How wide are Latin America’s health inequalities?

BUENOS AIRES — Health is much more than a personal matter; it is essential to a society’s well-being and productivity. But achieving equitable health outcomes for all remains a challenge. This is especially true in Latin America and the Caribbean (LAC), a region beset by extreme and persistent inequalities.

To be sure, when it comes to its biggest health concerns, LAC is far from an outlier. Whereas three decades ago the region dealt primarily with maternal, neonatal and communicable diseases, it is now confronting, like much of the rest of the world, a rising tide of noncommunicable diseases (NCDs), including cardiovascular conditions, cancers, diabetes, and mental-health disorders. But this shift presents unique challenges in a region where the disease burden is disproportionately borne by the most disadvantaged.

The region’s large health disparities are particularly pronounced in childhood. Infant mortality, for example, is nearly four times higher in LAC than in OECD countries. Our study found that, in Bolivia, Guatemala, Haiti, and Peru, mortality is roughly three times higher for infants whose parents completed at most a primary education compared to those whose parents completed secondary school. Moreover, in Colombia and Paraguay, infant mortality is more than five times higher for households in the lowest wealth quintile compared to those in the highest.

Stunting rates are also high in LAC, affecting around 13 per cant of children, mainly from the least educated and poorest households. The incidence of stunting is around double in children of less educated parents throughout almost the entire region, with very few exceptions. And that gap tends to widen significantly when comparing those in the highest and lowest wealth quintiles. Malnourishment is consistently higher in, but not exclusive to, the rural areas of most LAC countries.

Underprivileged young people in LAC experience an alarming array of health disadvantages, because nearly half of the region’s children and adolescents live in poverty. Moreover, the scarring effects of an unhealthy start in life and the intergenerational impact of poor health suggest that these disadvantages will threaten the well-being of future generations.

Even more worryingly, levels of infant mortality and stunting remain high among the poorest and least educated in LAC despite continual improvements in child-health indicators. Many countries in the region have improved access to, and the quality of, critical public services such as sanitation; expanded health coverage (thereby making it easier to access maternal- and child-health services); and begun providing social assistance through conditional cash transfers.

Moreover, a new dimension to health inequality among children in LAC is emerging: 8 per cent of this population is overweight. Being overweight is still not as prevalent as undernourishment, however, and is more common in children from wealthier and more educated households and those living in urban areas. Although the disparities are not as pronounced as in other health indicators, policymakers must continue monitoring this phenomenon closely.

LAC is also wrestling with inequalities related to reproductive health. The most glaring example is the region’s high rate of teenage pregnancy, which persists even though most adolescents are knowledgeable about modern contraceptives. In almost all LAC countries, at least half of women between 25 and 49 years old in the lowest wealth quintile had their first child as teenagers, more than double the proportion of those in the highest quintile. Teenage pregnancy likely exacerbates the region’s large gender gaps in education, labour-force participation, and earnings. More importantly, it plays a crucial role in the intergenerational transmission of inequalities, as the daughters of teen mothers are more likely to become teen mothers themselves.

Unfortunately, limited data on adult health indicators in the LAC population makes it difficult to assess the evolution of inequalities at this life stage. But there are identifiable socioeconomic gradients in the incidence of NCDs. Obesity, hypertension, and diabetes tend to be more prevalent among the least educated and the poorest, with urban areas experiencing a higher burden of these conditions. But the urban-rural divide does not uniformly apply across all NCDs, revealing a nuanced picture of health disparities within the region. Psychopathology, an increasingly significant component of LAC’s disease burden, also exhibits clear gender and socioeconomic disparities, with depression rates notably higher among women and the less educated. This points to the need for targeted mental-health interventions.

Despite the epidemiological transition under way, socioeconomic health disparities are more pronounced during early childhood and adolescence than in adulthood. But this pattern varies across the region: Wealthier countries with less inequality in children’s health outcomes often have larger disparities in certain areas of adult health.

This complex pattern of health inequalities across LAC suggests that a multifaceted approach is needed to address them. It is not simply a matter of reforming health-care systems: LAC countries have deployed a wide variety of organisational structures, but no single scheme has been conclusively shown to reduce health inequalities. While efforts to improve the quality of care must continue, effective solutions will also require addressing the broader social determinants of health outcomes.

Dolores de la Mata is a research economist at CAF – Development Bank of Latin America and the Caribbean. Copyright: Project Syndicate, 2024. www.project-syndicate.org