Topics

Territorial configurations and health care models (rural / urban / dispersed, city-region, provinces, etc.).

The territorial services can´t be without the analysis that is made of those important facts that have marked the policy of health services in a country; it is as well as from the knowledge of the contexts, of the territories and the analysis of the social, political, economic and cultural dynamics in which the people are immersed, it´s possible to define correctly models of attention in health that respond as much to the manifest needs in health matters, as well to the potentialities that exist within each community.

The recognition of the historical and socially determined nature of health-disease has been the axis of work of epidemiology and global social medicine, but there have been also, other trends such as North American and Latin American, which have been configured as alternatives to models of biomedical emphasis in public health. Based on the recognition of the limitations of the empirical-functionalist and biomedical approach, the World Health Organization, through the Commission on Social Determinants of Health, presented a series of conclusions and recommendations that were included in the report “Redress inequalities in a generation: achieving health equity by acting on the social determinants of health”, which demonstrated that in no country in the world the risk and damages to health among groups of population are distributed randomly, but systematically unequally, as a consequence of the structural and proximal determinants that generate inequalities in health.

On the other hand, in Colombia for example, the differentials of perinatal and infant mortality by place of residence (urban-rural) or educational level of the mother, as well as regional differentials (Chocó and Guajira vs. Bogotá), and the huge gaps of nutritional anemia according to urban / rural residence, particularly explained by the lack of drinking water, basic sanitation and other factors associated with the social conditions of these population groups (Vega, et al., 2008), are some of the most notable inequities that set a deep challenge.

Unite the construction of new models of health care to respond to local needs, having in count the territorial variable, becomes a strategy that begins to introduce intersectoriality and question the logic followed so far in the organization of services by type of benefit or by groups that did not have direct references to the territory. With this knowledge it will be possible to design in a relevant and differential way the health care models that would work for each territory (rural / urban / rural dispersed).

Based on the above, we pose the following questions:

How much does the territory consider when designing models, programs, projects and strategies in health?

  • Description
  • Problematization
  • Question

Does the design of models, programs, projects and strategies in health consider the territory as a fundamental element for its construction?

The role of the health systems, planning and development of the territory: service networks, free zones in health, industrial health districts.

The concept of territory is closely linked with the concept of space, which is the territory where a society unfolds. This involve a big relationship between territory, space and society. It is precisely the territory, the propitious scenario for the interrelation between society and nature, which is on permanent transformation, and that is where the public policies are executed, which through the planning process is planned in short, medium and long term. It is in the territorial entities where the big contrasts between the urban and the rural are observed, and their consequences observed in the different results and degrees of health in society. In other words, there is a close relationship between territory and the degree of development of the communities.

In this context, it is there where the greatest efforts must be made to close the gap in the level of health, guaranteeing well-being, social inclusion and equity. The national government since the 80s has developed different strategies to bring decision makers and communities together and looking as a team for the solution to the needs of each community. Strategies such as decentralization and other specific in the health sector such as health services networks, free zones in health, industrial health districts, and even primary health care from the local level.

How are the territorial entities prepared today to face this important role in the current health system?

Changes, transformations and performance of health systems: the challenges faced with the diversity of territorial configurations (inequalities, inequities, health situation, etc.).

Since the beginning of the 21st century, many governments and sectors of the population in the American region countries have recognized the crisis in health systems, for which they have been developing responses within two types of reforms. The first, have been oriented to give sustainability, mainly financial and technical to the systems; and the second, oriented to the development of fundamental rights health systems, social participation and political decentralization, developed under the influence and pressure of social movements and progressive political parties; although, in some cases, with a welfare focus and without sufficient resources to finance and sustain the new social and governmental responsibilities.

All the reforms have been formulated and implemented in a general context of globalization and economic changes within the framework of power relations and negotiations between state actors and civil society with predominance of interests among insurers, companies that produce medical technologies, providers of health services and professional associations, with almost no participation of citizens.

In both proposals, the flexibility and adaptability to differentiated local conditions and the possibility of evolution over time as it been modified, has not been evidenced in a relevant way, being the territory a legitimator of changes in health systems in their various contents and in its different modalities to respond in a particular way to the social demand and the structural specificities of the territory in which they operate. To understand these political, social, economic and sectoral dynamics that determine the political decisions on health and health systems in the 5th. International Congress of Health Systems, we seek to reflect and create a space for deliberation in order to understand the crises of health systems and for the construction of political and social alternatives that contribute to the development of reforms that transform the levels of illegitimacy into democratic participation in defense of social rights and structural changes in health systems adjusted to the conditions of the territory.

