Liderazgo, determinantes sociales de la salud y equidad en la salud: el caso de Costa Rica
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Campbell Barr, E., & Marmot, M. (2021). Liderazgo, determinantes sociales de la salud y equidad en la salud: el caso de Costa Rica [Journal articles]. https://iris.paho.org/handle/10665.2/54742
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2021
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[RESUMEN]. Costa Rica es un país de especial interés en la Región de las Américas y en la salud mundial debido a su buena salud. El Programa de las Naciones Unidas para el Desarrollo clasifica a los países según su nivel de desarrollo humano con base en la esperanza de vida, la educación y el ingreso nacional. Aunque Costa Rica está clasificada en el puesto 63 y dentro del grupo “alto”, en términos de salud pertenece al grupo “muy alto”. En el 2018, la esperanza de vida media de los países del grupo “muy alto” era de 79,5 años, mientras que en Costa Rica era de 80. En el 2018, la mortalidad en menores de 5 años era de 8,8/1000 nacidos vivos, inferior a la de los países clasificados en el grupo de desarrollo humano “muy alto”. Los años de escolaridad previstos en Costa Rica ascienden a 15,4; más cercanos al promedio de 16,4 años del grupo de desarrollo humano “muy alto” que el promedio del grupo “alto”. El país es mucho más saludable de lo que podría predecirse por su ingreso nacional; más bien, es probable que otras características del desarrollo de la sociedad hayan desempeñado un papel fundamental en el desarrollo de la buena salud. Entre ellas figuran: a) la decisión de dejar de invertir en la defensa nacional, que liberó dinero para invertir en la salud, la edu-cación y el bienestar de la población; b) la decisión de crear un sistema de salud universal financiado por el Estado, los empleadores y los trabajadores en el decenio de 1940; y c) el sistema educativo, que generó oportunidades para sacar de la pobreza a importantes sectores de la población, permitiéndoles disponer de condiciones sanitarias básicas que aumentan sus posibilidades de vivir más y mejor. A pesar de estos avan-ces, persisten desigualdades en términos de ingresos y condiciones sociales, lo que plantea desafíos en el ámbito de la salud, en particular para los grupos de menores ingresos y los afrodescendientes e indígenas. Estas desigualdades deben abordarse mediante decisiones basadas en pruebas científicas, un mayor uso de datos desglosados que revelen los progresos realizados para hacer frente a esas desigualdades, y una mayor articulación del sector de la salud con las políticas que actúan sobre los determinantes sociales de la salud.
[ABSTRACT]. Costa Rica has long been a country of special interest in the Americas and in global health because of its good health. The United Nations Development Programme ranks countries according to their level of human development based on life expectancy, education and national income. Although Costa Rica is ranked at 63 and classified as ‘High’, in terms of health it belongs in the ‘Very High’ group. In 2018 mean life expectancy for the ‘Very High’ countries was 79.5, while in Costa Rica it was 80. In 2018, under five mortality was 8.8/1000 live births, lower than countries ranked in the ‘Very High’ human development group. Expected years of schooling in Costa Rica is 15.4, closer to the average, 16.4 years, of the ‘Very High’ human development group than the average of the ‘High’ group. The country is much healthier than would be predicted by its national income; rather, other features of society’s development are likely to have played a key role in the development of good health. These include (i) the decision to cease investment in national defence, which freed up money to invest in health, education and the welfare of the population; (ii) the decision to create a universal health system financed by the State, employers and workers in the 1940s; and (iii) the educational system, that generated opportunities to lift important sectors of the population out of poverty, allowing them to have basic sanitary conditions that increase their possibilities to live longer and in better conditions. Despite these advances, inequalities in terms of income and social conditions persist, presenting challenges in the field of health, par-ticularly for lower-income populations and those of African and indigenous descent. These inequalities must be addressed using decisions based on scientific evidence, a greater use of disaggregated data to reveal progress in addressing these inequalities, and with a broader articulation of the health sector with policies that act on the social determinants of health.
