• INTRODUCTION
• LEADERS IN HEALTH INTERNATIONAL PROGRAM EDMUNDO GRANDA UGALDE 2009
• TRIBUTE TO DR. EDMUNDO GRANDA UGALDE
• MODULE ON NUTRITION, FOOD TRADE AND DEVELOPMENT
• DEVELOPMENT OF A COUNTRY TOPIC
• INTERVIEW
• SEMINARS, WORKSHOPS AND MEETINGS
• OTHER NEWS OF INTEREST
• WE INVITE YOU TO PARTICIPATE!

As we launch the third issue of the International Health Bulletin, we are pleased to announce the incorporation of the second cohort of the Leaders in International Health Program. This cohort, which began its activities in the Program on 23 March 2009, includes 55 professionals from 20 countries in the region of the Americas. For more information on the LIHP 2009, the participants and their country projects, we invite you to read the article Leaders in International Health Program Edmundo Granda Ugalde 2009 in this issue.

This issue of the International Health Bulletin is devoted primarily to the topic of nutrition, food trade and models of development, which shaped the framework for the fourth module of the Leaders in International Health Program 2008.

Addressing the topic of nutrition from an international health perspective involves looking at the macro factors that determine the inequality of access to basic foodstuffs, particularly those that are most needed to provide nourishment throughout the various stages of the life cycle. The future of the world’s nutrition depends in large part on food patterns, the impact of industrialized or processed foods, the effect of subsidies on agricultural production and barriers or lack of access to foodstuffs. Similarly, the reduced availability of arable land, attributable in part to changes in climate and the increased production of biofuels to respond to the mounting global demand for energy, have – at the same time – contributed to an increase in the price of some basic foods as well as deforestation as lands are devoted to the cultivation of other more ‘profitable’ crops. These factors, among others, have had an impact on the current world food crisis, which disproportionately affects poorer populations and which requires additional investigation and analysis.

The LIHP promotes the study of the effect of these factors on the life and health of communities, including an examination of the balance of food imports/exports in each country, the impact of marketing processed foods and the use of healthy foods in the household’s daily diet. It also encourages the analysis of treaties or trade agreements that may influence the access to healthy foods as well as food habits and cultural practices within our societies. This knowledge will allow for the formulation of public policies and international agreements that protect the quality of life in every country.

It is also important to mention other PAHO/WHO efforts such as the Pan American Alliance for Nutrition and Development launched at the end of 2008, that seeks to address the social determinants of nutrition through the promotion and implementation of a coordinated strategy between United Nations’ agencies and other actors that responds to the priorities set forth by the countries of the region in order to accelerate the achievement of the Millennium Development Goals.

The following sections of the newsletter will briefly describe the salient aspects of the LIHP module on Nutrition, Food Trade and Development so as to provide the reader with detailed information on the topics addressed and their development, the activities undertaken, the products obtained and the lessons learned in this first version of the virtual learning module within the LIHP.

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LEADERS IN INTERNATIONAL HEALTH PROGRAM EDMUNDO GRANDA UGALDE 2009

The Leaders in International Health Program (LIPH) began in 2008 as an initiative of the Pan American Health Organization under a new decentralized structure that aims to contribute to the development of the Health Agenda for the Americas 2008-2017 by strengthening the capacity of countries in the region to understand, act upon, and positively influence the international determinants of health, to promote their national interests and to achieve intersectoral health agreements in international environments, guided at all times by the principle of greater global equity in health.

The 2008 Program included 20 participants from 8 countries in the region all of whom satisfactorily completed the objectives of the Program and presented their final projects during a Closing and Transition event which took place in Brasilia, Brazil in December 2008. More information on the cohort, their institutions and their international health projects can be found in the first issue of the International Health Bulletin.

Following this successful experience, the call for applications for 2009 was announced resulting in approximately 200 candidates from the region. After a careful and competitive selection process, 35 individuals from 17 countries in the region were selected to participate in the Regional Program. In addition, based on an agreement between the ministries of health and foreign affairs in Cuba, the PAHO/WHO Country Office and the LIHP Coordination, the Program incorporated the Coordinators of the Cuban Medical Brigades working in the 5 PAHO priority countries (Bolivia, Guyana, Haiti, Honduras and Nicaragua) plus Guatemala, resulting in a total of 55 participants in the LIHP 2009. Information on these participants is found in the attached link.

