Global health. The current scenario and future perspectives

48 roughly constant to advanced economies for several decades showing its difficulties for converging to higher living standards in the world economy. At the same time, its economies are prone to economic cycles associated with fluctuations in terms of trade, financial flows and the ups and downs of the global economy. These macroeconomic cycles have also been linked to expansive fiscal and monetary policies adopted by governments that faced limitations in foreign currency availability (known as the “external gap”) and generated balance of payments fragility, inflationary pressures and stop- and- go policies. Social policies face constraints in fiscal financing, which also affects the healthcare sector. Additionally, in certain countries (e.g., Latin American countries in the 1980s and Greece between 2009 and 2017) austerity measures and adjustments were accompanied by a reduction in public healthcare spending (Solimano, 2022, 2023). A structural characteristic of the region is high inequality, which is a phenomenon with historical origins associated with the conquest of America. The Iberian colonization of the New World in the 15 th century and beyond involved granting land and indigenous people, known as “encomiendas”, to conquerors and adventurers from the Old World. This led to the accumulation of immense agricultural wealth and lands containing precious minerals such as gold and silver, particularly abundant in Mexico (Viceroyalty of New Spain) and Peru (Viceroyalty of Peru), in the hands of a few, which contributed to pronounced economic inequalities in the territories of America (Solimano, 2021b). A significant portion of the gold and silver was transferred to the Spanish crown, specifically the Habsburg and later the Borbon familie s 8 . The colonial era created a rigid social hierarchy consisting of peninsulares (white people born in Spain) at the top, accompanied by a dependent local ruling class known as criollos or the “creole aristocracy”. There was also a middle stratum composed of merchants, artisans and public officials, and a lower class comprised of laborers, indigenous people, mulattoes, black slaves and zambos . Internal economic inequality in Latin American countries did not change significantly after the wars of independence in the early 19 th century and the formation of independent Latin American and Caribbean republics, though the dominant Iberian elites were replaced by local elites. Land ownership was based on large extensions of land known as latifundio , a system that had replaced the encomiendas after the Borbon reforms. The new ruling classes of the republics consisted of landowners, merchants, and local and foreign financiers and industrialists who thrived alongside an emerging domestic industry. Booms in primary product prices primarily benefited the mining, trade and 8 During the colonial period Latin American nations could only engage in (legal) foreign trade with the Spanish Crown; this system retarded economic development in Latin American and Caribbean countries and consolidated inequalities.