimate morbidity associated with diseases and complications that occur during pregnancy, childbirth, or the puerperium. After adjusting the definition to a specific population and time, MNM is defined as a case in which a woman nearly died, but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. This indicator has the logistical advantage that MNM always occurs in a health institution, since if the event occurs in the community or far from a health service, it will inevitably become a maternal death (and therefore no longer a MNM).It also provides more complete information on cases of preventable maternal death, incorporates patient safety issues, and helps detect deficiencies in health care systems. This work falls within the broader objective of the Pan American Health Organization to reduce maternal mortality and strengthen the epidemiological surveillance of maternal health at the national level. The tool provides national health authorities with a system to actively identify, collect, process, and analyze information related to MNM, and may also be useful to local and regional health care service providers and managers.

Health of Afro-descendant People in Latin America

This report will build upon previous work and reports, analyzing existing publications to consolidate data already available on Afrodescendent health, with the aim of identifying key gaps in data on Afrodescendent health in the region, and recommending the areas of need for further work. This Regional Report on Afrodescendent Health in the Americas aims to analyze various dimensions of Afrodescent health, with particular attention to access to health service and social protection for these populations.

Frequently Asked Questions about COVID-19 Vaccines. Version 6, 12 February 2022

Are COVID-19 vaccines effective against new variants? What does it mean for a person to be fully vaccinated? These and other questions are among the most frequently asked questions about vaccination against COVID-19. In this sixth edition, you will find answers to these and other questions.

Older Persons: A Human Rights-based Approach

This publication is part of the Human Rights and Health series. In this publication, the main human rights standards regarding older persons and the measures to be adopted from a human rights-based approach are described, in particular, the right to health and other related rights.

XXVII Meeting of PAHO's Technical Advisory Group (TAG) on Vaccine-Preventable Diseases: Tailoring the SAGE Roadmap to the Requirements of the Americas and the Strategic Use of COVID-19 Booster Doses, 27 January 2022 (virtual)

The WHO SAGE Roadmap for prioritizing use of COVID-19 vaccines was updated on 21 January 2022. The latest iteration builds on WHO’s Strategy to achieve global COVID-19 vaccination by mid-2022. Since the start of the COVID-19 vaccine introduction process, countries of the Americas have followed the technical recommendations of the WHO Strategic Advisory Group of Experts (SAGE) on immunization to implement their vaccination prioritization strategies. The emergence of the Omicron variant and the corresponding explosive increase in COVID-19 cases, coupled with a massive expansion of vaccine availability across the world, led almost all countries in the Americas to take individual decisions on expanding vaccine eligibility to children and adolescents and to introduce booster doses of the COVID-19 vaccines. PAHO’s Technical Advisory Group (TAG) on Vaccine-Preventable Diseases convened on 27 January 2022 to discuss how to tailor updated SAGE Roadmap to the context of the Americas. Considering the available evidence, the members endorsed the updated WHO-SAGE Roadmap, and provided additional recommendations to guide the further use of COVID-19 booster doses in the Americas, so that priority groups receive them first. Finally, the TAG urged Member States to invest in improving the infrastructure and capacity of the national immunization programs both for routine vaccination and COVID-19 vaccination roll-out.

Thirty-fifth Meeting of the Caribbean Immunization Managers. Final Report

The 35th Caribbean EPI Managers’ Meeting was held virtually from 3-5 November 2021. The meeting convened 71 participants from 28 countries and territories of the English, Dutch and French-speaking Caribbean. Participants included representatives from the Ministries of Health, the Caribbean Public Health Agency (CARPHA), the Caribbean Community (CARICOM) and the Pan American Health Organization/World Health Organization (PAHO/WHO). The overall objective is to analyze achievements for 2020, review the challenges of 2020 and 2021 in the context of the COVID-19 pandemic, and plan activities for 2022 while sharing country experiences on the immunization program.