All of the participants began their Program in their countries of residence where, over a period of 7 weeks, they engaged in different activities, discussions and visits in relation to the principal health and development challenges facing the country and the region, while beginning to define a project to be developed later in-country in coordination with PAHO/WHO, the government and other authorities. This initial phase also included virtual sessions on Primary Health Care and the Social Determinants of Health, the harmonization of international cooperation, the conceptual model of international health and its relation to the LIHP and their country projects, and research methodologies. The participants also had the opportunity during this period to interact directly with the local PAHO/WHO Country Office so as to better understand the technical cooperation that it provides on the national, subregional and regional level.

At the end of this initial phase, the participants who are Coordinators of the Cuban Medical Brigades attended an on-site workshop organized by PAHO, the Ministry of Health of Cuba and the Department of International Health of the National School of Public Health in Cuba, during which they delved more deeply into the conceptual issues surrounding international health, while the remaining 35 participants from the Regional Program attended a two-week training program at PAHO’s Headquarters Office in Washington, DC from 11-22 May.

All participants had the opportunity to analyze in depth the conceptual model of international health and to advance in the development of their International Health Country Topics in coordination with PAHO experts, academic centers throughout the Region and other organizations. In addition, this year’s participants had the opportunity to visit with the Organization of American States (OAS) where they were briefed on the history of the institution and how human rights and health are guaranteed in the Inter-American Democratic Charter.

Upon returning to their countries, participants maintain a close link with the local PAHO/WHO Country Office to delve more deeply into aspects of international cooperation and continue to work on their country topics. Participants also undertake a series of problem-based virtual modules on relevant international health topics with experts from different academic and other institutions throughout the region.

The participants will reunite in a country of the region for one week in December for the closure of the Program, during which time they will present their final international health country topics.

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TRIBUTE TO DR. EDMUNDO GRANDA UGALDE

Beginning this year, the Leaders in International Health Program will take on the name of Dr. Edmundo Granda Ugalde, an academician, respected leader and champion for equity in health in his native country of Ecuador and throughout the region. In the opening ceremony of the 2009 Program, Dr. Pedro Brito, Area Manager, Health Systems and Services, delivered a moving speech in which he recognized the great work done by Dr. Granda in the field of health and promotion of equity for all people, as well as his contributions to the Training Program in International Health over the years. His widow, Mrs. Clarita Merchán, participated in the opening ceremony via webcast from Ecuador, and expressed her gratitude for the recognition made by PAHO in name of her husband. For PAHO, and particularly, for the Leaders in International Health Program, it is with great pride and honor that we associate the name of Dr. Granda Ugalde with the Program. We invite you to read his latest publication, La salud y la vida.

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MODULE ON NUTRITION, FOOD TRADE AND DEVELOPMENT

The Module on Nutrition, Food Trade and Development had the following learning objectives: (1) to analyze and understand the link between nutrition and development, the impact of international food trade on food security, and the cause(s) and effect(s) of the food crisis and; (2) to strengthen capacity for policy formulation and project management based on an understanding and analysis of real life situations.

The starting point was to reflect on human security within the framework of the right to food and its relationship to human development in order to address the following questions: What is the link between nutrition and development?, How does international food trade influence nutrition and development?, and What are the causes, consequences and possible scenarios of the food crisis? Based on the analysis of the above, participants developed an intervention proposal incorporating negotiation and advocacy (See Learning Path).

The content of the module was developed using theoretical elements, data and basic indicators for the analysis of real life situations, leading to the development of action proposals in relation to the following components:

     • Conceptual framework of nutrition and development
     • Food trade
     • Food crisis

Each component was accompanied by core and supplementary readings, activity guides, tutorial sessions and videos to facilitate virtual learning. The videos included experts on the various subject matters dealt with in the module. Virtual mentoring sessions allowed participants to share doubts, knowledge, experiences and perceptions of their own national situation with regard to a particular issue. Input was also provided to support participants in carrying out the activities related to each module component.

The reading of the basic and supplementary documents, the exchange of knowledge and experience, the resolution of doubts and the consultation of other national and regional sources were key inputs for analysis and reflection by the participants, which was evidenced in the various assigned activities for the module as described below.

1. Forum: “The right to food as a framework for nutrition and development”
One of the most valuable products of this module was the exchange of knowledge, experiences and viewpoints put forth by the participants in the virtual forum. Among the topics discussed were: the importance of the right to food and other related rights in achieving development, based on the legal framework to support action in this area; the need for indicators to assess progress with regard to compliance with the declarations, pacts and agreements that have been recognized and ratified by several countries; the manifestations of hunger and child mortality as manifestations of poverty and social exclusion; and the need for a comprehensive approach in order to achieve good nutrition that contributes to development.

