Hemispheric Health Successes Mask Underlying Gaps

Main Category: Public Health
Article Date: 10 Oct 2007 - 6:00 PDT

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Average life expectancy in the Americas has risen 6 years during the past quarter-century; the average child born in the region can expect to live to nearly 75, according to Health in the Americas 2007, a major report released this week by the Pan American Health Organization (PAHO).

The averages, however, mask significant differences between and within countries of the region. A child in North America can expect to live 6 years longer than a child in Latin America and the Caribbean. In Haiti, life expectancy is 59.7 years, compared with 77.7 in Costa Rica. People in Brazil, Nicaragua and Peru face life expectancy similar to levels seen in the United States in the 1950s.

Still, the gap between life expectancy in Latin America and the Caribbean and life expectancy in the United States and Canada has decreased from 10 years in the mid-1960s to 6 years as of 2005.

These and other trends in health, demographics, and living standards are presented in the new edition of Health in the Americas, a major PAHO report issued every five years. This newest edition points to significant progress in human development, reflecting well on regional health guidelines, policies, and programs. But it acknowledges that enormous challenges remain, chief among them inequities and gaps that keep the most vulnerable populations from sharing equally in the region's overall health progress.

The report points to several major trends that are shaping health in the Americas. In nearly all countries of the region, chronic illnesses-such as cardiovascular diseases, cancer and diabetes-have replaced communicable diseases as the leading causes of illness, disability and death. These diseases are on the increase throughout the region and are associated with population aging as well as such risk factors as sedentary lifestyles, changes in diet, tobacco use, and alcohol and drug abuse.

Coverage of basic services has improved in most of the region, though less so in rural areas. Today most of the region's population has better access to education, water and sanitation services, primary health care, and immunization. Growing urbanization has increased access to such services for some but has also created new pockets of deprivation.

"In Latin America and the Caribbean, migration has spawned large, sprawling cities with marginalzied areas that breed poverty, unemployment, violence, insecurity, pollution, and poorly distributed basaic services," says the report.

Among the major health challenges facing the region are the continuing HIV/AIDS epidemic, malaria, dengue and tuberculosis, as well as increasing chronic diseases. The most difficult to address, however, may be the economic, political, social and environmental factors affecting health.

"The greatest share of health problems is attributable to broad social determinants-the 'causes behind the causes' of ill health: poverty, malnutrition, unemployment, lack of access to education and health services, the social exclusion of certain populations, among others," says the report.

Other developments highlighted in the report include the following:

- Since 1950, the population of the Americas has nearly tripled, reaching 900.6 million inhabitants in 2006. Though the rate of growth has slowed, it is projected to pass the 1 billion mark by 2016.

- The proportion of the population living in urban areas has grown from 42 percent in 1950 to more than 77 percent as of 2005.

- The fastest-growing population groups are people over 60 and those over 80.

- The gap in life expectancy between the region's richest and poorest countries has widened to nearly 20 years.

- Some 218 million people in the Americas lack social security coverage in health, and 100 million lack access to health services due to geographic location or economic barriers.

- Many of the worst health inequities in the region can be found among the 45-50 million people who form part of the region's 400 racial, ethnic and other minority groups.

- Some 110,000 to 120,000 homicides occurred in the region in the last 10 years and 55,000 to 58,000 suicides, according to official registries.

- In 2002, 374,000 people died in traffic crashes, the ninth-leading cause of death in the region that year.

- Mortality among children under 5 declined by two-thirds between 1990 and 2005, and under-1 mortality decreased by one-half.

- Nearly 40 percent of all deaths of children under 5 occur in the poorest 20 percent of the region's countries.

- More than 22,000 women in Latin America and the Caribbean die each year from complications of pregnancy and childbirth.

- Despite advances in poverty reduction, nearly 213 million people in the Americas (over 40 percent) live in poverty, and 88 million (16.8 percent) live in extreme poverty.

The full text of Health in the Americas 2007 is available online.

The Pan American Health Organization, founded in 1902, works with all the countries of the Americas to improve the health and quality of life of their peoples. It serves as the Regional Office of the World Health Organization (WHO).

http://www.paho.org/