Public Health Challenges in Latin America and the Caribbean

New York          By César Chelala

The dramatic health situation in Venezuela, where the national health system has all but collapsed, invites an assessment on how Latin America and the Caribbean are doing regarding the health status of the population. While in the last decades, Latin America and the Caribbean have experienced measurable gains in several health indicators such as life expectancy, infant survival, and prevalence of infectious diseases, the Venezuelan people’s health status has deteriorated considerably.

Most countries in these regions, however, still face daunting challenges due to sprawling urbanization, environmental problems, and increasing levels of obesity that affect all ages, but particularly children. In the Caribbean, for example, obesity has increased by almost 400 percent in the last two decades, affecting also the infant population.

Prevalence of HIV/AIDS, malaria, dengue, tobacco and substance abuse, chronic non-communicable diseases (NCDs), and physical and mental disabilities continue to exact a heavy toll in most countries.80% of NCDs deaths occur in low- and middle-income countries. Although the prevalence of HIV/AIDS in the adult population of Central and South America has stabilized somewhat at 0.6 percent, the Caribbean, with an HIV infection rate of more than two percent, is the second most heavily infected area in the world after sub-Saharan Africa.

With little change in maternal mortality rates during the last decade, the gap in this indicator between Latin American and Caribbean countries, on one hand, and the United States and Canada, on the other, is still substantial. The risk of dying during pregnancy, childbirth and post labor is 50 times greater in developing countries than in Canada and the U.S.

Infant mortality, meanwhile, has declined gradually in most countries in the region due to better nutrition and effective public health and sanitation policies. Latin America is now leading the world in terms of decreasing infant mortality rates, which have declined from 43.5 percent per 1,000 live births in 1990 to 14.9 in 2017, according to the UN Inter-agency Group for Child Mortality Estimation.

Latin American and Caribbean countries, however, still face problems associated with low average income, volatile economic national growth, increasing wealth concentration, and extreme poverty - all manifestations of social and economic disparities.

It is still necessary to increase investment in infrastructure and in basic equipment and supplies, to increase coverage and access to proper health care, to improve the distribution of basic drugs, to make widely available safe blood supplies, and to improve epidemiological surveillance. It is also important to address issues, such as violence, that provoke an increasing number of victims and demand not only a political but a public health approach to be solved.

In many countries, violence against women has reached epidemic proportions. Homicides of women by their partners (called “femicides”) take thousands of lives in Mexico every year. According to the National Statistics Institute (INEGI) An average of nine women are murdered every day. The Mexican city of Juárez has been called “the capital of murdered women in the world.”

This is a crucial time to continue implementing a health-promotion model that addresses the social determinants of health. According to the World Health Organization (WHO), the social determinants of health are the conditions in which we live, learn, work, and play. These conditions include a broad range of socioeconomic and environmental factors, such as air and water quality, the quality of the built environment, opportunities for employment, income, early childhood development and education, access to healthy foods, health insurance coverage and access to health care services, safety from crime and violence, and public and private policies and programs that prioritize individual and community health in all actions

In this regard, it is critical to adopt new approaches of social protection to reduce the exclusion of wide sectors of the population, particularly the poor and the old, who in many cases are not adequately covered by insurance programs.

In addition, stronger alliances must be forged between the public health sector and the education, agriculture, labor, housing, and water and sanitation sectors. Effective actions aimed at the more disadvantaged and vulnerable sectors of society can be planned, coordinated, and put into effect.

At the same time, it is important to accelerate the creation of institutional networks and to improve the exchange of health information among countries. These actions will reduce the health, social and economic burden caused by disease, and translate into a better quality of life for the populations of Latin America and the Caribbean.

César Chelala is an international public health consultant and writer. He has carried out health-related missions in over 50 countries worldwide. He is a co-winner of an Overseas Press Club of America award, and two national journalism awards from Argentina.