Davos 2009

• 5 of 5
• 

The Great Fall

By MICHAEL ELLIOTT AND PETER GUMBEL / DAVOS

ILLUSTRATION FOR TIME BY DENNIS WONG

(3 of 4)

Should such national bank-rescue schemes be subject to international control, and if so, by whom? At one limit, Angela Merkel, the German Chancellor, has advocated a sort of United Nations Economic Council, much like the Security Council. The idea has as yet won few backers — and the long, unsuccessful attempt to reform the membership of the Security Council itself would suggest it will get nowhere. Brown and others have urged reform and recapitalization of the Bretton Woods international financial institutions (IFIs), with a much greater role handed to the International Monetary Fund, to which Japan, quietly re-establishing the credibility in international financial debates it had in the 1980s, has pledged $100 billion. But reform of the IFIs, especially to give more weight to the views of developing economies (a key theme of Davos, with the chorus led by South Africa's finance minister Trevor Manuel) has been on the international agenda for the better part of two decades, to little evident effect. And then there is this week's issue: should the pay of bankers whose firms are being bailed out be limited, as the Obama Administration in the U.S. has said it plans to do?

Hepatology 2009 is available for download (PDF, 9MB)

Sebastian.Kamps@amedeo.com

Dear Colleague,

Mauss et al. have just published

Hepatology 2009
A clinical textbook
501 pages
ISBN: 978-3-924774-63-9

Hepatology 2009 is available for download (PDF, 9MB) at
http://www.hepatologytextbook.com/download12.htm

Hepatology 2009 is the winner of the second Amedeo Challenge Award (http://www.AmedeoChallenge.org). The textbook includes chapters on Hepatitis (A-E), Coinfections, Liver Fibrosis, Hepatocellular Carcinoma, Liver Transplantation, and Autoimmune and Metabolic Liver Diseases.

The editors and the authors agree to remove the copyright on their book for all languages except English and German (see http://www.HepatologyTextbook.com/ht/cr.htm).


Please inform your students and colleagues.

Best regards,
Bernd Sebastian Kamps

___________________________________________
Bernd Sebastian Kamps, M.D.
Flying Publisher
Amedeo
www.bsk1.com

health and human rights

From: Ruggiero, Mrs. Ana Lucia (WDC)

Pan American Health Organization PAHO/WHO 2009

Website: http://new.paho.org/hq/index.php?option=com_content&task=view&id=549&Itemid=643

 

PAHO/WHO’s strategies on health and human rights have as an objective the dissemination and promotion of the international human rights norms and standards among community leaders, health service users, advocacy group members, ombudspersons, medical professionals, and government workers and decision-makers, among others

Reducing health inequities through action on the social determinants of health

From: Ruggiero, Mrs. Ana Lucia (WDC)

WHO 124th Session EB124.R6 - Agenda item 4.6 -  23 January 2009

 WHO  Executive Board, Having considered the Secretariat’s report on the final report of the Commission on Social Determinants of Health,1 

RECOMMENDS to the Sixty-second World Health Assembly the adoption of the following resolution:

 Spanish: http://www.who.int/gb/ebwha/pdf_files/EB124/B124_R6-sp.pdf 

English: http://www.who.int/gb/ebwha/pdf_files/EB124/B124_R6-en.pdf

 

            French: http://www.who.int/gb/ebwha/pdf_files/EB124/B124_R6-fr.pdf

 “………Confirming the importance of addressing the wider determinants of health and considering the actions and recommendations set out in the series of international health promotion conferences, from the Ottawa Charter on Health Promotion to the Bangkok Charter for Health Promotion in a Globalized World making the promotion of health central to the global development agenda as a core responsibility of all governments (resolution WHA60.24);

“……..URGES Member States:

(1) to develop and implement goals and strategies to improve public health with a focus on health inequities;

(2) to take into account health equity in all national policies that address social determinants of health and to ensure equitable access to health promotion, disease prevention and health care;

