Post on 02-Jan-2021
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