Adding a social component to sanitation work has traditionally been done as a separate, “decorative element,” which can be seen as dispensable. By this logic, a direct relationship is not forged between the objective of the project and the interest of its beneficiaries, and so the sanitation intervention is rendered ineffective.
The Federal District Environmental Sanitation Company (Companhia de Saneamento Ambiental do Distrito Federal) (CAESB) has used the Condominial Sewerage System for over 30 years with a great deal of success. It has become a reference point for this type of sanitary sewage modal, where the community mobilization social component, which involves community participation and environmental education, demonstrates that these areas are key to achieving success and effectiveness in a sanitation intervention, which is a fundamental element in the current context of chronic service deficits of this type of infrastructure as well as of insufficient resources.
This article seeks to describe the defining aspects of the Condominial Sewerage System in the Federal District and provide an overview of the key features of the methodology as used by CAESB and its experience in developing the social components of community participation and environmental education which are used in implementing this type of sanitary sewerage system. At CAESB, this social component is absolutely inseparable from the technical component, which is why it is called “technical-social mobilization.” It is a set of actions, always transversally linked with the technical procedures, establishing the common objective of universalization of sewerage system service. Operating in this way for more than 30 years has established a strong relationship between the company and the community, based on a sense of civic duty. This has optimized resource use and allowed every family to connect to the system, with more than 350,000 sewage connections, serving more than 1,500,000 inhabitants throughout the Federal District.
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Article
A Case Study of Brasília and the Federal District: Community Participation and Sanitary and Environmental Education in Condominial Sewerage Systems at CAESB
César Augusto Rissoli and Maria Martinele Feitosa Martins
Article
Active Global Citizens as Adolescents and Adults
Anna Jarkiewicz and Mariusz Granosik
Defining global citizenship (GC) depends on the perspective undertaken. The academic literature on GC is divided into two theoretical approaches: normative and interpretative. The first of these can also be called the attributive approach, because it refers to specific attributes that indicate whether someone is, or is not, a global citizen. This approach emphasizes the importance of education, during the course of which appropriate skills, competencies, and attitudes characterizing a global citizen are shaped. In contrast, representatives of the interpretative approach do not concentrate on creating a list of attributes through the prism of which the concept of GC can be identified but, rather, try to recognize what meaning individuals and language users ascribe to the concept. Understanding what GC is and what meaning actors ascribe to it is crucial in this view. The adopted theoretical perspective also determines who is and who can be a (global) citizen. The education emphasized in the normative approach, and the related course of acquiring specific attributes, means that only adults are recognized as (global) citizens. Young people are only citizens in the making. Consequently, full citizenship is an exclusive social category that is acquired on reaching the age of majority. In the interpretative approach, both adolescents and adults are considered equally as citizens. This approach stands in opposition to the age-determined order and seeks to broaden analysis by breaking from a transitional life-stage paradigm that works to divide childhood from adolescence and adolescence from adulthood. In this approach, we do not become citizens but are citizens from the very beginning of our lives. Within this concept, shifting young people’s understanding of life by applying “citizenship” as an inclusive social category is necessary. Depending on what theoretical perspective is used, a diverse range of educational practices will be employed—global citizenship education (GCE). The normative approach is related to the idea of GCE and practical notions about how GC could be taught in educational institutions or learned in other settings. In the interpretive approach, the emphasis is on cooperation in creation, joint and democratic decision-making, from which no one is excluded, regardless of age, race, religion, gender, and so on. In the same way that globalization became the target of criticism, the idea of GC and GCE is generating increasingly more discussion. Some of its aspects refer to the neoliberal foundation of GC; in that context, GCE can be understood as a system of influencing individuals to adjust them to the economic expectations of contemporary markets. Also, the expansion of the GC idea to other continents forced educators to take into account the achievements of cultural anthropology and academics to conduct international comparative research. What in the normative conceptualization was considered a universal norm in light of intercultural studies began to be perceived as a neocolonial expansion of Euro-American culture. This raises a fundamental question about a better (less colonializing) variant of global education. One of many answers is critical global learning, focused on demystification of dominant global discourses, mapping local discourses to recognize their statuses, tracing individual or institutional narratives to collective “root” meta-narratives, and emancipation of those who are discriminated against or not recognized in their formal civil rights.
