In Chile, taxes and social security contributions only account for half of spending on healthcare, with the other half coming from patients through mandatory prepayment fees and voluntary and out-of-pocket expenses

Governments across Latin America and the Caribbean must urgently ramp up spending on the right to social protection and health in order to tackle the region’s obscene socio-economic inequality that has proven fatal during the Covid pandemic, said Amnesty International and the Center for Economic and Social Rights (CESR) in a new joint report released today.

Unequal and Lethal: Five key actions to recover from the human rights crisis unleashed by the pandemic in Latin America and the Caribbean explains the factors behind the region’s disproportionate death toll from Covid compared to other parts of the world. With only 8.4% of the world’s population, the region has endured 28% of total global deaths due to COVID-19. The report finds that those countries with the highest inequality and lowest public spending on health and social protection suffered most during the pandemic, with the most devasting impacts on historically marginalized groups.

A human rights-based rethink of economic policies is key to avoiding future calamities in what is, by many measures, the world’s most unequal region. Despite the staggering inequality and poverty in Latin America and the Caribbean, over the last decades governments have failed to collect sufficient tax revenues and to do so in a way that combats inequality, even during times of economic boom. This has inevitably resulted in meagre spending on healthcare services and social protection – including unemployment, pensions and childcare support – which are vital for a life of dignity and to truly uphold human rights for all.  

“Governments have the obligation to proactively mobilize the resources needed to protect their populations from the worst impacts of discrimination, disease and economic disaster. If Latin American countries had done this in the decades before the pandemic, the region could have avoided so much pain and loss of life,” said Kate Donald, Acting Executive Director of CESR. “Now is their chance to prevent the next inequality-induced disaster and make the shift towards a rights-based economy.”

Countries such as Mexico, Brazil and Peru, where the richest 1% of the population hoards over 30% of national wealth, have recorded the highest numbers of Covid deaths in the region proportional to their populations. Chile, where the richest 20% of the population takes home 10 times more income than the poorest 20%, also has one of the region’s highest death rates per capita.

While many Latin American countries provided cash transfers during the pandemic, none of them expanded health insurance nor took sufficient action to implement universal social security mechanisms and expand coverage to ensure the most disadvantaged people were covered.

The impact of these shortcomings across the region fell most severely on women, who lost jobs at a higher rate than men and whose disproportionate role in caring for children and family continues to affect their unequal enjoyment of rights – even more so if they are Indigenous or of African descent.

“Being born with a certain skin colour or growing up in a certain postcode should not determine your chances of dying of infectious diseases like Covid. Two years into the pandemic, governments in Latin America have still not caught on to the urgency of implementing a human rights-based approach to recovering from the pandemic and tackling inequality,” said Erika Guevara-Rosas, Americas director at Amnesty International.

“Promoting equality does not mean treating everyone in the same way. Latin America’s present situation is the result of hundreds of years of colonial injustices that mean certain groups have been historically and systematically denied their rights. As countries recover from the pandemic governments need to address this head on by adopting a substantive equality approach and affirmative action measures.”

Although the Pan American Health Organization calls for a minimum of 6% of GDP to be spent on health in order to ensure universal coverage, nearly all the countries in the region spend far less on public health services, which means that they do not have enough hospital beds, doctors or nurses to effectively deal with Covid-19 or other health crises. In Peru, for example, in the decade prior to the pandemic, authorities failed to increase public spending on health despite years of sustained economic growth, only investing 3.3% of its GDP. Meanwhile in Mexico, over 15 million people lost access to health coverage in the two years before the pandemic, due to bureaucratic inefficiencies in government health policies.

In Chile, taxes and social security contributions only account for half of spending on healthcare, with the other half coming from patients through mandatory prepayment fees and voluntary and out-of-pocket expenses. Chile’s per capita public spending on health represents just a third of the OECD average, and it has half as many hospital beds per 1,000 inhabitants as the OECD average.

Even when they have adequate policies in theory, governments stumble on implementation, with a key barrier often being the failure to generate sufficient fiscal resources to make them effective. Countries in Latin America and the Caribbean generally collect less revenue from taxes than others with similar levels of development in different parts of the world. In 2019, the region only collected on average 22% of its GDP in taxes, compared to 33% for OECD countries.

Moreover, many have regressive taxation systems with taxes that do not ask enough from those most able to pay, thus undermining their resources to overcome inequality and redistribute wealth. For example, Latin American countries depend heavily on indirect taxes – which are more regressive as they represent a larger burden for poorer sections of the population – and collect very little from wealth taxes which target economic elites.

“Without boldly facing the need to tax more and tax better – as is their human rights obligation – countries in Latin America will continue to be dragged down by a malaise of socio-economic inequality, favouring a rich elite while harming society as a whole,” said Kate Donald.