(3) to ensure dialogue and cooperation among relevant sectors with the aim of integrating a consideration of health into relevant public policies;

(4) to increase awareness among public and private health providers on how to take account of social determinants when delivering care to their patients;

(5) to contribute to the improvement of the daily living conditions contributing to health and social well-being across the lifespan by involving all relevant partners, including civil society and the private sector;

(6) to contribute to the empowerment of individuals and groups, especially those who are marginalized, and take steps to improve the societal conditions that affect their health;

(7) to generate new, or make use of existing, methods and evidence, tailored to national contexts in order to address the social determinants and social gradients of health and health inequities;

(8) to develop, make use of, and if necessary, improve health information systems in order to monitor and measure the health of national populations, with data disaggregated according to the major social determinants in each context (such as age, gender, ethnicity, education, employment and socioeconomic status) so that health inequities can be detected and the impact of policies monitored in order to devise appropriate policy interventions to minimize health inequities  ……..”

 Eugenio Villar, Coordinator 

Department of Ethics, Equity, Trade and Human Rights (ETH) 
Information Evidence and Research (IER) World Health Organization 

Chronic Disease Cost Calculator

From: Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion 

Chronic diseases – such as heart disease, stroke, cancer, and diabetes – are among the most prevalent, costly, and preventable of all health problems. Medicaid spending has grown rapidly in recent years and is placing a significant burden on state budgets. It has become increasingly important to help states quantify and understand the financial impact caused by chronic diseases, as well as to inform state decisions on investments in chronic disease prevention and disease management programs.

To help states estimate the burden and financial impact of chronic diseases among their Medicaid beneficiaries, the Centers for Disease Control and Prevention and RTI International, in partnership with the Agency for Healthcare Research and Quality, the National Association of Chronic Disease Directors, and the National Pharmaceutical Council, developed the Chronic Disease Cost Calculator.

The Chronic Disease Cost Calculator is a downloadable tool that supports states in:

(1) Estimating state Medicaid expenditures for six chronic diseases – congestive heart failure, heart disease, stroke, hypertension, cancer, and diabetes.

(2) Generating estimates of the costs to Medicaid of selected chronic diseases using customized inputs (e.g., prevalence rates and treatment costs).

It is important to note that the Cost Calculator does not provide exact prevalence and Medicaid costs of the chronic diseases for each state. All reported numbers are estimates and could differ from actual values. The uncertainty in the estimates arises from a number of factors: the combination of several data sources, different levels of geographic detail available in the source data, and the fact that the parameters of the statistical analysis are themselves estimates. Due to differences in data sources and methods, the estimates will not necessarily agree with other cost estimates. When discrepancies occur between Cost Calculator estimates and other state Medicaid estimates, users should contact their state Medicaid department and state health department for clarification.

For a detailed explanation of Cost Calculator methodology, including how it calculates prevalence and per person costs, refer to the Chronic Disease Cost Calculator Technical Appendix (PDF–740K). For a detailed explanation of how to use the Cost Calculator, refer to the Chronic Disease Cost Calculator User Guide (PDF–781K).

Links:

• Download the Chronic Disease Cost Calculator
• Chronic Disease Cost Calculator Resources
• Chronic Disease Cost Calculator Top FAQ
• Help, technical questions or comments

FOR SOME, LDL CHECK DOES NOT PREDICT HEART’S FUTURE

By Paula Rasich Reviewed by Elizabeth Klodas, MD, FACC  January 21, 2009--New evidence shows that some people can be at increased risk for heart trouble even when their “bad” LDL cholesterol is at what’s considered a healthy level.

In an analysis from the INTERHEART study----a large-scale, case-control study looking at the relationship between blood fats and first heart attack in Asians---an international team of researchers found that even though LDL levels were on average 10 points lower in Asians than non Asians, heart attack risk was similar.

This scientific research, involving more than 12,000 people, is the first to compare data on ethnic groups across Asia---including South Asians, Southeast Asians, Chinese, and Japanese---as well as non Asians.  Researchers found that a greater proportion of Asians have LDL levels below 100 compared to non Asians, yet still have a high rate of heart attack. 

