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Social Determinants on Health and infectious diseases

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PAMSA HeartBeat


Imprint Editor in Chief Leonel Ayala, El Salvador Proofreading Helana Chapman, Dominican Republic Génesis cañas, El Salvador Laura Figueiredo, Brazil Design Leonel Ayala, El Salvador

Publisher

International Federation of Medical Students’ Associations General Secretariat: IFMSA c/o WMA B.P. 63 01212 Ferney-Voltaire, France Phone: +33 450 404 759 Fax: +33 450 405 937 Email: gs@ifmsa.org Homepage: www.ifmsa.org

Contacts

da.pubsmedia.pamsa@gmail.com

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Contents

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Introduction From our rc Publications team and the future Health systems and medical practice in venezuela

The ifmsa global health equity initiative Health determinants Advocating for a rational use of prescription drugs through medical education

Sdh and reproductive health Rio political declaration on social determinants of health. What we plan!

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Pamsa Team Gabriela Noles

Regional Coordinator IFMSA - Perú rcamericas@ifmsa.org

Alhelí Calderón

DA for NMO Development IFMSA - México da.nmo.pamsa@gmail.com

Mardelangel Zapata Americas Regional Projects Assistant APEMH amregpa@gmail.com

Frédéric Morin

SCOPE RA IFMSA - Quebec ra.scope.pamsa@gmail.com

Tessy Cerrón

SCOPH DA APEMH ra.scoph.pamsa@gmail.com

Erick Meléndez

SCORA RA IFMSA - El Salvador ra.scora.pamsa@gmail.com 4

Javiera Brierley

DA for NMO Development IFMSA - Chile da.nmo.pamsa@gmail.com

Leonel Ayala

DA for Publications and Media IFMSA - El Salvador da.pubsmedia.pamsa@gmail. com

Elías Ortega

SCOME RA IFMSA - Argentina ra.scome.pamsa@gmail.com

Roberto García

SCORE RA IFMSA - México ra.score.pamsa@gmail.com

Paola Aguirre

SCORA RA IFMSA - Perú ra.scora.pamsa@gmail.com

Ricardo Zules

SCORP RA IFMSA - Ecuador ra.scorp.pamsa@gmail.com PAMSA HeartBeat


Introduction Dear PAMSA family!

“Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in My name is Roberto Leonel Ayala Minero, a 6th year human beings of whom they know nothing” - Voltaire medical student, proud member of IFMSA - El Salvador and I’m pleased to introduce myself as the new DA on Remember, we owe nothing more than to give the Publications and Media for the term 2011 – 2012. best attention as possible to our society, try not to be identified by one of the most accurate quotes that I’m very honored to be able to continue the great work describe the patient’s opinion about doctors. We have that has been presented in the past HeartBeat numbers, to learn to give the best answers, practice to give the and with your help I know we’ll keep this amazing line best solutions, but mostly know our patients to be the of communication active and letting all PAMSA know best doctors. about different regions and cultures, so we can find ways to improve our own. Leonel Ayala DA for Publications and Media I’m truly excited to present this new edition of our magazine, being “Social Determinants on health and infectious diseases” the topic selected for it. This was selected for two main reasons, the first one honoring the PAMSA Regional Meeting 2012, product of the amazing work done by our fellow members from Peru, and the second due to the importance of being able to recognize the roots of the problems that are affecting health in our countries and getting to find solutions helping our society in a mayor scale. As medical students and doctors we acquire the responsibility to be aware of our patient’s environment and how it determines their health. As defined by the World Health Organization (WHO) “The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices”, making us clear that being a health provider is more than just taking care of our patients, but to have a more wider perspective and aside being physicians we should try to go deeper into the problem, so eventually we can improve the factors that have an influence in our health. You will find very interesting articles in this number, from which we can all learn about some of the most important determinants on health, including health systems, reproductive health and the importance of medical education.

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This magazine is an IFMSA Publication. © Portions if this magazine may be reproduced for non political, and non profit purposes mentioning the source provided. Notice: Every case has been taken in the preparation of this document. Nevertheless, errors cannot always be avoided. IFMSA cannot accept any responsability for any liability. The opinions expressed in this magazine are those of the authors and do not necessarily reflect the views of IFMSA.

