PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau

. PAN AMERICAN HEALTH ORGANIZATION Pan American Sanitary Bureau, Regional Office of the WORLD HEALTH ORGANIZATION SCHOOLS AS ENGINE FOR DEVELOPMENT AND HEALTH, A NEW WAY TO PROMOTE COMMUNITY DEVELOPMENT WITHIN THE FRAMEWORK OF THE SOCIAL DETERMINANTS OF HEALTH FOR THE ACHIEVEMENT OF THE MDGs Dr. Sofialeticia Morales Senior Advisor Millennium Development Goals Team Leader Education and Health Pan American Health Organization Unit of Health Determinants and Public Policies

MILLENNIUM DEVELOPMENT GOALS HIGHEST LEVEL POLITICAL CONSENSUS ON MEASURES TO COMBAT POVERTY HEALTH OCCUPIES A CENTRAL PLACE OF IMPORTANCE FOR DEVELOPMENT GOALS, TARGETS AND INDICATORS ARE QUANTIFIABLE AND AMBITIOUS / MEASURE THE PROGRESS AND DEMAND PROGRESS 2 ¿WHY ARE THE MDGs IMPORTANT? Commitment to Action • Consolidate progress, resolve problems • Position health as a top public priority IT IS POSSIBLE TO CALCULATE THE COST OF ACHIEVING THEM, WHAT IS AVAILABLE VERSUS WHAT IS NECESSARY GLOBAL PARTNERSHIP FOR DEVELOPMENT EMPHASIZES HUMAN SECURITY AND GLOBAL PROSPERITY SAFETY AND WORLD PROPOSPERITY Pan American Health Organization • Reduce inequities • Respond to national and regional needs ØInequity and Poverty ØHIV/AIDS Ø Environmental Protection 2

The Millennium Development Goals • • 3 A set targets & indicators bound by a specific time frame for completion (1990 2015) A synergic and indivisible unit that requires intersectorial action for their completion Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality and empower women Reduce child mortality Improve maternal health Combat HIV/AIDS, malaria, and other diseases Ensure environmental sustainability Pan American Health Organization Develop a global partnership for development 3

4 OBJETIVOS DE DESARROLLO DEL MILENIO PAHO’s STAND ON THE MDGs • Highlight the challenge of inequity in the world’s most inequitable region. • Go beyond advocacy and monitoring to become Consideronthe social, economic, political, directly • involved interventions at the municipal environmental and cultural determinants and level. impact mapping on health. exercises of the • Carry outtheir a regional • Analyzemunicipalities, and respond tobased the multi-dimensionality most vulnerable on MDG and level multi-causality the poverty related local indicators of derived from particularly. • Work at theand municipal level to work on all the National Censuses Population. MDGs respecting. Agreement their indivisibility and synergy. (ECLAC/CELADE/PAHO ) • Launch the initiative Faces and Places of the Pan American MDGs Health Organization 4

The Social Determinants, Health Promotion and the MDGs social determinants refer to the social conditions in which people live, study, work, and develop” 5 “The MDGs recognize the interdependence of health and social conditions, and offer an opportunity to develop health policies that address the social roots of avoidable human suffering arising from unjust social conditions. Pan American Health Organization POVERTY EDUCATION HUNGER HEALTH & DEVELOPMENT AT SCHOOL ENVIRONMENT LABOUR 5

6 HEALTH PROMOTION PROTECTING & RISK FACTORS SOCIAL DETERMINANTS OF HEALTH SCHOOLS ENGINES FOR DEVELOPMENT MILLENNIUM DEVELOPMENT GOALS TWO WAY INTERACTION WITH THE MUNICIPALITY Pan American Health Organization 6

7 THE SOCIAL NATURE OF HEALTH Health is not exclusively a bio-natural occurrence related to the individual, but the result of complex and changing relations and interactions between biological, individual, environmental, and living conditions of economic, environmental, cultural, and political order. We get sick and we die in relation to the way we live, eat, reproduce, work, relate to others, educate, develop our capacities and face ours limitations. This is the focus of SOCIAL DETERMINANTS OF HEALTH Pan American Health Organization 7

8 Declaration on the New Orientations for Primary Health Care (Declaration of Montevideo) Commitment to facilitate social inclusion and equity in health. Recognition of critical roles of both the individual and community in the development of PHC-based systems. Orientation toward health promotion and comprehensive and integrated care. Development of intersectoral work. Pan American Health Organization 8

Renewing Primary Health Care in the Americas Principles Values ü Right to the highest attainable level of health ü Equity ü Solidarity üResponsiveness to people‘s health needs. üQuality – oriented üGovernment accountability üSustainability üParticipation üIntersectoriality Pan American Health Organization

