Latin America has some of the highest COVID-19 death rates in the world. Why? For outsiders, much of the discussion of COVID-19 in Latin America has focused on Brazil and the errors of President Jair Bolsonaro. But the region as a whole is facing a humanitarian crisis borne out of political instability, corruption, social unrest, fragile health systems, and perhaps most importantly, longstanding and pervasive inequality—in income, health care, and education—which has been woven into the social and economic fabric of the region.

An estimated 231 million people in Latin America are predicted to be living in poverty by the end of 2020 (reaching a level last seen 15 years ago). Latin American countries have long had some of the most scarring income inequalities in the world, and they are predicted to worsen. The informal labour market is huge, making up 54% of all work across the region (up to 70% in some countries, such as Peru).

Informal workers have little access to social protection and have no choice but to continue to work daily to earn a living. The result is that their capability to follow quarantine and social distancing measures is limited. Informal workers also have less access to health care. The overall population health status in Latin America and the Caribbean has improved, as measured by life expectancy, under-5 mortality, and maternal mortality, but progress remains unequal across and within countries.

In Venezuela and Cuba, for example, population health has worsened, with disability-adjusted life-years increasing by more than 10% over the past decade. The syndemic nature of the pandemic—a combination of viral infection and non-communicable diseases embedded in social inequities—is acute in the region. The increases in obesity and diabetes in Latin America are surely major contributors to the high mortality rates. In Mexico and Chile, more than 75% of the female population is overweight.

Nutrient-poor and energy-dense processed foods are often the only type of food readily affordable to the most disadvantaged people. Although some countries, including Brazil and Costa Rica, have a universal health-care system, most Latin American countries have large gaps in accessibility caused mainly by out-of-pocket health expenditure, which is 34% of total health spending. Political power is overly concentrated.

There is corruption in the use of public resources. Often, the result is a strengthened private sector to the detriment of public health services. Without universal health coverage, tackling the pandemic will be impossible. Displacement of people has soared in central America, and the Venezuelan migrant crisis is impacting the region. Rising inequalities have driven domestic political tensions and social unrest in Colombia, Bolivia, and Chile. Gender inequalities are also important in Latin America’s pandemic. 73% of those employed in the region’s health sector are women, and gender-based violence is increasing.

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