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From our RC

Dear PAMSA friends, I am honored to write in this, the fourth RM special edition of the PAMSA Heartbeat “Social Determinants of Health and Infectious diseases� Why infectious diseases and social determinants of health? Mainly, for two reasons. First, it is the theme elected by our Regional Meeting 2012 OC as theme event for the RM and; Secondly, because even though non communicable diseases are nowadays one of the main health issue of our region, the infectious diseases are still important thus determinate future health but, most importantly, are the most affected by the social environment of the people. This is the reality that we see every day or must see. Before this, the big question is: what are we doing about it? Our members are sharing in these lines their thoughts, wishes and actions to tackle this topic. We cordially invite our readers to enjoy our publication and that every page encourage you to act. Yours, Gabriela Noles IFMSA Regional Coordinator for the Americas

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Publications Team & the Future How does IFMSA change your perspective of the future? Helena Chapman

Génesis cañas

IFMSA means ABCD: Adventurous spirit, Beautiful ideas, Collaborations in health and Dissemination of newsworthy findings. The adventurous spirit brings creativity to the table, as a desire to help fellow colleagues as well as populations in need. Beautiful ideas are required to develop proposals for sustainable health initiatives. Interdisciplinary or multidisciplinary health collaborations are critical components to effective teamwork and transmission of the health message to community members. Dissemination of health project findings at the local, national and international levels will permit further inspiration to health professional students across the globe. Since IFMSA means ABCD, the future of medicine and public health appears more creative, dedicated and collaborative in the development, implementation and reporting of program results.

Every single thing we do from IFMSA has the potential of becoming decisive for the future. Some projects are small efforts an other projects are just incredibly ambitious and complex, but either way, all the work we do just makes me realize that we really are taking the future in our hands and we are becoming a new generation of doctors commited with excelence, and I just could not be more proud of being part of this.

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Laura A. Figueiredo In the midst of our dazed lives of academic medicine and in moments of crisis in my course, i’ve found in IFMSA an endless source of encouragement to continue this journey. Was in IFMSA that I realized how to fight for a cause is extremely rewarding, even when everything goes against you. The IFMSA welcomed me and showed me how our society needs actions for health prevention, care and an attention especially. Today we see brutalities that happen in the Public Health and we can contemplate the importantance that IFMSA has to act on significant gaps of the state to provide health care to all, even though we can not change in large proportions, they are aware that we try and at least one person affected by the action already characterizes the success of our work.

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HEALTH SYSTEMS AND

MEDICAL PRACTICE IN VENEZUELA After obtaining the medical degree, the “Practice of Medicine of Venezuela Law” says that the graduate must serve a year of rural practice of medicine. At this stage the doctor makes educational and medical assistance to communities in remote locations. This is the stage where we are today.

Manuel Alejandro Rodríguez, MD. Belkis J. MenoniBlanco, MD (Alumni of FEVESOCEM, IFMSA Venezuela) The health system in Venezuela consists in clinics and hospitals, public and private, in rural and urban areas. That system is classified depending on the number of people in each community and the services in these health centers. The clinical system is developed to promote prevention, immunization and outpatient treatment of diseases. In contrast, the hospital system, which is classified into levels, is responsible for the assistance provided to patients with diseases that require rapid and short hospital stay (level I) and more specialized care that demands more technology (level IV). The public system have been made based also on preventive health programs, for example, breastfeeding, HIV and AIDS, Diabetes, Cardiovascular diseases, comprehensive care to children and adolescents, prevention of epidemics, tropical diseases... One of the most recent health campaigns is the “No Tobacco National Program”, which entered into effect on “World No Tobacco Day” (so decreed by the WHO)

In theory, as envisaged in our Constitution in force since 2000, health services must ensure the health protection to all inhabitants of the country and work in accordance with the principles of universality, participation, quality, complementarily, and even Coordination and Integration of Health System. In fact, these principles are not always used by the health administration in our country; both public and private are questionable. It is not uncommon that every day is discussed by the media the inefficiency of the health service, where there are no health habits, inefficiency in the administration of health systems, inadequate control, lack of quality of service and lack of resources. Despite some efforts by the state to make improvements in social conditions of life, in our assistance work, for example, we have seen numerous failures such as illiteracy in some of rural residents, which generates inability to follow guidelines for treatment and prevention.

From the early stages of medical school, the student has contact with Public Health and Health Prevention, because these matters are included in the curriculum of all universities of this country. During their training, the medical student goes to remote communities to develop research projects and promotes prevention and care for diseases of these communities.

