Declaración de Cuernavaca.

Los Institutos Nacionales de Salud (INS) miembros de la Red Regional Latinoamericana de la Asociación Internacional de Institutos Nacionales de Salud Pública, reunidos en forma presencial en la sede del Instituto Nacional de Salud Pública de México, en la Ciudad de Cuernavaca, los días 5 al 7 de octubre de 2022, contando con la participación de los directores o representantes de los INS de (...).

Endemismo urbano por COVID-19 en Petrópolis: Detección de un foco endémico mediante análisis espacial / Urban COVID-19 endemism in Petrópolis: detection of an endemic focus by spatial analysis

RESUMEN Se realizó un estudio con el objetivo de identificar un ecosistema de endemismo urbano que explique la persistencia del SARS-CoV-2 durante los primeros 18 meses de la pandemia en el municipio de Petrópolis, Río de Janeiro, Brasil. Se analizaron los registros oficiales de casos mensuales de COVID-19, georreferenciados según el domicilio de residencia de cada caso confirmado y se elaboraron mapas de calor mensuales que identifican puntos con diferentes densidades espaciales de la enfermedad mediante la aplicación de la metodología de kernel. Se identificaron puntos de calor con cinco niveles de intensidad para la densidad espacial de casos. Los puntos de mayor intensidad, conocidos como «hotspots¼, se mantuvieron constantes durante todo el período en un polígono de aproximadamente 4 km2 ubicado en el centro de la ciudad de Petrópolis. En conclusión, se encontró que la mayor concentración de casos se mantuvo en la misma ubicación a lo largo del tiempo, a pesar de la dispersión esporádica de los casos en el territorio municipal.

ABSTRACT This study aimed to identify an ecosystem of urban endemism that explains the persistence of SARS-CoV-2 during the first 18 months of the pandemic in the municipality of Petrópolis, Rio de Janeiro, Brazil. We analyzed official records of monthly COVID-19 cases, georeferenced according to the residence address of each confirmed case. Monthly heat maps identifying points with different spatial densities of the disease were constructed by applying the kernel methodology. Heat spots with five intensity levels were identified for the spatial density of cases. The points of highest intensity, known as hotspots, remained constant throughout the period in a polygon of approximately 4 km2 located in the center of the city of Petrópolis. In conclusion, we found that the highest concentration of cases remained in the same location over time, despite the sporadic dispersion of cases within the municipal territory.

Urban COVID-19 endemism in Petrópolis: detection of an endemic focus by spatial analysis. / Endemismo urbano por COVID-19 en Petrópolis: Detección de un foco endémico mediante análisis espacial.

OBJECTIVES.: Motivation for the study. During the COVID-19 pandemic, spatial analysis methodologies were used to identify the territorial determinants of its distribution and social inequalities in access to medical care. Main findings. We found a concentration of cases in a specific location of the municipality, which remained constant throughout the study period, with sporadic outbreaks in other areas. Implications. It is necessary to pay attention to possible endemic foci of viral diseases in urban settings and to take measures to eliminate them as well as to prevent their spread within and outside the area.

The future of public health education and research.

Not available.

Atención primaria en salud y gestión urbana en comunidades sujetas a elevada fragilidad socioeconómica y ambiental.

Based on the knowledge of the social determination of health, the challenge and the strategy of action to promote integrated public policies are posed, focusing on the concept of expanded health in territories where populations with high social exclusion prevail. For this purpose, the dialectic relationship between social classes, territories and health is considered. Based on the founding objectives of primary health care, the family health teams in the municipality of Petrópolis, state of Rio de Janeiro, Brazil, were trained to carry out a participatory rapid assessment related to the goals of the sustainable development objectives, in their areas of operation. This diagnosis guided the action plan for health promotion in eight pilot areas, within which conglomerates of greater social exclusion are defined through participatory mapping. Following criteria for the social control of the health system, established in the country's legislation, the creation of community forums is encouraged, which will elect legitimate community representatives to serve on local health councils, whose main mission is to discuss health and welfare problems on the basis of an intersectoral and expanded vision. The community forums, in conjunction with other local society organizations, discuss the main problems and propose alternative solutions that will collectively transform the reality of the territories. As an initial alternative, agro-ecological urban agriculture projects are established to promote sovereign and resilient transformations.