Article
Adolescent Sexual and Reproductive Health
Ndola Prata and Karen Weidert
Adolescence, spanning 10 to 19 years of age, begins with biological changes while transitioning from a social status of a child to an adult. For millions of adolescents in low- and middle-income countries (LMICs), this is a period of exposure to vulnerabilities and risks related to sexual and reproductive health (SRH), compounded by challenges in having their SHR needs met. Globally, adolescent sexual and reproductive ill-health disease burden is concentrated in LMICs, with sexually transmitted infections and complications from pregnancy and childbirth accounting for the majority of the burden. Adolescents around the world are using their voices to champion access to high-quality, comprehensive SRH information and services. Thus, it is imperative that adolescents’ SRH and rights be reinforced and that investments in services be prioritized.
Article
Advancements in Social Sciences Applied to Health in Latin America and the Caribbean
Aurea Maria Zöllner Ianni and Patricia Tavares Ribeiro
The second half of the 20th century saw the development of social thought in health in Latin America and the Caribbean in which the social sciences had a central role. Such an innovative development was based on the understanding that health and disease are social processes that require the understanding of different health contexts. The origins of this development dates back to the renewal of medical teaching in Latin America, which had important support from the Pan-American Health Organization. The so-called field of social sciences in health then took shape, especially beginning in the 1970s and 1980s. The social sciences became part of teaching and assistance activities in social medicine and public health in many countries and contributed to consolidating postgraduate programs and networks of professors, researchers, professionals, and government agents who were active in public health actions and policies. Regarding Latin American realities, the issues of inequality in incidences of sickness and death and in the healthcare delivered to populations became relevant during this time. In close dialogue with relevant social groups, these actors have been significant in constructing responses to health problems in the region. Given the profound political, social, economic, environmental, and sanitary changes that took place in the transition from the 20th to the 21st century, social thought has attempted to meet the new empirical as well as theoretical and conceptual challenges to social sciences as applied to health. The analysis of the trajectory of this regional development, its details, advancements, and limits, is an important endeavor that should help to encourage suggestions toward bettering public health as well as fairness in these times of uncertainties and of new risks for humanity, as evidenced in an unprecedented way in the handling of the Covid-19 pandemic.
Article
An Assessment of the Widespread Use of Increasing Block Tariffs in the Municipal Water Supply Sector
Dale Whittington and Céline Nauges
The design of municipal water tariffs requires balancing multiple criteria such as financial self-sufficiency for the service provider, equity among customers, and economic efficiency for society. Globally, various forms of water tariffs are in use (e.g., tariffs based on fixed or volumetric charges, single and two-part tariffs, and increasing or decreasing block tariffs) but increasing block tariffs (IBTs) have become popular worldwide over the last few decades for two main reasons. Apart from the fact that IBTs incentivize households to save water by charging large volumes at a higher price, there is a widespread belief that IBTs are pro-poor. The latter would be the consequence of providing all households with a minimum amount of water at a low (subsidized) price while large water users pay higher prices. However cross-subsidization between wealthy and poor households will occur only if poor households’ consumption falls in the low (subsidized) block and if rich households consume in the higher block and pay a price that is above the average cost of supply. These two conditions are rarely met in reality and IBTs often fail to allocate subsidies to the poor effectively. There are a few examples of water utilities making adjustments to the tariff to take into account that poor households with large families are likely to be adversely affected by IBTs. However, the provision of a minimum amount of water for free (as in South Africa), the design of household-specific low-cost water allowances (as in California), or tariffs being adjusted based on household size do not usually improve the targeting of subsidies to the poorest households. The widespread use of IBTs is difficult to rationalize, in particular while knowing that the use of a (simple) uniform volumetric tariff where water provision is charged at its full cost could improve social welfare by removing price distortions and would be easier for households to understand than IBTs. This simple tariff could be combined with some consumer assistance programs to help the poorest households pay their bills.
