MAIN PROBLEMS AND CHALLENGES IN THE FIELD

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MAIN PROBLEMS AND CHALLENGES IN THE FIELD OF HEALTH

 

INTRODUCTION:

More than a billion people live in the Region of the Americas. During the last decade, the Region made important progress in relation to health and by 2015 had achieved documented success in meeting the goals of the Millennium Development Goals (MDGs) regarding the reduction of extreme poverty levels and hunger and the decrease in mortality in children under 1 and 5 years, as well as considerable progress in environmental sustainability. However, the Region did not achieve the reduction of maternal mortality planned as part of MDG 5.

Main problems and challenges in the field of health

  Main problems and challenges in the field of health is dedicated to the analysis of the main causal factors (health problems and determinants of health), which represent the greatest challenges and the greatest burden for the population of the Region. These challenges and problems are analyzed in three convergent themes: the health problems that are considered crucial due to their severity, high prevalence, associated costs or long-term impact on the health of the population; the environmental and social determinants that are outside the director exclusive control of the health sector; and the obstacles that result from the lack of preparation of many health systems to face the challenges posed by health problems and their determinants, in particular the generalized and prevailing inequities.

In the topic, 1the progress of the Region in reducing the burden of communicable diseases in the last five years is analyzed while addressing the inequities that persist within countries and the large gaps between countries in the overall results of health such as maternal and infant morbidity and mortality. Although chronic diseases are increasing, in some countries the burden attributable to communicable diseases and the number of maternal and child deaths, including nutritional deficiencies, are still high and can not be underestimated in the transition to the 2030 Agenda for Sustainable Development. The persistence, The emergence, and re-emergence of some infectious diseases associated with poverty and changes in the physical and social context highlight the need to reinforce ongoing surveillance activities in order to prevent the emergence of new pathogenic strains of arboviruses.

There has been a resurgence of cholera in the Region, as well as recent outbreaks of dengue fever. In addition to dengue, new epidemics of arboviral diseases have emerged, mainly outbreaks caused by the chikungunya virus and the Zika virus. The Zika epidemic caused a major public health crisis due to new clinical manifestations in newborns related to neurodevelopmental syndromes and microcephaly, which can cause long-term morbidity and disability. 

On the other hand

In topic 2the unprecedented demographic, epidemiological and socio-economic changes that have led to an increase in non-communicable diseases (NCDs), mental disorders, disabilities, traffic-related injuries, and domestic and interpersonal violence, which have moved to occupy the first places among the main health problems that require multisectoral policies. Two fundamental approaches to addressing NCDs are the social determinants of health and the life-course perspective, both of which are widely discussed in Health in the Americas + 2017.

 The capacity and reach of health systems must be improved not only to provide care for people at risk or those who already have an ENT but also to build health throughout the course of life. Promoting the ability to self-care is a fundamental part of the efforts necessary to overcome the challenges that arise from the epidemiological and demographic transition and from the byproducts of disorderly development. Violence is one of the byproducts associated with weak governance, poor rule of law, increasing income inequality and limited educational opportunities, and women and children are its most frequent victims. Mental health problems, particularly depression, also lead to significant morbidity and are exacerbated in situations of conflict and natural disasters.

 The high suicide rate in some countries is also a cause for concern. Violence is one of the byproducts associated with weak governance, poor rule of law, increasing income inequality and limited educational opportunities, and women and children are its most frequent victims. Mental health problems, particularly depression, also lead to significant morbidity and are exacerbated in situations of conflict and natural disasters.
The high suicide rate in some countries is also a cause for concern. Violence is one of the byproducts associated with weak governance, poor rule of law, increasing income inequality and limited educational opportunities, and women and children are its most frequent victims. Mental health problems, particularly depression, also lead to significant morbidity and are exacerbated in situations of conflict and natural disasters. The high suicide rate in some countries is also a cause for concern. they also lead to significant morbidity and are exacerbated in situations of conflict and natural disasters. The high suicide rate in some countries is also a cause for concern. they also lead to significant morbidity and are exacerbated in situations of conflict and natural disasters. The high suicide rate in some countries is also a cause for concern.

