SECURITY HUMAN SECURITY: A Public Health Perspective HUMAN SECURITY: A Public Health Perspective...

HUMAN SECURITYSECURITY: A Public Health Perspective

HUMAN SECURITY: A Public Health Perspective

HUMAN SECURITY: A Public Health Perspective

Dr. Mirta Roses PeriagoDr. Mirta Roses PeriagoDirectorDirector

Pan American Health Organization (PAHO/WHO)Pan American Health Organization (PAHO/WHO)

LXVII Annual Meeting USMBHA /AFMESHuman Security: A New Border Response

El Paso, Texas, USA.June 3-5, 2009

HUMAN SECURITYSECURITY: A Public Health Perspective.

ContentContent

• Human Security: Its origins, development, and concept

• The contribution of human security to health

• National examples of human security and its usefulness for the MEX-US border


Three current topics that exemplify human security:

• Influenza A (H1N1) epidemic

• MEX-U.S. border violence

• Global economic crisis

IntroductionIntroduction


Mandatory References:

1. Human Development Report. New Dimensions of Human Security. UNDP (1994)

2. Millennium Summit - UN (2000)

3. Human Security Now.Intergovernmental Commission on Human Security – UN. S. Ogata & A. Sen (2003)

BackgroundBackground


A less violent world, but …

Number of armed

conflicts,1946-2003

Source: Human Security

Report 2005.

Uppsala/PRIO, 2004.

Number of armed

conflicts,1946-2003


Report 2005.

Uppsala/PRIO, 2004.


Number of armed

conflicts,1946-2003


Report 2005.

Uppsala/PRIO, 2004.

Number of armed

conflicts,1946-2003


Report 2005.

Uppsala/PRIO, 2004.


• Different from the concept of national security or state security. Emerges post-cold war

• Paradigm shift: state-centered security to people-centered security

• Need to address the human right to live without fear or want

• The key issue is to protect people from threats, risks, dangers, and want

What is new in the concept of human security?What is new in the concept of human security?


• Security against chronic threats such as hunger, disease, and repression

• Protection against sudden and harmful changes in everyday life, whether at home, in the job market, or at the community level.

HHUMAN SECURITY MEANS:UMAN SECURITY MEANS:


A world with fewer conflicts between countries but …

• Transnational organized crime (drug trafficking; human trafficking; weapons smuggling; money laundering)

• Interpersonal violence have become a visible phenomenon

Why human security? Why human security?


“ Protecting the vital core of all human beings in ways that

enhance human freedom and fulfillment. ”

“ Protecting fundamental freedoms - those which are the essence of life. It means protecting people from critical (severe) and

pervasive threats. ”

“ Creating political, social, environmental, economic, military and cultural systems that give people more reasons to live and enjoy a life with dignity. ”

Human Security Now. UN Commission on Human Security. New York, 2003.

Human Security is:Human Security is:


Relations and differences Relations and differences

HUMAN DEVELOPMENT

• Broad concept aimed at broadening options and opportunities

• Evaluates choices and access to public services and goods.

HUMAN SECURITY

• Focuses on risks, dangers and threats to the development of individuals

• Evaluates the degree of

confidence that people have in public services and goods

• Emphasis on what can be lost


1. Economic security2. Food security3. Health security4. Environmental security5. Personal security6. Community security7. Political security

Seven major categories of threats Seven major categories of threats to Hto Human uman Security Security


daily threats related to:

• Poverty• Pandemics• Environmental degradation• Lack of access to drinking water• Natural or man-made disasters • Maternal and child health risks• Unemployment• Violence• Lack of road safety

It attempts to addressIt attempts to address


• Protecting people in violent conflicts

• Protecting people from the proliferation of arms

• Supporting the security of people on the move

• Economic insecurity, the power to choose between different opportunities

• Health as a component of human security

• Knowledge, preparation for life, and values as components of human security

Six areas linking poverty and conflictSix areas linking poverty and conflict

Health and Well-beingHealth and Well-being

EducationAgriculture - FoodPotable Water/SewerageHousing

EducationAgriculture - FoodPotable Water/SewerageHousing

WorkEnvironmentEmployment

WorkEnvironmentEmployment

Violence & insecurityViolence & insecurityAddiction to narcoticsAddiction to narcotics

