Preventable losses: infant mortality increases in Venezuela
Authors: Chris Beyrer, Kathleen Page
Journal: The Lancet Global Health (2019)

The health-care system collapse underway in Venezuela is a cause of utmost concern for its people and, increasingly, for the wider region. Declines in provision of basic services, such as childhood immunisation, malaria control, water, sanitation, and nutritional support, have led to increasing morbidity and mortality rates from an array of preventable diseases, including malaria, measles, and diphtheria. Secondary and tertiary care have also been greatly affected, due to declining investment, out-migration of providers, and spiralling hyperinflation that has driven the country and its people into poverty.1García J Correa G Rousset B Trends in infant mortality in Venezuela between 1985 and 2016: a systematic analysis of demographic data.Lancet Glob Health. 2019; (published online Jan 24.)http://dx.doi.org/10.1016/S2214-109X(18)30479-0PubMed Scopus (17) Google Scholar As is so often, and so tragically, the case, the most affected populations have been the most vulnerable: infants and children, their mothers, the poor (now the great majority of the populations), and indigenous people. The losses of these lives are tragedies for their families and communities. But the reality that so many of these losses are preventable, that Venezuela's health-care system collapse is the outcome of failed governance and misguided macroeconomic policies, makes them both more terrible and more telling. Venezuela and its people need not be poor. It is an OPEC (Organization of the Petroleum Exporting) member state with enormous energy reserves, which, as Jenny García and colleagues1García J Correa G Rousset B Trends in infant mortality in Venezuela between 1985 and 2016: a systematic analysis of demographic data.Lancet Glob Health. 2019; (published online Jan 24.)http://dx.doi.org/10.1016/S2214-109X(18)30479-0PubMed Scopus (17) Google Scholar describe in The Lancet Global Health, saw steady gains in infant and child survival for more than five decades. Yet relentless impoverishment under the authoritarian and incompetent Maduro regime is the current fact of life for nearly all Venezuelans.2Restuccia D The monetary and fiscal history of Venezuela, 1960–2016.https://www.economics.utoronto.ca/diegor/research/MFHLA_paper.pdfDate: 2018Date accessed: November 29, 2018Google Scholar Some 3 million people have been forced to leave their homelands for work, food, health-care access, and basic security.3International Organization for MigrationNumber of refugees, migrants from Venezuela reaches 3 million.https://www.iom.int/news/number-refugees-migrants-venezuela-reaches-3-millionDate: 2018Date accessed: November 21, 2018Google Scholar Migrant crises are underway on both the Brazil and Colombia borders.4Daniels JP Increasing malaria in Venezuela threatens regional progress.Lancet Infect Dis. 2018; 18: 257Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar García and colleagues1García J Correa G Rousset B Trends in infant mortality in Venezuela between 1985 and 2016: a systematic analysis of demographic data.Lancet Glob Health. 2019; (published online Jan 24.)http://dx.doi.org/10.1016/S2214-109X(18)30479-0PubMed Scopus (17) Google Scholar have done an important service in their effort to estimate child mortality rates in this unfolding humanitarian crisis. They have had to rely on limited data, modelling, and estimation methods from the demographic literature to assess probable trends. Their approach is reasonable and their findings highly plausible. They were forced to take this approach because the Venezuelan authorities have ceased to make vital statistics data publicly available since 2013. The brief release of 2014–16 Epidemiologic Bulletins suggests that data are still being collected but actively suppressed. Days after these data were released, the Venezuelan Minister of Health was promptly fired, perpetuating what García and colleagues1García J Correa G Rousset B Trends in infant mortality in Venezuela between 1985 and 2016: a systematic analysis of demographic data.Lancet Glob Health. 2019; (published online Jan 24.)http://dx.doi.org/10.1016/S2214-109X(18)30479-0PubMed Scopus (17) Google Scholar call a systemic silence. The authors make an additional point regarding data challenges: some of the major international entities, including the UN Economic Commission for Latin America and the Caribbean (ECLAC) and WHO, continue to use projections for Venezuela based on earlier, and then improving, trends in infant mortality. This use of data has led to somewhat perverse outcomes where global reports are increasingly delinked from reality, and support the patently false narratives of the regime. In this context, the scientific and medical community must also note that it is an act of civic courage on the part of the Venezuelan coauthors of this work to share their estimates and publicly challenge the government's denial of the crisis. The suppression of information about the health crisis, taken together with its political and economic root causes, makes this arguably a complex humanitarian emergency. The outbreaks of measles, diphtheria, and malaria, as well as the large number of treatment interruptions among Venezuelans living with HIV infection make this crisis a regional health and security concern. Given these realities, and the unfortunately grim prognosis for reform, Garcia and colleagues1García J Correa G Rousset B Trends in infant mortality in Venezuela between 1985 and 2016: a systematic analysis of demographic data.Lancet Glob Health. 2019; (published online Jan 24.)http://dx.doi.org/10.1016/S2214-109X(18)30479-0PubMed Scopus (17) Google Scholar suggest that the regional and international response to this crisis has been muted, slow, and nowhere near to scale. A recent US$5 million commitment from the Global Fund to Fight AIDS, Tuberculosis and Malaria, and US$9·2 million emergency funding from the UN was a step in the right direction, but again, too small to have a substantial mitigating impact. One explanation for the limited response to date is that Venezuela is a comparatively prosperous country, which has known stability in the past decades, and so lacks the humanitarian actors, experience, and response capacity of sub-Saharan Africa, south Asia, or other regions where complex humanitarian crises are ongoing. Whatever the causes of the lack of response, much more robust regional and global action is called for to address the health and humanitarian crisis in Venezuela. But as with any complex emergency, humanitarian assistance alone will not address the political, economic, and social root causes of this collapse. Poor governance is at the heart of the problem.5Amnesty InternationalVenezuela: unattended health rights crisis is forcing thousands to flee.https://www.amnesty.org/en/latest/news/2018/03/venezuela-unattended-health-rights-crisis-is-forcing-thousands-to-flee/Date: 2018Date accessed: May 1, 2018Google Scholar And it is poor governance that is literally killing the youngest Venezuelans. Much more regional and global pressure must be brought to bear on the current government to end the denial of the health collapse, rein in hyperinflation, and begin to address the policy failures that are stealing Venezuelans' futures. We declare no competing interests. Trends in infant mortality in Venezuela between 1985 and 2016: a systematic analysis of demographic dataOur conservative estimation indicates that Venezuela is in the throes of a humanitarian crisis. The increase in infant mortality rate in 2016 compared with 2008 takes the country back to the level observed at the end of the 1990s, wiping out 18 years of expected progress, and leaves the Venezuelan Government far from achieving the target of nine deaths per 1000 livebirths stated in the UN Millennium Development Goals. Full-Text PDF Open Access