On the face of it, the people of Latin America are getting healthier. Statistics collected by national health authorities indicate a continuing improvement in virtually all health indicators.
In the past two decades, life expectancy has increased by nearly six years to 68.5 years. That is largely due to a fall in deaths due to communicable diseases – from 95 people per 100,000 in 1980 to just 57 per 100,000 in 2000.
Infant mortality has also fallen, with deaths from communicable diseases of children under the age of 12 months being halved in most countries in the region.
Cause for rejoicing, surely? Yes, but…
These welcome statistics hide an alarming trend: while the overall indicators are improving, the disparities – between and within countries, regions and population groups – are widening. For if one word sums up the biggest challenge facing public health actors in the Americas it is Equity.
For health gains have not been made equally – up to 25 per cent of the region’s population have no permanent access to health care services. Research shows that health inequalities are clearly linked to unequal access to the resources of society: education, health care, employment and so on. Too often the factors that determine access to these are related to ethnicity, gender and social class.
Narrowing the health equity gap is not just a question of fairness and social equality. I believe achieving equity in health – or at least actively moving towards it – is crucial for the development of the societies of Latin America.
National Red Cross Societies are present in every country in the Western Hemisphere, and the Red Cross mandate – to improve the situation of vulnerable people through mobilising the power of humanity – implies a fundamental commitment to equity.
So the Red Cross movement - with its vast volunteer network and experience in delivering health services at community level - is uniquely placed to play a catalytic role closing the inequity gap in the Americas. We must not only advocate on behalf of those left marginalized, but we must also give them a voice by making our membership as diverse and inclusive as possible.
To do this, the national Red Cross Societies, with the support of the International Federation, will continue working closely with national ministries of health and regional agencies, such as the Pan-American Health Organisation (PAHO). But they will also have to take a hard look at their existing health programmes and decide whether they genuinely address the question of equity.
Health programmes in the region vary hugely, from community health programmes to ambulance services, from managing national blood programmes to nursing schools.
Tackling inequity should be the cornerstone of any health programmes a national Red Cross Society undertakes. We must ask ourselves if our interventions are having a real impact on public health.
Two areas where I believe the Red Cross can make a real difference are woman and child health and HIV/AIDS.
One of the major health inequities affecting the Americas is reflected in the numbers of maternal deaths. While technical solutions are important, an effective response will be impossible without gender equity.
Furthermore, more than 170,000 children under the age of five die every year from illnesses that can easily be prevented or treated. The Integrated Management of Childhood Illness (IMCI) strategy is a proven technical response, but only through reaching out to - and including - the most vulnerable children will it manage to reduce health inequities. The Red Cross can, and must, make an important contribution.
An estimated 2.8 million people in the Americas are currently living with AIDS, but within the region, there are significant differences in the intensity of the HIV epidemic and its transmission trends. In Latin America, 1.4 million people are living with HIV/AIDS; in North America, 940,000; and in the Caribbean, 420,000. With an adult prevalence of over 2 per cent, the Caribbean is the second most affected region in the world, after sub-Saharan Africa.
Marginalization and exclusion of the most vulnerable groups – including people already living with HIV/AIDS - fuels the epidemic. Only through clear policies that fight stigma and discrimination and strengthen links with organizations of people living with HIV/AIDS will greater equity be achieved and the epidemic contained.
Our initiative to work towards equity in health will require a change of strategy for many national Red Cross Societies in the region, as well as a more coordinated approach between national societies. It is for that reason it is being presented at the 17th Inter-American Red Cross Conference in Santiago de Chile.
Health is the responsibility of governments. The Red Cross is merely an auxiliary to those governments, yet it can influence policy, by identifying gaps in the system, promoting solutions and advocating for health care for all.
If this strategy being presented in Santiago is adopted, it will make a significant contribution towards achieving equity in health. With their network of volunteers working at grassroots level, the Red Cross national societies are well placed to identify the specific interventions required to redress the inequities in their own communities.
I sincerely hope that this conference will be remembered as the occasion when the Red Cross movement truly nailed its colours to the mast and committed itself to achieving equity in health.
* Abel Peña y Lillo is President of the Bolivian Red Cross and of the Inter-American Regional Committee (CORI)
Related Links:
XVII Inter-American Conference, Santiago
Inter-American Conference, special page
Federation health activities
Bolivian Red Cross
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