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INFORME ALTERNATIVO SOBRE LA SALUD EN AMERICA LATINAis a city more inequitable than ten years ago. The numberof people with unfulfilled basic needs ("necesidadesbásicas insatisfechas"-NBI) has decreased, due to superiorcoverage of basic public services and sustained investmentsin infrastructure. Nevertheless, the numberof families that are not able to pay the growing cost ofthose basic services has increased. Families often do notsucceed in accessing more complex health and educationservices. In the poorest parts of Bogotá, nearly 15%of families could not afford to consume three meals aday, as recommended by the Living Standard Survey ofJune of 2003 1 . This signifies poverty has increased; howeverthe NBI measure does not provide a comprehensiveview of the phenomenon. When we look at theline of poverty (LP), which weighs family income againstthe cost of goods and services, the problem proves tobe alarming. Between 1993 and 2003, the populationunder the LP increased from 44,9% to 50%, roughly amillion more poor people. Under the line of indigence(LI), there was an increase from 8% to 17% in the sameperiod [Alcaldía Mayor de Bogotá, 2004].Families’ incomes have been affected by unemploymentand labor precariousness. Within Bogotá, thehighest unemployment rate of the country persists, aswell as high underemployment and informal labor. In2003, the city had a working age population of5.317.000 people, a labor force of 3.558.000. A total of593.000 were unemployed, 1.175.000 underemployed,and 1.760.000 were inactive [DANE, 2003]. In 2004,the labor force rose to 5.461 million, with an unemploymentrate of 14,8% [DANE, 2004]. These statisticsexceed the ones registered in other cities by morethan 50%. In Bogotá, 36,6% of the labor force is concentratedin the thirteen main cities and metropolitanareas of the country [DANE, consolidado 2000 a2004]. If the displaced population is included in this figure,the situation becomes even more serious.Though we face controversial data, all numbers coincidein reflecting a considerable and constant increase inforced displacement during the last decade. Accordingto the Social Solidarity Network, in charge of offeringservices to the displaced population the first sixmonths, between 1994 and February of 2005, 22.784families representing 90.643 inhabitants arrived in Bogotá[Presidencia de la República, 2005]. Consistentwith the Advisement for Human Rights and Displacement(CODHES), between 1995 and 2002 358.188 displacedpeople arrived in the city [El Tiempo, 2003] thisdifference demonstrates the great difficulty of the Stateto identify this population and respond to its needs.Opportunities to create a secure future are notequal.The progressive segmentation of the city has leftthe poor segregated in certain localities. For this reasonthe Magistrate declared a social emergency withinsix of the twenty localities. This inequality is most evidentin the health of the Bogotanos. Although preventablemortality indicators have improved, the pace isslow and has not brought equal benefit to everyone. In1993, 90 maternal deaths per 100.000 live births occurred,compared to 2003, when 61,66 were registered.During the same period, deaths of children youngerthan 1 year old decreased from 26 to 15,05 per 1.000live births. The deaths caused by preventable illnesses,such as diarrhea and pneumonia, in children youngerthan 5 years old decreased considerably. In the sameinterval, deaths from diarrhea shifted from 30,9 to5,16 per 100.000; and deaths from pneumonia droppedfrom 78,7 to 20,21 2 . These could be consideredadvancements if we did not have in mind the progressmade by other countries, which have accomplishedgreater improvements in living standard. The UnitedKingdom has a maternal mortality of 7 per 100.000 li-1.According to calculations performed by the Research Center for Development (CID) of the National University of Colombia based on the ECV-2003 of the DANE.2. DANE, Cifras preliminares224