Con base en los conocimientos sobre la determinación social de la salud, se plantea el desafío y la estrategia de actuación para fomentar políticas públicas integradas, con foco en el concepto de salud ampliada en los territorios donde prevalecen poblaciones de elevada exclusión social. Para ello, se considera la relación dialéctica existente entre las clases sociales, los territorios y la salud. Partiendo de los objetivos fundadores de la atención primaria de la salud, los equipos de salud de la familia en la municipalidad de Petrópolis, estado de Río de Janeiro, Brasil, fueron capacitados para realizar un diagnóstico rápido participativo relacionado con las metas de los objetivos de desarrollo sostenible, en sus áreas de actuación. Dicho diagnóstico orientó el plan de acción para la promoción de salud en ocho áreas piloto, dentro de las cuales se delimitan conglomerados de mayor exclusión social mediante la cartografía participativa. Siguiendo criterios del control social del sistema de salud, establecidos en la legislación del país, se fomenta la creación de foros comunitarios que elegirán representantes legítimos de la comunidad para integrar los consejos locales de salud, cuya principal misión es discutir los problemas de salud y bienestar a partir de una visión intersectorial y ampliada. Los foros comunitarios, en conjunto con otras organizaciones de la sociedad local, debaten los principales problemas y proponen soluciones alternativas que permitan transformar colectivamente la realidad de los territorios. Como alternativa inicial se establecen proyectos de agricultura urbana de carácter agroecológico para promover transformaciones soberanas y resilientes.

Atención primaria en salud y gestión urbana en comunidades sujetas a elevada fragilidad socioeconómica y ambiental

RESUMEN Con base en los conocimientos sobre la determinación social de la salud, se plantea el desafío y la estrategia de actuación para fomentar políticas públicas integradas, con foco en el concepto de salud ampliada en los territorios donde prevalecen poblaciones de elevada exclusión social. Para ello, se considera la relación dialéctica existente entre las clases sociales, los territorios y la salud. Partiendo de los objetivos fundadores de la atención primaria de la salud, los equipos de salud de la familia en la municipalidad de Petrópolis, estado de Río de Janeiro, Brasil, fueron capacitados para realizar un diagnóstico rápido participativo relacionado con las metas de los objetivos de desarrollo sostenible, en sus áreas de actuación. Dicho diagnóstico orientó el plan de acción para la promoción de salud en ocho áreas piloto, dentro de las cuales se delimitan conglomerados de mayor exclusión social mediante la cartografía participativa. Siguiendo criterios del control social del sistema de salud, establecidos en la legislación del país, se fomenta la creación de foros comunitarios que elegirán representantes legítimos de la comunidad para integrar los consejos locales de salud, cuya principal misión es discutir los problemas de salud y bienestar a partir de una visión intersectorial y ampliada. Los foros comunitarios, en conjunto con otras organizaciones de la sociedad local, debaten los principales problemas y proponen soluciones alternativas que permitan transformar colectivamente la realidad de los territorios. Como alternativa inicial se establecen proyectos de agricultura urbana de carácter agroecológico para promover transformaciones soberanas y resilientes.

ABSTRACT Based on the knowledge of the social determination of health, the challenge and the strategy of action to promote integrated public policies are posed, focusing on the concept of expanded health in territories where populations with high social exclusion prevail. For this purpose, the dialectic relationship between social classes, territories and health is considered. Based on the founding objectives of primary health care, the family health teams in the municipality of Petrópolis, state of Rio de Janeiro, Brazil, were trained to carry out a participatory rapid assessment related to the goals of the sustainable development objectives, in their areas of operation. This diagnosis guided the action plan for health promotion in eight pilot areas, within which conglomerates of greater social exclusion are defined through participatory mapping. Following criteria for the social control of the health system, established in the country's legislation, the creation of community forums is encouraged, which will elect legitimate community representatives to serve on local health councils, whose main mission is to discuss health and welfare problems on the basis of an intersectoral and expanded vision. The community forums, in conjunction with other local society organizations, discuss the main problems and propose alternative solutions that will collectively transform the reality of the territories. As an initial alternative, agro-ecological urban agriculture projects are established to promote sovereign and resilient transformations.

