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Pobreza desigualdad enfermedad América Latina Caribe COVID-19 coronavirus

Poor Health, Poverty and the Challenges of COVID-19 in Latin America and the Caribbean

May 25, 2020 by Samuel Berlinski - Jessica Gagete-Miranda - Marcos Vera-Hernández Leave a Comment


On May 15th, 2020, there were 450,000 confirmed cases of COVID-19 and more than 25,000 related deaths in Latin America and the Caribbean. In the absence of a cure or a vaccine, countries in the region have resorted to lockdowns and physical distancing to reduce the rate of infection and avoid overwhelming national health systems.

But the challenge of addressing the pandemic in the public health sphere go far beyond those measures. There are chronic and deep-seated problems of disease, poverty, and education in the region that complicate both the immediate response to the crisis and the eventual lifting of restrictions.

A study of more than 5,000 patients hospitalized in the New York City area shows that the most common comorbidities of COVID-19  are hypertension, obesity and diabetes. A systematic review of the literature suggests that these risk factors are more prevalent for severely affected patients compared with non-severely affected ones.

Using data from the Global Burden of Disease Study, a worldwide research program,  Andrew Clark of the London School of Hygiene and Tropical Medicine and colleagues estimate that 137 million people in Latin America and the Caribbean, or 21% percent of its population, have at least one factor that put them at higher risk of severe COVID-19 disease. The prevalence of one or more conditions was approximately 48% for those 50 and older and 74% for those 70 and older.

This vastly complicates the public health problem. According to recent data from nationally representative health surveys in Argentina, Brazil, Ecuador, Guyana, Mexico, Peru and Uruguay,  the prevalence of obesity, hypertension and high cholesterol in people older than 20  is staggering, at more than 30% in most countries, and over 40%  in others.

The size of this at-risk population will be a serious challenge for governments as they seek to ease lockdown restrictions and eventually distribute a vaccine when it becomes available.

Another cause for concern is that COVID-19 is likely to place a greater health burden on the poor than the rich. First, the incidence of risks factors such as diabetes, hypertension and obesity is generally higher among the poor. For example, in Argentina and Uruguay the prevalence of some of these risk factors is between 5 and 8 percentage points higher in people with low levels of education (completed primary education or less) than among the more educated. Moreover, poor people are more likely to have comorbidities (more than one risk factor) that increase the risk of severe COVID-19 disease.

Second, a large share of the population is unaware that they suffer from a risk factor. For example, in Argentina 33% of adults who think their blood pressure is not an issue actually have high blood pressure. Less educated people are also less likely (by 6 percentage points for high blood pressure in Argentina) to be aware of underlying health issues. That is probably because they are more likely to work in the informal sector and have worse health insurance coverage and poorer access to health services.

As we move from universal to targeted lockdowns it is important to bear in mind that those who do not know their underlying risk may fail to take the required preventive measures. This is especially significant given that poorest people in the region often have jobs that can’t be done from home. Because quarantine policies cause them the greatest financial strain, they also are the most eager to return to work.

Third, the disease might spread faster within and among the poorer households who, because of deficient housing conditions, may find it harder to quarantine. These factors may increase the transmission of the disease in slums, as is already seemingly the case throughout the region.

Finally, there is the issue of how underlying conditions that affect the severity of COVID-19 are managed during the pandemic. The pandemic disproportionately exposes the poor to economic hardship and, in the process, may force some households to spend their limited financial resources on food rather than medicine.

In this environment, governments must consider providing medicine for free to the poor with underlying chronic conditions. They must also consider the possibility of expanding primary care services, and the testing and monitoring of risk factors among their people.


Filed Under: Social Issues Tagged With: #coronavirus, #COVID-19

Samuel Berlinski

Samuel Berlinski is a Lead Economist at the Research Department of the Inter-American Development Bank. Prior to joining the Bank in 2010, he was an Assistant Professor of Economics at University College London and previously held appointments at Universidad de San Andrés and the London School of Economics. His work has appeared in numerous journals including the Journal of Public Economics, Journal of Law and Economics and Economic Development and Cultural Change. His research at the Bank focuses on the evaluation of public policy, with particular emphasis on Education, Health and Labor Markets. He completed his undergraduate studies in Economics at Universidad de Buenos Aires and obtained a Ph.D. in Economics at the University of Oxford, Nuffield College.

Jessica Gagete-Miranda

Jessica Gagete-Miranda is a postdoctoral researcher at University of Milano-Bicocca and a research fellow at Economic Research Southern Africa. She holds a PhD in Public Policy and Administration from Bocconi University and a bachelor's and a master's degree in Economics from the University of São Paulo. Her main research interests are development economics, with a focus on education, labor, and health.

Marcos Vera-Hernández

Marcos is Professor of Economics at University College London and a Research Fellow at the Institute for Fiscal Studies. His research focuses on the economics of health in developed and developing countries, combining theoretical models with experimental and quasi-experimental techniques to answer questions concerning the economic consequences of health-related risk, market failures in health-related markets, the behavior of health care providers, and household health investment choices. He has won several awards including the 2013 Royal Economic Society prize.

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