[ABSTRACT]. Costa Rica has long been a country of special interest in the Americas and in global health because of its good health. The United Nations Development Programme ranks countries according to their level of human development based on life expectancy, education and national income. Although Costa Rica is ranked at 63 and classified as ‘High’, in terms of health it belongs in the ‘Very High’ group. In 2018 mean life expectancy for the ‘Very High’ countries was 79.5, while in Costa Rica it was 80. In 2018, under five mortality was 8.8/1000 live births, lower than countries ranked in the ‘Very High’ human development group. Expected years of schooling in Costa Rica is 15.4, closer to the average, 16.4 years, of the ‘Very High’ human development group than the average of the ‘High’ group. The country is much healthier than would be predicted by its national income; rather, other features of society’s development are likely to have played a key role in the development of good health. These include (i) the decision to cease investment in national defence, which freed up money to invest in health, education and the welfare of the population; (ii) the decision to create a universal health system financed by the State, employers and workers in the 1940s; and (iii) the educational system, that generated opportunities to lift important sectors of the population out of poverty, allowing them to have basic sanitary conditions that increase their possibilities to live longer and in better conditions. Despite these advances, inequalities in terms of income and social conditions persist, presenting challenges in the field of health, par-ticularly for lower-income populations and those of African and indigenous descent. These inequalities must be addressed using decisions based on scientific evidence, a greater use of disaggregated data to reveal progress in addressing these inequalities, and with a broader articulation of the health sector with policies that act on the social determinants of health.
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Campbell Barr E y Marmot M. Liderazgo, determinantes sociales de la salud y equidad en la salud: el caso de Costa Rica. Rev Panam Salud Publica. 2021;45:e101. https://doi.org/10.26633.RPSP.2021.101
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Item Leadership, social determinants of health and health equity: the case of Costa Rica(2020)[ABSTRACT]. Costa Rica has long been a country of special interest in the Americas and in global health because of its good health. The United Nations Development Programme ranks countries according to their level of human development based on life expectancy, education and national income. Although Costa Rica is ranked at 63 and classified as ‘High’, in terms of health it belongs in the ‘Very High’ group. In 2018 mean life expectancy for the ‘Very High’ countries was 79.5, while in Costa Rica it was 80. In 2018, under five mortality was 8.8/1000 live births, lower than countries ranked in the ‘Very High’ human development group. Expected years of schooling in Costa Rica is 15.4, closer to the average, 16.4 years, of the ‘Very High’ human development group than the average of the ‘High’ group. The country is much healthier than would be predicted by its national income; rather, other features of society’s development are likely to have played a key role in the development of good health. These include (i) the decision to cease investment in national defence, which freed up money to invest in health, education and the welfare of the population; (ii) the decision to create a universal health system financed by the State, employers and workers in the 1940s; and (iii) the educational system, that generated opportunities to lift important sectors of the population out of poverty, allowing them to have basic sanitary conditions that increase their possibilities to live longer and in better conditions. Despite these advances, inequalities in terms of income and social conditions persist, presenting challenges in the field of health, particularly for lower-income populations and those of African and indigenous descent. These inequalities must be addressed using decisions based on scientific evidence, a greater use of disaggregated data to reveal progress in addressing these inequalities, and with a broader articulation of the health sector with policies that act on the social determinants of health.Item An examination of socioeconomic equity in health experiences in six Latin American and Caribbean countries(2018)[ABSTRACT]. Objective. Most Latin American and Caribbean (LAC) countries are working toward the provision of universal health coverage, and ensuring equity is a priority for those nations. The goal of this study was to examine the extent to which adults’ socioeconomic status was related to health care experience in six LAC countries. Methods. This cross-sectional study examined the relationship between educational attainment and seven health experience outcomes in three areas: assessment of the health system, access to care, and experience with general practitioner. For this work, we used data from an Inter-American Development Bank survey of adults in Brazil, Colombia, El Salvador, Jamaica, Mexico, and Panama that was conducted in 2012-2014. Results. Brazil and Jamaica, the two countries with unified public coverage, stood out for having substantially greater inequality, according to the results of bivariate analyses, with more-educated respondents reporting better health care experiences for five of the seven outcomes. For Jamaica, educational differences largely remained in multivariate analyses: college graduates were less likely (odds ratio (OR) = 