Cooperação estruturante em saúde e o papel das redes na CPLP / Structuring cooperation in health and the role of networks in CPLP

O artigo apresenta o contexto de emergência da cooperação estruturante em saúde, no âmbito da qual se destaca o papel e atuação das Redes Estruturantes de Saúde da Comunidade dos Países de Língua Portuguesa (CPLP), em substituição à tradicional cooperação norte-sul, focada em programas verticais. Posteriormente, os autores abordam aspectos históricos da formulação do Plano Estratégico de Cooperação em Saúde (PECS) da CPLP, os objetivos das Redes ­ Rede de Institutos Nacionais de Saúde Pública (RINSP), Rede de Escolas Nacionais de Saúde Pública (RESP) e Rede de Escolas Técnicas em Saúde (RETS) ­ bem como sua perspetiva de atuação estruturante junto aos sistemas de saúde e ciência e tecnologia em saúde dos países membros. Por fim, apontam os desafios e perspetivas que se apresentam na formulação e programação do próximo ciclo do PECS-CPLP (2017-2020).

The article presents the context of emergence of the structural cooperation in health, within which the role and activities of the Health Structuring Networks of the Community of Portuguese Language Countries / Comunidade dos Países de Língua Portuguesa (CPLP) are noteworthy, replacing the traditional North-South cooperation, focused on vertical programs. Subsequently, the authors address historical aspects of the formulation of the Strategic Plan for Cooperation in Health of the CPLP, the objectives of the Networks - Network of National Public Health Institutes / Rede de Institutos Nacionais de Saúde Pública (RINSP), Network of National Schools of Public Health / Rede de Escolas Nacionais de Saúde Pública (RESP) and Network of Technical Schools in Health /Rede de Escolas Técnicas em Saúde (RETS) ­ as well as their prospect of structural operation together with the health systems and the science and technology in health systems of member countries. Finally, they point out the challenges and prospects that are presented in the development and programming of the next PECS-CPLP cycle (2017-2020).

[Role of the UNASUR national institutes of health in generating evidence on the social determinants of health]. / El papel de los institutos nacionales de salud de UNASUR en la generación de evidencia sobre la determinación social de la salud.

The present article analyzes the role of the Union of South American Nations (UNASUR) national institutes of health since their creation at the beginning of the 20th century up until the present time. It postulates that the national institutes of health are in a position to play a strategic role in generating knowledge and evidence to facilitate decision-making through monitoring and research on the social determinants of health and health inequities. To explore this hypothesis, the national institutes of health are analyzed in the context of the current global scenario, which is generating increased social inequalities, thus leading in turn to serious inequities in health conditions. The article proposes a new model of health promotion, disease prevention, and health care, where necessary, as well as policies and intersectoral actions that address these social determinants. In this new stage, the UNASUR national institutes of health should play a significant strategic role in identifying and analyzing correlations between patterns of production and consumption, social divisions that exist in the territory, conditions of development, and the health of their populations. These national institutes of health are members of the UNASUR Network of National Institutes of Health (RINS-UNASUR). The literature on their creation, drawn from the Network's websites and the proceedings of its meetings and seminars, is reviewed. Given that the current globalized development model is generating enormous social inequalities, by definition, the proposed hypothesis is that the national institutes of health should assume a much broader role in addressing the consequent inequities in the health of the population, complementing their traditional activities with this new strategic role. Without a major reduction in the existing social inequalities and economic inequities, it will be impossible to make significant improvements in health in a democratic manner.

