Global health. The current scenario and future perspectives

46 Chile is a highly segmented society with varied social circles that generally do not connect between each other and live in different economic, social, territorial and cultural realities. Economic elites and high-income groups reside in neighborhoods with houses enjoy and services that are not far from those offered in developed countries and they have access to high- quality healthcare services. The middle classes have made progress in accessing to a wide range of goods and services but also depend on loans and credits with banks and commercial stores to acquire them. They have acquired new homes, send their children to private schools and are exposed to the allure of consumer society but have incurred in high debts along the way. In turn, lower-income sectors composed of the working class and marginalized groups receive modest wages, are subject to job insecurity and live in unsafe neighborhoods, which has become generalized to other sectors as well. Furthermore, working class populations are also indebted with the financial and commercial sector. In terms of healthcare access, most of the population that receives their health services from the public sector is affected by long waiting lists for surgeries and more complex treatments. Additionally, in highly congested cities, particularly in the capital city of Santiago, most residents spend long hours commuting to and from their workplaces. Neoliberal modernization in Chile has enabled access to material goods on a larger scale than in the past but a host of significant problems associated with this development strategy remain (see Solimano and Zapata- Roman, 2024). A great challenge for a post-neoliberal economic transformation project is building an economy that combines economic prosperity with social equality, better access to healthcare for the population and environmental sustainability within a more participatory democracy. Income and wealth inequality As mentioned, a structural characteristic of the Chilean economy and society is its high inequality in income, wealth, opportunities and access to social services, including healthcare. This inequality is reinforced by economic and institutional mechanisms that are difficult to change in the short term. In the past 50 years, income inequality reached its lowest levels during the Allende government but was reversed to its highest levels during the military regime. It has gradually decreased in the decades following the reestablishment of democracy but has remained high (by international standards), especially regarding wealth. The Gini coefficient of income, a widely used measure of the distribution of gross incomes (incomes before taxes and transfers), is close to 0.50, a level internationally considered as high. On the other hand, the Gini coefficient of personal wealth is much higher and reaches 0.70,