Health inequalities in Latin America: persistent gaps in life expectancy
Authors: Claudio A Dávila-Cervantes, Marcela Agudelo-Botero
Journal: The Lancet Planetary Health (2019)

Generally, health inequalities refer to disparities that are unnecessary, unjust, and avoidable.1WHO10 facts on health inequities and their causes. World Health Organization, Geneva2017https://www.who.int/features/factfiles/health_inequities/en/Date accessed: December 3, 2019Google Scholar Latin America has some of the most persistent health inequalities in the world, and a wide range of life expectancies at birth.2Cardona D Acosta LD Bertone CL [Inequities in health among Latin American and Caribbean countries (2005-2010)].Gac Sanit. 2013; 27: 292-297Crossref PubMed Scopus (37) Google Scholar These inequalities are not only due to health disparities, but are also affected by the surrounding social dynamics. The Article by Usama Bilal and colleagues in The Lancet Planetary Health3Bilal U Alazraqui M Caiaffa WT et al.Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis.Lancet Planet Health. 2019; (published online Dec 10)https://doi.org/10.1016/S2542-5196(19)30235-9Summary Full Text Full Text PDF PubMed Scopus (63) Google Scholar contributes to the literature on health inequalities by analysing the spatial gaps in life expectancy at birth and their association with socioeconomic status at the subcity level in six Latin American cities. Using various statistical, demographic, and geospatial tools, they analysed data from Buenos Aires, Argentina; Belo Horizonte, Brazil; Santiago, Chile; San José, Costa Rica; Mexico City, Mexico; and Panama City, Panama; comprising 266 subcity units, from 2011 to 2016. They found large differences between the ninth and first decile of life expectancy at birth (P90–P10 gap), with the largest gaps in see in Panama City (15·0 years for men and 14·7 years for women), Santiago (8·9 years for men and 17·7 years for women), and Mexico City (10·9 years for men and 9·4 years for women), and the narrowest gaps in Buenos Aires (4·4 years for men and 5·8 years for women), Belo Horizonte (4·0 years for men and 6·5 years for women), and San José (3·9 years for men and 3·0 years for women). They also found that social disparities directly and indirectly affect people's health. Using P90–P10 change unit-level educational attainment as a proxy for socioeconomic status, they found higher area-level socioeconomic status to be associated with higher life expectancy, particularly in Santiago (change in life expectancy of 8·0 years [95% CI 5·8–10·3] for men and 11·8 years [7·1–16·4] for women) and Panama City (7·3 years [2·6–12·1] for men and 9·0 years [2·4–15·5] for women). Such disparities are known to restrict people's access to and use of health services.4Barros MB Francisco PM Zanchetta LM César CL [Trends in social and demographic inequalities in the prevalence of chronic diseases in Brazil. PNAD: 2003- 2008].Cien Saude Colet. 2011; 16 (in Portuguese).: 3755-3768Crossref PubMed Scopus (146) Google Scholar In this sense, health disparities should be considered a by-product of a population's deficient living conditions.5Carvalho RA Santos VS Melo CM Gurgel RQ Oliveira CC Inequalities in health: living conditions and infant mortality in Northeastern Brazil.Rev Saude Publica. 2015; 49: 5Crossref PubMed Scopus (17) Google Scholar This study's findings raise several questions, such as, what are the causes of death that most increase a population's years of life lost? What age groups are most affected by these health inequalities? How do these disparities change over time? Differences and changes in life expectancy among different age groups, owing to illness or injury, are calculated by breaking down the different life expectancies in a population or subpopulation.6Beltrán-Sánchez H Preston SH Canudas-Romo V An integrated approach to cause-of-death analysis: cause-deleted life tables and decompositions of life expectancy.Demogr Res. 2008; 19: 1323-1350Crossref PubMed Scopus (91) Google Scholar This type of analysis provides a more detailed panorama of disparities in life expectancy and studying these differences over time shows which diseases and injuries increase or decrease a population's health inequalities. This information is very useful for those creating public policy and allocating health resources.7Bennett JE Pearson-Stuttard J Kontis V Capewell S Wolfe I Ezzati M Contributions of diseases and injuries to widening life expectancy inequalities in England from 2001 to 2016: a population-based analysis of vital registration data.Lancet Public Health. 2018; 3: e586-e597Summary Full Text Full Text PDF PubMed Scopus (64) Google Scholar Future research in this area should take other approaches to account for health inequalities and use a conceptual and multidimensional perspective. Several additional indicators could be used, such as measurements of disability, disease burden, or healthy life expectancy; these factors also directly or indirectly affect life expectancy at birth. Deeper exploration of health inequalities is needed. Most of the available relevant data are at a national scale, while little is known about health indicators in cities and at the subcity level. National-level or state-level data often hide the true dimensions of a problem and internal disparities. Thus, analysing these inequalities is fully appropriate to establish specific needs and priorities in each subarea, as a function of its social, economic, political, and cultural context. Such analysis is a powerful tool for policy and decision making. Evidence indicates that most of the causes of mortality that are decreasing life expectancy in Latin American are potentially avoidable.8Aburto JM Riffe T Canudas-Romo V Trends in avoidable mortality over the life course in Mexico, 1990–2015: a cross-sectional demographic analysis.BMJ Open. 2018; 8e022350Crossref PubMed Scopus (18) Google Scholar, 9Dávila-Cervantes C Agudelo-Botero M Changes in life expectancy due to avoidable and non-avoidable deaths in Argentina, Chile, Colombia and Mexico, 2000–2011.Cad Saude Publica. 2018; 34e00093417Crossref PubMed Scopus (9) Google Scholar Given the region's high health inequalities, work towards a life expectancy at birth level to which all individuals can aspire is crucial, independently of where they were born, grew up, or live today. In summary, the findings of Bilal and colleagues point towards specific geographical areas of the cities studied that require focused health promotion and disease prevention efforts via risk prediction and early diagnosis. Work in these areas must also focus on health-care access and quality, and the implementation of intersectoral public policies. Public health strategies should aim to reduce the life expectancy gap and consider the urban spatial segregation and socioeconomic factors that are connected with these disparities. We believe that these factors are essential for understanding health inequalities. Bilal and colleagues have laid the foundations for monitoring the benchmarks associated with the Sustainable Development Goals, the objective of which is to leave no one behind. We declare no competing interests. Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysisLarge spatial differences in life expectancy in Latin American cities and their association with social factors highlight the importance of area-based approaches and policies that address social inequalities in improving health in cities of the region. Full-Text PDF Open Access