LAUNCHING OF REGIONAL FORUM UNIVERSAL HEALTH IN THE XXI CENTURY: 40 YEARS OF ALMA-ATA

December 12, 2017 - Quito, Ecudor

Su Excelencia María Alejandra Vicuña, Vice Presidenta de la Republica de Ecuador
Dra. Verónica Espinosa Serrano, Ministra de Salud Pública del Ecuador
Dra. Carissa Etienne, Directora de la Organización Pan-Americana de la Salud
Embajadora Lourdes Puma, Vice-Ministra de Asuntos Internacionales y Movilidad Urbana, Subrogante
Distinguidos Ministros de Salud de las Américas, Señoras y Señores

Es para mí un verdadero placer estar en este lindo país hermano, estado miembro de la OEA, cuyo interés y desempeño en los temas grandes que preocupan a nuestros países en estos días se ve reflejado en la naturaleza del evento que hoy nos convoca.

I am deeply honored to participate in the launching of the Regional Forum Universal Health in the XXI Century: Forty Years of Alma-Ata, through which our Inter-American sister institution and strategic partner PAHO is trumpeting a call to all agencies and stakeholders to unite efforts to promote innovation and advocacy and to renew our commitment to universal health. Deseo también expresar a la Organización Pan-American de la Salud y en especial a la Dr. Etienne, nuestro agradecimiento por la amable invitación a participar en este foro. Les aseguro que pueden contar con todo el apoyo de la Secretaria General de la OEA en estos importantes trabajos.

At the Organization of American States, we hold that the health and well-being of our citizens is central to the organization’s agenda not only because it touches directly on two of our four pillars, that is, human rights and development, but also because it has a consequential bearing on the two other pillars of multidimensional security and democracy. In addition, the 2030 Agenda for Sustainable Development also requires that we boldly commit to good health and wellbeing across the Americas by ensuring opportunities for healthy lives and promoting wellness at all ages. Specifically, Goal 3, calls on us to commit to ending the AIDS epidemic, tuberculosis, malaria and other communicable diseases by 2030 with the aim of achieving universal health coverage, and providing access to safe and affordable medicines and vaccines for all. With Alma-Ata we are undoubtedly on the way to achieving these goals

We recognize that access to health is a fundamental human right and that we need to work together with PAHO, Member States and other strategic partners to give meaning and substance to this right in our hemisphere, particularly for groups in vulnerable situations and those that are traditionally excluded.

The Alma-Ata Declaration adopted in 1978, established a bold plan for global health action and social justice, identifying primary health care as the cornerstone for achieving health for all.

This demanded that nations establish health policies responsive to the many factors and determinants affecting the health of individuals and communities, ensuring universally accessible primary health care for all.

This hemisphere has certainly made important advances in health and human development, such as a dramatic decrease in infant mortality rates, an increase in life expectancy, in immunization and access to safe water and sanitation, to name a few, and the legacy of Alma Ata is truly undeniable. I will not go into specific statistics since these have been amply ventilated and analyzed over the last two days, suffice it to say that despite the progress achieved, we still face formidable challenges.

Our region has been recognized as having some of the highest socioeconomic disparities worldwide, often leading to insufficient access to quality health services and also to high mortality as a result of health related challenges, particularly for vulnerable groups.

In addition, some infectious diseases, such as tuberculosis, have not been eliminated, in large part because of its link to risk factors associated with living conditions, poverty and limited access to health services. HIV/ AIDS also continues to challenge the Americas and, Non Communicable Diseases (NCDs) continue to be the main cause of death, accounting for approximately 5 million deaths each year and disproportionately affecting the most vulnerable and disadvantaged groups. Even today, an estimated 36 million people remain without access to portable water and about 120 million lack improved waste water and sewage disposal. [1]

We still have notable shortfalls in terms of coverage of basic services, particularly in rural areas and in serving vulnerable and marginalized populations such as indigenous groups, afro-descendant populations and low-income groups.

Furthermore, our region has experienced widespread social and economic shifts, with significant health impacts. These include ageing populations, changes in diet and physical activity, urbanization and the deterioration of social structures that somehow contribute to health problems such as obesity, hypertension, increased injuries and violence, as well as problems related to alcohol, tobacco, and drugs. All of this, before we consider the health related stresses brought about by the continuous presence of natural disasters and emergent infections like the Zika Virus.