Then, questions arise about:

  • Do reforms and transformations of health systems include the diversity of territorial configurations?
  • Are health systems endowed with flexibility to safeguard and respect the history of individuals and communities within the framework of territoriality, that assess their health status, beliefs, norms and collective representations?
  • In health systems of Latin America, its reforms contemplate an integrated and coordinated model between the social and the health, including the mechanisms that allow maximum accessibility to users, the efficient use of available resources, among others, to make adjusted the response to the needs of the territory?

Territory in the context of global health: transcending the borders and limits of sovereignty of the nation state.

Global health, derived from public health and international health, refers to situations that have ceased to be the responsibility and exclusive management of a determined State, to become problems where, for its solution, it must necessarily work in a coordinated and collaborative way among nations for specific purposes and of common interest.

Global health does not stop only in aspects related to health and system services, but goes further in the recognition of transnational determinants of health that breaks with the traditional notion of territory demarcated by the political and administrative border and involves discussing on equity and social justice, such problems derived from migratory flows, climate change, food-nutritional security, the distribution of resources for development, the problems arising from the growing urbanization in the world, armed conflicts and violence in general in its different manifestations.

The global health situation has been affected by the expansion of globalization. Travels, commerce, capital flows, the global market and the computer technology have increasingly transcended the confines of States and have determined new challenges to control diseases and other health threats. Lifestyles that are now disseminated among millions of people in a few days or hours affect populations and accelerate the spread of all types of epidemics.

What are the actions that States must take, in the logic of their health systems together with international organizations, civil society and the community to respond to these problems of global impact?

Ethnic, cultural and religious diversity: territorialities that build socially alternative dimensions of health.

Diversity is inherent to the human being, from there different ways of being, think, feel and live the world materialize. Some social groups consider that animals, plants, water, sun, earth, and human being are part of a continuum, and from there, health is associated with balance, well-being, care, good live of people and territory.

However, throughout history it has been frequent that the social, political, economic, and cultural constructions of the so-called majority groups or that hold greater power in society, tend to be considered as the duty to be, leading to these “other” ways of being, understanding, and living in the world are invisible. Precisely this work table is oriented to discuss about diversity and how different ways of understanding the relationship between culture, territory and health are constructed from it.

Guiding questions:

  • How does the form of how the person-territory relationship mean itself give rise to different meanings and practices around health?
  • What are the relationships between culture, territory and health? Why is important to make these relationships visible?
  • Why is religion a relevant area to understand territory and health?
  • Why is it important to consider ethnic diversity within the framework of the territory-health relationship?

The body as a territory: exploring conflicts, inequities and injustices (gender and health, disability, aging, childhood, masculinities, etc.).

In recent history of Western medicine, the body has been a sacred place and soul; experiment and individual; disease, disability and death. Also, the body as a space of resistance has been claimed by feminist groups, ethnic communities, black people, indigenous people, peasants, union and workers organizations; Rescuing the value of the body as a territory and showing how it has been a space for the extraction of value, subordination and, also, emancipation. The public health conscious of the claims around the body as physical and social territory; at the same time, intersubjective and personal, invites the academy, society in general and all those who are working on the subject of the body as territory to present their developments, reflections and experiences in the matter; so that together we can build spaces for reflection and dialogue about the scope of these for the design of actions and policies on population health.

Deterritorialization and health: migrations, displacements and resettlements (caused by man and nature): extractive activities, violence, poverty and natural disasters.

The international mobility of populations has been an aspect that has been present since the beginning of human beings history, and the displacement of people across borders, has been present since they began to be part of the territories. Studies of human movements have been presented in a broad way, including all types of displacement of people, and in a more restricted way contemplating the changes of residence of those who move in territorial spaces. Currently, it is possible to point out that migration is part of the process of globalization, which is why there are necessary challenges to be addressed in the framework of human rights, equity and social justice.

Nowadays, studies demonstrates that migrations have generated demographic impacts in the increase of the population indicators of the countries (Cangiano, 2018, United Nations, 2017, Rodríguez y col, 2013); at an economic level, related to remittances, the economic contributions of migrants and human capital (Brain Drain) (World Economic Forum, 2016, OECD, 2015, ECLAC, 2008); in the environmental framework, due to the abandonment of traditional activities, the strong urbanization process of the places of arrival and origin, both at the level of the towns and the large cities (Adamo, 2016 European Commission, 2015, Observatory of Migrations of the Caribbean, 2013; Jónsson, 2010;); around changes in family, social conformations and changes to the ethnic and cultural level (Fernández, 2014, Puyana, 2007); and more recently in the so-called codevelopment (Khoudour-Castéras, 2016), all of the above has had a direct impact on health conditions, the response of health systems, the epidemiological profile of countries of departure and arrival, becoming new challenges to be addressed in the face of the health needs present in these populations. In this sense, deep reflections are required in terms of territory and human mobility. That is why, this topic during the congress will investigate some aspects that can be analyzed in the contemporary migratory context:

  • In the current migratory reality, how has the response to health care (beyond emergency care) been thought of towards the migrant population?
  • How to think of effective strategies for states to respond to the new realities present in the framework of international migration?

