An Unhealthy Synergy: Linking Poor Health Services to Civil Unrest in Latin America

Failure to provide basic public services has led to civil unrest in many Latin American countries, including Chile. From Edgard Garrido / Reuters (2019), https://www.foreignaffairs.com/articles/central-america-caribbean/2019-10-29/why-latin-america-was-primed-explode.

At the core of the World Health Organization’s mission is “the attainment by all peoples of the highest possible level of health” [2]. However, with continuous health inequalities, unequal access to medical care, and historical trauma in Latin America as the chief contributor for civil unrest, there is a need to evaluate global health’s moral responsibility to eliminate structural violence, and achieve a more just society overall.

In the last couple of months, the world has witnessed Latin America explode into a series of protests and social movements. From Chile to Haiti to Honduras, the region seems to have reached its breaking point. With the media reporting images of police riots and burning buildings, questions arise on what this state of civil unrest is doing to the region, and its population [6]. 

A common element that is apparent in Latin America’s current instability is the decline in public services and institutions, such as education and public health. As of 2018, the public spending of Latin American countries averaged around 29.7% of their GDP [7]. Although this is an increase from the region’s spending in the early 2000s, it does not nearly match other areas of the world [7]. Whereas most regions in the world have increased their public investment by more than 50% since the 1980s, Latin America has only seen a 5% increase in public investment per capita [7].

Civil unrest, whether characteristically violent or not, is reflective of a region’s desperate need for change, and an increase in necessary spending for public services. With growing reports of deaths and injuries across the continent, this becomes a necessary issue for global public health agencies to address [4]. As much as this issue relates to providing emergency care services and strengthening health departments to address the effects of protests in the short-term, responses relating to the cause of this unrest must come from public health agencies just as much as from political and economic leaders. 

Current academic literature on civil unrest characterizes this phenomenon as “community violence,” and emphasize how it threatens the victims of movements and protests, rather than those participating [8]. This focus on the victims, although merited, ignores social determinants of health and the health outcomes of individual protesters, also underestimating the importance of the factors driving the populations out to the streets to protest for their livelihoods in the first place [1]. 

At the end of the day, civil unrest in Latin America is connected to feelings of social inequality, which are only strengthened by weak healthcare systems, and the inadequate provision of health services [4]. These growing health concerns, coupled with socioeconomically driven stress, should be sufficient in receiving immediate attention from the international community. Yet as protests become more violent, and national health care systems become more burdened, there is an additional need to understand the long-lasting effects that this violence and state of stress has on populations. 

An often-overlooked way of understanding the effects of civil unrest on communities is through a parallel to those living in areas plagued by armed conflict. While these situations do have crucial differences, both are characterized by high-stress environments, and distrust for the government and public services [5]. During armed conflicts, public health infrastructure can be found to be halted or underfunded, and are frequently targeted by combatants. This lack of access to care is also seen in protests occurring in Haiti and Honduras, with problematic estimates of mortality, and a lack of health data overall [3]. This leads to a troubling understanding of the true effects and needs for care in the context of armed conflict, as with more violent protests. 

In Latin America, where protests stem from a historically entrenched fear and distrust of the government, measuring health outcomes during this time of unrest becomes especially difficult. The government focus moves its attention towards controlling the public rather than providing them with services to prevent negative health outcomes [6]. This phenomenon coupled with an already unsatisfied population with existing social services only leads to greater civil unrest. Thus, furthering a vicious cycle of structural violence and health inequity.

The current state of civil unrest in Latin America further emphasizes the need for stronger healthcare systems that can both withstand periods of political and social turmoil, rather than systems that drive their populations towards protests and even violence. Addressing both the immediate and long-term effects of civil unrest on the population needs to be considered, once change in the region eventually takes place. 

Global health, as a discipline, has the power, and the responsibility, to make a change in the health outcomes of those living in Latin America and other politically unstable regions. This case alone demonstrates just how interconnected health is to everyday political decisions. Governments need to consider the health of their populations in a much wider scope than that of disease control and sanitation. The important connections between the political climate, socio-environmental factors, and health continue to grow in evidence, and so should the scope of health globally. When governments are faced with an angry, dissatisfied population that fears, in part, for its health, there is a clear public and global health knowledge gap that must be addressed. 

References

[1] Distefano, M. J. (2018). Characterizing “Civil Unrest” as a Public Health Determinant.  American Journal of Public Health, 108(7), e20–e20. doi: 10.2105/ajph.2018.304482

[2] International Health Conference. (‎2002)‎. Constitution of the World Health Organization. 1946. Bulletin of the World Health Organization, 80 (‎12)‎, 983-984. Retrieved from https://apps.who.int/iris/handle/10665/268688

[3] Kadir, A., Garcia, D. M., & Romero, F. (2019). New ways to measure the effects of armed conflict in civilian population. The Lancet Global Health. doi: 10.1016/s2214-109x(19)30452-8

[4] Naim, M., & Winter, B. (2019, October 29). Why Latin America Was Primed to Explode.  Foreign Affairs. Retrieved from https://www.foreignaffairs.com/articles/central-america-caribbean/2019-10-29/why-latin-america-was-primed-explode

[5] Somali-Swedish Action Group for Health Research and Development. (2015). Healing the Health System after Civil Unrest. Global Health Action, 8(1). doi: 10.3402/gha.v8.27381

[6] Spinetto, J. P. (2019, October 20). Political Risk Is Revived in Latin America as Protests Spread. Bloomberg. Retrieved from https://www.bloomberg.com/news/articles/2019-10-20/political-risk-revived-in-latin-america-as-protests-spread

[7] Welsh, T. (2018, September 24). Inefficient spending costs Latin America $220B, stalls development. Devex. Retrieved from https://www.devex.com/news/inefficient-spending-costs-latin-america-220b-stalls-development-93486

[8] Yimgang, D. P., Wang, Y., Paik, G., Hager, E. R., & Black, M. M. (2017). Civil Unrest in the Context of Chronic Community Violence: Impact on Maternal Depressive Symptoms. American Journal of Public Health, 107(9), 1455–1462. doi: 10.2105/ajph.2017.303876