Latin America: Privatised health made the pandemic worse

The destruction of public health systems in many Latin American countries and the adoption of neoliberalism (an ideology which advocates privatisation of healthcare, among other things) have left millions in that continent helpless to face the scourge of COVID-19.

Roberto Bissio

AS winter started in the Southern Hemisphere on 21 June, four out of the 10 countries with the largest number of new COVID-19 cases were in Latin America and the Caribbean, the new global hotspot of the pandemic.

With a daily average of over 1,000 certified deaths by COVID-19, Brazil became the country with the highest pandemic mortality – and many sources believe these numbers to be severely under-reported. In Chile, meanwhile, the government admitted that if deaths ‘suspected’ to be from COVID-19 (because people had symptoms but were never tested) were added, the death toll, officially set at 4,500 at the time of writing, would be around 7,000. Mortality is even higher in Peru, while Mexico is also reaching the scary number of 1,000 daily deaths.

Meanwhile, other countries in the region are doing substantially better. Cuba, Jamaica and Uruguay seem to have descending curves and fewer than 200 active cases each. Costa Rica was similarly performing well, then saw the number of active cases rise to 1,000 in the last week of June, but, with only 12 deaths since the beginning of the pandemic, is still among the countries that seem to be fighting it succesfully.

Science still needs to explain what factors made the impact of COVID-19 much worse in Western Europe than in Eastern Europe, or why the poorer regions of southern Italy performed so much better than the rich north. Similarly, in Latin America and the Caribbean, there is no evident pattern to explain or predict the performance. Chile and Uruguay are the countries with the highest per capita income in the region and yet they are at opposite extremes in the table of COVID-19 mortality rates.

In terms of health expenditure per capita, Jamaica is at the bottom of the table, but it has fared much better than countries with double the money invested in health. Brazil, Cuba and Costa Rica spend between $800-1,000 per capita a year on health, with very unequal results in terms of COVID-19 impact. Inequalities need to be taken into account here and the key question is not so much how much money is spent on health, but who spends it.

In Brazil, which has one of the highest levels of inequality in the world, almost 60% of the total health expenditure is private, while in Chile and Mexico around half of the expenses in health are private. In comparison, in Jamaica, Costa Rica and Uruguay, government expenses account for between 65% and 75% of the total health expenditures, while in Cuba 90% of health expenses are public.

The people who spend their own money on health in Brazil come from the upper 10% of the population; the top 1% spend lavishly on cosmetic surgery. Public health expenditure, on which 9 out of 10 Brazilians depend, is only some 40% of the country’s total health expenses, leaving Brazilians much worse off on a per capita basis than the Jamaicans. On top of this, public health expenditure in Brazil has been declining steadily since the arbitrary impeachment of President Dilma Rousseff.

The neoliberal logic, which was first put into practice in Chile by Pinochet more than four decades ago and is now the official doctrine in Peru and Brazil also, claims that letting the rich pay for their own health or education would enable public services to better focus on the most vulnerable.

Nothing has been further from the reality, however.  As the economist Amartya Sen put it, ‘services for the poor end up being poor services’. The poor lack the capacity to make the service providers accountable, and all over the world the destruction of universal public health systems has resulted in a diminished number of hospital beds and of doctors and nurses working in structures available to the public at large.

A recent study* by Dr Jacob Assa from The New School for Social Research in New York and Cecilia Calderon, a statistics specialist at the United Nations Development Programme, found that a 10% increase in private health expenditure results in a 4.85% increase in COVID-19 cases and a 6.91% increase in COVID-19 deaths. This is on an average basis – some countries like the US perform worse while others like New Zealand fare a little better – but ‘the relationship is clear and statistically significant’. ‘Some of the highest mortality rates are in the US, Italy and Spain (which have around three hospital beds per 1,000 people), whereas less privatised systems have a much higher ratio of hospital beds per people, e.g. Germany (8.2), South Korea (10.9), and Japan (13.4).’

The Latin America experience appears to provide a ‘formula’ for combating the coronavirus pandemic, with five components:

1.   Free and universal public health services

2.   Early decision-making based on scientific evidence

3.   Strong institutions

4.   Trust between society and state, and

5.   Accurate public information.

Most of these components, if not all, are lacking in a majority of Latin American countries, which are characterised by highly unequal societies and extremely polarised politics. In Ecuador, Chile and Bolivia, governments that had been the target of popular ire before March are enjoying a respite as the pandemic has put a lid on mass protests. But opposition forces can only grow in the coming months, when the deadly consequences of long-term systemic failures, like the destruction of public health systems, become even clearer and combine with the short-term impacts of global recession, unemployment, increased poverty and more domestic violence against women whose care work, whether paid or unpaid, is overexploited.

If the curves that everybody wants to flatten in Latin America and the Caribbean these days follow a pattern similar to that in Europe, the ‘first wave’ of infections should be over by August. A second wave is feared and is impossible to predict, but a political tsunami might well follow the COVID-19 earthquake. The region that gave birth to ‘real neoliberalism’ may then be the first to bury it.                                       

Roberto Bissio, from Uruguay, is the coordinator of Social Watch, an international network of civil society organisations reporting on how their governments meet international commitments.


*Third World Resurgence No. 343/344, 2020, pp 29-30