What are the challenges of health, in the new framework of care for high-cost diseases from other latitudes such as HIV, Hemophilia, diabetes, etc.?

Virtual territories and health: Telemedicine; e-patient networks; ICT and Health; teleworking, geographic information systems (GIS), social networks and public health surveillance. etc.

The material world that historically inhabit humans and other beings, has today its counterpart, its parallel “other world”, although not always synchronous or universal: the virtual world. In this virtual world, territory of more and more humans, voices are heard – many times – inaudible in physical spaces and the realities of the territories of the globe are evidenced in different ways. Connected by our languages, images, videos and audios we seek to overcome painful geographic barriers and express needs in health, social expectations, territorial realities and problems that we share or separate us, either from our common bets or from the borders of our territories. This virtual space and its interactions with the materiality of human life, population and individual health, constitutes the place of possibility for the integration of voices, bits and wills that before, and even now, mountains, valleys, rivers, seas and borders separate.

The possibility of integrating in these spaces promises to our species the hope of facing the challenges of the contemporary world. Never as we have now known who and how many we are, where we are and how we live. The recognition, reporting and monitoring of events in health and disease, along with our demographic, economic and political dynamics happens, not only by paper format, but by mobile; social networks; the virtual communities of e-patients and digital citizens; by geographic information systems; text messaging and mobile applications. Distances previously impossible today are covered with telemedicine; patients and doctors connected by instant messaging; exams and laboratory results that arrive in seconds by transactional electronic medical records systems. Simulated humans, virtual reality and artificial intelligence that change the world of teaching. A different world, a new world … However, in this there are still injustices; Inequality continues to exist, although now with faces and words in ones and zeros …

Health systems must face the technological promise by reviewing their ethical principles according to the individuality, freedom and privacy from which information and communication technologies are enunciated. Possibilities all challenging, demanding and hopeful those that offer us these technologies if we approach them with critical attitude and open spirit. Our congress brings together researchers – and their diverse developments in the subject – of the health sector to reflect on the implications of information and communication technologies as a new territory for the health of populations.

Biospaces and Health.

Subtopic a) environmental health, healthy environments for the promotion of health and well-being.

Environmental Health includes aspects of human health and quality of life that are influenced by environmental factors, which include physical, chemical, biological, social and psychosocial factors. It also refers to the theory and practice of the evaluation, control and prevention of said factors.

In general, the territories are made up of migratory flows of people attracted by the opportunities that offer the natural wealth and subsoil. However, when the increase in population occurs in a disorderly manner, the health of the population is threatened by several events that are triggered, for example: The pollutant load in the wastewater is increased, which reaches the rivers that are used to irrigate the crops needed to feed the growing population, then the quality of the food decreases as they are irrigated with contaminated water. It also increases the production of solid waste, which implies a collapse of the systems that were designed for a lower capacity and an additional land demand for landfills. Likewise, air pollution increases, given that new industries appear and the vehicle fleet increases, both public and private transport. On the other hand, the increase in demand for electric power and new housing implies an increase in mining exploitation, which creates adverse effects on the environment, which subsequently translate into risks for the health of the populations.

What policies, actions and technologies can mitigate or prevent health hazards, caused by inadequate exploitation of resources and the consequences of the dynamics of disorderly population growth?

 

Subtopic b) work as a territory of life, health and illness.

Work as a biospace can be understood as a territory whose limits are not static but respond to the dynamics of social construction that arise from the complex relationships established between human beings and the context in which they work. Thus, the work environment can be seen as a scenario of dynamic interrelation between employment conditions (stable employment, precarious employment, informal work, child labor), working conditions (physical, biological, chemical, biomechanical and psychosocial conditions typical of labor activities, as well as organizational factors and production processes) and health.

The health – work relationship is not unidirectional, and, in that sense, it is necessary to affirm that health is necessary to work and work to promote health. Likewise, it can be said that work has the dual property of being configured in a setting of well-being, satisfaction and health; or in a propitious territory in which individual and collective health problems emerge.

The precariousness of employment conditions represents a reduction in social security and an increase in job instability, which is related to the health of the people, not only because of the limitations that this means in health care, the guarantee of have maternity / paternity and sick leave, and the protection of vulnerable populations (e.g. child laborers); but because of the tension generated by the uncertainty of having a job as a source of income, which in turn is associated with mental health problems and the promotion of tacit acceptance of working conditions that can be very harmful to health (e.g. exposure to chemical substances and highly dangerous physical conditions, high risk of accidents, work that represents a high physical exhaustion, strenuous working hours, high workloads, etc.).