El papel de los institutos nacionales de salud de UNASUR en la generación de evidencia sobre la determinación social de la salud / Role of the UNASUR national institutes of health in generating evidence on the social determinants of health

El presente artículo analiza el papel que desempeñaron los institutos nacionales de salud de la Unión de Naciones Suramericanas (UNASUR) desde su creación a inicios del siglo hasta la actualidad, para luego postular como hipótesis que pueden tener un papel estratégico en la generación de conocimientos y evidencias que faciliten la toma de decisiones mediante el monitoreo y la investigación de la determinación social y las inequidades en salud. Para dar cuenta de esa hipótesis, se analizan los institutos nacionales de salud en el escenario actual global, generador de crecientes desigualdades sociales que determinan graves inequidades en las condiciones de salud y donde es necesario un nuevo modelo de promoción, prevención y atención de la salud, además de políticas y acciones intersectoriales que aborde su determinación social. En esta nueva etapa, los institutos nacionales de salud de la UNASUR deberán desempeñar un papel estratégico significativo al identificar y analizar las relaciones entre la estructura de producción y consumo, la división social del territorio y las condiciones de desarrollo y salud de las poblaciones. Los institutos nacionales de salud analizados son miembros de la Red de Institutos Nacionales de Salud de UNASUR (RINS-UNASUR). Se revisa aquí la bibliografía sobre su creación, se consultan sus sitios web y las actas de las reuniones y seminarios de la propia Red. La hipótesis postulada es que, en el actual contexto de globalización de un modelo de desarrollo que genera, por definición, enormes desigualdades sociales y sus consecuentes inequidades en la salud de la población, los institutos nacionales de salud deberían asumir un papel mucho más amplio para la salud complementando sus acciones tradicionales con un nuevo rol estratégico, entendiendo que, sin una reducción significativa de las desigualdades sociales e inequidades económicas, será imposible mejorar la salud de forma significativa y democrática.

The present article analyzes the role of the Union of South American Nations (UNASUR) national institutes of health since their creation at the beginning of the 20th century up until the present time. It postulates that the national institutes of health are in a position to play a strategic role in generating knowledge and evidence to facilitate decision-making through monitoring and research on the social determinants of health and health inequities. To explore this hypothesis, the national institutes of health are analyzed in the context of the current global scenario, which is generating increased social inequalities, thus leading in turn to serious inequities in health conditions. The article proposes a new model of health promotion, disease prevention, and health care, where necessary, as well as policies and intersectoral actions that address these social determinants. In this new stage, the UNASUR national institutes of health should play a significant strategic role in identifying and analyzing correlations between patterns of production and consumption, social divisions that exist in the territory, conditions of development, and the health of their populations. These national institutes of health are members of the UNASUR Network of National Institutes of Health (RINS-UNASUR). The literature on their creation, drawn from the Network's websites and the proceedings of its meetings and seminars, is reviewed. Given that the current globalized development model is generating enormous social inequalities, by definition, the proposed hypothesis is that the national institutes of health should assume a much broader role in addressing the consequent inequities in the health of the population, complementing their traditional activities with this new strategic role. Without a major reduction in the existing social inequalities and economic inequities, it will be impossible to make significant improvements in health in a democratic manner.

El papel de los institutos nacionales de salud de UNASUR en la generación de evidencia sobre la determinación social de la salud / Role of the UNASUR national institutes of health in generating evidence on the social determinants of health

