BACKGROUND. What is Health Equity Report 2016?

Transcription

1 BRIEFING BOOK

2 UNICEF-LAC: Health Equity Report Briefing Book 1 BACKGROUND Although many countries throughout Latin America and the Caribbean have made efforts to expand health services for poor and vulnerable populations, health inequity remains widespread in the region, especially for women, infants and children. In order to contribute to countries' efforts to adjust priorities in order to implement Agenda 2030 for Sustainable Development, UNICEF partnered with the Tulane University Partnership Group for Health Equity in Latin America with the goal of examining available evidence on health inequities in the region. The resulting report, called Health Equity Report 2016: analyzing inequities in reproductive, maternal, neonatal, child and adolescent health in Latin America and the Caribbean for policy formulation, is based on more than 700 sources, including a review of results published in household surveys and other surveys (demographic and health, multiple cluster indicators, reproductive health and other national surveys) carried out from 2008 to 2014 to provide evidence on current inequities in health and highlight the need for better data, particularly in subnational levels. A review of studies conducted throughout the region has found that the inequities experienced by certain demographic groups are not isolated to a single health issue, but instead affect women and children throughout their lives. This study focus on contributing to the achievement of the Sustainable Development Goal number 3 (Health) and number 10 (Reduction of inequalities). However, these are not only SDG related to APR LAC. The Every Woman Every Child initiative set that, in order to positively impact health, it is necessary to work on goals number 1 (eradication of extreme poverty), 2 (zero hunger), 4 (quality education), 5 (gender equity), 6 (access to clean water and health services), 7 (clean and accessible energy) and 16 (peace, justice and institutions). What is Health Equity Report 2016? The Health Equity Report 2016 is an analytical study of national and regional statistics on maternal, child, adolescents and reproductive health that focuses on identifying the differences between social groups according to their economic status, place of residence, ethnic groups and degree of education. The main goals of this report is contribute with the regional efforts to reduce inequities in health in Latin America and the Caribbean and to assure universal access to reproductive health and rights. This study is aimed for public institutions and non-governmental organizations that focus on the health and well-being of the maternal and child population, but it is also interesting for

3 UNICEF-LAC: Health Equity Report Briefing Book 2 social development agencies as the study shows that many health inequalities are derive from deep social inequalities. Monitoring inequalities in health can generate change because it allows policymakers to have quantitative evidence to locate inequalities and their evolution over time. Therefore, they can use this information to identify priority areas that require action and support decisionmaking processes. Organizations related with the publication: UNICEF Tulane University Collaborative Group for Health Equity in Latin America (CHELA). A Promise Renewed for the Americas and the Caribbean. ADVOCACY GOALS 1. Provide evidence-based information for regional, national and local action that will accelerate the reduction of health inequalities between and within countries 2. Encourage decision-makers to develop evidence-based health care plans to improve the equitable coverage of reproductive, maternal, neonatal, and adolescent and child health interventions in the region. AUDIENCE Decision-makers in the public health area of Latin America and technical experts on health statistics and social inequities in the ministries of the Social Cabinet (Health, Education, Economy, among others) and dispatches of first ladies. Representatives of the academic, professional, civil society sectors and influencers of maternal, child, adolescent and reproductive health, and social inequalities in Latin America. Mass media. Members of the 24 organizations that integrate A Promise Renewed for the Americas movement.

4 KEY MESSAGES OF THE REPORT UNICEF-LAC: Health Equity Report Briefing Book 3 1. Health inequity remains widespread in the region, despite many countries throughout Latin America and the Caribbean have enacted efforts to expand health services for poor and vulnerable populations. Women, infants, children and adolescents are still the most vulnerable. The inequalities experienced by certain demographic groups are not isolated in a single health problem, but affect women and children in Latin America and the Caribbean throughout their lives. Most of the differences between populations found in perinatal, neonatal, infant and under-5 mortality are related to maternal wealth and education, rather than to rural or urban residence. In all countries studied, women from poor and low-schooling households report less access to modern contraceptive methods than women with higher incomes and higher or secondary education. Several studies have associated poverty and low levels of education with higher maternal mortality and morbidity. The vast majority of maternal deaths in Latin America and the Caribbean are preventable with quality obstetric care during pregnancy, childbirth and postpartum. 2. Health inequities consequences are multiple and lifelong. Throughout the region, women and children from low-income populations are more likely to face lifelong health inequities. The health of pregnant women and women of childbearing age often directly affects the health of their children and thus creates a cycle in which health inequities remain concentrated in certain populations for generations. Newborns from poorer families are less likely than those from wealthy families to be delivered with qualified medical attention and to be registered at birth. In childhood: they have more chances to be stunted and wasted, and contracting infectious and vector-borne diseases. After reaching adolescence, girls and boys from poorer demographics are more likely to attend poor-quality educational systems, and to face barriers in accessing sexual and reproductive health services. Without a bright outlook for their futures, they become pregnant at earlier ages. During pregnancy, low-income women often receive less adequate antenatal care than do wealthier women and also have a lower prevalence of delivering with a skilled birth attendant. Both of these factors, in addition to a woman s education level, affect the chance of survival for both women and children.

