EQUIDAD EN SALUD PARA EL DESARROLLO SOSTENIBLE
Abstract
Los notables logros del Programa Ampliado de Inmunizaciones en las Américas —a lo largo de cuatro décadas de arduo trabajo de control, eliminación y erradicación de enfermedades, discapacidades y mortalidades prevenibles— han demostrado que la universalidad en salud es alcanzable y la equidad en salud es posible. Transformar estos objetivos aspiracionales en metas realizables y sostenerlas en el tiempo demanda estratégica y explícitamente centrar la atención en la distribución justa de las oportunidades para la salud y el bienestar, incluyendo el acceso a las vacunas y sus determinantes proximales y distales. Las desigualdades sociales en salud son ubícuas, profundas y persistentes en la Región y la evidencia disponible muestra que tales gradientes en salud se reproducen en el acceso a los servicios de inmunización y las coberturas de vacunación. La noble aspiración por la equidad en salud es el soporte moral y político de toda propuesta por el desarrollo sostenible; la sostenibilidad misma del desarrollo dependerá del grado de equidad social logrado. Es imperativo fortalecer la acción sobre los determinantes sociales de la salud, mediante el alcance progresivo de acceso y cobertura universales en salud, la aplicación del enfoque intersectorial de salud en todas las políticas y el fortalecimiento de capacidades institucionales para generar evidencia sobre determinación social de la salud y reducción de desigualdades sociales en salud. Dos inconfundibles lecciones regionales han de iluminar este camino: las vacunas como elemento ecualizador en la salud pública y los programas de inmunización como práctica exitosa de universalidad en salud.
ABSTRACTThe remarkable achievements of the Expanded Programme on Immunization in the Americas —across four decades of hard work in the control, elimination, and eradication of diseases, disabilities, and preventable deaths— have shown that, indeed, universality in health is attainable and equity in health is possible. Transforming these aspirational objectives into achievable goals and sustaining them over time demand an strategic and explicit focus on the fair distribution of opportunities for health and well-being, including access to vaccines and their proximal and distal determinants. Social inequalities in health are ubiquitous, deeply entrenched, and persistent in the Region; the available evidence shows that such gradients in health are reproduced in access to immunization services and vaccination coverage. The noble aspiration for equity in health is the moral and political support of any proposal for sustainable development; actually, the very sustainability of development will depend on the degree of social equity achieved. It is imperative to strengthen the action on the social determinants of health, through the progressive realization of universal health access and coverage, implementation of the intersectoral approach to Health-in-All-Policies, and by building institutional capacity to generate evidence on social determination of health and reduction of social inequalities in health. Two distinct regional lessons shall illuminate this path: vaccines as an equalizer element in public health and immunization programmes as a successful practice of universality in health.
Key words: Equity, Health, sustainable development, Equity, Health, sustainable development.
Palabras claves: Equidad, Salud, Desarrollo Sostenible
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