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One of the main shortcomings is the current intention of establishing a parallel public health system, which is not related to the traditional. This new system is far from solving the current problems, quite the opposite, actually increases the clutter and creates a battle between the two systems. But both strive for similar goals, since they seek equality and population health and who loses in this battle are the users, because the administrators of these systems end up diverting resources from one and neglecting the other. At the present time, Venezuela unfortunately has a long list of problems in the health system, many of which could be prevented or simply solved. Examples of that wear are manifested by the constant lack of supplies in

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health centers, emergencies and sites of hospitalization, which are often evidenced by the deterioration of some buildings, lack of equipment, materials, drugs or beds to accommodate patients properly, as also not enough staff to handle the overwhelming number of people attending daily for health. In conclusion, the duty of health professionals and students worldwide, not only in Venezuela, should be promote health education, preventive campaigns and social assistance, based on medical ethics and morality. We found in IFMSA a preparation for entering this world of possibilities and take the reins, though young, of our careers, so that, in the future, we will use preventive policies and social actions in our communities.

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The IFMSA Global Mobilizing medical students By Nilofer Khan Habibullah and Renzo Guinto, on behalf of the IFMSA SWG on Health Inequalities We marvel at cutting-edge health care technology, yet there exists a life-span of 34 years at Sierra Leone and lack of basic amenities (i.e. drinking water) in other under-developed and developing regions of the world. We proudly register progress made by the Millennium Development Goals (MDGs), yet maternal mortality -one of the MDG indicators- reveal that as many as 170 for every 1,000 mothers die due to inaccessible or inadequate maternal care in the Philippines alone, while only 8 mothers die in Japan. We weigh our country’s development with a rising Human Development Index. Sample this: A 2005 United Nations’ Human Development Report reported that the annual income flow of the richest 500 people in the world exceeded that of the poorest 416 million people.

More appallingly, it also estimated the cost of ending extreme poverty at $300 billion, which equates to less than 2% of the income of the richest 10% of the world’s population. Even today, 1/3rd of the world’s 7 billion habitants lives in slum shelters. People affected by these health disparities are not merely faceless statistical figures. They live among us and once dreamed of a better future and fair means to live. Their only ‘misfortune’ is that they were born in under-developed regions of the world, where health disparities are still prevalent. These inequalities will continue to exist, unless we commit our collaborative efforts to fight these barriers in global health. What are the social determinants of health? According to World Health Organization (WHO), social determinants of health are “the conditions in which people are born, grow, live, work and age, including

Illustration from: Dahlgren, G. and Whitehead, M. (1991). Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute for Futures Studies. 10

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Health Equity Initiative to close the gap in health disparities the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries” (1). One can infer that the social determinants of health are a result of unjust distribution of resources, money and power, which all factor into health inequity.

health equity advocacy and campaign within the IFMSA and the global health community.

Health inequity results from a medley of unfair policies, which do nothing to ensure just and uniform distribution of money, power and resources. People live in different communities, each with unique characteristics, governance, structures and policies. Due to these differences, some people might have closer access to healthy food than others, or a subdivision may have safer roads than a village in the rural areas. Since these differences are shaped by social, economic and political forces that work in the municipal, national or international level, we must address these forces through collective action across all sectors.

Care enough about health inequity? Join us!

Key areas of programming of the Initiative will focus on, but not limited to, advocacy with grassroots action, education and training, policy dialogue and legislative action, media and publications, and building external networks and coalition for the IFMSA. The Initiative team structure will also involve lead contacts on each of these domains of action.

Show your solidarity for the Global Health Equity Initiative at the upcoming IFMSA March Meeting in Ghana! After its formal adoption, this Initiative will serve as a premier platform to join IFMSA medical students on the call to action for health equality and social determinants of health. Come be an active part of this cause! If you would like to join this cause or have any further questions, please contact Nilofer Khan Habibullah (nilo. metalrex@gmail.com).

