[Health risk factors associated with housing habitability in high vulnerability areas in Bogotá, Colombia]. / Riesgo en salud y habitabilidad de viviendas en zonas de alta vulnerabilidad en Bogotá, Colombia.

OBJECTIVES: To evaluate the habitability conditions of dwellings and their impact on human health in Mochuelo Bajo, sector in Bogota Colombia, within the framework of the Healthy Habitat project led by the Housing, Habitat and Social Innovation Center (CENVIS). METHODS: A tool was developed for field data collection about socioeconomic and healthy conditions of housing units and families assigned to the project. After which, a quantitative analysis was performed in order to answer to the stablished objective. RESULTS: It was found through the tool application: a) inadequate supply, storage and management of drinking water, b) poor disposal of human excreta and solid household waste, c) poor management of rainwater use, d) inadequate coexistence with domestic and consumption animals, e) interior air pollution and f) self-construction systems with unsafe materials and without technical advice. CONCLUSIONS: In the Mochuelo Bajo sector there were found generalized shortcomings related to an inadequate supplying and usage of potable water, a wrong disposition of human excreta and of solid household waste. At the same time, there are shortcomings in terms of rainwater and coexistence with animals, both domestic and for consumption.

OBJETIVOS: Evaluar las condiciones de habitabilidad de las viviendas y su incidencia sobre la salud en el sector de Mochuelo Bajo, en Bogotá (Colombia), en el marco del proyecto Hábitat Saludable, que es liderado por el Centro de estudios en Vivienda, Hábitat e Innovación Social (CENVIS). MÉTODOS: Se elaboró una herramienta de toma de información en campo sobre condiciones socioeconómicas y saludables de la unidad habitacional de familias adscritas al proyecto. Posteriormente, se realizó un análisis cuantitativo de la información recolectada para responder al objetivo de la investigación. RESULTADOS: Al aplicar la herramienta, se encontró: a) inadecuado abastecimiento, almacenamiento y manejo del agua potable, b) mala disposición de excretas humanas y desechos sólidos domiciliarios, c) mal manejo en el aprovechamiento del agua lluvia, d) inadecuada convivencia con animales domésticos y de consumo, e) contaminación del aire al interior y; f) sistemas autoconstrucción con materiales no seguros y sin asesoría técnica, además de construcción en terrenos inestables. CONCLUSIONES: En el sector de Mochuelo Bajo, existen falencias generalizables relacionadas con un inadecuado abastecimiento, almacenamiento y manejo del agua potable, una mala disposición de excretas humanas y de desechos sólidos domiciliarios. También respecto al manejo del agua lluvia, y la convivencia con animales tanto domésticos como de consumo.

[Limitations of the Water Quality Risk Index as an estimator of quality for human consumption]. / Limitaciones del IRCA como estimador de calidad del agua para consumo humano.

OBJECTIVE: To analyze the results of the Water Quality Risk Index (IRCA) in the 116 municipalities of the department of Cundinamarca, between 2007 and 2013. MATERIALS AND METHODS: Information collected from the 116 municipalities of the department of Cundinamarca, selected and classified according to the percentage data retrieved by IRCA. RESULTS: A decrease of the annual IRCA average is observed, which reflects an improvement of the water quality delivered in the department. However, 26.7% of the municipalities do not report information from their rural areas, and 56.9% of the municipalities report IRCA figures over 5, which means that even though they are at low risk, they receive water unfit for human consumption. CONCLUSIONS: A new weighting method for the parameters evaluated with the IRCA is proposed to make this index more representative of the risk to health. In addition, future studies should carry out a thorough statistical analysis on the size of the sample that allows the obtained results to be reliable for decision makers to improve the quality of drinking water.

OBJETIVO: Analizar los resultados del Índice de Riesgo de la Calidad del Agua para Consumo Humano (IRCA) para los 116 municipios del Departamento de Cundinamarca, del año 2007 a 2013. MATERIALES Y MÉTODOS: Información recolectada de los 116 municipios del Departamento de Cundinamarca, seleccionados y clasificados en función de los datos porcentuales del IRCA. RESULTADOS: Se observa una disminución del promedio anual del IRCA, lo cual refleja un mejoramiento de la calidad del agua entregada en el departamento; sin embargo, un 26,7% de municipios no reportan información de la zona rural y un 56,9% de los municipios reportan un IRCA superior a 5, que aunque se ubican en Riesgo Bajo, son un agua no apta para consumo humano. CONCLUSIONES: Se propone una nueva ponderación de los parámetros evaluados en el IRCA, con el fin de permitir que este índice sea más representativo del riesgo a la salud y, como estudios futuros un análisis estadístico concienzudo sobre el tamaño de la muestra que permita que los resultados obtenidos sean confiables para los tomadores de decisiones sobre el mejoramiento de la calidad del agua potable.