5 UNICEF-LAC: Health Equity Report Briefing Book 4 3. More research is needed to understand the dynamics of health inequities and drive the change necessary to address the causes from the root. Increased research is therefore crucial not only to fortify and expand existing health equity data, but also to document how the social, structural and economic barriers driving those inequities change over time. It is necessary to incorporate the perspective of inequity in research and public health statistics. The measuring and monitoring of health inequalities and inequities in Latin America and the Caribbean require strategies through which policymakers and researchers may assess health equity in the future: comprehensive health indicators; field-test relevant stratifiers for specific topics; reliable, time consistent and comparable data sources; and mixed measures (simple and complex). In the Latin American and Caribbean region, more information is needed on equitable access to life-saving interventions such as newborn resuscitation, kangaroo care, corticosteroid use and treatment of neonatal sepsis. Studies regarding interventions in the region have tended to focus on their costeffectiveness, availability and potential for future utilization, but neglect to mention inequalities in availability, access or outcomes between vulnerable populations. 4. Eradicating all kinds of inequities in health implies contributing to the achievement of two of the objectives of SDG and is therefore a priority for UNICEF. Health inequity refers to the concept that certain differences in health stem from broader social and economic inequalities. According to a classic definition, these differences are systematic, avoidable, unfair and unjust and obstruct individuals and communities from achieving their best health potential. Starting 2016, the Sustainable Development Goals, a series of 17 global targets that apply to all countries, will begin to guide policies and measures that are adopted internationally. These objectives explicitly include the reduction of social inequalities (SDG #10) and access to health (SDG #3). Inequities in health constitute a violation of the right to health and the full development of mothers, children and adolescents. In addition, it implies high social and economic costs. 5. To achieve equity in health, it is necessary to develop advocacy, statistical measurement and monitoring, and the development of multisectoral strategies. However, there are steps that the authorities can prioritize: Reproductive health: Expand equitable access to reproductive health services.

6 UNICEF-LAC: Health Equity Report Briefing Book 5 Maternal health: Facilitate and strengthen the continuum of quality care available to all women throughout pregnancy, labour, delivery and the postpartum period. Neonatal Health: Strengthen the integration of quality postnatal and neonatal services into the continuum of maternal health care. Child health: Create healthier environments that promote the health and wellbeing of children from marginalized or disadvantaged populations. Adolescents health: Establish accessible youth-friendly health services that cater specifically to the needs of diverse populations of adolescents. Violence and health: Advocate for the importance of addressing different forms of violence, create mechanisms to ensure justice for victims of violence and provide resources to aid in violence prevention and offer services to victims.

7 UNICEF-LAC: Health Equity Report Briefing Book 6 KEY FINDINGS Source: Health Equity Report ETHNICITY AND MATERNAL CHILDHOOD HEALTH Women of indigenous populations frequently experience social and economic exclusion an unequal situation that produces health inequities at numerous moments throughout their lives, especially during pregnancy and labour. Indigenous women in several Latin American countries are less likely to deliver with skilled birth attendance. Indigenous and Afro-descendant populations show lower health outcomes and less access to health services during pregnancy and childbirth: in addition to generalized social exclusion, there is a growing association between maltreatment in health facilities and poor health outcomes in Indigenous and Afro-descendant population. In 2010, indigenous adolescents from Bolivia, Guatemala, Ecuador and Nicaragua had less access to modern family planning services and contraceptive methods compared to the non-indigenous population. Adolescent pregnancy in indigenous populations has declined over the past decade, but is still higher compared to non-indigenous adolescents. The prevalence of teenage pregnancy is five times higher in indigenous girls in Costa Rica (49%) than in non-indigenous girls (10%) and almost double in Panama (17% in indigenous girls and 10% in non-indigenous girls). Not only are adolescent pregnancies associated with an increased risk of perinatal complications, but daughters of adolescent mothers may be more likely to become adolescent mothers themselves, thus creating an intergenerational cycle that prevents them from developing their own human capacities. Indigenous and Afro-descendant women are at increased risk of illness and death. Afro-Brazilians in Paraná (Brazil) and indigenous women in Guatemala are three times more likely to die in childbirth than non-indigenous women. SCHOOLING AND MATERNAL CHILDHOOD HEALTH Mothers with lower levels of schooling and their children have less favorable health outcomes than mothers with higher levels of education. Women with lower levels of education in Costa Rica, El Salvador, Guatemala, Panama, Peru and Suriname have an unmet need for contraception at least twice as high as women with secondary or higher education. In Colombia, Haiti, Nicaragua, Panama and Suriname, the coverage rate for prenatal care (at least 4 visits) is three times lower among women without schooling than among women with higher education. In Guatemala, Panama, Haiti and Honduras, women with higher education have greater access to skilled childbirth care than women without schooling.