In recent years doctors have realized that some versions of “bad” cholesterol and other fats are worse than others. And they reason that two protein checks, apolipoprotein A (Apo A-1) and apolipoprotein B (Apo B), may be just as---if not more---important as your cholesterol reading in predicting heart risk.

Apo A-1 is a protein that ushers artery-clogging fats out of the bloodstream, while Apo B delivers those potentially damaging substances to vessel walls and leaves them behind. HDL cholesterol (the “good” kind) carries Apo A-1 protein.  LDL cholesterol and several other “bad” fats carry the Apo B protein type.  So having a high concentration of Apo B containing particles predisposes to artery wall damage and plaque build up.

In this study, abnormal protein levels---a low apolipoprotein A (apo A-1) and a high apoliprotein B (Apo B)---emerged as the strongest warning signaling risk of first heart attack.

The implication of this study is that LDL and HDL may not be the best targets in regard to therapy for reducing cardiovascular events, says study co-author Salim Yusuf, DPhil, professor of medicine at McMaster University in Ontario, Canada. “Apo A-I and Apo B are better markers. We were looking at the wrong component of lipids in assessing risk.”

Editors Comment:  Apo A-1 and Apo B levels are tests which are not routinely performed in clinical practice today.  However, data continues to mount with respect to the utility of these measurements, and it is very possible that apolipoprotein monitoring will replace traditional cholesterol evaluations in the future.  Some laboratories do offer this analysis and patients should check with their physicians to see if they are good candidates for this type of testing.  Because the absolute cholesterol values which placed Asian patients at higher risk for heart attack were relatively low in this large study, goal cholesterol levels and thresholds for initiating cholesterol lowering therapy may need to be adjusted for this population.

This study was published in the January 27, 2009 issue of the Journal of the American College of Cardiology. 

SOURCES:

Karthikeyan G. et al. Lipif Profile, Plasma Apoliproteins, and Risk of a First Myocardial Infarction Among Asians: An Analysis from the INTERHEART Study. The Journal of the American College of Cardiology, 2008.

 Salim Yusuf, DPhil, Professor of Medicine, McMaster University, Hamilton, Ontario, Canada.

Depression in later life in primary care

Published 2 February 2009, doi:10.1136/bmj.a3079
Cite this as: BMJ 2009;338:a3079

Research

Outcome of depression in later life in primary care: longitudinal cohort study with three years’ follow-up

E Licht-Strunk, general practitioner and postdoctoral fellow¹, H W J Van Marwijk, general practitioner and associate professor of general practice¹, T Hoekstra, PhD student², J W R Twisk, professor of methodology and applied biostatistics³, M De Haan, general practitioner and professor of general practice¹, A T F Beekman, psychiatrist and professor of psychiatry⁴

¹ Department of General Practice and the EMGO Institute for Health and Care Research of VU University Medical Centre, Van der Boechorstraat 7, 1081 BT, Amsterdam, Netherlands, ² Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Netherlands, ³ Department of Methodology and Applied Biostatistics, Institute of Health Sciences, Faculty of Earth and Life Sciences, VU University, ⁴ Department of Psychiatry and the EMGO Institute for Health and Care Research, VU University Medical Centre

Correspondence to: E Licht-Strunk e.licht@vumc.nl

Abstract

Objectives To study the duration of depression, recovery over time, and predictors of prognosis in an older cohort (55 years) in primary care.

Design Longitudinal cohort study, with three years’ follow-up.

Setting 32 general practices in West Friesland, the Netherlands.

Participants 234 patients aged 55 years or more with a prevalent major depressive disorder.

Main outcome measures Depression at baseline and every six months using structured diagnostic interviews (primary care evaluation of mental disorders according to diagnoses in Diagnostic and Statistical Manual of Mental Disorders, fourth edition) and a measure of severity of symptoms (Montgomery Åsberg depression rating scale). The main outcome measures were time to recovery and the likelihood of recovery at different time points. Multivariableanalyses were used to identify variables predicting prognosis.

