Global health. The current scenario and future perspectives

45 The case of Chile and the Latin American region The economic and social development of Chile in the past decades is a process with advances, contrasts and shortcomings. On one hand, the country has achieved a respectable level of income per capita close to USD 28,000 annually (2022) and shows a significant degree of macroeconomic stability, although this process of economic modernization is uneven (Solimano and Zapata-Roman, 2024). Chile is a member of the prestigious OECD group of mostly advanced economies, but it is simultaneously a country characterized by great economic and social inequality. This feature has its historical roots in the colonial period that was marked by unequal land ownership and valuable natural resources such as gold, silver, saltpeter and copper, which were mostly in the hands of foreign English or American owners, although several attempts at reducing inequality took place in the 20 th century. Additionally, Chile’s pattern of economic growth relies on the exploitation of non-renewable natural resources, agro- industrial and forestry products as well as maritime resources. Since the mid-1970s, the country has experienced a persistent decline in the relative importance of the manufacturing sector, a phenomenon known as deindustrialization. Social spending financed by the State in healthcare, education, public transportation, pensions, science and technology and environmental protection is constrained by limited fiscal revenue and other public policy restrictions. As a percentage of GDP, fiscal revenues represent around 20 percent, much lower than the OECD average, which is closer to 35 percent 6 . Health spending per capita in Chile is USD 2,200 (2018) in purchasing power parity, which represents approximately 8 percent of GDP and positions it on the upper range in Latin America and the Caribbean, after Cuba, Argentina, Brazil and Uruguay. Chile also has an extensive primary care network that has played a significant role in various public vaccination campaigns for decades, including the recent COVID-19 vaccination campaign. The healthcare sector in Chile has a mixed system and consists of a segment of private healthcare (Isapres) and a segment of public healthcare (Fonasa). Which system to adhere to largely depends on the socioeconomic level of the affiliates, which replicates the inequalities observed at the macro- social level. However, Fonasa plays a leveling role in providing access to healthcare services for the middle class and lower-income populations. 6 Social spending competes with a level of military spending (over USD 5 billion in 2021) which is above that of its neighboring countries (Argentina, Bolivia and Peru, see Stockholm International Peace Research Institute, SIPRI 2022).