0.37) than those with primary education to report their health system needs major reform and were more likely (OR = 2.57) to have a regular doctor. In Brazil, educational differences were mostly eliminated in multivariate models, though people with private insurance consistently reported better outcomes than those with public coverage. Colombia, in contrast, exhibited the least inequality despite having the highest income inequality of the six countries. Conclusions. Future research is needed to understand the policies and strategies that have resulted in Colombia achieving high levels of equity in patient health care experience, and Jamaica and Brazil demonstrating high levels of inequality.Item Monitoring inequality changes in full immunization coverage in infants in Latin America and the Caribbean(2020)[ABSTRACT]. Objective. To compare inequalities in full infant vaccination coverage at two different time points between 1992 and 2016 in Latin American and Caribbean countries. Methods. Analysis is based on recent available data from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and Reproductive Health Surveys conducted in 18 countries between 1992 and 2016. Full immunization data from children 12–23 months of age were disaggregated by wealth quintile. Absolute and relative inequalities between the richest and the poorest quintile were measured. Differences were measured for 14 countries with data available for two time points. Significance was determined using 95% confidence intervals. Results. The overall median full immunization coverage was 69.9%. Approximately one-third of the countries have a high-income inequality gap, with a median difference of 5.6 percentage points in 8 of 18 countries. Bolivia, Colombia, El Salvador, and Peru have achieved the greatest progress in improving coverage among the poorest quintiles of their population in recent years. Conclusion. Full immunization coverage in the countries in the study shows higher-income inequality gaps that are not seen by observing national coverage only, but these differences appear to be reduced over time. Actions monitoring immunization coverage based on income inequalities should be considered for inclusion in the assessment of public health policies to appropriately reduce the gaps in immunization for infants in the lowest-income quintile.Item Subregional efforts to improve childhood cancer care in the Andean countries(2023)[ABSTRACT]. Cancer is one of the leading causes of death in children and adolescents younger than 19 years. An estimated 10 000 deaths are caused by this disease annually in this age group in Latin America and the Caribbean. In high-income countries, the survival of children and adolescents with neoplasms can reach 85%; however, in middle- and low-income countries, despite progress, survival rates are significantly lower (between 10% and 60%). Important inequities exist is survival from childhood cancer that need to be addressed through decisive actions from the health systems. This report describes the work of the ministries of health and the Secretariat of the Andean Health Organization (Organismo Andino de Salud – Convenio Hipólito Unánue (ORAS-CONHU)), to develop the Andean Cancer Prevention and Control Policy, with consideration given to childhood cancers. The policy was based on analysis of the cancer situation in the six Andean countries – Bolivia (Plurinational State of), Colombia, Chile, Ecuador, Peru and Venezuela (Bolivarian Republic of) – between 2015 and 2020, and it was approved in 2022. An in-depth study is currently being carried out on the situation of childhood cancer in the Andean countries.Item Aporte energético y de sodio de los alimentos notificados en la Encuesta Nacional de Ingresos y Gastos en los Hogares 2018-2019, Costa Rica, según la clasificación NOVA(2025-07-21)[RESUMEN]. Objetivo. Describir el aporte energético y de sodio de los alimentos notificados en la Encuesta Nacional de Ingresos y Gastos en los Hogares 2018-2019 de Costa Rica clasificados con el sistema NOVA según el grado de urbanización y los quintiles de ingreso. Método. Estudio descriptivo en el que se convirtieron los registros de compras de alimentos de la Encuesta Nacional de Ingresos y Gastos de los Hogares 2018-2019 en cuanto al contenido de energía y sodio, por medio de tablas de composición de alimentos. Se clasificaron los alimentos en los cuatro grupos NOVA y se analizaron según el grado de urbanización y los quintiles de ingreso. Resultados. De los 737 alimentos analizados, 52% eran procesados (14% del grupo 3) y 38% ultraprocesados (grupo 4). El 48% restante correspondió a alimentos naturales e ingredientes culinarios procesados (grupos 1 y 2). De la energía total consumida, 2 302 kcal por persona por día (kcal/p/d), aproximadamente 26% provenía de los grupos 3 y 4. En la zona urbana, el consumo de energía fue mayor (2 252 kcal/p/d versus 2 422 kcal/p/d en las zonas rurales); se destaca un mayor consumo de alimentos del grupo 4 en zonas urbanas (21,3% versus 14,0%, respectivamente). El grupo 2 aportó 2,53 g/p/d de sodio, seguido del grupo 4 con 0,84 g/p/d. Conclusiones. Los ingredientes culinarios procesados y los alimentos ultraprocesados son las principales fuentes de sodio dietético en Costa Rica, lo que indica la necesidad de políticas públicas para prevenir enfermedades crónicas no transmisibles asociadas al consumo excesivo de sodio. Se mantiene el patrón de consumo de energía en Costa Rica, la principal fuente son los alimentos naturales y mínimamente procesados, liderado por el subgrupo de los cereales, granos y pastas. A pesar de ello, los alimentos procesados y ultraprocesados contribuyen con al menos una cuarta parte del consumo calórico.