IFMSA Global Health Equity Initiative Let us investigate the causes of health inequity and The IFMSA Global Health Equity Initiative represents a reach out to the poor, marginalized, vulnerable and unique vision and mission to motivate young leadership in underserved populations! As medical students, we can global health matters. The vision describes: To mobilize make a difference in our local and global community! youth towards the achievement of “health for all” (Alma Ata Declaration) and “closing the gap in a generation” (WHO Commission on Social Determinants of Health). References: The mission states: To lead the world’s medical students (1) World Health Organization. (2011). Social and future physicians in advocating for health for all, determinants of health. Available from: http://www. fulfilling Rudolf Virchow’s vision that physicians are who.int/social_determinants/en/. “natural attorneys of the poor.” The IFMSA Global Health Equity Initiative will serve four main purposes. First, it will act as an Institutional voice for global health equity within IFMSA, especially in regards to global health equity and social determinants of health. Second, it will serve as a Clearinghouse of information, advocacy tools, and technical guidance on global health equity for IFMSA members. Third, it will act as a Dynamic forum for intellectual exchange and dialogue on health equity between IFMSA members and external partners. Lastly, it will be a Cornerstone of PAMSA HeartBeat

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Health Determinants: Kevin Stephen Acosta Velásquez *, Martha Liliana Ospina Gutiérrez ** *3rd year Medical Student, School of Medicine, University of Tolima. Ibagué -Tolima- Colombia **5th year Medical Student, School of Medicine, University of Tolima. IbaguéTolima-Colombia As the youth represent agents of change, they have an important future role in developing countries. Although only a small percentage of Colombian youth have access to super education, they are the innovators that have united their voices toward a better society. Within this population, the medical students have created strength in their presence, where they have developed various opportunities for students in their early medical education to have direct contact with community members. These individuals represent decisive agents that will direct the focus on the principal health determinants in the rural and urban communities: Education. Due to the local and global activities promoted by the governments and different organizations, including the Association of Medical Students, education has been successful in many areas. In particular, the initiative of the International Week of Maternal Breastfeeding was founded by the World Alliance for Breastfeeding Action (WABA). By forming strategies for annual implementation between August 1-7, future physicians have become critical and active agent of change for this health topic.

This focus on the rights of this social and vulnerable group is an advantage for the remaining hospital functions, as a University Hospital and principal rotation site for the medical students at the Faculty of Health Sciences of Tolima. In promotion of this program, at the start of the latter half of this year, the Scientific Association of Medical Students of the University of Tolima (ACEMED UT) (Local Committee of ASCEMCOL) and the respective Hospital, created and implemented the “First Week for Collaboration: The IAMI HFLLA and the ACEMED UT.” The implemented strategy was to create a collective and equal work environment between the IAMI Hospital and the public university, where both would act as a social, education and health base of the relevant community, from an epidemiologic and geographic perspective. The hospital roles were defined and permitted the Tolima medical students to become involved in the planning, organization and development of education activities and promotion of maternal breastfeeding. In this manner, this educative center can combine the directed objectives of the maternal and infantile population with the group members and leaders of the project, where health determinants would be considered.

Considered by the World Health Organization (WHO) as a natural act and behavior to learn, maternal breastfeeding is an important topic, especially due to the offered benefits in the biopsychosocial environment of the individual. Currently, the Hospital Federico Lleras Acosta (HFLLA) is considered one of the most important Colombian institutions that offer health services, where an initiative (1992) between the WHO and UNICEF, established the Institution “Amiga de la Mujer y la “Holding life” by Ramón Llorente, FEVESOCEM Venezuela Infancia” (IAMI).

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Acting locally, Thinking Globally during the International Week of Maternal Breastfeeding in Colombia. These strategies are proposed for a direct intervention between the community and public hospitals as a solution for the actual health problem. The timespace-communication triangle can be implemented in the search for the appropriate promotion of maternal breastfeeding with the media. It is important that all members of each association of medical students implement concrete actions for these initiatives, which would permit a strong collaboration between hospital and university as well as offer solutions for the public health problems that affect the local, national and global community.

3. World Health Organization. (2011). Child and adolescent health and development: World breastfeeding week. Available at: http:// w w w. w h o. i n t / c h i l d _ a d o l e s c e n t _ h e a l t h / n ew s / archive/2011/03_08_2011/en/index.html.

References: 1. Zambrano, A. Determinantes del estado de salud en Colombia y su impacto según área urbana y rural: Una comparación entre 1997 y 2003. Available at: http://www.asivamosensalud.org/descargas/lecturas/ Zambrano_estado_de_salud.pdf.

6. World Health Organization. (2004). Estrategia mundial: Lactancia materna, fundamental para la supervivencia infantil. Available at: http://www.who. int/mediacentre/news/releases/2004/pr19/es/.

4. Hospital Federico Lleras Acosta de Ibagué- Tolima E.S.E. (2011). Homepage. Available at: http://www. hflleras.gov.co/. 5. World Alliance for Breastfeeding Action. (2011). World Breastfeeding Week. Available at: http:// worldbreastfeedingweek.org/.