Article
An Intersectional Feminist Approach for Advancing Sexual and Reproductive Health and Rights Through Universal Health Coverage
Mandira Paul, Rajalakshmi RamPrakash, Veloshnee Govender, and Jesper Sundewall
It is broadly agreed that sexual and reproductive health and rights (SRHR) and universal health coverage (UHC) are intimately linked. UHC has been described as a pragmatic means for advancing SRHR, and SRHR is considered an essential component of UHC. SRHR is universally recognized as a fundamental dimension of health and well-being and a human right. Ensuring SRHR requires a comprehensive, intersectional, and life-course approach, recognizing the layers of privilege or vulnerability that may influence one’s sexual and reproductive health needs and opportunities to fulfill one’s sexual and reproductive rights, as well as the shifting needs of individuals across the life course. UHC, on the other hand, implies that all people have access, without discrimination, to nationally determined sets of the needed promotive, preventive, curative, rehabilitative, and palliative essential health services. UHC also entails access to quality medicines and vaccines while ensuring that the use of these services does not expose the users to financial hardship. In 2019, the Political Declaration on UHC stipulated that access to SRH services as a key aspect of UHC was to be achieved by 2030. The declaration also reaffirmed commitments to the International Conference on Population and Development Programme of Action and Beijing Platform for Action. While SRHR is integral to the UHC agenda, and the delivery of both SRH services and UHC relies on functioning and quality primary health care systems, there are limitations of the UHC agenda for advancing SRHR.
The aspiration of UHC and to what extent it has integrated SRHR under its ambit and advanced it from a gender and rights perspective can be revealed by a set of cases reflecting the experiences of people in vulnerable situations, which illustrate different shortcomings in the current UHC framework and its translation on the ground. These shortcomings include systematic exclusions and discrimination of persons currently belonging to marginalized groups, inadequate investment in and respect for women health workers, violations of autonomy and dignity, lack of accountability, and power of politics. These shortcomings, which limit access to and experience of quality health services, cannot be removed by narrowly focusing on addressing the “ability to pay” or reducing the financial barriers alone. Therefore, the current framing of UHC is insufficient to progressively realize SRHR and thus demands a reconceptualization and/or extension of current framing and design.
To address the shortcomings, an intersectional feminist approach to UHC is proposed. Shifting mindsets and including gender and power analysis in UHC design, operationalization, and measurement of UHC outcomes will allow for achieving the UHC objectives of financial protection, equity in access, and service quality. Taking an intersectional feminist approach to UHC would improve not only SRHR outcomes but also health outcomes at large. It will furthermore offer a pathway to truly deliver on the objectives of UHC—equitable health care for all.
Article
Application of One Health Principles to the Control of Antimicrobial Resistance
Meghan F. Davis
One Health interventions that address human, animal, and environmental health domains are critical for controlling the global challenge of antimicrobial resistance (AMR). These interventions can target upstream conditions, such as prevention strategies like vaccination or policies, to restrict antimicrobial use in humans, animals, and plants, with a goal to reduce the selective pressure that can drive the emergence and expansion of drug-resistant pathogens. Downstream, environmental hygiene initiatives can target transmission pathways between people and animals to limit exposure to drug-resistant pathogens. Holistic, transdisciplinary approaches that address the factors driving antimicrobial use in people, animals, and the environment hold promise to help curb the global challenge of AMR.
Article
Approaches to Contraceptive Methods for Men
Christina Wang and Ronald S. Swerdloff
Unlike female contraception methods, male contraception has had no new approved approaches since the introduction of no-scalpel vasectomy over 40 years ago. Men who wish to share family planning responsibilities have withdrawal or condoms as available reversible methods of contraception. These methods have a high failure rate and are user dependent. While a vasectomy can be surgically reversed, it should be considered a form of permanent contraception because pregnancy in the partner cannot be guaranteed after reversal. Experimental methods, including chemicals to block the vas deferens, are undergoing testing.