Results The median duration of a major depressive episode was 18.0 months (95% confidence interval 12.8 to 23.1). 35% of depressed patients recovered within one year, 60% within two years, and 68% within three years. A poor outcome was associated with severity of depression at baseline, a family history of depression, and poorer physical functioning. During follow-up functional status remained limited in patients with chronic depression but notin those who had recovered.

Conclusion Depression among patients aged 55 years or more in primary care has a poor prognosis. Using readily available prognostic factors (for example, severity of the index episode, a family history of depression, and functional decline) could help direct treatment to those at highest risk of a poor prognosis.

Bridging the divide: global governance of trade and health

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia@paho.org>
crossposted from: EQUIDAD@listserv.paho.org

Bridging the divide: global governance of trade and health

 

Kelley Lee, Devi Sridhar, Mayur Patel

This is the second in a Series of six papers on trade and health Centre on Global Change and Health, London School of Hygiene and Tropical Medicine,

London, UK (K Lee DPhil); and All Souls College, Department of Politics and International Relations (D Sridhar DPhil) and Department of International

Development (M Patel MPhil), University of Oxford, Oxford, UK

Volume 373, Issue 9661, Pages 353-432 - 31 January 2009-6 February 2009

 

Abstract:  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)61776-6/abstract

 

The main institutions responsible for governing international trade and health—the World Trade Organization (WTO), which replaced the General Agreement on Tariff s and Trade (GATT) in 1995, and WHO—were established after World War 2. For many decades the two institutions operated in isolation, with little cooperation between them.

The growth and expansion of world trade over the past half century amid economic globalisation, and the increased importance of health issues to the functioning of a more interconnected world, brings the two domains closer together on a broad range of issues. Foremost is the capacity of each to govern their respective domains, and their ability to cooperate in tackling issues that lie at the intersection of trade and health. This paper discusses how the governance of these two areas relate to one another, and how well existing institutions work together…"

 

Trade and Health SERIES – The Lancet

Launched in London, UK, Jan 21, 2009

"The fact that trade directly and indirectly affects the health of the global population with an unrivalled reach and depth undoubtedly makes it a key health issue", states a Comment introducing the Series.

Executive summary

Many health professionals perceive trade as complex or unrelated to their practice. The Series on trade and health provides timely analysis of the key challenges to achieving an appropriate balance between trade and health across a diverse range of issues. This six-part Series examines differences in structures of the World Trade Organization and the World Health Organization that promote wealth before health. Issues of global trade governance, effects of trade practices on health of workers and the implications of intellectual property rights for access to live-saving medicines are all explored.

 

Series Comments

Trade and health: time for the health sector to get involved

Rhona MacDonald, Richard Horton

Full Text | PDF

Trade agreements and health in developing countries

Joseph E Stiglitz

Full Text | PDF

Health before profits? Learning from Thailand's experience

Mongkol Na Songkhla

Full Text | PDF

Trade and health: the need for a political economic analysis

David Legge, David Sanders, David McCoy

Full Text | PDF

Series Papers

Managing the pursuit of health and wealth: the key challenges

David P Fidler, Nick Drager, Kelley Lee

Summary | Full Text | PDF

Bridging the divide: global governance of trade and health

Kelley Lee, Devi Sridhar, Mayur Patel

Summary | Full Text | PDF

Trade and social determinants of health

Chantal Blouin, Mickey Chopra, Rolph van der Hoeven

Summary | Full Text | PDF

Trade in health-related services

Richard D Smith, Rupa Chanda, Viroj Tangcharoensathien

Summary | Full Text | PDF

Trade, TRIPS, and pharmaceuticals

Richard D Smith, Carlos Correa, Cecilia Oh

Summary | Full Text | PDF

Trade and health: an agenda for action

Richard D Smith, Kelley Lee, Nick Drager

Summary | Full Text | PDF

State of the World's Forests 2007 Food and Agriculture Organization of the United Nations  Rome, 2007