El presente artículo analiza el papel que desempeñaron los institutos nacionales de salud de la Unión de Naciones Suramericanas (UNASUR) desde su creación a inicios del siglo hasta la actualidad, para luego postular como hipótesis que pueden tener un papel estratégico en la generación de conocimientos y evidencias que faciliten la toma de decisions mediante el monitoreo y la investigación de la determinación social y las inequidades en salud. Para dar cuenta de esa hipótesis, se analizan los institutos nacionales de salud en el escenario actual global, generador de crecientes desigualdades sociales que determinan graves inequidades en las condiciones de salud y donde es necesario un Nuevo modelo de promoción, prevención y atención de la salud, además de políticas y acciones intersectoriales que aborde su determinación social. En esta nueva etapa, los institutos nacionales de salud de la UNASUR deberán desempeñar un papel estratégico significativo al identificar y analizar las relaciones entre la estructura de producción y consumo, la división social del territorio y las condiciones de desarrollo y salud de las poblaciones. Los institutos nacionales de salud analizados son miembros de la Red de Institutos Nacionales de Salud de UNASUR (RINS-UNASUR). Se revisa aquí la bibliografía sobre su creación, se consultan sus sitios web y las actas de las reuniones y seminarios de la propia Red. La hipótesis postulada es que, en el actual contexto de globalización de un modelo de desarrollo que genera, por definición, enormes desigualdades sociales y sus consecuentes inequidades en la salud de la población, los institutos nacionales de salud deberían asumir un papel mucho más amplio para la salud complementando sus acciones tradicionales con un nuevo rol estratégico, entendiendo que, sin una reducción significativa de las desigualdades sociales e inequidades económicas, será imposible mejorar la salud de forma significativa y democrática.

The present article analyzes the role of the Union of South American Nations (UNASUR) national institutes of health since their creation at the beginning of the 20th century up until the present time. It postulates that the national institutes of health are in a position to play a strategic role in generating knowledge and evidence to facilitate decision-making through monitoring and research on the social determinants of health and health inequities. To explore this hypothesis, the national institutes of health are analyzed in the context of the current global scenario, which is generating increased social inequalities, thus leading in turn to serious inequities in health conditions. The article proposes a new model of health promotion, disease prevention, and health care, where necessary, as well as policies and intersectoral actions that address these social determinants. In this new stage, the UNASUR national institutes of health should play a significant strategic role in identifying and analyzing correlations between patterns of production and consumption, social divisions that exist in the territory, conditions of development, and the health of their populations. These national institutes of health are members of the UNASUR Network of National Institutes of Health (RINS-UNASUR). The literature on their creation, drawn from the Network’s websites and the proceedings of its meetings and seminars, is reviewed. Given that the current globalized development model is generating enormous social inequalities, by definition, the proposed hypothesis is that the national institutes of health should assume a much broader role in addressing the consequent inequities in the health of the population, complementing their traditional activities with this new strategic role. Without a major reduction in the existing social inequalities and economic inequities, it will be impossible to make significant improvements in health in a democratic manner.

Classes sociaIs, território e saúde: Uma proposta para analisar e intervir sobre a situação de saúde a partir da sua determinação social / Social classes, territory and health: A proposal to analyze and intervene on the health situation situation based on its social determination

Faz mais de meio século que estudos de epidemio logistas sociais e sanitaristas latino-americanos e de outras partes do mundo expõem, com argumentos teóricos e demonstrações empíricas, o papel das con dições sociais e económicas na determinação do pro cesso saúde ­ doença nas populações. Esses trabalhos têm antecedentes que datam a partir de fins do sécu lo XIX e primeira metade do XX, incluindo, dentre muitos outros a Virchow, S. Allende, S. Pessoa, J. de Castro, etc…

Classes sociaIs, território e saúde: Uma proposta para analisar e intervir sobre a situação de saúde a partir da sua determinação social / Social classes, territory and health: A proposal to analyze and intervene on the situation of health from its social determination

Faz mais de meio século que estudos de epidemiologistas sociais e sanitaristas latino-americanos e de outras partes do mundo expõem, com argumentos teóricos e demonstrações empíricas, o papel das conidições sociais e económicas na determinação do processo saúde ­ doença nas populações. Esses trabalhos têm antecedentes que datam a partir de fins do século XIX e primeira metade do XX, incluindo, dentre muitos outros a Virchow, S. Allende, S. Pessoa, J. de Castro, etc. Fortes resistências epistemológicas, baseadas, sobretudo, numa arraigada compreensão positivista da realidade, fortalecida pelas descobertas Pasteurianas, foram sendo parcialmente vencidas até que o conceito dos determinantes sociais e económicos da saúde foram plenamente assumidos por autoridades nacionais, organismos internacionais de saúde e pela socie dade civil. Dessa forma, a Organização Mundial da Saúde - (OMS), publica em 2008, por intermédio da Comissão dos Determinantes Sociais da Saúde, um documento que propõe "reduzir as desigualdades sociais actuando sobre os determinantes sociais das iniquidades em saúde" Diversas preocupações teóricas e operacionais vinculadas ao assunto culminaram na Conferência Mundial dos Determinantes Sociais da Saúde, realizada em outubro de 2011, durante a qual os Governos membros da (OMS) assinaram a "Declaração Política do Rio sobre Determinantes Sociais da Saúde" Esse evento também propiciou a elaboração de declarações alternativas por parte de organizações da sociedade civil e estimulou a elaboração de trabalhos reflexivos críticos a respeito tanto de suas construções teóricas quanto das proposições operativas. .