climate change

climate change:3the threat posed by climate change is analyzed, whose rapid evolution is particularly serious in the case of the small island developing States of the Caribbean and the coastal zones of Central America. The Region of the Americas is an area prone to natural disasters, such as hurricanes, volcanic eruptions, earthquakes, and floods, often with a high associated cost due to loss of human lives, damage to the environment and destruction of the infrastructure.
Some projections indicate that by 2050 large coastal areas will be lost as a result of global warming, and vector-borne diseases and threats to food security will spread. This threat to public health still goes largely unnoticed, so it is a subject that requires our immediate attention. Policymakers need the best available information to assess the magnitude of current and future impacts of climate change and its implications for health and to formulate and execute a variety of responses to ensure adaptation and strengthen health systems. 
The theme concludes with some policy recommendations to reduce the side effects of human activity on climate change, particularly those related to the health sector, and minimize their effects through the action of different sectors. Policymakers need the best available information to assess the magnitude of current and future impacts of climate change and its implications for health and to formulate and execute a variety of responses to ensure adaptation and strengthen health systems.
The theme concludes with some policy recommendations to reduce the side effects of human activity on climate change, particularly those related to the health sector, and minimize their effects through the action of different sectors. Policymakers need the best available information to assess the magnitude of current and future impacts of climate change and its implications for health and to formulate and execute a variety of responses to ensure adaptation and strengthen health systems. The theme concludes with some policy recommendations to reduce the side effects of human activity on climate change, particularly those related to the health sector, and minimize their effects through the action of different sectors.

Increase in Population

Increase in population: 4The unprecedented increase in population aging is addressed, which has implications for social security systems, the structure of the workforce and health systems. The increase in the proportion of people living to an advanced age produces an increase in dementias, disabilities, and frailty. The dynamic of living to advanced old age has changed radically and requires the urgent creation of favorable environments. In addition, there is an urgent need in the Region to strengthen national capacities to formulate and execute evidence-based policies and programs.

High levels of migration

High levels of migration: 5the high levels of migration in the Region of the Americas are addressed, caused by irregular and forced migration driven largely by economic factors, but also by wars, conflicts, and violence. Many irregular migrants attempt to cross Central America to reach the United States and are at greater risk of violence, abuse and exploitation, trauma, illness, and mental disorders, to which is added limited access to health care and services.
This situation constitutes a public health crisis and must be addressed as such. This theme refers to the broader framework for the actions of health systems to protect the health and well-being of all migrants, as shown in the strategic lines of action defined in resolution WHA61. 17 of the World Health Organization (WHO) approved in 2008 and resolution CD55.R13 of the Pan American Health Organization (PAHO) approved in 2016 on the health of migrants. One of these lines recognizes the need to strengthen and promote intersectoral action and frameworks that cover multiple countries to address the social determinants of migrant health, increase the resilience of the community, and develop social policies and programs that are sensitive to migrants.
In topic 6, inequities in the Americas are analyzed. Latin America and the Caribbean continues to be the most unequal region in the world, with almost a third of the population below the poverty line. This enormous disparity is one of the causes that underlie not only the higher risk of suffering from NCDs, infectious diseases, malnutrition and a lower life expectancy for the lower quintiles of socioeconomic distribution but is also directly associated with reduced access to health services. As a result, inequities are a major obstacle to achieving universal access. Specific interventions and investments are needed to transform health systems into comprehensive, integrated and equitable services available to all.
The MDGs provided useful lessons on the dangers of transforming imprecise objectives into programs and policies. The emphasis on consolidated figures at the national level concealed the growing inequities and led to health coverage policies that accentuated these inequities.
The adoption of the Sustainable Development Goals and the 2030 Agenda is a call for the Region to act to end poverty and strive to achieve comprehensive prosperity, in all its basic dimensions. These objectives will have to be translated into quantifiable goals that guide governments and partners towards universal health coverage and the reduction of all inequities in health outcomes.
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