Salud Global. Los riesgos para Chile y América Latina

SALUD GLOBAL – LOS RIESGOS PARA CHILE Y AMERICA LATINA 23 países. Lo mismo sucede para el porcentaje de este gasto que es considerado público (desde 35,5 en Guatemala hasta un 94,7 en Cuba) como se puede ver en la Ilustración 10. Ilustración 10. Ingreso per capita, gasto total en salud, y gasto público en salud El gasto público en salud es mostrado como porcentaje del gasto total en salud. Fuente: Banco Mundial. Tomado de: Atun F. et al. Health-system reform and universal health coverage in Latin America Lancet 2015; 385: 1230–47 El enfrentar estos desafíos puede ser abordado desde distintas perspectivas, las que suelen y pueden ser complementarias. El análisis sobre como América Latina debiese hacer frente a los riesgos globales en salud será desarrollado en los comentarios finales del presente Series USA (G Almeida PhD) ; The World Bank, Washington, DC, USA (D Cotlear DPhil, T Dmytraczenko PhD, AWagsta ff PhD) ; School of Public Health, University of Chile, Santiago, Chile (P Frenz PhD) ; School of Public Health and Administration (FASPA), Universidad Peruana Cayetano Heredia, Lima, Peru (Prof P Garcia PhD) ; National Institute of Public Health of Mexico, Cuernavaca, Mexico (O Gómez-Dantés MPH) ; Institute for Global Health Equity and Innovation, Dalla Lana School of Public Health, University of Toronto, ON, Canada (Prof C Muntaner PhD) ; Pan American Health Organization, Brasília, Brazil (J Braga de Paula MSc, F Rígoli MD) ; and National School of Public Health, king countries of the untries had a di ff erent untries studied. We nomic, demographic, ms indicators for these he world regions and that emerged after racy were diverse in governance, political merged after the end azil, Chile, Colombia, nezuela; at the end of after revolutions in mounts of citizenship s in governance also ealth-system reforms sections. The intro- is of the contextual in American health tem reforms aimed at n the study countries. ents of health-system verage in the study d. The final section atin American health ca Series, Cotlear and alysis of the historical ms and Andrade and rminants of health in change in Latin context: the ate to near or below rise in life expectancy ht about rapid demo- s, which increased the es and chronic illness de episodic and acute tin America could not emiological transition. Rica, and Colombia, health-system reform, and economic factors, major drivers of health- mpetus for universal These dictatorships lasted until around the 1980s in Brazil (1964–85), Peru (1962–63 and 1968–80), Chile (1973–90), Argentina (1966–73 and 1976–83), and Uruguay (1973–85). Costa Rica and Mexico, which had established parliamentary dem cracies i th early 20t century, avoided military rule ( one-party rule prevailed in Mexico until 2000), whereas in Colombia military interventions briefly overthrew governments in 1953 and 1958. The Cuban revolution, which began in 1952, established in 1959 a socialist state ruled from 1965 by one party—the Communist Party of Cuba. Themilitary dicta r hips in Latin America unde mined human rights, suppressed democratic rights of citizens, and, with the exception of Cuba, curtailed investment in the social sectors, including the publicly financed a d delivered elements of health systems. Limits on citizens’ entitlements disenfranchised subgroups of the population, especially the poor, and widened socioeconomic and health inequalities, prompting the civil society in countries such as Argentina, Brazil, Chile, Peru, and Uruguay to Figure 1 : Per-person income, total health expenditure, and health expenditure from public sources Health expenditure from public sources is shown as a percentage of total health expenditure. Data fromTheWorld Bank. 9 GDP=gross domestic product. NA=not applicable. 9·7–10·9 8·2–9·5 7·3–8·1 6·1–6·8 4·8–5·4 Not applicable Chile GDP US$15356 47·0% public Bolivia GDP US$2576 70·8% public Peru GDP US$6568 56·1% public Ecuador GDP US$5425 41·0% public Panama GDP US$9534 67·5% public Costa Rica GDP US$9396 70·1% public El Salvador GDP US$3790 63·3% public Guatamala GDP US$3351 35·5% public Mexico GDP US$9747 49·4% public Honduras GDP US$2335 48·1% public Cuba GDP NA 94·7% public Dominican Republic GDP US$5736 49·3% public Nicaragua GDP US$1754 54·3% public Venezuela GDP US$12729 73·6% public Colombia GDP US$7752 74·8% public Brazil GDP US$11340 45·7% public Paraguay GDP US$3813 38·6% public Uruguay GDP US$14449 67·6% public Argentina GDP US$11452 60·6% public Total health expenditure (%GDP)