The Causes of the Causes 10 SOCIAL CONTEXT CULTURE, RELIGION, SOCIAL SYSTEM HUMAN RIGHTS, LABOUR MARKET, EDUCATIONAL SYSTEM GLOBALIZATION ARISE FROM THE CONFIGURATION OF THE SOCIAL ESTRATIFICATION AND DETERMINE THE DIFFERENCES OF EXPOSITION AND VULNERABILITY TO THE CONDITIONS UNHEALTHY CONDITIONS BIOLOGICAL PROCESSES Pan American Health Organization HEALTH/ILLNESS 10 SOCIAL PROTECTION INTERMIDIATE DETERMINANTS HEALTH SYSTEMS PRIMARY HEALTH CARE PRODUCE SOCIAL STRATIFICATION AND INCLUDE TRADITIONAL FACTORS SUCH AS EDUCATION AND INCOME, AS WELL AS GENDER, ETHNIC ORIGIN AND SEXULITY HEALTH PROMOTION STRUCTURAL DETERMINANTS

Determinants of Health and the Millennium Development Goals Structural Determinants + Intermediate Determinants Social Poverty and Inequality Economic Political Environmental Degradation Environmental Styles of Life not Healthy Technological Biological Structural Determinants Pan American Health Organization + Intermediate Determinants + Risk Factors = Negative Impacts On Health Morbidity Hunger & Malnutrition Limited Access to health Services & Education Quality Unemployment Contamination and Climate Change Addictions Obesity Reduction of Factors of Risk Results in the Health 11 Vulnerability Maternal and Child` Diseases Communicable Diseases Chronicles Mental Health Problems HIV-AIDS = Millennium Development Goals 1990 -2015 Better Results in the Health Mortality Reduce Life Expectancy Low Quality of Life (-) Negative On Health Impact Positive in the Health 11 and the Quality of Life

DETERMINANTES SOCIALES DE LA SALUD Y SU IMPACTO EN LA ESCUELA Y EN LA COMUNIDAD 12 • Bad Quality Education • Bad Quality Health Services • Morbidity and Mortality • Materno. Adolescent Mortality • Access to education and ECONOMIC POLITICAL health services • Social Security POVERTY COMMITMENT TO HEALTH, and Protection MARGINATION SOCIAL POLICYL, LAWS MINIUMUM WAGE Programs REGULATIONS INCOME • Health and COMPENSATIONS Education as a FACES, VOICES right AMBIENTALES & PLACES SOCIALES Y SCHOOLS CULTURALES AIR AND WATER QUALITY • Poor basic sanitation SANITATION CHEMICAL SUBSTANCES • Parasites CONTAMINATION • Enfermedades infecciosas OZONE LAYER DEPLETION, CLIMATE CHANGE • Respiratory Infections Pan American Health • Diahreal Diseases Organization • Malaria, Dengue • Discrimination STRATIFICATION FACTORS Obesity ETHNIC GROUP, • GENDER, SEXUAL ORIENTATION. • Prevention Culture HEALTH HABITS • Stress PERCEPTIONS HEALTH/ ILLNESS • Sedentarism • Cardio Vascular and 12 metobolic pathologies • Violence

13 SOCIAL DETERMINANTS OF HEALTH AND EDUCATION Diagnosis and Context ECONOMIC • To what socioeconomic group the students belong to? • What economic problems have and how these affect their education and health? SOCIAL • Are their parents are illiterate or university graduates? • Do they have access to culture at home? CULTURAL • What is the value that their culture assigns to the education and health? ENVIRONMENTAL • Where is the school located? • Pan American What are the environmental problems in the municipality? Health 13 • Organization How do these problems affect their health?

Quality Education and teaching capacities for life 14 SELF UNDERSTANDING How to help students to understand themselves better? With themselves CREAT AND SUSTAIN RELATIONSHIPS How to educate to create and sustain healthy relationships? EMOTION CONTROL How to educate them to control their emotions? EMPATHY HANDLING STRESS How to make students empathetic? How to teach them to control their stress? SEXUAL RELATIONS Providing relevant information and respect for themselves and others? With others How to commit students to improving their social sorroundings? DECISION TAKING PROBLEM SOLVING CRITICAL THINKING CREATIVE THINKING Pan American Health Organization TRANSFORMING THEIR SORROUNDINGS With the community Education for freedom 14

