Official Document No. 302 Promoting Health in the Americas Annual Report of the Director – 2001 Pan American Health Organization Pan American Sanitary Bureau, Regional Office of the World Health Organization 525 23rd Street, N.W. Washington, D.C. 20037 U.S.A. 2001 PROMOTING HEALTH IN THE AMERICAS Pan American Health Organization Also published in Spanish with the title: Promoción de la salud en las Américas. Informe Anual del Director – 2001 ISBN 92 75 37302 7 PAHO Library Cataloguing-in-Publication Data Pan American Health Organization Promoting Health in the Americas. Annual Report of the Director–2001.— Washington, D.C.: PAHO, © 2001 xix, 124 p.—(Official Document 302) ISBN 92 75 17302 8 I. Title II. Series III. Author 1. HEALTH PROMOTION 2. HUMAN DEVELOPMENT 3. HEALTH SERVICES 4. TECHNICAL COOPERATION 5. COMMUNICABLE DISEASE CONTROL 6. SUSTAINABLE DEVELOPMENT NLM WA590 The Pan American Health Organization welcomes requests for permission to reproduce or trans- late 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, reprints and translations already available. © Pan American Health Organization, 2001 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 re- served. The designations employed and the presentation of the material in this publication do not imply the expression 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 nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. Photos: Page 26, Carlos Gaggero, PAHO; page 40, Julio Vizcarra, PAHO; all other photos, Armando Waak, PAHO. This publication is available on-line at www.paho.org. ii Annual Report of the Director – 2001 Mission of the Pan American Sanitary Bureau The Pan American Sanitary Bureau is the Secretariat of the Pan American Health Organization (PAHO), an international agency specializing in health. Its mission is to cooperate technically with the Member Countries and to stimulate cooperation among them in order that, while maintaining a healthy environment and chart- ing a course to sustainable human development, the peoples of the Americas may achieve Health for All and by All. iii Annual Report of the Director – 2001 To the Member Countries In accordance with the Constitution of the Pan American Health Organization, I have the honor to submit the 2000–2001 annual report on technical cooperation activities of the Pan American Sanitary Bureau, Regional Office of the World Health Organization. Within the context of the strategic and programmatic orientations for the 1999–2002 qua- drennium, defined by the Governing Bodies of the Pan American Health Organization, the report analyzes the salient activities of the Organiza- tion’s technical cooperation program during this period. The report is complemented by the Interim Financial Report of the Direc- tor for the Year 2000. George A. O. Alleyne Director v Annual Report of the Director – 2001 Contents The Director’s Message . ix Chapter 1: . 1 Health Promotion and Protection Chapter 2: . 23 Health in Human Development Chapter 3: . 39 Environmental Protection and Development Chapter 4: . 59 Health Systems and Services Development Chapter 5: . 85 Disease Prevention and Control Chapter 6: . 109 Supporting the Delivery of Technical Cooperation: The Secretariat vii Annual Report of the Director – 2001 Health Promotion and Protection PASB directed much of its technical cooperation toward creating a new culture of health promotion and protection that views1 health as a social value. Health Promotion and Protection The Bureau pursued this goal by promoting a broad concept of health as the basis for human development and for an acceptable quality of life, and by encouraging Mem- ber States to pursue the five action areas or strategies of health promotion: estab- lishing healthy public policies, creating supportive environments for health, empow- ering communities, developing personal skills, and reorienting health services. A growing number of countries in the Region have recognized the importance of health promotion as a powerful public health strategy and have incorporated many of these action areas in their national health plans and programs. These advances have been achieved through active collaboration among national governments, non- governmental organizations (NGOs), national and international institutions, and com- munities. Although progress has been made toward many of the goals of “health for all,” challenges remain. The Fifth Global Conference for Health Promotion—”Health Promotion: Bridging the Equity Gap”—held in June 2000 in Mexico City, built on the advances of the four previous international health promotion conferences (Ottawa, 1986; Adelaide, 1988; Sundsvall, 1991; Jakarta, 1997). This conference brought together 100 countries to re- view the lessons learned since the first conference was held in Ottawa and to renew the commitment to promote the health of the world’s people, to increase intersec- toral collaboration, and to improve the infrastructure for health promotion. Ministe- rial delegations from almost all of the countries of the Region of the Americas partic- ipated and all signed the “Ministerial Statement for the Promotion of Health: From Ideas to Action,” also known as the Mexico Declaration. In signing the Declaration, PAHO Member States have committed themselves to strengthening health promotion planning by making health promotion a fundamental priority in local, regional, na- A young man’s lifestyle choices in tional, and international policies and programs; taking a leadership role to ensure adolescence will have far-reaching that all government sectors and actors in civil society participate in the implemen- consequences throughout his life: tation of health promotion activities that strengthen and expand partnerships for staying active and avoiding risky health; using every means available to support the preparation of nationwide health behaviors are like buying health promotion plans of action tailored to each country’s circumstances; establishing or insurance for adulthood and old age. strengthening national and international networks to promote health; advocating PASB has worked actively with Member that UN agencies be accountable for the impact on health of their development States, as well as in partnership with agenda; and informing the Director General of the World Health Organization of the other international agencies and progress made in the performance of the above actions so she can report on this to nongovernmental organizations, to the 107th session of WHO’s Executive Board. sponsor healthy policies and advocate A strategic planning process involving PASB, the Caribbean Food and Nutrition In- for legislation that protects adolescents’ stitute (CFNI), the Latin American Center for Perinatology and Human Development, rights. In addition, by encouraging the and the Institute of Nutrition of Central America and Panama (INCAP) was initiated to wide use of life skills training, many of integrate the technical areas within a conceptual and methodological framework for the young in the Americas have been health promotion. Understanding of the basic determinants of health inequities has empowered to take charge of their own improved significantly, yet social and economic inequities in the Region continue to health and sprint into a healthy future. 3 Annual Report of the Director – 2001 PROMOTING HEALTH IN THE AMERICAS Pan American Health Organization PAHO’s Representative in Canada Speaks Out on Health Issues As PAHO’s representative in Canada, the Canadian Society for International Health (CSIH) has vig- orously fought to focus attention on health issues. To publicize PASB’s work, CSIH organized a pres- entation on equity and health by Dr. George A.O. Alleyne, the Bureau’s Director. The presentation was well covered by the media and also drew representatives from several NGOs. CSIH celebrated World Health Day with a special ceremony and a forum to discuss this year’s theme, “Safe Blood Saves Lives.” The gathering provided an opportunity to distribute PAHO/WHO information kits on the issue to public health clinics, blood clinics, hospitals, health care associations, and government officials throughout Canada. Finally, the Society sponsored study tours of Canada for high-level health sector officials from the ministries of health of Bolivia, Honduras, Mexico, and Peru. In a press conference held in Ottawa, CSIH joined several other international organizations to plead for a quicker and more effective response to the growing worldwide crisis of children with HIV/AIDS. The Society also organized a media breakfast at the National Press Club to further pub- licize the issue. Representatives from television stations, Radio Canada, the Medical Post, and the Canadian Medical