Latin America’s Emerging Burden of Chronic Non-Communicable Diseases

By Fernando De Maio*

Photo credit: FLICKR.com/diapositivasmentales / Foter.com / CC BY

Photo credit: FLICKR.com/diapositivasmentales / Foter.com / CC BY

Despite significant improvements over the past 30 years in some of the most crucial health indicators – including increases in life expectancy and decreases in infant mortality – Latin America faces an impending epidemic of chronic non-communicable diseases such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes.  The region has avoided the worst effects of the HIV/AIDS epidemic.  Brazil, for example, is now widely accepted by health policy analysts as offering the world valuable lessons for combating the spread of HIV and in ensuring access to life-saving antiretroviral medicine.  But chronic non-communicable diseases are now stretching under-funded and fragmented health care systems, revealing deep lines of social inequality.

The World Health Organization (WHO) has warned of an impending epidemic of such ailments, which are already the leading causes of death in all areas of the world except for sub-Saharan Africa.  In Latin America, chronic diseases account for more than 60 percent of deaths, with some variance between countries (more than 70 percent in Uruguay, more than 60 percent in Argentina and Chile, but less than 40 percent in Bolivia and Paraguay).  The latest data indicate that this burden is growing across the region, driven by increases in some of the most important risk factors (physical inactivity and obesity in particular).  Surveys in the region allow us to disaggregate national data, revealing the social inequalities underlying the problem.

In Argentina, we have used the National Risk Factor Surveys from 2005 and 2009 to examine how social gradients are changing:

  • Physical inactivity – an important risk factor for cardiovascular disease – has increased substantially (from 46 to 55 percent).  The further down we go in the socioeconomic hierarchy, the more this important risk factor seems to be increasing.
  • Obesity has also increased in this four-year period (from 14 to 18 percent), with a steepening social gradient for women.
  • Data on diabetes from these surveys are mixed.  The percentage of the adult population told they have diabetes or high blood sugar has risen (8.4 to 9.6 percent), but experts believe the increase reflects both increases in diabetes in the population and an in access to health care resulting in more cases being detected.
  • Some good news may be found in preventive cancer screening: rates of mammograms and pap smears have increased, and social gradients for mammograms are decreasing, raising the hope of diminished inequalities in cancer mortality in the future.

The WHO’s Commission on the Social Determinants of Health recently concluded that “reducing health inequalities is… an ethical imperative.  Social injustice is killing people on a grand scale.”  Among its recommendations is a call for the routine monitoring of health inequalities.  The growing body of data documents the linkage between inequality and the occurrence of chronic non-communicable diseases – demonstrating that, fundamentally, it is a question of social justice.  Social inequalities in physical inactivity, obesity, diabetes – and, crucially, tobacco consumption – are not natural but socially and politically produced.  Empirical research in the coming years will need not only to document the rise of chronic non-communicable diseases in aggregate terms, but also to closely monitor the inequalities embedded in national figures.  Policy analysis will likewise need to examine not just the national-level effects of new initiatives, such as new taxes on tobacco products or new standards for salt consumption, but, at a disaggregated level of analysis, examine how new initiatives affect people across the socioeconomic spectrum.

* Dr. De Maio is a professor in the Department of Sociology at DePaul University.

 

Transgender Rights: Signs of Progress in Latin America

By Emily McGranachan

Marcha de Orgullo, Buenos Aires, Argentina / Photo credit: blmurch / Foter.com / CC BY

Marcha de Orgullo, Buenos Aires, Argentina / Photo credit: blmurch / Foter.com / CC BY

Social and structural discrimination limit the economic, health, and social prospects of transgender individuals, often leading to precarious lives fraught with human rights violations.  According to Argentine psychologist Graciela Balestra, transgender people around the world have an average life expectancy of only 30 years.  In Latin America, they have the highest rate of HIV infection (35 percent) and frequently face violence and insecurity.  According to the 2012 Trans Murder Monitoring Project report, of the total reported murders of transgender people in the world between 2008 and 2011, 79 percent took place in Latin America.  International HIV/AIDS Alliance and Red Latinoamericano y del Caribe de Personas Trans (REDLACTRANS) published similarly startling statistics in a 2012 report titled “The Night is Another Country.”  While the report focused on the experiences of transgender women, it also reveals that transgender men also experience high rates of discrimination and violence throughout Latin America.  Of the transgender women interviewed in the study, about 80 percent reported experiencing violence or threats by police and other officials.  Throughout Latin America the prevalence of transphobia – defined as the fear or hatred of transgender people – has led to impunity for violence and discrimination against transgender people, and these crimes, including murder, are seldom prosecuted.  The transgender community also faces challenges of social discrimination and the lack of access to health care and jobs, marginalizing transgendered people in society.

While the current situation is stark, some societies have shown greater openness to transgender people.  Whereas Brazil and Colombia allow identity card changes only after surgery and board evaluation, Argentina in 2012 became the first country in Latin America to pass a progressive law easing the rules with regard to gender identity and identification.  Now a person in Argentina can change the name and sex on their identity card without having to go through the long and discriminatory process of sex reassignment surgery or going before a judicial review board.  In 2009, Uruguay slightly loosened its controls when it began requiring only board approval for identity card changes.  Government initiatives, like that of Argentina, have direct impacts on the lives of transgender people, who are able to access jobs and other securities, according to Balestra.  Greater inclusion in society and stronger legal protections by the government can signify or signal a change in social values within the broader society.

The Obama Administration has been a vocal supporter of LGBT (Lesbian, Gay, Bisexual and Transgender) rights as part of a broader human rights agenda in international diplomacy.  Among its initiatives are the Global Equality Fund to support local LGBT organizations and advocates, a greater recognition of refugee rights for LGBT people, and a general promotion of rights abroad through working with NGOs and states.  Recognizing the situation in Latin America, the State Department highlights its work trying to establish a special rapporteur for LGBT human rights within the Inter-American Commission for Human Rights.  As some aspects of LGBT rights progress in the United States (the U.S. still has a high rate of violence against transgender people as well), it is expanding its understanding and definition of human rights.  While the right to security, health care, employment and dignity have long been international human rights, only recently has the discrimination and violence transgender people face become an important part of the human rights platform.  The incorporation of LGBT human rights into U.S. foreign policy, backed by a strong U.S. example of justice and security for transgender citizens, will encourage other countries to follow suit.