Aline Ricly and Luiz Pistone (Forum Itaboraí - Fiocruz Petrópolis)
An action plan for the promotion of health equity was the result of the work carried out during the Seminar of the International Association of National Institutes of Public Health (IANPHI) Latin American Network, which took place on the 21st, 22nd and 23rd at the Itaboraí Palace, headquarters of the Itaboraí Forum-Fiocruz Petrópolis. The plan proposals include training activities in Public Health with a focus on social inequalities, as well as the implementation of social technology projects, will be consolidated in a final report to be presented in October at the meeting of the IANPHI Latin American network in El Salvador.
IANPHI's US Office Director, Ellen Whitney; the vice-president of Environment, Care and Health Promotion (VPAAPS/Fiocruz), Hermano Castro; the mayor of Petrópolis, Rubens Bomtempo; and the director of the Itaboraí Forum and coordinator of the IANPHI Latin American network, Felix Rosenberg (photo: Fiocruz Petrópolis)
Representatives from Argentina, Brazil, Chile, Costa Rica, El Salvador, Ecuador, Mexico, Peru, and Venezuela, as well as Canada, Mozambique and the PAHO Regional Office for South America participated in the seminar, which was supported by the US CDC.
During the opening, the Brazilian Minister of Health, Nísia Trindade Lima, sent a video highlighting the importance of the initiative at a time when, for her, it is urgent – given the relevance of the social and environmental determinants of health – to clearly put forward the issue of health inequalities and inequities.
“I have been saying that the time is now to put the issue of overcoming inequalities on the agenda, which is reinforced as Brazil is now presiding over Mercosur and the G20 as well, an event in which I have just been present, taking agendas very close to those discussed in this event. We will be waiting very carefully at the Ministry of Health for suggestions for proposals from such a relevant meeting for thinking and practice in health, and I hope that we can have excellent subsidies from this discussion”, said Nísia.
Also in the opening presentation of the seminar, Hermano Castro, Vice President of Environment, Healthcare and Health Promotion (VPAAPS/Fiocruz), outlined an overview of the situation of health inequalities in Brazil, pointing out issues such as violence, including by the State on the working-class suburbs and due to land conflicts in quilombola territories; the relaunch of the Mais Médicos program and the challenges in this context, the importance of the SUS [Unified Health System] which, according to him, avoided a major tragedy in the country during COVID-19; the need to fight against fake news for health education and food insecurity.
“These are some issues that science needs to pursue, such as overcome fading powers, advance the knowledge with new constructions of all technologies involved in diagnosis and treatment in the field of health, but also social technologies further involving issues that are returning to the discussions in Brazil, what are the integrative practices, that is, everything that should meet the health needs of our population”, said Hermano.
The mayor of Petrópolis, Rubens Bomtempo, also participated in the opening of the event and said that the document, a result of the seminar, could act as a guide to broaden the discussion of public health. “May Petrópolis, together with Fiocruz, with the institutes present here, be strengthened in the idea of building the State, that the guarantee of human rights is on the agenda of all of us, and that we leave here increasingly strengthening our democracies”, he emphasized.
Guiding axes of the seminar
The seminar's action plan was drawn up taking into account three main axes. The first of a global nature, related to sovereignty in the production and access to health inputs and products, with emphasis on diagnostic kits and antivenom and snakebite serums, with attention to the most vulnerable populations in Latin American countries.
The second discussed the need to comparatively analyze inequalities in the access to health systems in the participating countries, with a focus on primary care and health systems in border areas.
The third, of a local territorial nature, addressed the implementation of social technologies, such as the Rapid Participatory Appraisals (RPA) and participatory cartography to strengthen the organization and community participation in primary care.
For Ellen Whitney, director of the IANPHI Office in the United States, based on the result of this work, it will be necessary to translate discussions into concrete activities with measurable results. “By championing health equity in Latin America, we are also contributing to IANPHI's broader global efforts to identify ways in which the National Health Institutes can contribute to improving health equity for all”, he said.
Ellen explained that health equity is fundamentally about social justice and ensuring equal health opportunities for all, regardless of background or circumstances. “Investing in health equity can increase the productivity of the workforce, reduce long-term health costs, as well as promote economic growth in Latin America”, she highlighted.
Felix Rosenberg, director of the Itaboraí Forum and coordinator of the IANPHI Latin American network, added that the action plan that will result from the Seminar is a document for the Public Health Institutes to expand their strategic actions beyond diagnosis and laboratory investigation, incorporating social technologies, aiming at greater inclusion in health policies. “This meeting was extremely successful as it was able to define concrete and specific actions by the National Health Institutes in Latin America to face health inequalities after intense and fertile discussions, with great participation and enthusiasm from all. The most important thing is that we are leaving here with an action plan that defines the future commitments of the Network”, he said.
Carlos Arosquipa, consultant in the Pan American Health Organization (PAHO) Subregional Program for South America, pointed out that, among the main challenges in Latin America, is that there are the enormous differences and gaps between population groups, which explains a significant part of the disease burden in these countries.
“The only way to tackle these health problems is to address their causes, and one of those causes is the inequality that exists not only in the access to services, but also in living conditions. And this seminar was aimed precisely at addressing the role that the national health institutes would play in this effort to reduce inequalities. It is an effort that requires the participation of multiple players from different sectors. National health institutes are critical in advancing this challenge, not only because they are institutions that have a specific role in all of our countries, but also because they have established competencies and capacities that help carry out this work, especially in research and surveillance”.
The seminar was broadcast online on the Youtube channel of the Itaboraí Forum, with translations in English and Spanish, and it can be accessed at this link