8 UNICEF-LAC: Health Equity Report Briefing Book 7 In all countries of Latin America and the Caribbean, postnatal care is less frequent among mothers without schooling or with few degrees of education. Pneumonia is the leading cause of mortality among children aged 1-59 months in Latin America and the Caribbean. However, a smaller proportion of children with no schooling are taken to medical attention when symptoms of pneumonia appear compared to children of mothers with secondary or higher education. Pregnancy in adolescents is systematically more frequent among girls with lower levels of schooling. Mortality is higher among boys and girls whose mothers have little or no schooling compared to children of mothers with secondary or higher education. Bolivia has the largest gaps within a country: the Neonatal Mortality Rate (under 28 days of birth) is three times higher among women without schooling than among women with higher education. The Infant Mortality Ratio (RMI) among infants (under one year old) whose mothers do not have schooling is greater than among infants whose mothers have a secondary or higher education: seven times higher in El Salvador, three times greater in Bolivia, Guatemala, Colombia and the Republic Dominican Republic and twice as large in Peru. Children of mothers without schooling are more likely to have growing problems compared to children of mothers with secondary or higher education. In Haiti and Colombia, children of mothers with secondary or higher education have greater access to DPT3 and measles vaccines than children of mothers with little or no schooling. INCOME AND MATERNAL AND CHILDHOOD HEALTH Helping children survive and thrive involves reducing the economic factors associated with infant and under-five mortality. In Latin America and the Caribbean, an estimated 196,000 children under five died in 2015 (underfive mortality rate of 18 deaths per 1,000 live births). Of these, 85% (167,000 children) were less than one year old (infant mortality rate of 15 deaths per 1,000 live births). The poorest group of the Latin American population has a higher child mortality burden. In 2015, the risk of dying before 28 days of birth in the poorest countries was 2.5 times higher than in the richest countries. In the region, during 2015, the risk of a child dying before reaching the fifth birthday in the lowest-income countries was three times higher than in the highest-income group. The largest gaps in DPT3 vaccine coverage (diphtheria, tetanus, and whooping cough) are among the richest and poorest in Surinam, Panama, Haiti, and the Dominican Republic. The largest gaps in measles vaccination coverage are among the poorest and the richest in Guyana, Panama, and Suriname. Poverty and low levels of schooling coincide as factors associated with adolescent pregnancy, as it is systematically more frequent among girls from the poorest households in all countries with available data.

9 UNICEF-LAC: Health Equity Report Briefing Book 8 Cuba, Chile, and Costa Rica are examples of countries where inequality has been successfully reduced by narrowing the gap between richer and poorer population groups, mainly by improving women's access to education and increased coverage of public health measures. MATERNAL AND NEONATAL MORTALITY IN COUNTRIES Statistics on maternal and infant mortality are not the same for all countries in the region. While Uruguay has a Maternal Mortality Ratio (MMR) of 15 per 100,000 live births, the figure in Haiti is 359: the country with the highest number of maternal deaths has 20 times more deaths than the country with the lowest maternal mortality ratio. In the subregions, the difference between countries is sustained: o In the Caribbean, MMR ranged from 27 dead mothers per 100,000 live births in Barbados and Granada to 39 in Cuba, 92 in the Dominican Republic and 359 in Haiti. o In Central America, RMM ranges from 25 in Costa Rica to 150 in Nicaragua. o In South America, Uruguay (15) and Chile (22) have RMMs below 25, but in Bolivia the RMM is 206 and Guyana, which is 229. In 2015, the highest Neonatal Mortality Ratio (NMR) is in Haiti, with an estimated rate of 25.4 per 1,000 live births. The regional average of 9.3 per 1,000 live births. ADOLESCENT HEALTH Adolescence is a period of increasing vulnerability, particularly to malnutrition, substance abuse and sexually transmitted diseases such as HIV. Inequalities based on income, education, gender or ethnicity can worsen young people's vulnerabilities to these conditions, which can have lifelong consequences for their health and well-being. Latin America and the Caribbean, has the highest concentration of teenage pregnancies in the world: 26% of births between occurred among adolescents and girls between 15 and 19 years of age). In Latin America and the Caribbean, as in the world, young women aged are 50% more likely to contract HIV than men of the same age. Evidence suggests that current sexual education programs may not sufficiently reach adolescents most vulnerable to HIV or STI acquisition. Knowledge about HIV remains incomplete among adolescent boys and girls in the region. Over the last decade, almost all countries in Latin America and the Caribbean have expanded access to antiretroviral therapy (ART) for children and adolescents. While increased research has brought to light the problems affecting LGBT youth in the region, discrimination continues to hinder these adolescents from achieving optimal mental, physical and sexual health outcomes. Condom use remains low among adolescents of both sexes throughout the region. Less than 4 out of 10 teenage girls in Peru, the Dominican Republic, Honduras, and Colombia reported using

