How wide are health inequalities in Latin America?

This note was published in Project Syndicate, with the support of the Women in Economics Leadership Initiative of the International Economics Association, which aims to improve the role of women in the economy through research, creating alliances and amplifying voices.

Health is much more than a personal matter; It is essential for the well-being and productivity of a society. But achieving equitable health outcomes for all remains a challenge. This is especially true in Latin America and the Caribbean (LAC), a region affected by inequalities extreme and persistent.

Certainly, when it comes to its main health concerns, LAC is far from an exception. Three decades ago, the region mainly dealt with maternal, neonatal and communicable diseases. Now, like much of the rest of the world, faces a growing rise in non-communicable diseases (NCDs), including cardiovascular conditions, cancers, diabetes and mental health disorders. But this shift presents unique challenges in a region where the disease burden falls disproportionately on the most disadvantaged.

The large health disparities in the region are particularly pronounced in childhood. For example, infant mortality is almost four times greater in LAC than in OECD countries. Our studio finds that, in Bolivia, Guatemala, Haiti, and Peru, mortality is approximately three times higher for children whose parents completed at most primary education compared to those whose parents completed secondary school. Furthermore, 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% of children, mainly from the least educated and poorest households. The incidence of stunting is about double in children of less educated parents in 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. Malnutrition is consistently higher in rural areas of most LAC countries, although it is not exclusive to them.

Disadvantaged youth in LAC experience an alarming range of health disadvantages, asalmost half of children and adolescents in the region live in poverty. Furthermore, the drag effects of a poor start to life and the intergenerational impact of poor health suggest that these disadvantages will threaten the well-being of future generations.

Even more worrying, levels of infant mortality and stunting remain high among the poorest and least educated in LAC despite continued improvements in child health indicators. Many countries in the region have improved the access and thequality of critical public services such as sanitation; they have expanded health coverage (thus facilitating access to maternal and child health services); and have begun to provide social assistance throughconditional income transfers.

A new dimension of health inequality among children in LAC is also emerging:the 8% of this population is overweight. However, being overweight is still not as prevalent as undernutrition and is more common in children from wealthier, more educated homes and those who live in urban areas. Although disparities are not as pronounced as in other health indicators, policymakers should continue to monitor this phenomenon closely.

LAC also presents significant challenges in terms of inequalities related to reproductive health. The most striking example is the high teen pregnancy rate of the region, which persists although most of the teenagers They have knowledge about modern contraceptives. In almost all LAC countries, at least half of women aged 25 to 49 in the lowest wealth quintile had their first child as teenagers, more than double the proportion of those in the highest quintile. Teenage pregnancy probably exacerbates major gender gaps of the region in education, labor force participation and income. More importantly, it plays a crucial role in the intergenerational transmission of inequalities, as daughters of teenage mothers have a higher probability of also becoming teenage mothers.

Unfortunately, limited data on adult health indicators in the LAC population make it difficult to assess evolving inequalities at this stage of life. But there are identifiable socioeconomic gradients in the incidence of NCDs. Obesity, hypertension and diabetes tend to be more prevalent among the less educated and poorer, with urban areas experiencing a greater burden of these conditions. But the urban-rural divide does not apply uniformly across NCDs, revealing a nuanced picture of health disparities within the region. Mental health problems, an increasingly significant component of LAC's disease burden, also show 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 ongoing epidemiological transition, 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 child health outcomes, often have greater disparities in certain areas of adult health.

This complex pattern of health inequalities in LAC suggests that a multifaceted approach is needed to address them. It is not simply a matter of reforming healthcare systems: LAC countries have implemented a wide variety of organizational structures, but no specific scheme has been shown to conclusively 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.