2. Alvarez, L. (2009). Los determinantes sociales de la salud: Más allá de los factores de riesgo. (2009). Rev Gerenc Polit Salud, Bogotá (Colombia), 8 (17): 69-79.

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Advocating for a Rational Use of Prescription Drugs through Medical Education

Prescription drugs constitute one of the main tools in the art and science of medical practice. They give the physician an enormous power in the recuperation process of the patient, where the medication may produce beneficial or deleterious effects in the human body. Reflecting on the common phrase, “great power comes with a great responsibility,” we must emphasize proper use of prescription drugs in the best interest of our patient. The increasing numbers of pharmaceutical products and marketing names are also a major challenge in developing countries. Why? The answer may exist in the variation of regional drug regulators. In Argentina, like in other countries in the Americas, once a new drug is discovered, it must go through a research process that considers drug efficacy and safety, prior to approval for general market sales. Although both criteria are essential, this evaluation does not take into account other factors. For example, in Norway, the drug evaluation process considers necessity. If an existing drug with proven mechanism of action has been successful, then the regulators forbid any similar drugs to be approved for the general market sales. In this way, they prevent the market from overflowing with the same pharmaceutical products.1 Of course, this is a result of the lobbying performed by the pharmaceutical industry to healthcare professionals, which eventually reaches the academic environment. A global issue2… •Two-thirds of global antibiotic sales occur without any prescription. •90% of injections are estimated to be unnecessary. •Adverse drug events rank among the top 10 causes of death in the USA, where it is estimated to cost between US$ 30 and US$ 130 billion each year.

Elias Jesus Ortega Chahla. Universidad Nacional de Tucuman. San Miguel de Tucuman, Tucuman, Argentina. 2011. 14

Globally, there is a large quantity of prescriptions written by physicians every single day. If we could analyze each individual prescription, we would observe that a considerable percentage is completely unnecessary or incorrect for the patient. This may be a consequence of multiple factors, including inadequate knowledge about PAMSA HeartBeat


prescription drugs. At the same time, just as not all disease For this reason, we are at the best moment to improve this conditions require prescription drugs, some medications educational process in early medical education, before produce deleterious effects in the human body. This may medical students become certified health professionals. constitute a frequent form of poor medical practice.3 As medical students, how can we advocate for a Rational Use of Prescription Drugs? We can: Common examples of Irrational Use of Prescription •Demand that our professors and mentors base their Drugs2… drug prescribing practices on evidence-based medicine. •Too many medications are prescribed per patient •Participate in curriculum changes that improve the (polypharmacy). teaching of rational practice in medical education. •Injections are used where oral formulations would be •Participate and organize courses, workshops and other more appropriate. activities to promote the rational use of prescription •Antimicrobial medications are prescribed in inadequate drugs. doses or duration or for non-bacterial infections, thereby •Develop independent criteria when reviewing treatment contributing to the alarming problem of antimicrobial guidelines while following WHO standards in selection resistance. of the appropriate medication. •Prescriptions do not follow clinical guidelines. •Patients self-medicate inappropriately or do not As future healthcare professionals, it is our sacred duty adhere to prescribed treatment. and privilege to promote the best quality of attention to our patients. We have the responsibility to advocate for the rational use of prescription drugs. Within our reach, Across the world, there are countless examples of we have organizations (i.e. IFMSA) that offer the unique incorrect and unnecessary use of prescription drugs. and wonderful opportunity to work as one global team, Although the motive for these prescriptions may be gathering the appropriate resources and tools to fight based on many factors, the most important reason is for improved prescription practices. inadequate education on prescribing practices among medical students and health professionals. So the “The power of a doctor’s pen is mightier than the deadliest question arises, why are medical students not taught disease…” how to use prescription drugs correctly? The answer is complicated, although one possibility is that medical References: school professors are not aware of the Rational Use of 1. National Therapeutic Form. (2011). Medical Prescription Drugs. Confederation of the Argentine Republic, 11th ed. Argentina. Why does it happen? •Studies in Canada, Australia, Kuwait and the USA, as 2. De Vries, T.P.G.M, Henning, R.H., Hogerzeil, H.V., well as in middle-income countries, such as South Africa Fresle, D.A. (1994). Guide to the good prescribing: A and Thailand, have revealed that inappropriate use of practical manual. Geneva: World Health Organization, medications is widespread in teaching hospitals.3 Action Programme on Essential Drugs. •The high cost of medications contributes to low adherence levels by patients. In some studies, an estimated 90% 3. Mordujovich, P., Buschiazzo, H. (2006). of consumers buy antibiotics for three or less days, Rationalized approach on therapeutics. Argentina: which makes compliance with the recommended dosage National University of La Plata. impossible.2 If we do not start to educate the healthcare professionals about the Rational Use of Prescription Drugs, how can we expect that they will be responsible prescribers?

