450 Million people 33 COUNTRIES HEALTH IN LATIN AMERICA. Regions: South America (12 Countries) Central America & Mexico Caribbean

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1 HEALTH IN LATIN AMERICA Dr. Jaime Llambías-Wolff, York University Canada 450 Million people 33 COUNTRIES Regions: South America (12 Countries) Central America & Mexico Caribbean ( 8 Countries) (13 Countries) 1

2 CONTRADICTIONS OF POST-WAR ECONOMIC GROWTH From 1940 s onwards, Latin America has gone through an important socio-economic transformation. Industrialization and growth in population brought in high demands of food production that could not be met by the agricultural sector. Modernization generated unexpected waves of unemployment leading 70% of the population into poverty by the 1980 s. Modernization has produced an acceleration of the growth in the largest cities creating urbanization. Health care and social security = determined by changing economic, political and social conditions and changes Post war economic growth (in terms of GNP) : 5% in 1950s 5.5% in 1960s 6.3% IN 1970s 2.6% in 1980s 10% in 1990s 7% in 2000s Still great disparities between the population : poor, middle sectors and upper class 2

3 CONTRADICTIONS OF POST-WAR ECONOMIC GROWTH ² Urban growth rates were caused by the increase in rural-urban migration. Rural-rural migration movements brought on two main sets of health care problem: 1. The need to give health care to illegal workers; improve the hazardous social conditions of workers 2. The need to solve the difficulties of sanitary control in border areas Mostly an URBAN region, since 1960s and in the Caribbean, since the 1970s We will concentrate on The Latin American Region Urban Latin America Latin America population is predominantly urban since the 1960 s, only 28% of L.A. live in rural areas. In the cities, 20-30% live in marginal areas, 21% don t have drinkable water, 52% not connected to sewage system so waste percolates into water and air causing major health threats and have poor health care services. Along with urbanization is increasing violence, drug abuse, accidents, homicide, and suicides. 3

4 20% to 30% of population in large cities live in marginal areas, with poor sanitation conditions. Rural migration increases expecting better life: more violence, overcrowded villages, sanitation problems, drugs, criminality, lack of work, etc. Triple burden of diseases : Diseases of poverty Chronic diseases Inequity and poor public health care services in most countries MODERNIZATION, SOCIAL CHANGES AND HEALTH CARE ² Health care systems in Latin America were formed through social struggle ² When the national health departments were created, access to health was limited to upper elite groups ² As modernization and industrialization began to take over the region, founding a new educated middle class, trade unions etc, access to health care began to expand ² Populism, a powerful political movement in Latin America which thrived in the 1940s, also contributed to the expansion of health care access 4

5 Health Care Systems in Latin America 1: Private health care systems with profit-making characteristics for high socio-economic status groups, financed by direct payment in advance and private insurance. 2: Health care systems provided by health department of ministries, financed by the state through taxes. 3: Social security health care designed for workers and their families, financed through the state, workers and their employers. Contribution is based on salary level. MODERNIZATION AND SOCIAL IMPROVEMENTS ALWAYS A STUGGLE BEWEEN SOCIAL CLASSES AND INTERESTS GROUPS (Political parties, unions, business, etc.) LOCAL NATIVE POPULATION Mostly traditional medicine, public services, herbal methods, healers PESEANTS AND URBAN POORS Charitable services, extended poorly public sector. Minimal coverage, public clinics and urban public hospitals INDUSTRIAL WORKERS Have social security for medical care. Public hospitals (salaries and employers premiums) INDUSTRIAL WORKERS FROM BIG COMPANIES Unions. Special health care programs WHITE COLLAR AND SMALL ENTREPRENEURS Insurance programs (salary deductions) Better quality and access to more services MILITARY AND POLICE Special hospitals. Special insurance plans Better coverage UPPER CLASS Private health care services. Private Health Insurance Plans or direct payments 5

6 Combinations of these health care systems Countries in which the responsibility for health care is preserve of health ministries Cuba, Nicaragua, Haiti, English speaking Caribbean Social Security System Argentina, Brazil, Costa Rica, Mexico, Panama, Uruguay, Venezuela Ministry of Health & Social Security Bolivia, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Paraguay, Peru, Dominican Republic % Coverage Under 20% coverage Under 10% coverage Cuba, Argentina, Costa Rica, Uruguay, Chile Paraguay, Guatemala, Colombia, Peru Nicaragua, Ecuador, Dominican Republic, Honduras, El Salvador, Haiti Crisis for some countries health services? Increased unemployment rates+ lowered income due to inflation= less contribution + tax collection for health care= poorer health care. The unemployed don t contribute but still receive care. Third World predominance for expensive curative medical care instead of cheaper and more preventative care. Also there is a preference for high technology and excessive use of medicines. Less Income Fewer Imports Private Income Lower real salaries More unemployment Public Income Lower tax revenue High morbidity; malnutrition; accidents; mental ill-health Lower payments to private health care Lower coverage of social services Lower payments to social services Lower public expenditure on health More demand for public health care Changes in the composition of health expenditure Lower quantity/quality of public health care Poorer health in the population The relationship between income reductions, expenditure on health and public health levels 6