[Safe water for rural communities from an alternative filtration system]. / Agua segura para comunidades rurales a partir de un sistema alternativo de filtración.

OBJECTIVE: Propose a prototype system for safe water treatment in Colombian rural areas. MATERIALS AND METHODS: The prototype consists of four chambers working on a water -clarification process using alum stone, also working on a filtration processes using granular materials such as different grain sizes of sand, pumice stone, activated carbon and gravel. The water problem was emulated based on the average water features found in the countryside and its monitoring mechanism tracked the current regulations in Colombia. RESULTS: There was a reduction of the fecal and total coliform of the 99.9 %, a reduction of the 98 % of turbidity, and of an 83 % of color. In all the cases, the records obtained enable to catalog the treated water as fit for human consumption. The pH, presented a slight increment due to the presence of pumice and other limestone in the filter material, but the measured value was included under the upper limit accepted for potable water. CONCLUSIONS: The treatment (purification) system evaluated in this study produced suitable water for human consumption obtained from countryside average water. The proposed technology is easy for adoption and diffusion and contributes to prevent water-borne diseases in areas without water systems.

OBJETIVO: Proponer un prototipo de sistema de tratamiento de agua para zonas rurales colombianas. MATERIALES Y MÉTODOS: El prototipo consta de cuatro compartimientos en los cuales se adelantan procesos de clarificación del agua con piedra de alumbre y filtración, utilizando materiales granulares como: arenas de distinta granulometría, piedra pómez, carbón activado y gravilla. El agua problema se emuló siguiendo las características del agua encontrada en la zona rural del país y su monitoreo se realizó siguiendo la normatividad vigente en Colombia. RESULTADOS: Hubo reducción en coliformes fecales y totales del 99,9 %, turbiedad del 98 % y color del 83 %. En todos los casos los registros obtenidos permiten catalogar el agua tratada como apta para el consumo humano. El pH presentó un ligero aumento debido a la presencia de piedra pómez y otras calizas en el material filtrante, pero el valor medido, está dentro del límite máximo aceptado para agua potable. CONCLUSIONES: El sistema de tratamiento (purificación) evaluado en el presente estudio, produjo un agua apta para consumo humano a partir de agua con características promedio de zonas rurales semi-templadas del país. La tecnología propuesta es de fácil adaptación y difusión, y permite el control de enfermedades de origen hídrico en zonas desprovistas de sistemas de acueducto.

[Quality of life and environment in communities close to industrial mining activity in Boyacá, Colombia]. / Calidad de vida y ambiente en comunidades próximas a la actividad de minería industrial en Boyacá, Colombia.

OBJECTIVE: To compare the life quality perception and environmental situation, in nearby and distant towns from the mining industry of the Boyacá Department of Colombia. METHOD: Cross-sectional study. The towns near of influence area were grouped into zones 1 and 2, and distant towns as zone 0. Conglomerates carried out a simple, multistage, random sampling. A sample of 1,117 households was determined and the unit of analysis was the family. To measure the quality of life and health perception, the WHOQOL-BREF instrument was used. Frequency distributions and comparisons between qualitative and quantitative variables were calculated. Univariate and bivariate analyzes were performed. RESULTS: The life quality perception and satisfaction with health was greater in zone 0. The means calculated for the four domains of the questionnaire, by towns, shows that Ramiriquí has the highest interquartile ranges. The life quality perception decreases in women and with increasing age. In zones 1 & 2, the environment was described as "very bad" and without any improvement at the last five years. CONCLUSION: Communities close to mining-industrial activities report a worse perception of health, greater concern about the risk of exposure and do not consider that mining industry provides greater benefits for their quality of life.