---

The designations employed and the presentation of material in this information product do not imply the expression of any opinion whatsoever on the part of the Food and Agriculture Organization of the United Nations concerning the legal or development status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

The designations employed and the presentation of material in the maps do not imply the expression of any opinion whatsoever on the part of FAO concerning the legal or constitutional status of any country, territory or sea area, or concerning the delimitation of frontiers./.../

Alcoolismo causa 57 mortes por dia no Brasil

Data: 20/01/2009

Estado: MS

A taxa de mortalidade por doenças associadas ao alcoolismo subiu de 10,7 para 12,64 óbitos por 100 mil habitantes em seis anos. 

Os dados, revelados em uma pesquisa feita pelo Ministério da Saúde, comparam os números registrados em 2000 e 2006 e, na avaliação de especialistas, pode ser ainda maior. 

“Esta é uma mostra do grave problema de saúde pública provocado pelo excesso de bebida”, assegura a coordenadora do Departamento de Análise de Situação de Saúde do Ministério da Saúde, Deborah Malta. 

Global Warming May Be Irreversible

Global Warming May Be Irreversible

Written by Nancy Atkinson

A new paper published by a leading researcher says many effects of climate change are already irreversible. Susan Solomon, a leader of the International Panel on Climate Change and a scientist with National Oceanic and Atmopheric Association (NOAA) said even if carbon emissions were stopped, temperatures around the globe will remain high until at least the year 3000. And if we continue with our current carbon dioxide emissions for just a few more decades, we could see permanent "dust bowl" conditions.Global Warming May Be Irreversible
Written by Nancy Atkinson

Early Life Stress May Have Consequences for Immune Function

By Todd Neale, Staff Writer, MedPage Today
Published: January 27, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

MADISON, Wis., Jan. 27 -- Children who go through stressful situations early in life may have weakened immune systems as they enter adolescence, researchers found.

Dinheiro bom...

28 de janeiro de 2009 |Jornal Zero Hora N° 15862
ARTIGOS
Dinheiro bom...,
por Aloyzio Achutti *
Há uma expressão popular que diz: Não se coloca dinheiro bom em cima de coisa ruim.

Entendidos no assunto têm, repetidas vezes, afirmado que a tão falada, e sentida, crise econômica tem sua origem em defeitos na aplicação do sistema econômico. Há quem considere até como autodefesa do capitalismo contra os abusos que vêm sendo tolerados e acobertados – particularmente onde o volume de dinheiro rola mais livre.

Problemas estruturais e de macropolítica são evidentes, basta lembrar a enorme e progressiva desigualdade socioeconômica espalhada pelo mundo, degradação do meio ambiente (chegando a ameaçar o clima global e a vida), a necessidade de inventar guerras para incrementar a indústria de material bélico para destruir e depois reconstruir, sem falar no pretexto de invasões para controlar insumos estratégicos...

Se perguntarem por que um médico mete sua colher torta em assunto que não é de sua especialidade, eu diria que além de sentir no bolso, e na consciência de cidadão do mundo, também a prática da medicina está contaminada, e favorece associar os feitos da economia com situações semelhantes de nossa experiência.

O decantado progresso da medicina tem se feito (principalmente a partir do modelo americano) através de investimentos em intervenções caríssimas e pouco eficientes, voltadas para pequeno número com doenças avançadas – atingindo hoje US$ 1 trilhão por ano nos EUA – e deixando 30 milhões sem cobertura.

Ninguém pode dizer que faltam médicos no Brasil. A falta de saúde não será resolvida injetando mais médicos onde faltam condições socioeconômicas para a população, acesso aos serviços e melhores condições de trabalho para os profissionais.

Ao modo da indústria bélica, a farmacêutica e de equipamentos também influem na percepção das necessidades e na definição das prioridades na pesquisa, na formação profissional e no serviço.