The Essential Environmental Public Health Functions. A framework to Implement the Agenda for the Americas on Health, Environment, and Climate Change 2021-2030

This publication presents a framework to implement the Agenda for the Americas on Health, Environment, and Climate Change 2021–2030 (the Agenda) that is structured around essential public health functions focused on environmental determinants of health. The Agenda is a call to action to the health sector to lead the charge to address environmental determinants of health in the Americas. The Pan American Health Organization (PAHO) will work with Member States to achieve its goal and objective to ensure healthy lives and promote well-being for all at all ages using a sustainable and equitable approach that places a priority on reducing health inequity. The Agenda was developed under the umbrella of the WHO Global Strategy on Health, Environment, and Climate Change, and builds upon the commitments set forth in the Sustainable Health Agenda for the Americas 2018–2030 and the PAHO Strategic Plan 2020–2025. The Agenda was developed in consultation with the Technical Advisory Group and through a consensus-driven, decision-making process with Member States during the 2019–2020 period. Looking toward the achievement of Sustainable Development Goal 3, the Agenda focuses on: improving the performance of environmental public health programs and institutions; fostering environmentally resilient and sustainable health systems; and promoting environmentally healthy and resilient cities and communities. Its implementation will be context-specific, based on the needs and realities of the countries. It will benefit countries and territories by promoting good governance practices, strengthening the leadership and coordination roles of the health sector, fostering cross-sectoral action, focusing on primary prevention, and enhancing evidence and communication. It will facilitate access to human, technical, and financial resources necessary to address environmental determinants of health and ensure that the Region is fully engaged in global health, environment, and climate change processes and agreements. The objective of the Agenda is to strengthen the capacity of health actors in the health and non-health sectors to address and adapt to environmental determinants of health, prioritizing populations living in conditions of vulnerability, in order to meet Outcome 18 of the PAHO Strategic Plan 2020–2025 directly and several other outcomes of the Plan indirectly. To address and adapt to the challenges of environmental determinants of health in the Region, an integrated and evidence-informed approach within the health sector and across sectors will be needed one enabled and supported by good governance practices, adequate management mechanisms, high-level political will, and adequate human, technical, technological, and financial resources.

Immunization in the Americas. Summary 2020

The countries of the Americas, with support from the Pan American Health Organization (PAHO), have made remarkable progress in providing children with an umbrella of protection against basic vaccine-preventable diseases. Sustained high national immunization coverage levels, the eradication of polio, the interruption of endemic measles virus transmission, and the more recent efforts towards rubella and congenital rubella syndrome elimination are hemispheric benchmarks of this progress. Countries are now vaccinating age groups outside those usually targeted in the traditional childhood immunization program, thus showing the critical need for national immunization programs to transition from child to family immunization. In the current context of the COVID-19 pandemic, the countries of the Region have taken important actions to implement innovative strategies and to maintain the high commitment of health workers to national immunization programs. Although these strategies have improved access to supply services, the COVID-19 pandemic and containment policies in the countries of the Region have affected the demand for vaccination services. In support to countries, one of PAHO's roles is to disseminate information that can highlight progress and challenges faced in the Region. This brochure highlights some of the achievements and challenges in immunization and summarizes 2020 key regional data in the Region of the Americas.

Gendered Health Analysis: COVID-19 in the Americas

This document focus on the direct consequences of the virus (morbidity and mortality) in specific populations and on the results of measures aimed at mitigating the spread of the virus, with indirect impacts on socio-economic conditions. In this complex scenario, the gender approach has not received due attention during the pandemic. Gender is one of the structural determinants of health, but it does not appear in analyses of the direct and indirect effects of the pandemic, despite being essential in the recognition and analysis of the differential impacts on men and women and their interaction with the different determinants of health.