Since the 1970s, hormonal male contraception using testosterone alone and testosterone combined with a progestin demonstrated high efficacy and few short-term adverse effects. Long-term adverse effects cannot be determined until a hormonal male contraceptive method is approved, allowing safety studies to be performed. Contraceptive efficacy studies have shown failure rates comparable to those of hormonal female contraception. Current studies focus on user-controlled methods such as daily transdermal gels, oral pills, and long-acting injectables. Large-scale population studies performed in the early 2000s confirmed that over 50% of men surveyed would try a new male contraceptive, preferring an oral pill over injections or implants. These surveys also showed that over 80% of the women welcomed a new method of contraception, and over 90% of them would trust their partner to use the male method consistently. With changes in gender roles and gender equity in relationships, it is anticipated that male participation in family planning methods will be enhanced. Successful efficacy, safety, and reversibility with hormonal male-directed methods may pave the way new, targeted nonhormonal approaches. Once the testicular target is selected, new compounds can be identified based on structure function analyses or high-throughput screening to identify agonists or antagonists of the target.
Article
Behavioral Interventions as Policy Instruments to Manage Household Water Use
Leong Ching and Swee Kiat Tay
Water planners and policy analysts need to pay closer attention to the behavioral aspects of water use, including the use of nonprice measures such as norms, public communications, and intrinsic motivations. Empirical research has shown that people are motivated by normative as well as economic incentives when it comes to water. In fact, this research finds that after exposure to feedback about water use, adding an economic incentive (rebate) for reducing water use holds no additional power. In other cases, nonprice measures can be a way to increase the salience, and subsequently, effectiveness of any adopted pricing mechanisms. We review these empirical findings and locate them within more general literature on normative incentives for behavioral change. Given increasing water scarcity and decreasing water security in cities, policy planners need to make more room for normative incentives when designing rules for proenvironmental behavior.
Article
Behavioral Interventions to Reduce and Prevent Racial Bias
Nicole Farmer, Alyssa Baginski, and Talya Gordon
Unlike other public health crises, attention to the role of prevention in racial bias has not predominated. Most human actions, including racism, are informed by unconscious thoughts. Behavior-change interventions seek to understand facilitators and barriers to human action and antecedent unconscious thoughts, which are guided not only within an individual but also in interpersonal and societal environments. Current behavioral interventions on implicit and explicit racial bias can identify gaps and opportunities in the literature to evaluate operational definitions of behavior and bias, discuss psychological and neurobiological processes involved in racial bias, that may provide insight into prevention. Furthermore, a focus on public health–based interventions which integrate behavioral science foundations may assist to develop adaptable, accurate, and effective interventions across global communities. Based on the literature results discussed, the benefit for the field of public health may be to inform future studies and create a multilevel, behavioral-based framework to prevent or mitigate racial bias behaviors..
Article
Big Data and Urban Health
Mark Stevenson, Jason Thompson, and Thanh Ho
Understanding the varied effects of urban environments on our health have arisen through centuries of observation and analysis. Various units of observation, when compiled spatially or linearly, have provided considerable understanding of the causal pathways between environmental exposures in cities and associated mortality and morbidity. With growing urban agglomerations and a digital age providing timely and standardized data, unique insights are being provided that further enhance the understanding of urban health. No longer is there a potential lack of urban data; over the 2010–2020 decade alone, the resolution and standardization of satellite and street imagery, for example, alongside methods of artificial intelligence such as self-supervision methods, have meant that technology and its capacity have surpassed the accuracy and resolution of many administrative data collections typically used for urban health research. From Bills of Mortality in 1665 to 20th century surveillance systems to the innovation and global reach in the period of “big data,” data has been the mainstay of decision support systems over the centuries. This new world of big data characterized by volume, velocity, variety, veracity, variability, volatility, and value is paramount to answering the significant urban health challenges of the 21st century.