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SDH and Reproductive Health By Erick Melendez & Paola Aguirre Camino SCORA Regional Co-Assistants for Americas 2011/2012 During the last year we were hearing about something that is revolutionizing the global health and is making a new era on health work: the social determinants of health (SDH). They are described as “the conditions in which people are born, grow, live, work and age, including the health system”(1) and, there is no need to say that they affect the people’s health in every aspect. In 1998 a group at University College London summarized the evidence on the social determinants of health, and published it as The Solid Facts.(2)It had ten messages on the social determinants of health based on: the social gradient, stress, early life, social exclusion, work, unemployment, social support, addiction, food, transport; making the big first review on the topic, in that opportunity based on evidence on their region, Europe. Even with all that revolution about the social determinants on health there is not much information about their influence in the reproductive health; to try to understand better the topic we will give u the definition of reproductive health according to the WHO: “Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this are the right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant”. (3) While the last two decades have seen improvements in access to and utilization of sexual and reproductive health services, progress in many countries has been slow and, after decades of investments, disappointing. On a global scale, women living in low and middle income countries experience higher levels of morbidity and mortality attributed to sexual and reproductive health than do women living in wealthier countries. (4) 16

The relationship between poverty and poor reproductive health is well established. Greene and Merrick conducted a thorough review of the social, financial and health consequences of key reproductive health indicators including maternal survival, early childbearing and unintended pregnancy. The report concluded that large family size was associated with increased risk of maternal mortality and less investment in children’s education. Unwanted pregnancy was positively correlated with health risks of unsafe abortion. Short birth intervals were found to negatively influence child survival, and early pregnancy was associated with lifelong risk of morbidities. (5) Social Determinants of Health influencing the sexual and reproductive health is a reality, but additional research is needed to better understand how exactly they are interfering on the topic, we as medical students have the tools and the energy to perform amazing research, to advocate on the topic and to change this. This is brief review on the topic but there are a lot of information to look out, to inspire you to work on it; the course of the world is in our hands and we have to be sure that we do not disappoint next generations. References (1)WHO. Social Determinants of Health. Available in: http://www.who.int/social_determinants/en/ (2)The Regional Office for Europe of the World Health Organization. Social Determinants of Health: The Solid Facts. 1st Edition. WHO. Copenhagen, Denmark; 1998. (3) WHO. Reproductive Health. Available in: http:// www.who.int/topics/reproductive_health/en/ (4) Shawn Malarcher. A view of sexual and reproductive health through the equity lens. Department of Reproductive Health and Research World Health Organization. Geneva, Switzerland; 2010. (5) Green ME, Merrick T. Poverty reduction: does reproductive health matter? Washington, DC: The International Bank for Reconstruction and Development / The World Bank; 2005 (Health, Nutrition and Population (HNP) Discussion Paper)

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Rio Political Declaration on Social Determinants of Health. Invited by the World Health Organization, the Heads of Government, Ministers and government representatives came together on the 21st day of October 2011 in Rio de Janeiro to express their determination to achieve social and health equity through action on social determinants of health and well-being by a comprehensive intersectoral approach. They quoted “We underscore the principles and provisions set out in the World Health Organization Constitution and in the 1978 Declaration of Alma-Ata as well as in the 1986 Ottawa Charter and in the series of international health promotion conferences, which reaffirmed the essential value of equity in health and recognized that ‘the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition’. We recognize that governments have a responsibility for the health of their peoples, which can be fulfilled only by the provision of adequate health and social measures and that national efforts need to be supported by an enabling international environment.” as well as “We reiterate our determination to take action on social determinants of health as collectively agreed by the World Health Assembly and reflected in resolution WHA62.14 (“Reducing health inequities through action on the social determinants of health”), which notes the three overarching recommendations of the Commission on Social Determinants of Health: to improve daily living conditions; to tackle the inequitable distribution of power, money and resources; and to measure and understand the problem and assess the impact of action.”