Violence & insecurityViolence & insecurityAddiction to narcoticsAddiction to narcotics

Social and Economic Development

Social and Economic Development

Health care 1. Resources2. Administration and management3. Opportunities Access Quality Users’ perception

Health care 1. Resources2. Administration and management3. Opportunities Access Quality Users’ perception

Social Network Condition of LifeFamily size

Social Network Condition of LifeFamily size

AgeGenderGeneticsLifestyle

AgeGenderGeneticsLifestyle

Adapted from WHO

H e a l t h D e r t e r m i n a n t sH e a l t h D e r t e r m i n a n t s


Conditions in which people are Conditions in which people are born, grow, live, work, and ageborn, grow, live, work, and age

Structural conditions that affecthealth at the global, national, and local level

Relationship between Human Security and Social Determinants of Health:

three levels of action

Research, Monitoring, Training


“ Public Health is joint action by the State and civil society to protect and improve the health of the people. It is an interdisciplinary social practice. ”

HUMAN SECURITY AND HEALTHHUMAN SECURITY AND HEALTH

Concept of Public Health

PAHO. Public Health in the Americas. Conceptual Renewal, Performance Assessment, and Bases for Action. Washington, D.C. 2002.


Two questions:

• How does human insecurity affect health?

• How do disease and adverse health conditions affect people’s security?

Relationship between Human Security and HealthRelationship between Human Security and Health


Gaps to fill in Human Security and Public Gaps to fill in Human Security and Public Health Health

• Give higher priority to granting universal access to basic, quality health care

• Empower all people by providing universal basic education

• Acknowledge the need for a global human identity, while respecting the freedom of individuals to retain their different identities and affiliations


Human security is reflected in a child who doesn’t die, a disease that doesn’t spread, a job that isn’t eliminated, ethnic tension that doesn’t explode into violence, a dissenter who isn’t silenced. Human security doesn’t involve concern about arms, but concern about human life and dignity.



“ In both developing and industrialized countries, threats to health security tend to be greater for the poorest populations, particularly children and rural dwellers. ”



“ Although the poor are generally less secure when it comes to health, poor women are in a particularly difficult situation. One of the most serious risks that they face is childbirth... ”



Human security and health are interdependent…

as health improves, so does human security

as human security improves, so do health conditions



• Infectious diseases: HIV/AIDS, avian flu, influenza A (H1N1), bioterrorism, epidemics, and outbreaks (special impact on fragile states)

• Poverty-related threats that impact health: the majority of preventable infectious diseases, nutritional deprivations, maternity-related risks

• All forms of violence and lack of road safety

The more evident challenges HUMAN SECURITY AND HEALTHHUMAN SECURITY AND HEALTH


• 230 million people (46%) lack health insurance

• 125 million (25%) lack access to basic health services

• 17% of births without the presence of a qualified birth attendant

• 152 million people lack access to safe drinking water and basic sanitation

SOCIAL EXCLUSION IN HEALTH THREATENS SOCIAL EXCLUSION IN HEALTH THREATENS HUMAN SECURITYHUMAN SECURITY


OUT OF POCKET EXPENDITURE IN HEALTH OUT OF POCKET EXPENDITURE IN HEALTH THREATENS THE FINANCIAL SECURITY OF THREATENS THE FINANCIAL SECURITY OF

HOUSEHOLDS HOUSEHOLDS

• Household out of pocket expenditure in health represents 37% of total spending in health and in various countries it exceeds 50%.

• Health spending is considerably greater among lower income families

• Out of pocket spending in health is between 16% and 40% greater in women than in men


SOCIAL SECURITY AND HEALTH SOCIAL SECURITY AND HEALTH

• Social achievement of workers.

• The basis of wellbeing • Human Rights – Right to Health

• Public Policy for poverty reduction, economic growth and social development


REDUCED CONTRIBUTIVE

BASELINE OF SOCIAL SECURITY

7,2

8,5

9,9

10,5

10,09,8

10,610,5

10,7

10,3

6,0

6,5

7,0

7,5

8,0

8,5

9,0

9,5

10,0

10,5

11,0

1990 1995 1998 1999 2000 2001 2002 2003 2003-1sem.

2004-1sem.