Recursos econômicos não faltam nos países onde a crise se desencadeou. Injetar mais dinheiro público é parecido com propiciar mais comida para quem já tem excesso de peso, ou sofre de complicações da obesidade (uma das causas mais importantes de doenças crônicas no mundo de hoje).

Há mais de 50 anos, o diretor da OMS já dissera que, se nenhum avanço tecnológico se fizesse, mas se melhorasse a distribuição dos cuidados básicos, com o que já se conhece, haveria mais saúde no mundo.

Da mesma forma, suspeito que se tanto dinheiro junto como nunca se viu (podendo chegar a US$ 3 trilhões) fosse empregado para a reforma do sistema, a busca de soluções energéticas renováveis e menos poluentes, teríamos mais chance de encontrar melhores saídas para a saúde global – incluindo a financeira – e para o equilíbrio macropolítico e do poder.

*MÉDICO

Relative Child Poverty, Income Inequality, Wealth, and Health

Eric Emerson, PhD
JAMA. 2009;301(4):425-426.

Abundant evidence now suggests that living in relative poverty and exposure to relative income inequality, especially in childhood, may have a detrimental influence on health and well-being during childhood and across the life course. This Commentary discusses the importance of relative poverty in childhood and the implications of income inequality for population health.

Child relative poverty (ie, children living in a household with relative income poverty) appears to be a potentially important indicator for children's health. Relative income poverty is commonly defined as having equivalized household income of less than 50% of the national median.1 Equivalization is calculated by dividing household income by an indicator of household composition or need, for example, the square root of the number of individuals living in the household.2 Child relative poverty is strongly related to overall income inequality as measured by the Gini coefficient, which reflects inequalities in the distribution of income and wealth for the population of a nation; a lower Gini coefficient suggests more equal income or wealth distribution, whereas a high Gini coefficient reflects more unequal distribution of income and wealth.3 For instance, the United States has both the highest national wealth and the highest Gini coefficient.3 Thus, in the United States, as with many of the world's richest countries, there is little or no association between national wealth and the levels of income inequality evident within those nations.

A conceptual framework for public health: NICE's emerging approach

Ruggiero, Mrs. Ana Lucia (WDC) to EQUIDAD
show details 1:33 PM (6 hours ago)

M.P. Kelly, E. Stewart, A. Morgan, A. Killoran, A. Fischer, A. Threlfall and J. Bonnefoy

Centre for Public Health Excellence, National Institute for Health and Clinical Excellence, London, UK; Greater Manchester Public Health Network, Manchester, UK ;Division of Healthy Public Policies, Ministry of Health, Santiago, Chile

Public Health 123 (2009) e14–e20 December 2008 - The Royal Society for Public Health - . e-Supplement

“….This paper outlines the National Institute for Health and Clinical Excellence's (NICE) emerging conceptual framework for public health. This is based on the experience of the first 3 years of producing public health guidance at NICE (2005–2008).



The framework has been used to shape the revisions to NICE's public health process and methods manuals for use post 2009, and will inform the public health guidance which NICE will produce from April 2009. The framework is based on the precept that both individual and population patterns of disease have causal mechanisms.

These are analytically separate. Explanations of individual diseases involve the interaction between biological, social and related phenomena. Explanations of population patterns involve the same interactions, but also additional interactions between a range of other phenomena working in tandem. These are described.

The causal pathways therefore involve the social, economic and political determinants of health, as well as psychological and biological factors.
Four vectors of causation are identified:
- population,
- environmental,
- organizational and
- social.

The interaction between the vectors and human behaviour are outlined. The bridge between the wider determinants and individual health outcomes is integration of the life course and the life…”

Funding: NICE and the Universidad del Desarrollo, Santiago Chile received funding to establish the Measurement and Evidence Knowledge Network which was one of nine knowledge networks established by WHO to support the WHO Commission on the Social Determinants of Health. This paper is not a statement of the views of WHO or the Commission.

É o SUS – ou é a pobreza?