What is the role of Schools in community development? 15 School Engines for Development play a key role in community transformation. Ø They promote health through knowledge, understanding, and reassessing the students immediate context. Ø The educational community is certain of the context where its everyday life takes place and can describe it by identifying the social determinants of health and analyzing how these social determinants play a key role in school life Ø An initial analysis takes place from the school and about the school to identify the interplay of the school and community and how its location limits or promotes educational quality and the school as motor for community transformation beyond classroom walls. Pan American Health Organization 15

16 What is the role of Schools in development, health promotion and addressing the determinants Ø The initial context analysis exercises is endogenous and centered around the school and mindful of the elements that promote or limit the provision of quality education. Ø The secondary level analysis is exogenous in nature and centered on the municipality as a geographical, jurisdictional and political entity. The analysis is based on the history, its peculiarities, and its cycles; sources of employment, economy, Pan American politics, and environment Health Organization 16

17 SCHOOLS AS AN ENGINE FOR DEVELOPMENT Human Development: Sustainable / Equitable Millennium Development Goals & other relevant national agendas Social Policy Health Promotion, Renewed Primary Health Care TARGET Children, Teenagers, Young Adults, Pan American Health Organization Social Determinants of Health 17

18 The Pedagogy of Development Ø Schools and Engines for Development base their strength in the pedagogy of development that has as its axiological foundation the value of human life as a fundamental right. Ø Takes on the paradigm of Education for Freedom, where education occurs through dialogue. This approach requires the development of alternatives and critical visions. Where the analysis of various points of view is essential for evaluating, transforming conceptions, attitudes, substantiate beliefs, and worldviews. Pan American Health Organization 18

19 The Pedagogy for Development and Education Ø The pedagogy of the development in the classroom where the educational act allows the transformation of the student’s understanding of community’s reality through dialogue and an analysis of the problems being faced. Ø The pedagogy of the development in the school implies a collegiate action that leads the students and the educator to develop a school project that involves the whole school. Ø Learning will take place by doing and the transformation of an aspect of the school. Ø The pedagogy of the development in the community through an action of co. Panresponsibility between the educational community and the key American Health actors of the community. Organization 19

20 Schools Engines for Development and Health Ø Arises from the analysis of the social determinants of health and aims advancing toward the achievement the Millennium Development Goals and other pertinent agendas with the understanding that schools are the engine for development. Ø The commitment implies first creating or consolidating the national, provincial and local networks of schools and later to promote the international networks. Ø The national Networks become solid foundations for the sharing of experiences, success stories and challenges in making that schools become promoters of development. It is necessary to link the schools with the first level of care within the framework of Primary Health Care to ensure that the local development is consolidated Pan American through Health the partnerships between schools and health services. Organization 20

SUPPORTING TECHNICAL PARTNERSHIPS 21 Social Protection and Education Workers Health UNESCO/OREALC/ PAHO/ILO Health and Occupational Health Virtual Network • Health Promoting Schools(1995), • Programs Educational Environments Responding to Violence in Schools. Healthy and Free settings Network of Healthy • HIV/AIDS prevention. Environment For Children Health Promotion and Prevention Primary Health Care Provision of Health Services Training and Education Strategies Pan American Health Organization 21

Other methods to promote health within the framework of the determinants 22 The promising introduction of programs that combine financial assistance with the human resources development and the improvement of health and living conditions ØBolsa Familia - Brasil ØOportunidades - México ØChile Solidario/ Chile Puente ØBarrio Adentro - Venezuela ØFamilias en Acción - Colombia ØBono de Salud - Bolivia ØBeca escolar - Ecuador ØPrograma de Asignación Escolar Honduras ØBono Alimentario y Escolar -Nicaragua ØRed de solidaridad y oportunidades El Salvador Ø Plan Familia - Argentina Pan American Health Organization 22

EMPHASIS: EQUITY IN THE RESPONSE TO THE SOCIAL DETERMINANTS Education with gender and intercultural perspective SCHOOLS ENGINES FOR DEVELOPMENT IN RELATION TO THE SCHOOL PROYECT AND THE MUNICIPALITY TO ADVANCE THE MDGs THE PEDADOGY OF DEVELOPMENT CAPACITIES FOR LIFE AS A TEACHING-LEARNING PROCESS AND EDUCATION’S 4 DIMENSIONS: LEARNING TO BE, LEARNING TO KNOW, LEARNING TO DO, AND LEARNING TO CO-EXIST IN TERMS OF LEVELS THE EMPHASIS IS PLACED ON INITIAL EDUCATION, PRE-SCHOOL, PRIMARY, SECONDARY, AND VOCATIONAL OR TECHNICAL. THE ROLE OF HEALTH AND Pan American DEVELOPMENT PROMOTING UNIVERSITIES Health Organization