Article
Bioethics and Reproduction With Insights From Uruguay
Lillian Abracinskas and Santiago Puyol
As time goes by, the world experiences advances and setbacks in the field of sexual and reproductive health and rights. But new challenges appear in terms of professional performance and implementation of services created by newer laws and policies. The development of new ethical frames in dialogue with disputed value systems is one of the main obstacles to ensuring universal access and comprehensive services to guarantee the exercise of these rights.
Since 2002, Uruguay has been one of the few countries in Latin America and the Caribbean that has achieved significant advances regarding sexual and reproductive rights by recognizing them as human rights. The passage of several laws has resulted in the implementation of programs in SRHS and legal abortion as being considered mandatory for the National Health System. The follow-up and monitoring of this process by the Observatory of Mujer y Salud en Uruguay (MYSU) has demonstrated how changes in the legal framework led to a new stage for health-care providers, politicians, and decision makers and also for the social movement that has historically advocated for this agenda, all now facing new problems and challenges—some of which are completely unexpected. The high prevalence of conscientious objection exercised by physicians and OB/GYNs in refusing the provision of care in SRHS is one of the ethical dilemmas that needs to be discussed to innovate solutions to the problems and promote best practices from a gender equity and human rights paradigm.
Article
Biological and Social Aspects of Human Infertility: A Global Perspective
Marie Thoma, Jasmine Fledderjohann, Carie Cox, and Rudolph Kantum Adageba
Infertility remains a neglected area in sexual and reproductive health, yet its consequences are staggering. Infertility is estimated to impact about 10–25% (estimates range from 48 to 180 million) of couples of reproductive age worldwide. It is associated with adverse physical and mental health outcomes, financial distress, severe social stigma, increased risk of domestic abuse, and marital instability. Although men and women are equally likely to be infertile, women often bear the societal burden of infertility, particularly in societies where a woman’s identity and social value are closely tied to her ability to bear children. Despite these consequences, disparities in access to infertility treatment between low- and high-income populations persist given the high cost and limited geographic availability of diagnostic services and assisted reproductive technologies. In addition, a considerable proportion of infertility is a result of preventable factors, such as smoking, sexually transmitted infections, pregnancy-related infection or unsafe abortion, and environmental contaminants.
Accordingly, programs that address the equitable prevention and treatment of infertility are not only in keeping with a reproductive rights perspective but can also improve public health. However, progress on infertility as a global concern in the field of sexual and reproductive health and rights is stymied by challenges in understanding the global epidemiology of infertility, including its causes and determinants, barriers to accessing quality fertility care, and a lack of political will and attention to this issue. The tracking and measurement of infertility are highly complex, resulting in considerable ambiguity about its prevalence and stratification in reproduction globally. A renewed global focus on infertility epidemiology, risk factors, and access to and receipt of quality of care will support individuals in trying to reach their desired number and spacing of children and improve overall health and well-being.
Article
Brasília’s Experience With Wastewater Treatment Systems: A Case Study
Klaus Dieter Neder
Brasília is one of the few large cities in the developing world that provides full coverage of sanitation services for its population, including the collection of wastewater and adequate wastewater treatment. Caesb, the local water and sanitation utility, has developed a lot of experience in the planning, design, construction, and operation of sanitation systems, with a special emphasis on the need to use appropriate treatment technologies. Today, serving a population of more than three million people, Caesb runs 16 wastewater treatment plants, using technologies from very simple natural treatment processes, such as stabilization ponds and overland flow processes, to very sophisticated units, including tertiary activated sludge plants, with flotation as an effluent-polishing treatment step. During the development of the several different sanitation solutions, Caesb has found that it has been best to use simple, natural, low-cost treatment processes to achieve feasible and sustainable solutions even when, in specific circumstances, more sophisticated processes are required. The desire to increase the sustainability of the treatment plants has also stimulated Caesb to improve the performance of the applied treatment processes, which was achieved by the implementation of several modifications aimed at reducing costs and improving the efficiency of the plants. Today, the treatment of all wastewater produced in the city guarantees the quality of the discharge to the point that water bodies located downstream of wastewater treatment plants are used as resources for water supply for the city.