OBJETIVOS: Comparar la percepción sobre calidad de vida y situación ambiental, en municipios próximos y distantes de la actividad minero industrial del Departamento de Boyacá. MÉTODO: Estudio epidemiológico transversal. Los municipios próximos al área de influencia fueron agrupados en zonas identificadas como 1 y 2, y los municipios distantes como zona 0. Se realizó un muestreo aleatorio simple, multietápico, por conglomerados. Se determinó una muestra de 1 117 hogares y la unidad de análisis fue la familia. Para medir la calidad de vida y percepción de salud se utilizó el instrumento WHOQOL-BREF. Se calcularon distribuciones de frecuencia, diferencias entre variables y comparaciones entre variables cualitativas y cuantitativas. Se realizaron análisis univariados y bivariados. RESULTADOS: La calificación de la calidad de vida y satisfacción con la salud es mayor en la zona 0. Las medias calculadas para los cuatro dominios del cuestionario, por municipios, muestra que Ramiriquí presenta los rangos intercuartílicos más elevados. La percepción de calidad de vida y salud disminuye a medida que aumenta la edad y se presentan resultados menos satisfactorios entre las mujeres. En las zonas 1 y 2, el medio ambiente del municipio se calificó como "muy malo" y la situación ambiental de su municipio sin ninguna mejora en los últimos cinco años. CONCLUSIÓN: Las comunidades próximas a actividades minero-industriales, reportan una peor percepción de salud, mayor preocupación ante el riesgo a la exposición y no consideran que dicha actividad aporte mayores beneficios para su calidad de vida.

[Waterborne diseases and basic sanitation in Colombia]. / Enfermedades transmitidas por el agua y saneamiento básico en Colombia.

OBJECTIVE: To analyze the relationship of sewerage coverage and wastewater treatment with waterborne disease behaviour. METHODS: A descriptive retrospective study was conducted using secondary sources (document review and information available in databases) about basic sanitation coverage, treatment of domestic sewage in the country and the prevalence of waterborne diseases during the period 2008-2014. RESULTS: The country invested USD 1,100 million in the implementation of wastewater treatment systems from 2011 until the first half of 2013. However, the incidence of waterborne diseases, such as acute diarrheal disease, foodborne diseases and typhoid and paratyphoid fever did not decrease during the period 2008-2014; only hepatitis A registered a decrease. DISCUSSION: Investment in water supply and sewerage systems is relevant to improve health conditions of the population and to reduce the incidence and prevalence of various health conditions; however, it is necessary to address other aspects such as health education and social empowerment to address this problem more efficiently.

[Identification of capacities in environmental health from environmental authorities in Colombia]. / Identificación de capacidades en salud ambiental de las autoridades ambientales en Colombia.

Objectives To diagnose the capabilities that environmental authorities and the Ministry of Environment and Sustainable Development have to assume their role in environmental health, based on the capacity model of the United Nations Program for Development UNDP. Method Document review, interviews on key issues and a commented survey were conducted. 84 entities were selected for a tailored survey; complete information was obtained from 76 institutions. Results The valuation of environment favorability was within the acceptable and unfavorable categories; knowledge management capabilities were found to be precarious and assessment of functional capabilities ranged between appropriate and acceptable. The assessment of specific capabilities had a rating of poor or barely acceptable. Conclusions Two major problems were found: a. The environmental authorities do not conceive or implement these capabilities based on the UNDP model but on the conventional model of the Ministry of Environment, Housing and Territorial Development; b. Environmental authorities show an incipient level of incorporation of environmental health policies in their field of action.

[Evaluation of environmental conditions: air, water and soil in areas of mining activity in Boyacá, Colombia]. / Evaluación de condiciones ambientales: aire, agua y suelos en áreas de actividad minera en Boyacá, Colombia.

Objectives To determine concentrations of PM10, mercury and lead in indoor air of homes, water sources and soil in municipalities near mining operations. Method 6 points were evaluated in areas of influence and 2 in control areas. For measurements of indoor air, we used the NIOSH 600 method (PM10), NIOSH 6009 (mercury) and NIOSH 7300 (lead). For water analysis we used the IDEAM Guide for monitoring discharges. For soil analysis, we used the cold vapor technique (mercury) and atomic absorption (lead). Results In almost all selected households, the average PM10 and mercury concentrations in indoor air exceeded applicable air quality standards. Concentrations of lead were below standard levels. In all water sources, high concentrations of lead were found and in some places within the mining areas, high levels of iron, aluminum and mercury were also found. In soil, mercury concentrations were below the detection level and for lead, differences between the monitored points were observed. Conclusions The results do not establish causal relationships between mining and concentration of these pollutants in the evaluated areas because of the multiplicity of sources in the area. However, such studies provide important information, useful to agents of the environmental health system and researchers. Installation of networks for environmental monitoring to obtain continuous reports is suggested.

