The title of this presentation deals with such a broad subject that it greatly exceeds my capabilities. Counting on the organizers kindness, I shall limit myself to Latin America. My former position as head of International Relations in the Spanish Ministry of Health and Consumer Affairs (1987-1991) and my current position as a Pan American Health Organization consultant (PAHO/WHO), have given me direct experience and not mere literature knowledge on this part of the developing world.
To focus on the subject, I shall not discuss the health care situation, or describe health care systems in Latin America. There are recent and excellent reviews covering both topics (PAHO, 1994, pp. 12-36; ROEMER, 1993). I shall limit myself to analyze: first, the economic and social context and the role of the State at the beginning of this decade; second, some of the Health Systems and Services reform processes; and, finally, the pharmaceutical market and the essential drugs. Even so, my approach will be cautious.
Since at least the end of the 18th Century, the relationships between Health, Economy and Development have been (and still are) the object of extensive and varied studies where both terminology and opinions have been frequently ambiguous. From the beginning of the present decade, the relevance of health within the notion of development is being reformulated in the light of the concept of «sustainable development» (RODRÍGUEZ-GARCÍA and COLDMAN, 1994, pp. 1-57). In 1993, the United Nations Development Program (UNDP) included for the first time health indicators as part of the Human Development Index (UNITED NATIONS DEVELOPMENT PROGRAM, 1993). At the end of 1994, the results of a rigorous investigation on this issue, which will be published shortly, were presented during the 7th Conference of the Federation of Public Health International Associations (RODRÍGUEZ-GARCÍA, 1995).
Even so, our world today, is more and more global and interdependent, and therefore increasingly complex and diverse. In a single continent, a single country, a single city, several worlds coexist, not always well linked to one another, sometimes in conflict, frequently ignorant of each other. As with other issues and topics in health care and in Latin America, mean figures and general overviews often hide more than they reveal. As a good friend of mine usually says, simplifying the complicated may be useful to create a press headline but it does not help us to understand what is happening.
I would like to thank Rosalía Rodríguez-García, from George Washington University; Matilde Pinto, Pablo Isaza and Ernesto Gozzer, from the PAHO/WHO Investment Programme in Environment and Health, and Enrique Fefer, from the PAHO/WHO Essential Drugs Program for their comments, criticisms and contributions. No doubt they helped to improve the text. Mistakes and omissions are obviously mine.