7 Time Line Pressure from wage workers ensures growth of health coverage and social services share of GNP grew 17-25% (modernization period) National Health 1985 poverty departments created GNP grows National health Latin America level at 30-50% by 5.5 % in Argentina, department if Haiti, El undergoes Unicef, USAID, IADB of Latin American Uruguay, Brazil, support extensive Salvador, Costa Rica socioeconomic families Paraguay Pan American Sanitary transformation immunization Bureau created (1902) National against 6 diseases health 1994 life Introduction of DDT Latin American societies expectancy over department universally experience a Social health care of Panama, GNP grows 70 in half of new process of change services in Argentina, Guatemala, GNP grows by 5% by 6.3% Latin America influences by world National health Chile, Uruguay, Brazil, Nicaragua tendencies of democracy department of Cuba Cuba Food production and decentralization created Populist political per capita less than movements flourished in prewar years 40% of Latin America s 1984 Sao Paula population live in poverty measles epidemic Oral rehydration Caribbean population therapy support Latin America s predominantly urban increase Mexico, Colombia, population becomes Venezuela, Peru predominantly urban establish social security 70% poverty, Latin America has systems influenced by 40% indigence easy access to International Labour Organizations Growth of private International credit hospitals & hospital SILOS established beds 60 s and 70 s political changes reduced the power of the pressure groups Under and Unemployment % % % FOLK MEDICINE In Latin America, folk or traditional medical systems coexist with modern systems. Folk medicine involves a magico-religious concept in which diseases are viewed as supernatural phenomena produced by spiritual forces. The folk therapy can be herbal, mineral, animal, magical, empirical and intuitive. Folk medicine has a strong bond with culture and tradition. This puts pressure on physicians to appreciate the existence of folk thought, because health actions can generate a high resistance among people. The objective of improved sanitation and environmental health cannot be obtained without popular co-operation. Conclusion Latin America s health issues and health care systems differ greatly from the rest of the world due to its particular history and the impact of world economic and political transformations to the region, as well as cultural and regional factors specific to each country. There is need for a health care model independent from infectious disease to better respond to the issues and causes of chronic diseases. The infectious disease model needs more community participation and better sanitation and intervention methods. The chronic disease model, on the other hand, need medical technology to help diagnosis and treat patients and needs to have a integrative community and individual approach. 7

8 Conclusion The stress of the public and private sector of Latin America. The public sector suffer from lack of resources and the private sector has decreased in funds due to lack of clients as most of the population cannot afford the rates. As a consequence, the majority of Latin Americans live with inadequate health protection. SOME COUNTRIES BETTER THAN OTHERS They developed very strong public systems Argentina, Chile, Brazil, Cuba, Uruguay, Mexico, Costa Rica In general coverage for Latin America protects about 61% of the Population. In some countries Argentina, Chile, Cuba, Uruguay, and Costa Rica coverage is between 75% and 100%. In other countries the coverage is very low (10% to 20%) = Paraguay, Peru, Guatemala, Colombia, Nicaragua, Ecuador, Honduras, Haiti, etc. THE CASE STUDIES OF CUBA AND CHILE 8

9 Cuba challenges the assump0on that genera0ng wealth is a fundamental condi0on for improving health Cuba is able to sustain itself from the margins of globaliza0on Cuba, like most of La0n America, has pronounced income inequality Cubans live like the poor & die like the rich Cuba able to sustain itself o For ex. Cuba developed the human resources to meet its health needs & developed a self- reliance approach Cuba uses alterna0ve public policy approaches o Educa0on, housing, employment, nutri0on, sports & culture New policies reorganized the healthcare system + social, poli0cal, & educa0on systems 9

10 Low under-5 mortality rate High life expectancy Use of traditional & alternate treatments used Good human resources to meet health needs Health system financed by state o For ex. preventive medical care free, low prices & subsidized by state Primary care & vertical integration QUESTIONS Social capital is seen as representing trust and connectedness within a society. Why is it important to health? 10

11 Are good health outcomes more strongly associated with policies supportive of neoliberalism (stimulating economic growth) or those stressing equity & distribution of wealth? Los Naturistas Healers Why do you think biomedical doctors do not recognise the Andean system when dealing with certain sicknesses while LN recognise both? Acknowledgments: I wish to recognize and thank the many students that, during several years, have kindly facilitated various slides, which are incorporated in this presentation. 11

12 THE END 12

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