Global health. The current scenario and future perspectives

51 “pink wave”) occurred in Argentina, Brazil, Bolivia, Venezuela and Ecuador, where their governments strived to move away from Washington Consensus policies. The period between 2002 and 2012/13 showed a boom in the prices of primary commodities such as oil, copper, soybeans and various metals, which benefited Latin American economies that heavily relied on primary products for export. Post-neoliberal governments also intensified poverty alleviation programs and, in several cases, increased public investment. This period saw a cycle of higher economic growth and reduced inequality but not of economic diversification away from natural resource-based exports and reduction of overall external dependence. Concentration of Economic Power and the Weak Redistributive Role of the State The high concentration of wealth among the richest segments of the population leads to excessive influence of economic elites, who control a significant portion of financial and productive wealth and the ownership of mass media in countries, over public policies. Several mechanisms can be identified to exert this influence, such as donating to political campaigns, controlling media outlets and influencing experts and intellectuals (Solimano, 2022). Particularly in Latin America, economic elites have historically and presently effectively blocked progressive redistribution to deny increases in income and wealth taxes, which results in reduced fiscal resources for social sectors, including healthcare. States in Latin America are weak in using the tax system and state transfers for correcting inequalities generated endogenously by the economic system. This is reflected by the fact that in Latin America, indirect taxation (value-added tax and specific taxes) accounts for about 50 percent of total tax revenue, which is in contrast with less than an equivalent share of one-third in the OECD. In the latter, the contribution of direct taxes (personal income and corporate taxes) to total state income is significantly higher than in Latin America. Moreover, social transfers have lower coverage compared to developed countries. The European welfare state, with universal provisions for healthcare, education and pensions, is associated with taxation revenues close to 35 percent of GDP, with Scandinavian countries reaching 50 percent. In contrast, the average tax-to-GDP ratio in Latin America is around 20 percent only. With fewer tax resources, the capacity to finance higher-quality and wider-reaching social expenditures 11 , 11 The average difference between the market income Gini and the disposable income Gini (market income adjusted for taxes and transfers made by the government) is 3-4 percent in Latin America. In contrast, in OECD countries, on average this difference is 12-14 percent, associated with State action through taxes and transfers.