2. Analysis of current affairs
During the module, participants were encouraged to analyze global events related to those determinants responsible for the rise in food prices. This allowed participants to analyze information reported in the news, in declarations, and through countries’ actions to address what has been deemed a “food crisis” and its consequences over the short, medium and long term.

To promote current knowledge on the subject and provide more items for analysis, participants conducted a news search, and prepared a summary and position paper that were placed in the International Health Situation Room (IHSR), and which covered the food crisis, agricultural trade, the lack of food, child nutrition, the launch of programs to cope with the food crisis, etc. This activity allowed participants to relate to world events regarding the rise in the cost of food that were taking place during the period the module was underway and to apply their analytical competencies.

3. Analysis and intervention proposals
Various tasks were undertaken during the module, of which two have been selected as outstanding work presented by the participants:

a. Causes, consequences and scenarios regarding the impact of the food crisis: This task involved the development of a comprehensive analysis, which consisted of research and analysis of information related to the Consumer Price Index, poverty levels and its relation to chronic malnutrition; analysis of each component of the Global Hunger Index; and a diagnosis of the current food and nutritional situation in each country. Tareas_componente_3_Ecuador_Perú_Chile

b. Intervention Proposal: For this task, participants were asked to use the country situation diagnosis from the previous activity. The work envisaged the basic components and entailed the development of an advocacy path. Participants presented a summary of their final work on 30 September, 2008.
Tareas_componente_4_Colombia_Guatemala_Perú

4. Forum: "Successful strategies for nutrition and development"
To expand upon and become acquainted with the experiences of some intervention models, a forum entitled "Successful strategies for nutrition and development" was planned for 23 September, as an activity related to the component on action strategies. During this forum, Dr. Nila Heredia, former Minister of Health and Sports of Bolivia and Dr. Adrian Díaz, Advisor in the PAHO/WHO Country Office in Peru presented the Zero Malnutrition Program and the Growth (CRECER) Strategy, respectively. Both presentations provided valuable input for the intervention proposals developed by the participants. The recording of the session is accessible through the following link:
https://sas.elluminate.com/site/external/jwsdetect/playback.jnlp?psid=2008-09-23.0739.M.A275CD6054885215D072F773FD310D.vcr

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The international health topic developed by the Peru - Bolivia team was "Alliance between Bolivia - Peru to contribute to the eradication of malnutrition in the Andean region" with the objective of analyzing the differences in food trade and cooperation strategies for the eradication of malnutrition in Bolivia and Peru and proposing effective intersectoral and interagency actions. To achieve this, each country team prepared a specific paper. Peru was responsible for the international cooperation portion while Bolivia sought to define aspects relating to food trade, both within a nutrition framework. Both issues were developed by team members during the period May through November 2008 with support from their respective communities of practice and tutors.

In the case of Peru, a community of practice was already in place to support the CRECER Strategy, formed by 13 organizations (including United Nations agencies, NGOs and other organizations), allowing for work on the topic of the eradication of child malnutrition and supporting the work of different government organs to achieve their objectives.

In the case of Bolivia, the community of practice was established and included institutions from the public sector, civil society, the UN system and NGOs. The participation of the Technical Committee of the National Council of Food and Nutrition was important in this initiative given their responsibility for coordinating the implementation of the Multisectoral Program Zero Malnutrition. This entity expressed their interest in giving continuity to the IHSR of Bolivia.

To develop the topics, two complementary International Health Situation Rooms (IHSR) were created: 1) IHSR Bolivia responsible for the development of food trade; and 2) IHSR Peru in charge of the impact of international cooperation on nutrition programs, agreements, treaties, declarations and summits.

One of the products of the two situation rooms was an intervention plan, prompting the formulation and implementation of a technical cooperation proposal (TCC) between the countries. This, in turn, allowed the countries to address the socioeconomic determinants of nutrition from a local perspective taking into account different social actors, so as to contribute to a reduction in the prevalence of chronic malnutrition in the border zone of Lake Titicaca in the municipalities of Puno and Copacabana (Peru - Bolivia). For more information, please visit Peru’s IHSR at https://ssi.campusvirtualsp.org/peru/ and Bolivia’s IHSR at https://ssi.campusvirtualsp.org/bolivia/files/2008/11/proyecto-bolivia-final.doc

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Dr. Julio Hernández, economic adviser, former Vice Minister of Agriculture in Guatemala and advisor to international negotiations meetings of the World Trade Organization, was interviewed. The interview, entitled "The Implications of International Trade:: Free Trade Treaties in the Context of Latin America", is accessible through the following hyperlink:
https://sas.elluminate.com/p.jnlp?psid=2008-12-10.1040.M.162BFB692B8439068E8D80C9B6490E.vcr

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The second International Health Seminar, which took place on 10 September via Elluminate, was attended by more than 50 participants. Attendees were participants from the Leaders in International Health Program 2008, the communities of practice of the IHSR of each country and other national actors involved in the topic: "Nutritional Food Crisis in an International Health Context".