On the other hand, the approach of the different forms of production, organization and distribution of work involves differential exposures to working conditions that would be related to particular patterns of health – disease, which represents a challenge to approach this relationship from a classical approach of exposure to risk agents (chemical, physical, biomechanical, psychosocial, etc.), without neglecting the emerging challenges for the health-work relationship derived from new forms and work dynamics (teleworking, temporary work flexibility, work of migrant populations, balance between work and family life, intensification of work, aging of the working population, and incursion of new generations in the workplace, to mention just a few).

In this context, this panel seeks to convene works that allow generating a reflection and discussion around the following question: how is work, as a biospace, configured as a territory in which the health – disease process takes place?

 

Subtopic c) urban, rural, habitat and health territories.

The habitat refers to the permanent place where people live and involves both geographical and physical spaces and their environments, where production processes are developed, reproducing in a stable way for the perpetuation of the human species. In the territorial organization, the rural and the urban have been distinguished as two different dimensions of these spaces, as extremes of a continuum in which other forms emerge, such as conservation zones for the protection of ecosystems and metropolises, for example. As a permanent place of life, the habitat directly implies healthy housing, road infrastructure and services for mobility, recreation and socialization of community life such as parks, cultural centers, schools, public transport, among others.

The problematic situations that are located in this context have to do most of the time with inequitable access to decent housing that respects the dynamics and cultural practices of the populations in the conception of this space of socialization and life, which has services public and basic sanitation, free from overcrowding and that is safe. Especially critical is access to drinking water, management of solid and liquid waste, exposure to vectors, among others.

In the housing environment, especially in the urban periphery areas, those in which people with high degrees of marginality and social exclusion settle, the possibility of having a healthy habitat is even more limited because they are circumscribed not only to the lack of sufficient services for the quality of life, but also the fact that the low cost of land is an incentive for the proliferation of industrial production generating exposures to risks of a biological and chemical nature, but also to the generation of spontaneous settlements in areas risky. On the other hand, rural areas have historically been those to which less attention is given in the configuration of a healthy habitat, given that it has not been possible to configure differential policies for these populations, in addition to the severity that is expressed in the deficit of infrastructure, services, equipment, etc. State responses to the precariousness of rural housing are not relevant because they tend to extrapolate massive urban housing designs, ignoring the productive role of rural housing as a scenario not only of settlement but of work.

Although the configuration of healthy habitats requires comprehensive and articulated actions of various state sectors, there is a demand for leadership from the health sector, as the habitat is a determining factor to guarantee the right to health due to the impacts that the deficits existing ones generate on individual and collective health.

How are health and system policies contributing to the generation of healthy habitats? What are the consequences that on health are generating deficit of healthy habitat and how these affect health inequities?

 

Subtopic d) Territory, sovereignty and food security: strategies for health and territorial development.

Food and nutrition security, as well as food sovereignty are recognized as human rights in connection with the life, health and well-being of populations and with the fundamental right of every person not to suffer from hunger. Food security refers to the permanent availability of food, its access and timely consumption in conditions of quality and safety. Food sovereignty has to do with the organization of the production and consumption of local foods, respecting the choices of peoples, their practices and cultural traditions. It also implies the protection and regulation at the national level of agricultural production and the domestic market.

The lack of guarantee of the equitable right to a healthy diet is the cause of undernourishment and malnutrition, conditions that especially affect vulnerable groups and those living in poverty. Hunger, caused by extreme conditions of food shortages and increased costs, not only contributes to the impoverishment of populations but also to the spread of morbidity and mortality in communities. On the other hand, phenomena such as displacement, forced migration, lack of field productivity, climate change, environmental pollution, lack of protection to local production and consumption, bad practices in the food industry, together with globalization phenomena and free trade agreements that transform the dynamics of own production, supply, access and availability of healthy and nutritious food are, among others, the factors that threaten food sovereignty and security. These represent a multidimensional problem and therefore require State actions and public policies in a multisectoral logic that represent comprehensive responses to affect food and nutrition vulnerability, accompanied by adequate monitoring, regulation and intervention mechanisms to guarantee timely availability and access to food.

However, the existing responses do not seem to be enough to address these problems; particularly from the health systems, where the solution is sectored and centered essentially on the individual clinical attention of the problems, with little prevention and promotion actions, and often in the absence of intersectoral logic.

How are health systems responding to the problems of food security, nutrition and food sovereignty? What are their successes, failures and challenges to guarantee these rights and their implications for the health of populations?

Organized by:

With the support of

Maestría en Gobierno del Territorio y Gestión Pública

Contact

Pontificia Universidad Javeriana
Phone: +57 (1) 320 8320
Ext: 2208 – 2210 – 3668
congresosistemasalud@javeriana.edu.co