[Multidimensional analysis of environmental health capabilities in the Ministry of Environment and Sustainable Development in Colombia]. / Análisis multidimensional de las capacidades en salud ambiental del Ministerio de Ambiente y Desarrollo Sostenible en Colombia.

OBJECTIVES: To approach the multidimensional analysis of functional capacities in environmental health in the Ministry of Environment and Sustainable Development, based on the UNDP model of interactions between central problems and functional capabilities. METHOD: Individual institutional results obtained through surveys and information from secondary sources, CAR (Autonomous Regional Corporations) and environmental authorities on policies, strategies, action plans, regional environmental management plans, regulations, activities, and accountabilities related to environmental health during the period 2012-2015 were used as sources of information. RESULTS: The consolidation of results per corporation about core issues and functional capabilities, in terms of the level of response, shows a significant heterogeneity. CONCLUSIONS: Public leadership and social empowerment constitute a virtuous circle that allows strengthening capacities in projects of high social interest. Moreover, other capacities such as achieving commitments and institutional and technical capacities (policy design, implementation, evaluation, etc.) can be strengthened as well. Three alternatives for environmental health capabilities implementation have been proposed.

OBJETIVOS: Realizar una aproximación al análisis multidimensional de las capacidades funcionales en salud ambiental del Ministerio de Ambiente y Desarrollo Sostenible, con base en el modelo del PNUD de interacciones entre problemas centrales y capacidades funcionales. MÉTODO: Se utilizaron como fuentes de información los resultados institucionales obtenidos por medio de encuestas, b) información de fuentes secundarias, proveniente de las CAR y las autoridades ambientales, sobre las políticas, estrategias, planes de acción, planes de gestión ambiental regional - PGAR, normativas, actividades y rendición de cuentas. RESULTADOS: La consolidación de los resultados institucionales, con respecto a los problemas centrales y capacidades, muestran una heterogeneidad importante. CONCLUSIÓN: El liderazgo público y el empoderamiento social, constituyen un círculo virtuoso que permite fortalecer las capacidades en proyectos de alto interés social. En el marco de este encadenamiento es posible fortalecer las otras capacidades como el logro de compromisos y las de tipo institucional y técnico (diseño de políticas, implementación, evaluación, etc.). Se presentan tres alternativas que permiten la implementación de capacidades en salud ambiental.

[Economic assessment in health and environment from control of persistent organic pollutants in Colombia]. / Valoración económica en salud y medio ambiente del control de contaminantes orgánicos persistentes en Colombia.

Objective To estimate the economic benefits related to environment and health in the context of the implementation of the Stockholm Convention for the control of Persistent Organic Pollutants in the country. METHOD: The estimation was conducted based on two scenarios: non-compliance with the agreement and compliance with the Convention. Gross profit was derived from the difference in present value between the health and environmental costs that are assumed in each scenario. Results Gross profit by decreasing health costs arising from the implementation of the Convention was estimated at USD $ 511 and USD $ 501 million. By introducing variables such as management costs and agreement on potential benefits for access to international markets, the benefits to the country were estimated at between USD $1 631 and USD $ 3 118 million. Discussion Despite the economic benefits generated by lower expenditure on health for the Convention implementation, the costs associated with reducing pollutant emissions generated a negative balance, compensated only by the expectation of higher revenues for international market access. We consider this initial economic assessment an important contribution, but it should be reviewed to include valuation methodologies involving other social profitability variables and different scenarios for emerging technologies, new scientific knowledge about these pollutants, changes in legislation and / or changes in trade agreement conditions, among others.

Riesgo en salud y habitabilidad de viviendas en zonas de alta vulnerabilidad en Bogotá, Colombia / Health risk factors associated with housing habitability in high vulnerability areas in Bogotá, Colombia