[National public health institutes: a coordinated and comprehensive approach toward influenza A H1N1 and other threats to public health]. / Los institutos nacionales de salud pública: un enfoque coordinado e integral contra la influenza A H1N1 y otras amenazas a la salud pública.

The current influenza A H1N1 epidemic has demonstrated once again the importance of being able to count on robust, coordinated, and comprehensive public health systems. Countries that do rely on such health systems have proven to recognize, diagnose, and treat influenza in a timely manner, and to provide the public with the education needed to minimize the number of deaths and acute cases. The International Association of National Public Health Institutes (IANPHI) recommends that all countries begin to coordinate their national public health efforts. IANPHI offers its support and guidance to all who would create or strengthen their national public health institutes. By strengthening national public health systems, the ability to collaborate and the security of all countries is heightened. These institutions exist for the public good, and any improvements made to them are also a contribution toward better health for the population.

Los institutos nacionales de salud pública: un enfoque coordinado e integral contra la influenza A H1N1 y otras amenazas a la salud pública / National public health institutes: a coordinated and comprehensive approach toward influenza A H1N1 and other threats to public health

The current influenza A H1N1 epidemic has demonstrated once again the importance of being able to count on robust, coordinated, and comprehensive public health systems. Countries that do rely on such health systems have proven to recognize, diagnose, and treat influenza in a timely manner, and to provide the public with the education needed to minimize the number of deaths and acute cases. The International Association of National Public Health Institutes (IANPHI) recommends that all countries begin to coordinate their national public health efforts. IANPHI offers its support and guidance to all who would create or strengthen their national public health institutes. By strengthening national public health systems, the ability to collaborate and the security of all countries is heightened. These institutions exist for the public good, and any improvements made to them are also a contribution toward better health for the population.

Mecanismos legais de controle da segurança do medicamento / Legal mechanisms of medicine´s safety control

O controle da segurança dos medicamentos é realizado através de leis nacionais interagindo no cenário mundial, pois cada país apresenta características específicas. Para análise desse controle, no Brasil, há vários aspectos essenciais: a viabilidade legal, ou seja, o conjunto de leis vigentes no país que regulam esta matéria; a viabilidade econômica e financeira, particularmente, no Brasil, com a descentralização do sistema de saúde; a viabilidade política, a qual contrasta muitos interesses. A respeito da viabilidade política, discorre sobre dois temas: os programas implementados e a criação da ANVISA ligada à fiscalização e ao controle de qualidade e a legislação sanitária e os problemas relacionados para aplicação em diversos países. O último aspecto essencial refere-se às estratégias de atuação da OMS e OPAS, organismos internacionais, em relação à legislação nacional, visando-se à sua harmoniosa convivência.

Vigilância sanitária e qualidade em saúde no Brasil: reflexöes para a discussäo de um modelo / Health surveillance and health quality in Brazil: reflexions for a moddel discuss

Aborda a vigilância da qualidade em saúde definida como um espaço de intervençäo na política de saúde, coloca em discussäo a sua forma de articulaçäo setorial. A estratégia de articulaçäo da vigilância da qualidade em saúde estabelecida em funçäo da viabilidade política, econômica, social e tecnológica de sua organizaçäo dentro do setor e assinala os cortes institucionais