No Jornal ZH de Hoje Moacyr Scliar comenta desigualdade e cita nosso trabalho que foi premiado como o melhor na área de Epidemiologia de 2008 nos Arquivos Brasileiros de Cardiologia.

27 de janeiro de 2009 | N° 15861
MOACYR SCLIAR


Na semana passada um estudo realizado pelo Instituto do Coração de São Paulo e publicado nos Arquivos Brasileiros de Cardiologia deu manchete em vários jornais do país. Segundo a pesquisa, pacientes que sofreram infarto do miocárdio e são atendidos pelo Sistema Único de Saúde, SUS, têm 36% mais chances de morrer do que aqueles que são acompanhados por médicos particulares ou de convênios.

Lendo esta frase, leitores, qual é a conclusão que se tira de imediato? Que o SUS não funciona, vocês dirão; que é um sistema ruim, precário. Mas será que é mesmo?

Indo um pouco adiante no trabalho descobrimos que na fase de internação a proporção de óbitos é praticamente a mesma nos dois grupos. A mortalidade maior em pacientes do SUS ocorre após a alta, quando a pessoa retorna a seu ambiente habitual. E isto enseja uma reflexão não apenas sobre infarto do miocárdio, como sobre o Brasil em geral. Em primeiro lugar é preciso dizer que, por paradoxal que pareça, uma maior mortalidade por doença cardíaca pode ser sinal de progresso – um progresso meio estranho, mas progresso de qualquer jeito. No passado, os brasileiros pobres não morriam de infarto, porque nem chegavam à idade em que o problema ocorre: faleciam antes, não raro na infância, de desnutrição, de diarreia, de doença respiratória. A expectativa de vida cresceu, e cresceu nos países ricos e pobres. As mortes por desnutrição e por doenças infecciosas, causadas por micróbios, diminuíram. Mas isto tem um preço. Viver mais não quer dizer viver de forma mais saudável. O pobre hoje tem mais comida, mas é comida calórica, gordurosa – pobre não come salmão nem caras saladas, nem frutas. Pobre fuma mais, e pobre é mais sedentário – passou a época em que trabalho implicava necessariamente movimento e trabalho físico, e academia de ginástica não é para qualquer um. Pobre tem menos acesso à informação sobre saúde, pobre consulta menos, às vezes porque não tem sequer como pagar a condução que o levará ao posto de saúde. Aliás, temos evidências disto em nossa própria cidade de Porto Alegre: um trabalho recentemente realizado pelos doutores Sérgio L. Bassanesi, Maria Inês Azambuja e Aloysio Achutti mostrou que a mortalidade precoce por doença cardiovascular foi 2,6 vezes maior nos bairros mais humildes da Capital.

Tudo isto explica a conclusão a que chegou o simpósio internacional sobre desigualdade em saúde reunido em Toronto, Canadá: “A pobreza, e não os fatores médicos, é a principal causa de doença cardiovascular”. Um artigo publicado no importante periódico médico Circulation salienta o fato de que 80% dos óbitos por doença cardíaca ocorrem em países pobres e acrescenta: “Os fatores de risco para doença cardiovascular aumentam primeiro entre os ricos, mas à medida que estes aprendem a lição e corrigem o estilo de vida os riscos concentram-se nos mais pobres. A suscetibilidade para esses problemas também cresce por causa do estresse psicológico.” Quando falamos no estresse psicológico não podemos esquecer aquele que está se tornando cada vez mais frequente, o desemprego. Vários estudos mostram que problemas cardíacos são mais comuns em desempregados.

Estas coisas não diminuem a responsabilidade dos serviços de saúde, públicos ou privados, ao contrário, aumentam-na. A questão da informação e da educação em saúde hoje é absolutamente crucial.

SUS e sistemas privados não são antagônicos, são complementares. É claro que a tarefa do SUS é muito maior – afinal, o sistema atende cerca de 80% da população – e é mais difícil: este é um país pobre, que tem poucos recursos inclusive para a saúde. Mesmo assim, e o próprio trabalho o mostra, estamos no caminho. Apesar de tudo, as coisas melhoram.