RESUMEN Objetivos Evaluar las condiciones de habitabilidad de las viviendas y su incidencia sobre la salud en el sector de Mochuelo Bajo, en Bogotá (Colombia), en el marco del proyecto Hábitat Saludable, que es liderado por el Centro de estudios en Vivienda, Hábitat e Innovación Social (CENVIS). Métodos Se elaboró una herramienta de toma de información en campo sobre condiciones socioeconómicas y saludables de la unidad habitacional de familias adscritas al proyecto. Posteriormente, se realizó un análisis cuantitativo de la información recolectada para responder al objetivo de la investigación. Resultados Al aplicar la herramienta, se encontró: a) inadecuado abastecimiento, almacenamiento y manejo del agua potable, b) mala disposición de excretas humanas y desechos sólidos domiciliarios, c) mal manejo en el aprovechamiento del agua lluvia, d) inadecuada convivencia con animales domésticos y de consumo, e) contaminación del aire al interior y; f) sistemas autoconstrucción con materiales no seguros y sin asesoría técnica, además de construcción en terrenos inestables. Conclusiones En el sector de Mochuelo Bajo, existen falencias generalizables relacionadas con un inadecuado abastecimiento, almacenamiento y manejo del agua potable, una mala disposición de excretas humanas y de desechos sólidos domiciliarios. También respecto al manejo del agua lluvia, y la convivencia con animales tanto domésticos como de consumo.(AU)

ABSTRACT Objectives To evaluate the habitability conditions of dwellings and their impact on human health in Mochuelo Bajo, sector in Bogota Colombia, within the framework of the Healthy Habitat project led by the Housing, Habitat and Social Innovation Center (CENVIS). Methods A tool was developed for field data collection about socioeconomic and healthy conditions of housing units and families assigned to the project. After which, a quantitative analysis was performed in order to answer to the stablished objective. Results It was found through the tool application: a) inadequate supply, storage and management of drinking water, b) poor disposal of human excreta and solid household waste, c) poor management of rainwater use, d) inadequate coexistence with domestic and consumption animals, e) interior air pollution and f) self-construction systems with unsafe materials and without technical advice. Conclusions In the Mochuelo Bajo sector there were found generalized shortcomings related to an inadequate supplying and usage of potable water, a wrong disposition of human excreta and of solid household waste. At the same time, there are shortcomings in terms of rainwater and coexistence with animals, both domestic and for consumption.(AU)

[Characterization of the training and practice of human talent working in environmental health in Colombia]. / Caracterización de la formación y desempeño del talento humano que labora en Salud Ambiental en Colombia.

Objectives To characterize the peculiarities in the training, exercise, and performance of human talent working in environmental health in Colombia. Method Documentary and database reviews. Surveys and semi-structured interviews. Results Approximately 70 % of professionals in the area of environmental health work in health management, food engineering, environmental engineering, sanitary engineering, veterinary medicine, and pharmaceutical chemistry. 63 % of technologists belong to the field of sanitation technology. Only 20 % of surveyed educational institutions apply the competence approach to training to their students and the identification of occupational characteristics in the labor market is only used at the undergraduate level as a criterion of academic analysis and design. Only 20 % of educational institutions identify educational trends in Colombian and or international environmental health as a contribution to their programs. In prospective practices, the following topics to be strengthened were identified: risk factor identfication, measurement, and control; design and implementation of mechanisms for controlling environmental risks; forms of interdisciplinary work between the natural, social and health sciences; preventative and environmental protection measures and the concept of environment (natural, social, and cultural). Conclusion The human talent currently working in environmental health in the country is concentrated in primary care activities (inspection, monitoring and control) and a large spread exists in mission processes and competences, both professionally and technologically. A lack of coordination between the environmental sector and the education sector can be observed. A great diversity exists among the profiles offered by the different educational programs related to environmental health.

[Variables involved in the individual and collective practice of healthy habits]. / Variables involucradas en la práctica individual y colectiva de hábitos saludables.

OBJECTIVE: To conduct a descriptive review of the concepts related to the practice of healthy habits by identifying the main variables associated with their managment in terms of health promotion actions. METHODOLOGY: In consultation with groups working in health promotion in the city of performed by consulting databases and documentary sources. The strategy and criteria for the selection of documents was previously defined. Finally, we proceeded to organizing and structuring the information. RESULTS: It was established that, to promote healthy habits, four groups of behavior are involved: a) consumption, b) phyisical activity and hygiene, c) safety, and d) social participation. All of these are reviewed in order to point out the main concepts contained in each. CONCLUSION: The promotion of healthy habits must involve not only the transmission of behaviors associated with them. It must also involve understanding and adapting these habits to the environments of life in which people operate, with consideration for the different roles that they perform and the psychological and cultural demands that each space implies.

[Dry toilets: a means of alternative sanitation]. / Sanitario seco: una alternativa para el saneamiento básico en zonas rurales.

