Impact of the Peace Agreement on the social determinants of health in Colombia

a descriptive, ecological study, based on documentary data from 2008 to 2018. The records of victims, epidemiological indicators, and structural social determinants of health in Colombia were analyzed.

Results:

there was a correlation between the period in which the Peace Agreement process was developed and the indicators of structural determinants in health with p<0.05. With the Poisson regression analysis, the favorable correlations between the peace process and the determinants were confirmed, besides allowing the understanding of the changes in these indicators before the Peace Agreement.

Conclusions:

the implementation of the peace process has a positive impact on structural social determinants of health, which is observed by the beginning of the decrease of economic, educational, health, and social inequalities and inequities, a fact that offers the possibility of living in peace.

Descriptors:
Social Determinants in Health; Violence; Investment; Poverty; Armed Conflicts

Variables	Average	Md	IQR	SD	W p value^a a *p-value of the Shapiro-Wilk normality test;	Correlation Analysis p value (95%CI)
Governance
Victims	426.16	488.38	301.36	182.70	0.890 p = 0.143	0.283^b b Correlation analysis - Pearson's coefficient; (-0.754 0.381) p = 0.398
Events Violence	580.97	622.5	257.98	232.76	0.941 p = 0.537	-0.789 (-0.942 -0.360) p = 0.003 ^b b Correlation analysis - Pearson's coefficient;
Macroeconomic policies
PIB	34.6	2.6	2.3	1.93	0.852 p = 0.046	-0.369 (0.570 -0.977) p = 0.264 ^c c Correlation Analysis - Spearman's Coefficient.
Health Investment	72.33	72.34	5.03	2.85	0.912 p = 0.299	0.729 (0.184 0.931) p = 0.016 ^b b Correlation analysis - Pearson's coefficient;
Education Investment	15.75	15.69	0.74	0.65	0.990 p = 0.997	0.051 (-0.597 0.659) p = 0.887^b b Correlation analysis - Pearson's coefficient;
Protection Investment	11.39	11.27	0.78	0.81	0.911 p = 0.288	-0.457 (-0.844 0.241) p = 0.183 ^b b Correlation analysis - Pearson's coefficient;
Social policies
Monetary poverty	32.28	30.6	7.75	5.46	0.873 p = 0.086	-0.954 (-0.988 -0.828) p < 0.001^b b Correlation analysis - Pearson's coefficient;
Extreme poverty	10.20	9.1	3.45	3.02	0.878 p = 0.099	-0.928 (-0.981 -0.742) p < 0.001^b b Correlation analysis - Pearson's coefficient;
Unemployment	10.2	9.7	1.75	1.12	0.900 p = 0.184	-0.842 (-0.958 -0.489) p = 0.001 ^b b Correlation analysis - Pearson's coefficient;
Public policy
Health coverage	94.83	95.66	2.27	2.32	0.875 p = 0.090	0.593 (-0.010 0.879) p = 0.054 ^b b Correlation analysis - Pearson's coefficient;
Illiteracy	17.52	17.45	2.5	1.71	0.970 p = 0.898	-0.998 (-0.999 -0.989) p< 0.001^b b Correlation analysis - Pearson's coefficient;

Variables	Coef^a a Coefficient;	SE^b b Error Patrão;	Z^c c Test z;	p value	RR^d d Relative Risk;	95%CI^e e 95% confidence interval.
Governance
Victims	-0.04	0.05	-0.80	0.430	1.00	0.88	1.05
Events Violence	-0.10	0.02	-4.47	<0.001	0.90	0.87	0.95
Policies macroeconomic
GDP	-0.06	0.04	-1.52	0.130	0.90	0.87	1.02
Health Investment	0.01	0.00	4.74	<0.001	1.00	1.01	1.01
Education Investment	0.00	0.00	0.16	0.880	1.00	0.99	1.01
Protection Investment	-0.01	0.01	-1.41	0.160	1.00	0.97	1.00
Social policies
Monetary poverty	-0.05	0.00	-11.69	<0.001	0.95	0.94	0.96
Extreme poverty	-0.08	0.01	-10.39	<0.001	0.91	0.90	0.93
Unemployment	-0.03	0.01	-4.96	<0.001	0.97	0.96	0.98
Public policy
Health coverage	0.00	0.00	2.17	0.030	1.00	1.00	1.01
Illiteracy	-0.04	0.00	-105.47	<0.001	0.96	0.96	0.97

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Edna Johana Mondragón Sánchez. E-mail: ejmondragon@uniquindio.edu.co