10 UNICEF-LAC: Health Equity Report Briefing Book 9 a condom during the most recent sexual relationship to protect themselves against HIV or other STIs. While male teens are more likely to be sexually active, female teens are less likely to use a condom during sex. These trends have been observed in Nicaragua, Brazil, Mexico, Colombia and Panama.

11 UNICEF-LAC: Health Equity Report Briefing Book 10 COMMUNICATIONALS GOALS 1. Positioning health equity as a main topic of discussion in society. 2. Position UNICEF as a key partner in the region in the efforts to reduce inequities in maternal and child health. 3. Position APR LAC as a movement for equity in reproductive, maternal, child and adolescents health. DECEMBER 2016-MARCH 2017 ACTIONS Materials Health Equity Report 2016 (full version digitally available in English Spanish and English summary of the Health Equity Report 2016 (available in digital). Briefing book. Press release. Social media package. Rapporteur and video recording of the event on YouTube. When? Pre event Peri event am (Panama time). Duration: 75 min. aprox. What? Invitation of panelists and assistants. Online publication of executive summaries of the Health Equity Report, in English and Spanish. Online publication of the Report on Equity in Health (complete), in English. Sending to Country Offices (CO) and APR LAC agencies: Press Release. Social media package. Live Broadcasting Health Equity Report 2016 Opening: María Cristina Perceval, UNICEF Regional Director for Latin America and the Caribbean. Luisa Brumana, UNICEF Regional Health Adviser for Latin America and the Caribbean, and member of Executive Committee for A Promise Renewed for the Americas and the Caribbean (APR-LAC). Presentation: Health Equity Report 2016 Arachu Castro, Director of the Collaborative Group for Health Equity in Latin America (CHELA), Tulane University. 5 min 15 min Testimonies: Discrimination against indigenous women. Better not going. The way they treat us, we better don t go [video] 3:42 min

12 UNICEF-LAC: Health Equity Report Briefing Book 11 Panelists: How can we reduce health inequities in Latin America? PanAmerican Health Organization Andrés de Francisco, Director, Family, Gender and Life Course Department. Pan American Health Organization / World Health Organization. 10 min Closure: Question and answers Luisa Brumana, UNICEF LAC Regional Health Adviser, and member of Executive Committee for A Promise Renewed for the Americas and the Caribbean (APR-LAC). 5 min 5 min Publishing messages in social media from UNICEF LAC accounts. Management of comments and questions. Post event Dissemination of the Health Equity Report 2016 between health sector personalities. Interviews with media in Latin America. Record on the YouTube channel and the APR LAC and UNICEF website. Incluir fragmentos del debate en el paquete de redes sociales UNICEF y canales de APR LAC (website y newsletter). Excerpts of the debate in the UNICEF social media and APR LAC channels (website and newsletter). Thank you to attendees with the recording link and attached report.

13 SUGGESTED KPI FOR IMPACT IN LAC UNICEF-LAC: Health Equity Report Briefing Book 12 KPI DETERMINANT VOICE Number of informational pieces in mass media referring to the Health Equity Report o Digital media o Print media o Broadcasting media o Social media REACH Number of posts in UNICEF social media o Twitter o Facebook o YouTube Number of persons reached by the event o Number of visualizations during live broadcasting. o Number of replay of the recording. ENGAGEMENT Numbers of interventions from follower or viewers o Number of comments during the launch. o Numbers of likes and shares in Facebook. o Numbers of retweets and likes in Twitter. o Number of visits in YouTube and other shared materials SPOKEPERSONS Nombre Cargo Idiomas María Cristina Perceval UNICEF Regional Director for Latin Spanish (NL), English, French America and the Caribbean Luisa Brumana UNICEF LAC Regional Health Adviser, and member of Executive Committee Spanish, English, Italiano (NL) for A Promise Renewed for the Americas and the Caribbean (APR-LAC). Arachu Castro Director of the Collaborative Group for Spanish (NL), English Health Equity in Latin America (CHELA), Tulane University (NL: native language) For interviews, please contact: María Alejandra Berroterán Communications consultant UNICEF APR LAC maberroteran@unicef.org