OBJECTIVE: Evaluating dry toilet use in a rural area of Colombia. METHOD: Fifteen families were selected by convenience sampling from the rural area of a municipality in the Cundinamarca department in Colombia. A dry (composting) toilet was installed in one house and used for demonstration purposes over a five-month period. An ex-post evaluation was made concerning technical and economic matters. RESULTS: A dry toilet is easy to construct/install and has environmental benefits associated with less contamination of water sources reduction and a reduced amount of chemical fertilizer. Dry toilets’ construction and operating costs may represent savings of Col$616973456 (US$308487) in the municipality being studied, compared to the costs involved in conventional toilet use. However, cultural barriers were found regarding their use. DISCUSSION: A large percentage of households in many countries’ rural sectors do not have a sewerage system for disposing of human waste. This situation creates significant challenges regarding environmental health and ecosystem conservation. Dry toilets represent an environmentally-acceptable solution from a technical and economic perspective; however, work is required concerning social and cultural factors producing cultural perceptions and prejudices about handling excreta to provide the necessary coverage and produce a significant impact on people’s awareness.

[Cooperative learning for improving healthy housing conditions in Bogota: a case study]. / Aprendizaje cooperativo para forjar vivienda saludable en Bogotá: estudio de caso.

OBJECTIVE: This was a community-based effort at constructing an educational proposal orientated towards self-empowerment aimed at improving the target population's sanitary, housing and living conditions through cooperative learning. METHODS: A constructivist approach was adopted based on a programme called "Habitat community manger". The project involved working with fifteen families living in the Mochuelo Bajo barrio in Ciudad Bolívar in Bogotá, Colombia, for identifying the most relevant sanitary aspects for improving their homes and proposing a methodology and organisation for an educational proposal. RESULTS: Twenty-one poor housing-related epidemiological indicators were identified which formed the basis for defining specific problems and establishing a methodology for designing an educational proposal. DISCUSSION: The course which emerged from the cooperative learning experience was designed to promote the community's skills and education regarding health aimed at improving households' living conditions and ensuring a healthy environment which would allow them to develop an immediate habitat ensuring their own welfare and dignity.

[A case study regarding the technical and public health feasibility of collecting water from fog]. / Factibilidad técnica y de salud pública de la recolección de aguas nieblas: Estudio de caso.

OBJECTIVES: Evaluating the collection of water for human consumption from fog nets in San Antonio (Cundinamarca department). METHOD: Water was collected from fog using a prototype 6 m²sensor unit which was installed In the area for 53 days; this water was analysed to assess its quality regarding human consumption. RESULTS: The collection area's average daily volume was 43.26 L/day and the parameters evaluated met the minimum values established by local regulations for drinking water (RAS 2000), except for pH. CONCLUSION: This technique represents an alternative for obtaining water fit for human consumption and can be scaled-up to produce the quantity needed for communities living in low rainfall areas. It can thereby lead to improving such populations' health conditions. Its economic feasibility should thus be assessed regarding its implementation and sustainability.

[Medical consultation concerning the productive aged population and air pollution in Bogotá: 2008 and 2010]. / Consulta médica en población en edad productiva y contaminación atmosférica en Bogotá: 2008 y 2010.

OBJECTIVE: Exploring the relationship of current air pollution levels in Bogota for breathable particulate matter (<10 microns) PM10 and medical consultation during productive age (18 to 65 years old). METHODS: Data regarding Bogota's air quality monitoring network for 2008 to 2010 was reviewed, specifically PM10 levels and diagnosis arising from medical consultations in Bogota's public hospitals during this time. RESULTS: According to the air quality monitoring network's results there was an 8 µg/m³ decrease in annual average PM10 from 2008 to 2010 (11.9 %) and, although consultations on grounds relating to air pollution increased by 58.7 % from 2008 to 2010, an overall 1.2 % decrease was observed when comparing this to the total of medical consultations each year. CONCLUSIONS: A significant percentage of medical attention provided in Bogota may be related to its air quality; the set of control policies developed in Bogota for some time now have led to a significant reduction in PM10 levels.

[Environmental health: the evolution of Colombia's current regulatory framework]. / Evolución del marco normativo de la salud ambiental en Colombia.