During the seminar, Dr. Daniel López Acuña, Director of Recovery and Transition Programmes, Health Action in Crisis, WHO, presented "A Vision from WHO on Problems and Solutions to the Food Crisis". Dr. Rubén Suárez, Regional Adviser, Health Economics and Finance, PAHO/WHO, presented "The Development of Human Capital and Caring for Children for the Future of our Societies". Mr. Rory Narvaez, Program Officer, World Food Programme (WFP), presented an exposé on “The Rise in Food Prices and Climate Change: Threats to Food and Nutritional Security".

The following individuals were invited to make closing comments and provided valuable feedback on the issue: Dr. Maria Isabel Rodríguez, former rector of the University of El Salvador (currently Minister of Health in El Salvador), Dr. Hernán Delgado of the Nutritional Institute of Central America and Panama (INCAP) and Dr. Manuel Peña, PAHO/WHO Representative in Peru.

For more information on the events, see: Invitation to Seminar on Food Crisis

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The closing-transition activity of the Leaders in International Health Program 2008 took place from 1-4 December in Brasilia, Brazil. One of the main events during the meeting was the presentation by the participants of the 2008 cohort of the international health topics that they had developed during the year, including the development of the International Health Situation Rooms and their interactions with their communities of practice. The meeting also included an evaluation of the 2008 Program, which underscored the importance of the experience for the professional development of the participants and the recommendations of which have been taken into consideration in the development of the 2009 Program. The meeting also provided an important opportunity for the exchange of ideas, visions and experiences with participants from the Specialization Course in Global Health and Health Diplomacy developed by the Oswaldo Cruz Foundation (FIOCRUZ) and PAHO-Brazil. The participants were privileged with the presence of noted individuals who have been instrumental in the evolution of the Program within the Organization and in Health Human Resources in the region: Dr. Carlyle Guerra de Macedo, Director Emeritus of the Pan American Sanitary Bureau; Dr. María Isabel Rodríguez, first Program Coordinator, , former rector of the University of El Salvador and current Minister of Health of the Republic of El Salvador; Dr. José Romero Teruel, former Director of Planning of PAHO; Dr. Francisco Campos, General Secretary for the Management of Labor and Education of the Ministry of Health of Brazil; and Dr. Mirta Roses, current Director of the Pan American Sanitary Bureau. We would like to acknowledge the PAHO/WHO Country Office and Ministry of Health of Brazil who provided an important contribution for the carrying out of this important event, as well as for sharing their valuable experience in technical cooperation and global health. The LIHP participants closed the meeting with the Declaration of Brasilia, in which they reiterated their commitment to international health and as defenders of the right to health for the peoples of Latin America and the world.

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• Call for Applications LIHP 2010: In the coming months there will be an open call for applications for the Leaders in International Health Program Edmundo Granda Ugalde 2010. Detailed information will be available in the next newsletter.


 

• Coming editions of International Health Bulletin: Volume 4 of the International Health Bulletin will address the topic of medicines and will be available soon.

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• Invitation to contribute to the collective development of a conceptual model on international health The first documents that have been developed to support the conceptual model, "Towards a new construction of the conceptual model of international health", can be reviewed in the Regional International Health Situation Room. We invite you to visit the Regional Situation Room at the following link to contribute to the development of the model: https://ssi.campusvirtualsp.org/?page_id=3
   

• International Health Situation Room: We recommend visiting the International Health Situation Rooms (IHSR) to review the country proposals and progress made by the country teams of the 2008 and 2009 cohorts of the Leaders in International Health Program Edmundo Granda Ugalde. These proposals have been developed with the support of the PAHO/WHO Country Offices, technical experts, national authorities and other actors. The IHSR provides space to interact with the country teams through discussion-generating questions and analyses. We look forward to your active participation. https://ssi.campusvirtualsp.org/

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