Some of the support policies, strategies, programmes and action plans the plan to develop as a way to fight against the inquieties on health are: -To adopt better governance for health and development -To promote participation in policy-making and implementation -To further reorient the health sector towards reducing health inequities: Acknowledging that accessibility, availability, acceptability, affordability and quality of health care and public health services are essential to the enjoyment of the highest attainable standard of health, one of the fundamental rights of every human being, and that the health sector should firmly act to reduce health inequities -To strengthen global governance and collaboration -To monitor progress and increase accountability: Establish, strengthen and maintain monitoring systems that provide disaggregated data to assess inequities in health outcomes as well as in allocations and use of resources -Call for global action

If you’d like to read the whole article you can visit the following link: http://www.who.int/sdhconference/ declaration/Rio_political_declaration.pdf

We can all have clear, thanks to the statements above, that the authorities are taking a bigger consideration regarding the growing problems in health, setting as objective to treat the very reason of all these problems, the social determinants on health.

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What we plan! As a family, we wanted all PAMSA to know what each of us is planning on doing on this amazing journey waiting ahead for us! So here is a little message from all of us to our dearest PAMSA. Dear PAMSA family, as you know my name is Gabriela Noles but almost all people call me Coti. I am glad and honored to be the IFMSA Regional Coordinator of the amazing Region of the Americas. This year as IFMSA RC Americas I will be focused mainly in supporting, updating and linking NMOs by being in close contact with each one of them. Also, I will organize the procedures in the region by updating/creating our Internal Operating Guidelines and all the attachments to it. Finally, I will assure a well organized and enjoyable RM2013 by working closely with the OC.

“Hello IFMSA! As NMO DAs we want to improve the communication between NMOs, and ensure that the region develops to it’s fullest potential. We believe that PAMSA can take IFMSA very far, and we want to contribute to this by working with our beautiful RC, the PAMSA NMO Presidents and all PAMSA members. So, let’s do this! Llama Hugs. Alheli and Javiera”

“Dear PAMSAeans, It is with great honor and satisfaction that I introduce myself as the person in charge of the projects of our beloved region. I am really motivated to make our region bigger than ever through our projects. Initially, we have to work on our data base and strengthen the Project Support Division (PSD) in each NMO, developing and supporting them. Getting an IFMSA official status for most of the projects of our region is one of my goals. I will work constantly with the national projects coordinators and each project coordinator in order to give them support to present their projects during the MM and AM. To summarize, the constant evaluation, communication and motivation of the people of our region will be important things to consider in my period. We are hardworking and full of energy. That is one of the reasons why I feel really proud of being PAMSAean. On the other hand, projects are connected with all the committees and the NMOs, we considered them as the heart of our federation. I’m sure that with our hard work, everybody will get to know that PAMSA has the BIGGEST heart of the world! Do not hesitate to contact me if you have any doubt related to projects. Lots of hugs Mardelangel Zapata Ponze de Leon (Maggie ) Regional Projects Assistant” 18

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“Hey my awesome SCOMEdians! It is with great pleasure that I write to you in the frame of the Regional Meeting of PAMSA! Since my appointment as Regional Assistant I’ve been working really hard Integrating and developing SCOME in PAMSA. In this sense, I am working closely with the NOMEs of the region to improve communication and collaboration between NMOs in creating and maintaining Transnational regional Projects and SWGs that attend to PAMSA’s needs and priorities. I deeply believe in the involvement of students in medical education, since we are the recipients I think it is only fair that we have input on it, and SCOME gives us a space for that purpose, making us one single voice in advocating for a better, modern and wholesome medical education. It is this very voice I want to see roar in the Americas! Let’s Rock SCOME in PAMSA! Elias Ortega. SCOME RA”

“Hi Dear PAMSA members As SCORP Regional Assistant for PAMSA during these months I have experienced big positive feelings and I can`t find the exact words to describe them. I have used all of them to inspire myself and all PAMSA SCORPions to continue working as hard as we can for Human Rights and Peace all over the Americas and in each NMOs. But our work as SCORP can`t stop right there; we need to continue the improvement in our region to create a solid structure all over PAMSA. If we achieve this main goal, our regional communication and projects will develop in an efficient mode. Personally, as a motivated SCORP member I will put my best to give all my dear SCORPions the mechanisms and tools to increase the amazing job they are developing in their NMOs and also being an integral participant of all SCORP PAMSA projects; hopefully to accomplish a TRANSANATIONAL SCORP PAMSA PROJECT for all NMOs. Yeah! I wish everybody an amazing RM and remember that motivation is the best way to change the world positively. Ricardo Gabriel Zules Oña SCORP Regional Assistant for PAMSA 2011-2012”