This essay presents an analysis of the evolution of environmental health management in Colombia, covering the period from the introduction of the Colombian Healthcare Code (1979) to laws 99 and 100 in 1993 and the introduction of Environmental Health Policy in Bogotá DC (2011). It proposes a conceptual model for environmental health management at three levels: proximal (physical, chemical and biological setting), intermediate (natural and cultural environment) and distal (economic, political and social structures). Relevant aspects of environmental health policy in Bogotá are analysed based on the proposed model.

Limitaciones del IRCA como estimador de calidad del agua para consumo humano / Limitations of the Water Quality Risk Index as an estimator of quality for human consumption

RESUMEN Objetivo Analizar los resultados del Índice de Riesgo de la Calidad del Agua para Consumo Humano (IRCA) para los 116 municipios del Departamento de Cundinamarca, del año 2007 a 2013. Materiales y Métodos Información recolectada de los 116 municipios del Departamento de Cundinamarca, seleccionados y clasificados en función de los datos porcentuales del IRCA. Resultados Se observa una disminución del promedio anual del IRCA, lo cual refleja un mejoramiento de la calidad del agua entregada en el departamento; sin embargo, un 26,7% de municipios no reportan información de la zona rural y un 56,9% de los municipios reportan un IRCA superior a 5, que aunque se ubican en Riesgo Bajo, son un agua no apta para consumo humano. Conclusiones Se propone una nueva ponderación de los parámetros evaluados en el IRCA, con el fin de permitir que este índice sea más representativo del riesgo a la salud y, como estudios futuros un análisis estadístico concienzudo sobre el tamaño de la muestra que permita que los resultados obtenidos sean confiables para los tomadores de decisiones sobre el mejoramiento de la calidad del agua potable.(AU)

ABSTRACT Objective To analyze the results of the Water Quality Risk Index (IRCA) in the 116 municipalities of the department of Cundinamarca, between 2007 and 2013. Materials and Methods Information collected from the 116 municipalities of the department of Cundinamarca, selected and classified according to the percentage data retrieved by IRCA. Results A decrease of the annual IRCA average is observed, which reflects an improvement of the water quality delivered in the department. However, 26.7% of the municipalities do not report information from their rural areas, and 56.9% of the municipalities report IRCA figures over 5, which means that even though they are at low risk, they receive water unfit for human consumption. Conclusions A new weighting method for the parameters evaluated with the IRCA is proposed to make this index more representative of the risk to health. In addition, future studies should carry out a thorough statistical analysis on the size of the sample that allows the obtained results to be reliable for decision makers to improve the quality of drinking water.(AU)

[Environmental health policies emphasizing air pollution and childhood in Colombian cities]. / Políticas en salud ambiental, con énfasis en contaminación atmosférica e infancia, en ciudades colombianas.

OBJECTIVE: Responding to an initiative advanced by the National Economic and Social Policy Council (CONPES, 3344/2005), this article presents the results of a research project concerned with environmental health in Colombian cities emphasising air pollution. METHOD: The project was carried out between 2008 and 2009 for the Colombian Ministry of the Environment, Housing and Territorial Development using strategic environmental assessment (SEA) methodology contained in the complementary and decision-centred approach known as analytical strategic environmental assessment (ANSEA), relying on expert participation in different areas. RESULTS: Five key issues were identified to base such policy on: urban planning, mobility and transport, industry and services, energy sources and risk management. Each theme was diagnosed regarding its current state from experts' knowledge and official information. CONCLUSIONS: Such diagnosis led to a series of actions or interventions to be implemented at different levels by the state entities involved. Complementary recommendations were made for decision-making relating to the suggested interventions. Methodological guidelines were proposed for research into economic variables and the pertinent epidemiological surveillance.

[Colombian healthcare reform: a proposal for adjusting healthcare-related insurance and financing]. / Reforma colombiana en salud: propuesta de ajuste en el esquema de aseguramiento y financiación.

Colombian healthcare system reform (incorporated over fifteen years ago) has been the frequent object of analysis and the system currently seems to be facing one of its most serious crises. This has led to large-scale change being suggested from many social, professional and academic spaces, ranging from varied adjustments to the healthcare-related insurance model's total elimination. Research over the last ten years has suggested a balance of what may have been central to the current problem and has suggested that, although adjustment must be made from a wide national consensus, it is reasonable to maintain a healthcare-related insurance model as long as this reflects the learning achieved to date. Precautions and the necessary control measures must be taken to impede a fresh wave of frustration regarding the aim of ensuring a healthcare system which would be more equitable for all.