• In Latin America and the Caribbean, the definition of health has evolved from the absence of disease to a multidimensional concept, which covers individuals’ interactions with their sociocultural, economic and environmental context.


• However, health systems in the region still have highly varied characteristics —in terms of investment, out-of-pocket costs, integration of the public health and social security systems, good-quality health-care coverage and outcome indicators— that reflect differences in the historical evolution of the welfare State.

• In order to reduce inequalities in the health domain, progress must be made in universalizing coverage and access to good-quality services, so that all people can prevent, detect and treat their health problems.

Challenges

• Although employment-related affiliation or contribution to health systems has increased and socioeconomic gaps have narrowed, there is still a long way to go before more equitable access to good-quality services is attained.


• Despite the steep decline in fertility rates in Latin America and the Caribbean in recent decades, it remains high among adolescent girls, a worrying situation given the adverse effects on children born to adolescent mothers and on mothers' health and development. Young women living in rural areas are more likely to be adolescent mothers than those in urban areas and, within each area, those in the lowest income quintile are more likely to become mothers, perpetuating the cycle of poverty, increasing inequalities and entrenching education gaps. Meanwhile, although the incidence of motherhood among indigenous adolescents has fallen in most countries of the region, the percentage is still double that of non-indigenous adolescents.


• It is estimated that the number of new HIV infections among adult men in the region has increased recently, which means that more investment is needed in sex education, in particular, and universal access must be ensured to sexual and reproductive health-care services, in general.


• Health benefits and coverage remain highly segmented in the region, as shown by the large differences in the quality of services accessed by different population groups, and this translates into profound inequalities in health and represents an obstacle to the guarantee of a healthy life for all.


• Many countries must cope with the challenges still posed by communicable diseases such as cholera, dengue and Chagas disease, as well as some emerging threats, such as the Zika and chikungunya viruses, which have a greater impact on population groups that are traditionally more vulnerable.


• Air and water pollution are responsible for thousands of deaths and illnesses in the region, and mainly affect children and older persons; thus, there is a need for public policies to reduce the impact of pollution on people's health.

Opportunities

• The progress made in reducing transmission of HIV to children was due to greater prevention of mother-to-child transmission and actions for the dual elimination of transmission of HIV and syphilis.


• With regard to access to contraceptives, their prevalence is high in most of the countries of the region, more so in some cases than in developed countries. Emergency contraception is legal in all the region’s countries except Honduras. Although emergency contraception has recently begun to be used more widely, there are formidable barriers to accessing it in the public sector in several countries.

• Health systems in Latin America and the Caribbean are organized through public sector services for people living in poverty, social security services for formal workers and private services for those who can afford them. These services vary significantly in terms of the quality of care provided. Few countries have universal health systems that can be accessed independently of employment status, as is the case of Brazil’s Single Health System (SUS). This increases inequality between people of different socioeconomic groups and widens gaps in well-being and health.

• Access to adequate sexual and reproductive health services is crucial to moving towards achieving target 3.7 of the 2030 Agenda for Sustainable Development and the commitments of the Regional Gender Agenda. In most Latin American countries, such services are guaranteed by a law or decree, or even under the national constitution. In many cases, this right was recognized following the International Conference on Population and Development, held in 1994.

• It is important to consider the dimensions of people’s current state of well-being —such as income, housing, health, education, social relations, security and subjective well-being— but also to take into account the natural, human, economic and social resources required for the long-term sustainability of well-being.


• In the region, concerted efforts are required to achieve good-quality universal health coverage and sustainable financing of health; to tackle the growing burden of non-communicable diseases, including in mental health; and to address antimicrobial resistance and environmental factors that contribute to poor health, such as air pollution and lack of safely managed water and sanitation.

• Efforts need to be stepped up to reach those who are still not receiving treatment for HIV because they have not been diagnosed and those groups whose retention in health services is low owing to stigmatization and discrimination.


• Together with the increase in life expectancy, the epidemiological transition in the region is reflected in the higher incidence of non-communicable chronic diseases, among older persons and in people in the earlier stages of the life cycle, and it is therefore advisable to consider the additional pressure on health and social security systems this implies.