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Plano Nacional de Saúde 2011-2016

“Comunidades, Autarquias & Saúde”

Lisboa, 28-29 Abril 2011

1. Experiências Europeias

Promover a saúde e reduzir as desigualdades em

saúde: desafios, oportunidades - uma experiência

europeia

Dr Erio Ziglio

European Office for Investment for Health and Development, Venice

World Health Organization

Regional Office for Europe

5 Lições

5 Aspectos

Contexto

Sumário

Health promotion is the

process of enabling

people to increase control

over their health and its

determinants, and thereby

improve their health.

Promoção da Saúde

Saúde Pública num mundo em rápida

mudança…

Lisbon 2011

Mudanças Climáticas

Source: Climate Change 2007: The Physical Science Basis

http://www.ipcc.ch/pdf/assessment-report/ar4/wg1/ar4-wg1-chapter10.pdf

Um Mundo de Pessoas Urbanizadas

Rural

Urban

Source: World Urbanisation Prospects | 2005 Revision

http://www.un.org/esa/population/publications/WUP2005/2005wup.htm

United Nations Projected Percentages

of Global Population

Source: World Population Prospects: The 1996 Revision, Annex 2 (low-variant projection). UN Population Division.

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

Year

0

5

10

15

20%

of

Glo

bal P

opula

tion

Age <5

Age 65+

Projected Actual

Na próxima vez que nos encontramos …

Haverá mais pessoas com > 65 do que < 5

Source: World Population Prospects: The 1996 Revision, Annex 2 (Low-Variant Projection) UN Population Division

Contexto Europeu da Saúde em rápida

mudança

A Região Europeia da OMS

HEALTH2020

Nova Politica de Saúde da OMS Europa

Porquê uma Nova Política de Saúde para a

Europa?

New era, with rapid

global and European changes

Increasing complexity of factors that

shape health and health inequities

Uneven progress in achieving health

goals to-dateNew challenges/

opportunities for

health as an asset for development

These demand a new approach to Health

Governance in 21st Century

5 Lições

5 Aspectos

Contexto

1. Aumento de inequidades em

saúde

Source: WHO Europe, HFA Database, July 2010

65

70

75

80

1980 1990 2000 2010

PortugalEuropean RegionEU CIS

Life expectancy at birth, in years

Inequidades em Saúde e Gradiente

Social

Source: Norwegian Ministry of health Care Services, 2007

Diferença de 8-10 anos em Esperança de Vida

com picos acima dos 30 anos.

Copenhagen

Évora

Lisbona

www.who.int/social_determinants

A world where

social justice

is taken

seriously!

Reduzir as Desigualdades numa Geração

2. Necessidades de investimentos mais

equilibradosPromotion

Individual Population

Treatment

3. Reforçar o Papel dos Sistemas de Saúde

Korányi Hospital, Budapest, Ungheria

Melhorar o desempenho através de prestação

de serviços efectivos

4. Consistência de Acção pela Saúde e outros

Sectores

Source: Adapted model from Diderichsen (2002) and from Morgan, Davis & Ziglio 2010

Decrease differential exposure

Decrease differential vulnerability

Decrease differential access

Decrease differential consequences

Increase health and development “Assets”

Consistência através dos diferentes

sectores: Saúde em todas as Políticas

Social capital

Social exclusion

Economic security

Individual and community coping resources

Physical environment

Community sense of frustration and failure

Inequities and Inequalities

Sustainability

Adelaide Statement on Health in All Policiesmoving towards shared governance for health and well-being

5. Níveis de governança

Joint new policy

Adjusted + more

efficient sectoral

policies

More efficient

sectoral policiesCooperation

Coordination

Integrated

Policies

Source: Adapted from Meijers E, Stead D. Policy integration: what does it mean and how can it be

achieved? A multi-disciplinary review. Delft University of Technology OTB Research Institute fir housing,

Urban and Mobility Studies.

Melhorar o desempenho através de

“Stewardship”, Project MURA, Slovenia

Source: www.euro.who.int/eprise/main/WHO/Progs/SED/socmarketing/20051024_3

IfH

HEALTH CARE

CENTERS

HOSPITAL

Schools

Kindergartens

Mayors

Employment agency

Regional & local development

agencies

Chamber of

commerce

NGOs Agricultural

extension service

Tourist association

Food Industry

Health spa resorts

Local coordinators

Regional park

Goričko

Parcerias ao nível nacional, regional e local

Uma imagem vale mais do que 1000 palavras

...

Source: Vionen, M., 1998

- Sustained political commitment

- System rigidity

- Skilled human resources

- Develop integrated approaches

- Create incentives for intersectoral action

- Avoid fragile financing mechanisms

- Avoid Isolated programmes

- Strengthen Organizational / Institutional capacity

Lidar com o Sistema de Saúde

5 Lições

5 Aspectos

Contexto

Como podemos tornar a vida dos

indivíduos e comunidades mais fácil?

Religar Pessoas e Comunidades

Análise de implementação

Experiências Sub-nacionais

Slovenia

Czech Republic United Kingdom

MURA Project

Liberec

South Moravia

South Bohemia

North West Region

Italy

Tuscany

Veneto

Friuli Venezia Giulia

1. Maior Capacidade (nacional/ local)

– sufficient capacity in terms of personnel;

– with adequate training;

– and sufficient mandates and responsibilities

allotted to them.

Source: Adapted from Ståhl T, Wismar M, Ollila E, Lahtinen E, Leppo K, eds. (2006). Health in

All Policies. Prospects and Potentials. Helsinki: Ministry of Social Affairs and Health, pag. 276.

Reduce

Risk

Factors

Reduce

Risk

Conditions

Maximize

Assets

2. Gerir „Sistemas‟ não apenas intervenções

isoladas

3. Um Modelo Integrado de Acção

Source: NHS, Scotland

LIFE CIRCUMSTANCES

LYFESTYLE

INDIVIDUAL

BEHAVIOUR

SETTINGS

Programmes

Policies

Health

Economic

Development

Social

Development

4. Reposicionamento da Saúde no

desenvolvimento

5. Maximizar os recursos da comunidade

local