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Health in the Americas 2002 Edition Volume I HIAcovSpF1.qxd 9/23/02 10:55 AM Page 1 ISBN 92 75 31587 6 OPS Scientific and Technical Publication No. 587 Pub. Cient. y Téc. No. 587 La salud en las Américas, edición de 2002, es la decimotercera entrega de una serie ininterrumpida de informes cuadrienales sobre la salud de los in the pueblos de la Región. La obra se publica en dos volúmenes y cubre fun- Health damentalmente el período comprendido entre 1997 y 2000. En esta edi- ción, el análisis está orientado a documentar las desigualdades de salud. Los ocho capítulos del volumen I reúnen las contribuciones de diversas unidades técnicas de la OPS para ofrecer una perspectiva regional. Se examinan así aspectos relacionados con los principales indicadores de salud, que van desde la mortalidad y los cambios en la esperanza de vida hasta la relación entre la Americas distribución del ingreso y el estado de salud. En el marco de la globalización, la reforma sectorial y otros factores macroeconómicos, se analizan las condiciones actuales y las tendencias generales de la salud, incluidas las que prevalecen en mate- ria de prevención y control de enfermedades, promoción de la salud, pro- tección del ambiente, disponibilidad de insumos y tecnología, y coopera- ción externa en salud. En el volumen II se presenta un análisis actualizado de la situación de salud correspondiente a cada uno de los países y territorios de las Américas. Expresión de un esfuerzo analítico que abarcó toda la Región y a partir de un marco común, este volumen examina los problemas gene- VOLUME I rales y específicos de salud, y la respuesta del sistema de salud. 2002 Edition Asimismo, se actualiza la información acerca de la organización institu- cional, las normas sanitarias y el funcionamiento del sistema de salud y de los servicios de atención de salud. La edición de 2002 de La salud en las Américas constituye una expre- sión colectiva de la voluntad política de los 47 países y territorios de Edición las Américas de superar las dificultades actuales con el mismo espíritu de 2002 panamericanista que dio lugar a la creación de la OPS en 1902. Esta edi- VOLUMEN I ción especial, que coincide con la celebración del centenario de la OPS, Am La conmemora también 100 años de cooperación interamericana y de pro- gresos en salud pública. salud é Organización Panamericana de la Salud Oficina Sanitaria Panamericana, Oficina Regional de la r Organización Mundial de la Salud icas Pan American http://www.paho.org/ en las Health Organization Celebrating 100 Years of Health Health in the Americas 2002 Edition Volume I Scientific and Technical Publication No. 587 PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the WORLD HEALTH ORGANIZATION 525 Twenty-third Street, N.W. Washington, D.C. 20037, U.S.A. 2002 Also published in Spanish (2002) with the title: La salud en las Américas, Edición de 2002 Publicación Científica y Técnica de la OPS No. 587 ISBN 92 75 31587 6 PAHO Library Cataloguing-in-Publication Data Pan American Health Organization Health in the Americas: 2002 edition Washington, D.C.: PAHO, © 2002—2v. (PAHO Scientific and Technical Publication No. 587) ISBN 92 75 11587 7 I. Title II. (Series) III.Author 1. HEALTH STATUS INDICATORS 2. PUBLIC HEALTH ESSENTIAL FUNCTIONS 3. EQUITY IN HEALTH CONDITION 4. HEALTH CARE REFORM 5. SUSTAINABLE DEVELOPMENT 6.AMERICAS NLM WB141.4.P187 2002 The Pan American Health Organization welcomes requests for permission to reproduce or translate its publications,in part or in full.Applications and inquiries should be addressed to the Publications Program, Pan American Health Organization, Washington, D.C., U.S.A., which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © Pan American Health Organization, 2002 Publications of the Pan American Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention.All rights are reserved. The designations employed and the presentation of the material in this publication do not imply the ex- pression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the status of any country,territory,city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar na- ture that are not mentioned. Errors and omissions excepted, the names of proprietary products are distin- guished by initial capital letters. PAN AMERICAN SANITARY BUREAU VALUES,VISION, and MISSION The Pan American Sanitary Bureau (PASB), the oldest international health agency in the world, is the Secretariat of the Pan American Health Organization (PAHO). The Bureau is committed to pro- viding technical support and leadership to PAHO Member States as they pursue their goal of Health for All and the values therein. Toward that end, the following values, vision, and mission guide the Bureau’s work. VA LU E S Equity Striving for fairness and justice by eliminating differences that are unnecessary and avoidable. Excellence Achieving the highest quality in what we do. Solidarity Promoting shared interests and responsibilities and enabling collective efforts to achieve common goals. Respect Embracing the dignity and diversity of individuals, groups, and countries. Integrity Assuring transparent, ethical, and accountable performance. VISION The Pan American Sanitary Bureau will be the major catalyst for ensuring that all the peoples of the Americas enjoy optimal health and contribute to the well being of their families and communities. MISSION To lead strategic collaborative efforts among member countries and other partners to promote equity in health, to combat disease, and to improve the quality of, and lengthen, the lives of the peoples of the Americas. CONTENTS Page Preface . xvii Introduction . xix I. REGIONAL HEALTH ANALYSIS . 1 Socioeconomic and Health Context in the Region of the Americas . 1 Political Factors . 1 Economic and Social Trends . 2 Environmental Trends . 4 General Trends in Public Health . 4 Effect of Economic Inequalities on Health Indicators . 5 Population Characteristics and Trends . 5 Population Distribution in the Americas . 6 Population Growth . 6 Annual Population Growth . 6 Births . 6 Birth Rate . 7 Fertility . 7 Mortality . .7 Deaths . 7 Crude Mortality Rate . 8 Infant Mortality . 8 Life Expectancy at Birth . 8 Age Structure . 8 Age Groups . 8 Aging . 9 Natural Population Growth . 9 International Migration . 9 Urbanization . 10 Percentage of the Population Living in Urban Areas . 10 Rate of Urbanization . 10 Growth of Cities . 11 The Relationship between Fertility and Mortality in the Americas . 11 Mortality Situation and Trends . 11 Mortality Profile, Magnitude, and Trends . 12 Communicable Diseases . 12 Neoplasms . 12 Diseases of the Circulatory System . 12 Diseases Associated with the Perinatal Period . 12 External Causes . 12 Impact of Mortality on Life Expectancy at Birth . 12 Infectious Diseases . 13 v HEALTH IN THE AMERICAS, 2002 EDITION, VOLUME I Neoplasms . 14 Diseases of the Circulatory System . 14 Diseases Originating in the Perinatal Period . 15 External Causes . 15 Other Causes . 15 Regional Health Inequalities . 16 The Socioeconomic Dimension of Health Inequalities . 16 Inequalities in Life Expectancy at Birth . 17 Inequalities in the Risk of Dying . 17 Inequalities in the Supply and Production of Health Services . 18 Inequalities in Health Determinants . 18 Regional Scenarios for Health Action . 19 Pan Americanism and Equity: Efforts toward a Healthier Hemisphere . 19 Methodological Annex . 58 Technical Notes . ..
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