Global health. The current scenario and future perspectives

52 including healthcare, is lower. It is a long-standing structural characteristic of the Latin American state to have an endemic inability to ensure that economic elites contribute more through taxes to finance social spending that benefits the poorest sectors. Naturally, healthcare spending also falls within this social expenditure. Final Thoughts One of the most important characteristics of inequality in Chile and the rest of Latin America is its persistence and continuity over time. This inequality is reflected in the healthcare sector where fewer resources are allocated both in absolute amounts and relative terms compared to nations with higher levels of economic development (an exception in the Latin American and Caribbean context is Cuba with a higher ratio of health spending to GDP than the average corresponding share given its per capita income level). The colonial period laid the foundations for a significant inequality in land ownership and natural resources within socially stratified societies. After independence and the formation of independent republics in the 19 th century, ownership of key physical economic resources remained in the hands of local elites which kept the high economic inequality in the now independent nations. Nevertheless, economic elites benefited from weak democracies with minimal electoral participation by the population at large that allowed these elites to maintain their concentration of economic and political power. In the 20 th century, income inequality stayed high and even grew compared to the 19 th century, with average Gini coefficients around 50 percent. The “great leveling” that occurred in Europe and North America between 1913 and 1970 did not take place in Latin America, despite advancements in electoral participation, democratization, autonomous development, expansion of public education and middle classes, the creation of social insurance systems, the expansion of public health and workers’ unionization. The 1970s were politically turbulent in Chile and Latin America. Waves of democratization and progressive redistribution early in that decade were followed by authoritarian retrogression and the adoption of the socially regressive neoliberal model. Inequality increased during the period of 1980-2002, which included the external debt crisis (1980s) and the implementation of Washington Consensus policies in the 1990s. However, in the first decade of the 21 st century, several countries experienced a “post-neoliberal” shift, helped by improved terms of trade, increased capital inflows and remittances, a slight compression of the wage scale and increased cash transfers to the poor. As a result of these changes, the upward trend in inequality of the last two decades of the 20 th century started to reverse between 2002 and 2012, with effects extending until 2018- 19 before the onset of the Covid-19 crisis.