Health surveillance in the framework of regional integration and its contribution to the improvement of the South American population´s health conditions30/08/2018 - Eduardo Hage
The South American region has presented an epidemiological pattern that maintains some similarities with other regions and, at the same time, has particularities framed by the permanence of social inequalities and their consequences in the health of the population.
Among the similarities are the changes in demographic indicators (decrease in infant mortality, increase in life expectancy at birth, proportional increase in the population of older people), reduction of communicable diseases (especially in mortality), and increase in proportional mortality due to other causes (chronic noncommunicable diseases, causes related to violence, metabolic diseases), to name a few. Some trends that have been deeper in other regions while in the South American region they continue to be more tenuous, such as the reduction in maternal mortality, in relation to which, in most of the countries, the goal established in the framework of the Millennium Development Goals was not met.
The particularities of the region are represented by broad ranges in the health indicators both among the countries of the region and among population groups. These inequalities, manifested as inequities (due to the injustice they represent) and the modification of universal access to health policies that are already being accompanied by setbacks in the health conditions of the population in some of the region´s countries, threaten the important advances that have occurred over the last decades. When we look, for example, at the most recent trends in communicable diseases, such as immuno-preventable diseases and tuberculosis, we identify how the maintenance of inequalities and the difficulties in accessing health technologies represent threats to the achievements made.
In recent decades, the South American region has witnessed great advances in the reduction of immuno-preventable diseases, such as the elimination of polio, measles, rubella and congenital rubella syndrome, as well as the reduction of most other diseases in this group. Meanwhile, outbreaks continue to occur and some of them present higher incidence levels than in past decades, as evidenced by outbreaks of measles in Brazil (in the northeastern region between 2013 and 2015 and in 2018 with wider dissemination) and in Venezuela (2018), in addition to a maintenance or an increase in the incidence of whooping cough in many countries of the region.
In relation to tuberculosis, there was a significant reduction in incidence and mortality in the region, for example, between 2000 and 2015, the incidence rate was reduced by 22.2% and the death rate by 37.9%. Meanwhile, this reduction is more visible until 2010 and as of this year there is a stagnation or slowing down of the reduction intensity. There is a very large heterogeneity among the countries of the region in these trends (for example, in relation to incidence there is a range of variation between – 49.6% (reduction) to + 37.5% (increase), which can reflect differences in the effectiveness of each country’s programs / actions, access to actions and technologies for diagnosis and treatment through primary health care, and different trends are identified within each country, with higher incidence (and maintenance of high rates) in more vulnerable population groups, for which the difficulty of accessing technologies, precarious housing conditions and hunger represent barriers for the improvement of epidemiological indicators.
Added to these threats are the emergence of new diseases, the resurgence of diseases that were under control and public health emergencies, which in the region find favorable conditions (vulnerable populations) for their production and dissemination. The occurrence of the Zika epidemic and its congenital and neurological repercussions, as well as the recurrence of epidemics by other arboviruses, are examples of this vulnerability in the region.
Health surveillance has historically represented a field of public health that has offered important contributions to achieve and maintain the achievements observed in the improvement of health conditions in the region. Whether through specific actions, such as vaccination, the early notification of suspected cases for the initiation of preventive actions, the detection and timely treatment of cases of diseases that spread person-to-person, or jointly with the care network, including intersectoral actions, necessary to address the determinants of noncommunicable diseases, violence, disasters, among others.
Since the beginning of UNASUR, South American countries formed a technical health surveillance group, which together with other regional and national bodies (ORAS-CONHU, MERCOSUR, PAHO), have provided the harmonization of procedures (such as definitions of cases, laboratorial diagnosis and measures of prevention and control of communicable diseases), facilitating the joint action in light of the common problems. Regional preparation for public health emergencies has been another example of the contributions of integration, within the framework of the International Health Regulations, for which countries developed common positions, presented at the annual sessions of the World Health Assembly and they supported each other in the development of the capacities foreseen in this framework.
In addition, disaster preparedness and response can be identified as areas of progress, for which the UNASUR Health Disaster Risk Management Network developed a specific Plan to effectively address this issue, which is under consultation at the countries, as defined by the South American Health Council (made up of the 12 Ministers of Health of the region), at its regular meeting held in September 2017. The National Institutes of Health were organized in a corresponding Network and have worked on important guidelines for the region, including topics related to laboratory diagnosis, as well as research on issues related to communicable diseases, environmental changes and their impact on the health of populations, among others.
The South American Institute of Government in Health (ISAGS) has contributed with these efforts for the strengthening of health surveillance in the region, in the areas of epidemiological, health and environmental surveillance in health. From the production and dissemination of knowledge on issues relevant to the region, such as the publication of the book Surveillance in Health in South America, support for the development of the guidelines established by the technical groups and corresponding networks (in own meetings or through participation in international events) and in the promotion of information exchange and identification of lines of cooperation between countries.
The approach to health surveillance from the performance of ISAGS in these activities, as well as that of all the bodies of the Health Council of UNASUR, has sought to work on issues related to the health situation in the region and surveillance actions in health, in an articulated way with the reduction of inequalities, understanding that the improvement of the health conditions of our region, in particular for the most vulnerable groups, depends on overcoming these inequalities.
Specialist in Surveillance in Health of the South American Institute of Health of UNASUR