Global health. The current scenario and future perspectives

49 agricultural elites and not laborers, peasants and manual workers. The very limited democracies of the 19 th century in Latin America allowed for the political independence from Spain to be led by these new propertied and local elites, who experienced no serious challenges from excluded sectors. Sokoloff and Engerman show that between 1840 and 1900, the percentage of people who voted in elections (where the vote was not secret) did not exceed, at best, 5 percent of the population (Sokoloff & Engerman, 2000). Furthermore, only landowners and literate individuals were eligible to vote, i.e., the wealthier sectors of the populatio n 9 . Health services for the lower-income population were mostly provided by religious entities and mutual aid societies. Infant mortality rates were high and life expectancy did not exceed 40 years. In the early decades of the 20 th century, inequality fluctuated with economic cycles and recessions, the most severe one being the Great Depression of the 1930s, which heavily affected the economies of Latin America and the Caribbean. Chile, however, according to the League of Nations, experienced the most severe economic contraction in the world between 1930 and 1933 (Solimano, 2020). Between 1940 and 1970, various Latin American governments adopted a strategy of import substitution and state-led industrialization, with private-sector participation, to reduce the economic vulnerability of countries to international fluctuations in main economic variables of trade and finance. Economic development was accompanied by a process of social modernization, including rapid urbanization, the expansion of public education, the strengthening of labor unions, an increased access for the middle class to the state apparatus and the creation of social security systems. Between the 1930s and 1950s, different Latin American countries established public health systems for their population and health indices improved. In the second half of the 1960s and early 1970s, attempts were made at progressive income and property redistribution in Chile (under the governments of Frei Montalva and Salvador Allende), with similar policies adopted in Peru under the government of Velasco Alvarado. These policies also spread to Uruguay with the Frente Amplio of Liber Seregni and to Argentina with Cámpora and Perón. However, the wave of democratization and progressive redistributions in the southern cone was stopped and reversed by right-wing military coups in Chile, Argentina and Uruguay with the help of US intervention. The new military dictatorships adopted 9 Towards 1940, voting shares reached 15-20 per cent in Argentina, Uruguay and Costa Rica, as compared to voting levels close to 40 percent in Canada and the USA in those years.