Article
Burn-Related Injuries
Ashley van Niekerk
A burn occurs when cells in the skin or other tissues are destroyed by hot liquids (scalds), hot solids (contact burns), or flames (flame burns). Injuries to the skin or other organic tissue due to radiation, radioactivity, electricity, friction or contact with chemicals are also identified as burns. Globally, burns have been in decline, but are still a major cause of injury, disability, death and disruption in some regions, with about 120,000 deaths and 9 million injuries estimated in 2017. Low-to-middle-income countries carry the bulk of this burden with the majority of all burn injuries occurring in the African and Southeast Asia regions. Thermal injuries are physically painful and may leave disabling scars not only to the skin or the body, but also impair psychological wellbeing. Severe injuries often impose significant psychological, but also educational consequences and social stigmatization, with the consequent adjustments exacerbated by a range of factors, including the circumstances of the burn incident, the severity and site of the injury, the qualities of the affected individual’s personality, and the access to supportive interpersonal and social relationships. The contributions of: economic progress, enhanced environmental and home structures, energy technology, and safety education interventions have been reported as significant for burn prevention. Similarly, legislative and policy frameworks that support access to modern energies such as electricity, govern domestic appliances and heating technology, and control storage and decanting of fossil fuels are important in energy impoverished settings. The recovery of burn survivors is affected by the availability of specialized treatment, physical rehabilitation and psychosocial support to burn victims and families, but which is still limited especially in resource constrained settings.
Article
Case Study of the Federal District of Brasília: CAESB’s Experience With Condominial Sewerage
Maria Martinele Feitosa Martins and César Augusto Rissoli
Brasília, the capital of Brazil, which is located in the Federal District, has one of the highest sanitary sewerage connection rates in the country. More than 92% of its more than 3 million inhabitants are served by sewage collection and treatment systems, and Companhia de Saneamento Ambiental do Distrito Federal (CAESB), the local public sanitation company, is firmly committed to reaching universal coverage. A condominial sewerage system has been used by CAESB as a powerful tool to make universal coverage possible. The system offers advantages in reduced costs and guaranteed connections and a close partnership with the community. Installed throughout the Federal District beginning in the early 1990s, this system has provided effective service to more than 1.6 million inhabitants of all social classes, which has contributed to the resurgence of civic participation and improved the population’s quality of life.
Article
Changing Open Defecation Behavior
Mark Radin
Open defecation (OD) remains a persistent problem in many low-income countries. The international community, through the Sustainable Development Goals (SDGs), has committed itself to eliminating OD by 2030. While access to and use of latrines has steadily increased, much is unknown on how to eliminate OD. The history of the elimination of OD in high-income countries offers potential lessons for achieving the sanitation targets of the SDGs. A desk review of sanitation literature revealed a well-documented effort to eliminate OD in the United States, which faced many of the same obstacles as those encountered in low-income countries in the 21st century. One of the important lessons is that eliminating OD takes sustained efforts over decades and substantial resources. The international efforts to eliminate OD have evolved through numerous phases within the global development agenda. To eliminate OD will require continued investment in new and ongoing programs, which are often led by national governments in partnership with international organizations, civil society, and the private sector. Many successful programs have utilized numerous approaches for eliminating OD as the barriers to sanitation use are different across societies and for each individual. Access to sanitation in institutions such as schools and health care facilities as well as public facilities remains a problem in both high- and low-income countries. Finally, the international community will need to deploy more resources and develop effective approaches for ensuring that latrine adoption and use is sustainable.