Ta

sa

de

de

se

mp

leo

en

%

51

51

52

52

53

53

54

Ta

sa

de

oc

up

ac

ión

en

%

Tasa porcentual de desempleo Tasa porcentual de ocupación

High unemploymentHigh unemployment

Increase in Increase in informal laborinformal labor

Source: ECLAC, 2004

Empleo Informal (como % del empleo total)

30%

43%48%

0%

10%

20%

30%

40%

1980 1990 2000

Classic Social Security is not enough to reduce Classic Social Security is not enough to reduce social exclusion and promote human securitysocial exclusion and promote human security


SOCIAL PROTECTION, CHANGING THE SOCIAL PROTECTION, CHANGING THE FOCUSFOCUS

• In short and medium term, employment cannot be the only mechanism to access social protection

• A better balance is required between incentives and solidarity

• New pressures due to demographic and epidemiological changes, as well as in the family structure

• Synergy of contributive and non contributive mechanisms

• Integral and integrating public policy


Expansion of classic social security schemes,

including the incorporation of informal workers

Promotion and development of innovative protection strategies, including

community based initiatives

Broadening mechanisms and projects for the extension of coverage of health systems

Develop links between previous mechanisms and other

protection mechanisms and public initiatives (overcome fragmentation, segmentation

and improve equity)

INOVATIVE ALTERNATIVES FOR THE EXTENSION OF SOCIAL PROTECTION IN HEALTH

SYNERGY AND COHERENCE


PAHO/ILO JOINT INITIATIVE ON THE EXTENSION OF

SOCIAL PROTECTION

IN HEALTH

EXTENSION OF SOCIAL PROTECTION IN HEALH


Decisions by PAHO/WHO, governments, and the scientific community aimed at:

• PROTECTING the population from the risk of contracting the virus

• PROVIDING timely quality care for infected people to lower case-fatality

• MINIMIZING as much as possible the adverse economic impact

THE CASE OF INFLUENZA A (H1N1)


RESSCADHealth and Human Security Agreement

Guatemala, Sept. 2006

• Priority given to violence and human security with a public health approach; emphasis on comprehensive prevention of youth violence

• Improvement of information systems

• Development of national and sub regional plans and programs


HONDURAS

Human Security Program UNDP, PAHO, UNICEF (JICA – UNFHS) • Violence prevention (selected municipalities)

• Information systems and observatories on violence (at national and local level)

• Social Culture

• Research


COLOMBIA Project: “Healthy and Safe Environments to ensure a decent

and productive life to young people affected by violence”

UNDP, PAHO, UNODC, UNICEF (JICA–UNFHS)5 DEPARTMENTS (Provinces)

• Advocacy, dissemination of knowledge

• Access to people-friendly health and education services, healthy and safe environments, guarantee of safe maternity services for young women

• Opportunities for employment and income generation


SÃO PAULO, BRAZILProject: “Human Safety in São Paulo” UN, UNESCO, PAHO, UNFPA, UNICEF (JICA-UNFHS)

• Violence reduction and creation of a culture of peace and harmony through education, health, and community participation

• Family-friendly hospitals and health centers • Health-promoting schools, reproductive health and sexual

education

• Violence-free environments, strengthening of community networks-social cohesion


SONSONATE, EL SALVADOR

Project: “ Improving Human Security, Social Cohesion, and Public Safety in Three Municipalities” UNDP, PAHO, UNICEF, ILO (JICA-UNFHS)

• Information systems and observatories on violence

• Community networks

• Promotion of employment and income generation for young people


GUATEMALAProject:“ Consolidating Peace in Guatemala through violence prevention and conflict resolution” UNDP, PAHO, UNFPA, UNDAF, UNHABITAT, UNESCO, UNICEF (AECI – MDG Fund) 3 municipalities

• Policy and legal framework reviewed and adapted - gender-based violence, youth violence, and violence against children and indigenous people

• National capacity to prevent conflict and address social violence: information systems, networks, indigenous communities


1. Raise regional commitment to incorporate the human security approach in health plans

2. Expand the concept beyond issues related to violence and conflict.

3. Identify and reduce threats to human security in each country

HUMAN SECURITY AND HUMAN SECURITY AND HEALTH HEALTH Challenges for PAHO and countriesChallenges for PAHO and countries


THANK YOU

GRACIAS

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