Observatorio Latinoamericano de Salud.ve births, and an infant mortality of 6 per 100.000 livebirths. Chile has this last indicator in 10 per 1.000; andSweden, in 3 per 1.000.Despite these low rates, the majority of healthindicators reveal unfair and avoidable differencesamong localities. For instance, in Ciudad Bolívar, therate of mortality among children younger than 5 yearsold is 250,9 per 100.000 in 2002 3 . In Teusaquillo, it reached166,08 per 100.000. If we acknowledge the factthat this is a question of children’s lives and not merelynumbers, then the difference between 217 and 12seems intolerable. Sweden did not report any deathsof children under 5 years old in 1999. In Kennedy, aprenatal mortality rate of 809,9 per 100.000 live birthspresented in 2002, while in Teusaquillo it reached235,8 4 . In Kennedy, the proportion of pregnancy, childbirthand post childbirth related mortality, was 83,27per 100.000 live births, explicitly 11 women this year.Comparatively, in Teusaquillo no deaths were reported.These inequities constitute the foremost healthproblem of the population of Bogotá.With regard to nutrition, during 2002 it was establishedthat 11 of 100 live births had low birth weight(less than 2.500 grams). Of these, 67% presented intrauterinemalnutrition 5 . Among children younger than7 years old, the Survey of Demography and Health ofProfamilia (2002) confirmed that acute malnutritionreached 0,5%. If this analysis is applied to the populationsof strata 1,2 and 3, which consult with the socialinstitutions of the State (ESE), the mentioned prevalencegrows to 6,3% 6 .This is further evidence of social inequity.In Usme, the acute malnutrition rate for the totalpopulation was 13,8% in 2002; in Usaquén, it was only3,3%.A Discriminatory and InaccesibleHealth SystemThe General System of Social Security in Health(SGSSS), defined by Law 100 of 1993, had its major developmentin Bogotá. The percentage of the populationaffiliated with the Contributory Regime has remainednearly 55%. By December 31st of 2003, affiliatedcoverage through the Subsidized Regime in theamount of 1.369.970 was obtained, corresponding to19,95% of the total population of Bogotá (6.865.997).Nevertheless, not all the quotas correspond to people:when the number of units per person paid in thisregime is taken, the number decreases to 1.099.164.This implies that people, for reasons not always controllableby the insurer or the SDS, do not use all theawarded quotas. There are still roughly a million and ahalf people without insurance called "connected participants."They receive care from the public networkand by contacting the non-appointed network, withresources from the Nation and the District administeredby the District Financial Fund of Health (FFDS).The supply of services has increased. In 2003,the SDS registered 12.502 providers in the city 7 . Ofthese, 2.196 correspond to health services providerinstitutions (IPS), 31 to institutions of assisting transportation,and 10.275 to independent professionals.At the end of 2003, 78% of the providers were situatedin the north zone, and 11%, 6% and 5% in the southeasternzone, central eastern zone and southern zoneof the city respectively. This distribution can be attributedto the dynamic of the services market, followingthe preferences of those making the offers morethan the population’s needs. At present, this is recog-3. Población: Cifras del Departamento Administrativo de Planeación Distrital (DAPD)4. Nacidos vivos. DANE, Colombia.5. Certificados de nacidos vivos en Bogotá D.C. en 2002.6. Secretaría Distrital de Salud de Bogotá D.C. Sistema de Vigilancia Alimentaria y Nutricional SISVAN.7. The number was obtained as the result of the subscription realized by providers of health services to comply with the period established by the Decreed 2309of 2002.The deadline is June 30th of 2003.225
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PEOPLE’S HEALTH ASSEMBLY 2GLOBAL
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LATIN AMERICAN HEALTH WATCHAlternat
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"Our elders taught us that the cele
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12. Neoliberalism, Pesticide Use an
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1Alternative Health Report :A Tool
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Observatorio Latinoamericano de Sal
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Monopoly,Inequity and Health
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INFORME ALTERNATIVO SOBRE LA SALUD
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3The Right to Health and the Free T
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Institutionalizationof Violenceand
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EconomicFundamentalism,Legal Regres
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Life and Healthas Commodities
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Cultural Agresi nUniculturality and
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Biodiversity:Destructionand Monopol
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