International Policy Centre for Inclusive Growth (IPC-IG)

Welcome to IPC-IG

The International Policy Centre for Inclusive Growth (IPC-IG) is a joint project between the United Nations Development Programme and the Brazilian Government to promote South-South Cooperation on applied poverty research and training. It specializes in analyzing poverty and inequality and offering research-based policy recommendations on how to reduce them. IPC is directly linked to the Institute for Applied Economic Research (IPEA), which does research for the Brazilian Ministry of Strategic Affairs, and the Bureau for Development Policy, UNDP. More...

Publications

IPC publications include Working Papers, Policy Research Briefs, issues of Poverty In Focus magazine, One Pagers and Country Studies.
All publications, by Country and Region and by Thematic Area.

ODM de todos os municípios

Reportagens


Belém, 20/01/2009
Site mapeará
Portal de monitoramento dos Objetivos do Milênio das 5.654 cidades do país será lançado durante Fórum Social Mundial realizado em Belém


DAYANNE SOUSA
da PrimaPagina
O lançamento de um portal de acompanhamento dos Objetivos de Desenvolvimento do Milênio (ODM) marcará a participação do PNUD e do UNICEF no Fórum Social Mundial, evento anual de movimentos e organizações da sociedade civil que nasceu como contraponto ao Fórum Econômico Mundial de Davos, na Suíça. Os ODM são uma série de metas socioeconômicas que os países da ONU se comprometeram a atingir até 2015. Durante o Fórum, serão discutidas formas de as metas serem incorporadas não só em nível federal, mas também pela administração dos municípios brasileiros.

No terceiro dia do evento, que ocorre em Belém de 27 janeiro a 1 de fevereiro, o Portal ODM será apresentado ao público. O site, que por enquanto conta com apenas algumas informações sobre as metas, reunirá índices sobre todos os 5.564 municípios do Brasil, o que permitirá saber o quanto falta para cada localidade atingir os ODM. Além disso, vídeos, artigos e notícias relacionadas aos Objetivos do Milênio poderão ser acessados pelo endereço. “O Fórum é o lugar ideal para a gente iniciar uma estratégia para incentivar ações locais em prol dos ODM”, afirma Luciana Brenner, uma das coordenadoras do projeto que deu origem ao portal.

Cognitive Impairment in Older Persons Linked to Vitamin D Deficiency

By Kristina Fiore, Staff Writer, MedPage Today Published: January 26, 2009 Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

CAMBRIDGE, England, Jan. 26 -- A low level of vitamin D in older patients is associated with a higher risk of cognitive impairment, researchers here said. Those with the lowest levels were more than twice as likely to have cognitive impairment (P<0.001),>Journal of Geriatric Psychology and Neurology. "Our results suggest that high levels of serum 25-hydroxyvitamin D are associated with lower odds of cognitive impairment," the researchers said./.../

Heart Association Recommends Daily Intake of Omega-6 Fatty Acids

By Kristina Fiore, Staff Writer, MedPage Today Published: January 26, 2009 Reviewed by Zalman S. Agus, MD; Emeritus Professor  University of Pennsylvania School of Medicine.

VERMILLION, S.D., Jan. 26 -- At least 5% to 10% of daily caloric intake should come from omega-6 fatty acids, according to an American Heart Association science advisory that emerged from a literature review.  Consumption of this level of omega-6 polyunsaturated fatty acids was associated with a reduced risk of coronary heart disease, William S. Harris, Ph.D., of the University of South Dakota, and colleagues reported in the advisory, published in the Feb. 17 issue of Circulation: Journal of the American Heart Association.  "Aggregate data from randomized trials, case-control and cohort studies, and long-term animal feeding experiments indicate that the consumption of at least 5% to 10% of energy from omega-6 fatty acids reduces the risk of coronary heart disease relative/.../