Unfortunately, most of the health problems of the Americas are related to social determinants such as poverty and exclusion.



These trends widen health inequities and threaten gains already made, endangering future progress towards better health and human development for all of our citizens.

Health deficits limit opportunities for people to generate income, to be educated and develop their potential, diminishing their capacity as individuals to participate in their communities.

There is no doubt that health is an essential element for reducing poverty and inequality and for achieving integral development across all of the Americas.

At the OAS, we already have the institutional instruments and the legal architecture to address the problems of poverty and its attendant maladies such as the challenges in the health sector both as an issue of human rights and of development. For instance, The Inter-American Democratic Charter, states that “the promotion and observance of economic, social, and cultural rights such as health are inherently linked to integral development, equitable economic growth, and to the consolidation of democracy in the states of the Hemisphere”.

In addition, the efforts of the OAS to advance the regional agenda of human rights is also based on the Additional Protocol to the American Convention on Human Rights in the area of Economic and Cultural Rights known as Protocol of San Salvador which has been in effect since 1999. The Protocol of San Salvador establishes the obligations of the countries of the Americas in relation to the fulfillment of rights, inter alia, to health, to adequate nutrition, to enjoying a healthy environment and to education, in addition to the right to work and organize, the right to the benefits of culture and social security.

In this sense, the Protocol of San Salvador institutes an innovative mechanism through a system based on reports by State Parties using a methodology grounded on indicators to measure progress on each of the rights. The indicators provide information on advances in public policies and are a useful tool for States to assess the status of the situation of economic, social and cultural rights at the national level and to improve public policies to ensure the realization of these rights.

Also worthy of mention are the Social Charter of the Americas and its Action Plan adopted in
2015, which reflect the OAS member states’ determination and commitment to eradicate poverty and hunger and urgently address the serious problems of social exclusion and inequality at all levels to achieve equity, inclusion, and social justice. The Plan of Action seeks to advance universal access to health care and universal coverage of comprehensive and quality health care, with equity, accompanied by social protection models in health care, particularly for populations in situations of vulnerability.

The OAS recognizes the importance of the coordination and integration of efforts at the multilateral level, and is moving assiduously in these efforts. For example, in 2014, our Secretariat and PAHO signed a joint declaration aiming to strengthen cooperation to promote the design and implementation of social protection and more equitable and integrated health systems toward achieving universal health and to expand quality health services for all citizens of the Americas.

Building upon that initiative, in 2015, the OAS through the Secretariat for Access to Rights and Equity joined PAHO and other multilateral agencies, such as ECLAC, the World Bank, the IADB and IICA on the Inter-American Taskforce on Non Communicable Diseases to coordinate activities and promote collaborative work between relevant sectors and governments to address Non Communicable Diseases. This commitment at the highest political level is important since, as I pointed out before, NCDS affect close to 250 million people in the Americas and are the main cause of death in the region, immensely impacting groups in vulnerable situations.

Another example, I would like to highlight is that in 2016, on the margins of the OAS 3rd Ministerial Meeting for Social Development, the OAS together with PAHO organized a discussion with Ministers of Social Development on the linkages of social inclusion strategies and health in all policies focused on Non Communicable Diseases in the region. This was an important discussion since social exclusion and persistent inequality in the distribution of income and access to services have an impact on the health of our citizens and these factors continue to erode any advances sought through poverty and development strategies.
In addition in 2016, the OAS and PAHO agreed to collaborate to undertake actions in the implementation of the 2030 Agenda and the SDGS to support Member States particularly addressing social determinants of health, equity and social inclusion as common challenges of the region.

Today, in the spirit of common purpose and collaboration, I want to reiterate the openness and readiness of our political forum as a hemispheric space for dialogue so that the OAS, PAHO, member countries and all stakeholders can discuss and exchange ideas, proposing solutions for the development of inclusive and comprehensive public policies to advance health as a human right for each individual and primary health care as the cornerstone for achieving health for all.

This is without a doubt a critical element for the development of our Member States and the security and stability of our democratic societies. We are committed to fostering and facilitating initiatives that address inequality and equal access to quality health services and social protection of those most excluded and we are committed to the success of this Forum.

We encourage the Ministers of Health gathered here to support our joint efforts and we look forward to continue working with PAHO to maximize the impact of our actions and to contribute from our end, based on the Inter-American instruments and mandates, towards the full realization of the right to health of every citizen in the Americas.

Thank you