“Hi! We are Paola and Erick, SCORA Regional Co-Assistants! During this term we are going to work towards ensuring that SCORA keeps its growth within the region, have a great team with all the NORAs in the region and encourage the PAMSA SCORAngels to develop more projects according to the reality of our region. To us, teamwork and mutual cooperation is a priority when developing and growing as a unit. We are sure it is the only way we can achieve the goals we have and make SCORA, the PAMSA region and its NMOs grow and develop.”

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“Hey PAMSA, my name is Roberto Garcia and I’m the SCORE RA As RA this year, the first activity will be the RM and Pre-RM, where I’ll meet all the NOREs of the assisting NMOs, and together we will work as close as possible. We have to analyze the actual situation of SCORE in PAMSA, seek which NMOs aren’t active and support them so they can achieve the activation of SCORE in their NMOs. I think SCORE is a highly important committee to the medical students, because it gives us the opportunity to involve ourselves deeper into the investigation field, and not only locally but internationally. I’ll work as well with the Exchange Workshop along the SCOPE RA where we will give the National officers the tools to coordinate the committee that they represent. I wish as well, by this mean, to tell every NMO that they count with my total unconditional support for the development of SCORE in their country. We will be working as well, with collaboration of other committees, in seeking the common strengthen and the growth of PAMSA. I hope that at the end of this year, many of the NMOs that don’t have SCORE active in them, will be able to do so, and that in our region IFMSA continues to grow so we can keep creating leaders for a society that needs them so much.”

“Hi my dear PAMSA family This year I want to improve the SCOPH exchange in PAMSA, because we have a lot of good projects that can be useful for this and we have a lot of people that have so many good ideas about this topic. Also I want to do online trainings about the topics you’d like, helping this way to capacitate LPOs and NPOs in all the SCOPH related matters. For me, it’s important to do more online meetings, where we can talk about all the problems we have, as well as projects (already implemented or new ones). I want to motivate you to participate more in ifmsa-scoph@yahoogroups.com, IFMSA- SCOPH in facebook and ifmsa-pamsa@yahoogroups.com, there you can write all you want, share photos, videos, and any other thing you’d like to share of a project. I would like to be your friend, someone that is near you when you need. Kisses and love” GianinaTessyCerron Calderon RA SCOPH PAMSA

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“Dear PAMSAmigos and SCOPEans, My name is Frédéric Morin, I am a 3rd year medical medical student at University of Montreal and the SCOPE Regional Assistant (RA) within PAMSA. SCOPE, as you may know, is the oldest Standing Committee (SC). One of IFMSA main goals is to give medical students around the world a better understanding of what is global health and its influences. Regarding this specific goal, SCOPE is definitly reaching this goal by giving a practical example of how a health system can influence a population’s health and by creating reflexions and discussions among medical students. We will have the chance during the following days, of what I already consider as a successful Regional Meeting (RM), to share our ideas and visions of SCOPE, to gather our energy and enthousiasm to show the rest of the world how proactive we can be in PAMSA and how fruitful our sessions can be. To me, this Regional Meeting rhymes with tools development. I truly believe that such meetings allow us to share our problems, our solutions, our ideas, through group discussions, activites, reflexions and projects. I really want all of us to leave this meeting with more IFMSA/SCOPE knowledge and concrete ideas on how to improve your standing committee in YOUR NMO. To make this possible, I would suggest all PAMSAmigos, not just SCOPEans, to write down a list of goals they want achieve during RM. It looks a bit childish but I promise you will not regret the outcomes of any meeting if you do so. I also invite you to see the potential in every activities. We have a very packed agenda but I also encourage you to take advantage of lunch times and other free time to learn more about IFMSA’s potential and to NEVER stop sharing your ideas/problems/solutions with other delegates. I will be easily reachable during the whole RM so don’t hesitate to talk to me at any moment during sessions, lunch, free time or on the dancefloor, why not? ;) Your questions, ideas and comments are always welcome. After 3 RMs, I can assure that: We are a family! Frederic alias Fico/Fede/Fred”

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Heartbeat - Social Determinants on Health and Infectious Diseases