HEARTS in the Americas: Regulatory Pathway to the Exclusive Use of Validated Blood Pressure Measuring Devices

Cardiovascular disease (CVD) is the leading cause of disease burden globally. According to the 2017 Global Burden of Disease estimates, there were 14 million new cases of CVD, 80 million people living with this condition, and nearly 1 million deaths attributed to CVD in the Americas. Hypertension is the major risk factor for CVD, causing half of the cases, and is highly prevalent, affecting one in four adults, including 40% of those over age 25 years.To appropriately detect hypertension, accurate measurement of blood pressure is critical, and inaccurate measurement of BP has important consequences for policies to address hypertension, as well as for patient safety and quality of care. The Fourth World Health Organization (WHO) Global Forum on Medical Devices identified several critical issues related to medical devices. Among those issues were recommendations for increased regulation of medical devices in low- and middle-income countries and development of technical specifications to optimize procurement of priority medical devices. World Health Assembly Resolution 67.20 (Regulatory system strengthening for medical products) stresses the importance of regulation of medical devices for better public health outcomes and to increase access to safe, effective, and quality medical products. This publication seeks to contribute to meeting these recommendations by providing a practical tool for governments to improve their national regulatory frameworks to improve accuracy of blood pressure measuring devices (BPMDs), in turn contributing to the exclusive use of accuracy validated automated BPMDs in primary health care (PHC) facilities by 2025. This publication can also guide the development of procurement mechanisms that will ensure exclusive availability of BPMDs in PHC facilities. Specifically, this publication will provide a brief background on the importance of using validated BPMDs and highlight key elements of regulations related to pre-market approvals to promote accurate BPMDs.

Leishmaniasis: Epidemiological Report of the Americas, No. 10 (December 2021)

The Pan American Health Organization (PAHO) continues to support endemic countries in order to achieve the objectives of controlling and eliminating leishmaniasis as a public health problem in the Region, in accordance with the PAHO Disease Elimination Initiative: A Policy for an Integrated Sustainable Approach to Communicable Diseases in the Americas, the World Health Organization (WHO) Roadmap for Neglected Tropical Diseases for 2021 to 2030 and the Plan of Action to Strengthen Leishmaniasis Surveillance and Control in the Americas 2017-2022. PAHO has provided support to endemic countries and together with them has implemented initiatives aimed at promoting prevention, surveillance, and control actions, with the aim of reducing morbidity, mortality and severe forms of the disease through access to early diagnosis, appropriate treatment, and the reduction of contact between people and leishmaniasis vectors. This report presents a detailed analysis of cutaneous, mucosal, and visceral leishmaniasis data in the Region of the Americas for 2020 and includes a series of infographics with specific data on cutaneous and mucosal leishmaniasis in endemic countries. As a result of the COVID-19 pandemic, active search activities, early detection and treatment of cases, as well as other field activities, have been reduced. Among the challenges facing the Region, we highlight the need for countries to resume activities and move forward with the diagnosis and treatment of cases of the different clinical forms of the disease. Furthermore, it is necessary to identify strategies for the follow-up and monitoring of cases, in order to achieve the targets of treating at least 90% of patients diagnosed with cutaneous and mucosal leishmaniasis, as well as reducing the lethality of visceral leishmaniasis to less than 50% in the Region.

PAHO’s Progress on Gender Equality in Health 2009–2019

Reducing gender disparities in health outcomes in the Americas remains a challenge, especially for groups with less economic and social empowerment. Member States of the Pan American Health Organization (PAHO) approved the PAHO Gender Equality Policy in 2005 and its associated Gender Equality Plan of Action in 2009. The goal of the Gender Equality Policy is to contribute to improved commitment and responses from ministries of health and the Pan American Sanitary Bureau for better health outcomes for diverse women, men, and children of the Americas. This brochure presents the highlights of the 2020 PAHO Gender Equality Policy: Progress Report, which describes the clear achievements of Member States and the Pan American Sanitary Bureau as well as the gaps in advancing gender mainstreaming in the health sector. It serves as an effective and attractive snapshot of the gains and remaining challenges to achieve gender equality in health in the Americas.

Suicide Mortality in the Americas. Regional Report 2015-2019

This report provides updated data on suicide in the Region of the Americas and is issued every five years, this being the fourth edition. In addition to including analysis similar to previous reports (suicide according to age, sex, as well as methods used), this report includes an expanded set of analysis on risk factors for suicide in the Americas: the analysis of the annual age-standardized gender-specific suicide mortality rate trends over time by country and sub-region and to identify points of inflection, and evaluates the association of specific risk factors on country-level suicide mortality rates.