Health and inequality: institutions and public policies in the 21st century.

A key characteristic of Latin American countries has been the association between extreme inequality and intense poverty, along with the inability of previous social and economic policies to alleviate these conditions. In recent decades, fiscal adjustment policies proposed by international financial agencies have led to monetary stability, but by fo-cusing solely on economic growth, they have intensified the preexisting poverty and inequality. For some time, studies on the relationship between a population's living conditions and state of health have corroborated that health and disease have social determinants. There is also evidence that the poor have less access to health services and encounter difficulty obtaining comprehensive, case-resolving care for diseases, even when such care is guaranteed as a universal right. Still, few studies have established a more precise relationship between social justice at a broader level and equity in health, as expressed through policies, programs, and actions. A seminar entitled " Health and Inequality: Institutions and Public Policy in the 21st Century " was held under the auspices of the Brazilian National School of Public Health/Oswaldo Cruz Foundation (ENSP/FIOCRUZ) and the Pan American Health Organization (PAHO) on 29 November through 1 December 2001 in Rio de Janeiro. It explored the relationships among health, inequality, and poverty in the realm of health public policy, institutions, and programs. The seminar covered the following topics: situations of vulnerability and their relationship to living conditions and health care; the influences of political and civic tradition and institutional performance on the extent of inequality and poverty; and innovations in the field of social policy designed to guarantee protection of health with equity. The seminar also sought to identify gaps in knowledge and methods for the evaluation of public policies. A common agenda for research and technical cooperation among the participating institutions was also launched at the seminar. It is hoped that implementing this agenda will foster scientific collaboration by institutions of excellence at the national and international levels and create institutional conditions conducive to linkage between the production of knowledge and public policy management , so that research activities may respond to the needs of managers of the Brazilian public health system, the Unified Health System (UHS). The seminar consisted of two addresses, a roundtable, and three workshops. The opening presentation was by Dr.