Article
Child Development, Major Disruptive Events—Public Health Implications
Tracy Vaillancourt and Peter Szatmari
The COVID-19 pandemic has upended nearly all the safeguarding systems in the lives of children and youth, such as family life, school, extracurricular activities, sports, unstructured social opportunities, health care, and church. With many of the typical promotive and protective factors disrupted all at once, and for so long, the mental health of children and youth has deteriorated in many areas, but not all, and for many children and youth, but not all. It is important to acknowledge, however, that the mental health of children and youth was in crisis before the pandemic, with 1 in 7 children and youth worldwide having a mental disorder. Given the continued decline in this area of health, children and youth may well be on the cusp of a “generational catastrophe” that could involve lasting harms if immediate action is not taken. Of particular concern are marginalized and vulnerable children and youth—they are the ones unduly enduring the brunt of this global crisis. Accordingly, child and youth mental health recovery must be prioritized, along with the reduction of inequity within and across countries. A commitment to public health strategies that never include harming children and youth as a tolerated side effect must also be made.
Article
Child Health in Latin America
Célia Landmann Szwarcwald, Maria do Carmo Leal, Wanessa da Silva de Almeida, Mauricio Lima Barreto, Paulo Germano de Frias, Mariza Miranda Theme Filha, Rosa Maria Soares Madeira Domingues, Elisabeth Barboza Franca, Silvana Granado Nogueira da Gama, Cristiano Sigueira Boccolini, and Cesar Victora
Child health has been placed at the forefront of international initiatives for development. The adoption of the Millennium Development Goals has propelled worldwide actions to improve maternal and child health. In the course of the year 2000, the Latin American (LA) countries made marked progress in implementing effective newborn and infant life-saving interventions. Under-five mortality in LA fell by a third between 1990 and 2015, with a sharp decline in diarrheal diseases and respiratory infections. Due to the successful immunization programs in the region, some vaccine-preventable diseases have been eliminated. Many of the LA countries have reached nearly universal coverage of childbirths attended by skilled personnel and >80% coverage for antenatal care. In 2015, 18 countries in the region reported the elimination of mother-to-child transmission for both HIV and syphilis.
Although the advances in the public agenda aimed at promoting child health and development in Latin American countries are undeniable, unresolved issues remain. While many stillbirths and neonatal deaths could be averted by improving access to antenatal, intra-partum, and postnatal interventions, Latin America has the highest cesarean rate among all regions of the world with an excessive number of such operations without medical indications. The simultaneous lack and excess of cesarean deliveries in LA countries reflects a model of care that excludes a considerable portion of the population and reveals the persistent gaps and inequalities in the region. One of the main challenges to be faced is the lack of sustainable financing mechanisms to provide integrated and high-quality health care to all children, equal education opportunities, and social services to support disadvantaged families. When planning interventions, equity should be restored as the guiding principle of actions to ensure inclusion and social justice. Children represent the future of society in Latin America and elsewhere. For this reason, social commitment to provide universal child health is the genesis of sustainable development and must be an absolute priority.
Article
Cities, Health, and Intersectorialities
Marco Akerman, Gabriela Murillo Sancho, and Samuel Jorge Moysés
Cities have been considered in many places and times a cornerstone of innovation and wealth creation in society, fostering the privilege of more comfortable lives, with existential dignity and producing healthier generations, as well as an important source of pathogenic determinants. The concept of health in cities and its intersectoral relationships unfolds in a new era of urban sociability, mediated by technologies that connect citizens in social networks and in many services provided by digital platforms. All changes have their respective economic and cost-effective impacts. Healthy cities, or smart and sustainable cities, intend to express well-being and the fulfillment of good health among people who enjoy social inclusion, effectively using policies and services concentrated in the most developed cities. However, the extent of the challenges that permeate the current urban civilization cycle is also related to the social inequities manifested in health problems and public mismanagement in cities around the world. It is necessary to think about the integration of the intersectoral habitus of conceptualizing health promotion, considering all its inclusive scope of diversity, without leaving any social and identity group out, with a view to the full realization of healthy cities. There is an ethical, political, and cultural imperative to urgently adopt an ecosocial approach to promoting the health of populations in cities around the world, recognizing the interactions between ecological determinants (all planetary systems and living species) and the very internal dispositions of what constitutes human health.
