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COVID-19: transformative actions for more equitable, resilient, sustainable societies and health systems in the Americas

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BMJ
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Carissa F Etienne, James Fitzgerald, Gisele Almeida, Maureen E Birmingham, Monica Brana, Ernesto Bascolo, Camilo Cid, Claudia Pescetto

Summary box

  • COVID-19 has exposed structural deficiencies in health, social and economic policies and sectors in the Americas impacting the resilience of health systems and societies.

  • Due to the pandemic, the region of the Americas is facing unprecedented challenges in the health, economic and social sectors, intensifying inequalities already present in the region.

  • Strategic areas for priority action moving forward include (1) realignment of core values in favour of health and social development with economic development; (2) prioritisation of and investment in health, social cohesiveness, social development and protection, and (3) transformation of health systems based on primary health care.

  • Key actions that promote needed change comprise (1) elevating health as a priority, essential for human security, as a driver for economic and social development; (2) prioritising integrated policy development and planning; (3) transforming health systems to achieve universal health and human security; (4) investing in science, technology and innovation to ensure equitable access to medicines and other health technologies; (5) strengthening the essential public health functions and risk reduction and mitigation.

INTRODUCTION

The COVID-19 pandemic has resulted in terrible loss of life, disproportionately impacting the poor and those with underlying health conditions, devastating lives and livelihoods as a consequence of its effect on economic activity. Weak health system responses, chronic and longstanding underinvestment, and inadequate policies to tackle the root causes of inequity that most affect those living in conditions of vulnerability to access needed health and social services have exacerbated the problem. In addition, this pandemic has confirmed the precarious relationship and interdependence of health and the economy in the context of a disease outbreak. The impact on economies and sustainable development is evident, with COVID-19 uncovering the structural deficiencies and inequities in access to health services and social protection. The region of the Americas, similar to the rest of the world, is already experiencing a deepening economic crisis caused by the COVID-19 pandemic and the necessary measures for its mitigation. The most recent forecast suggests a global contraction of 4.9% and a Gross Domestic Product decline in the order of 9.4% for Latin America and the Caribbean, with the greatest losses registered by Mexico at 10.5% and Brazil at 9.1%. Although a gradual recovery is projected in 2021, this recession constitutes the worst economic crisis in the past 80 years. The region will face unprecedented challenges in fiscal, monetary and social protection policy, intensifying the inequalities already present in the region.

As the Americas persistently remains one of the most impacted regions globally by COVID-19 and one of the most inequitable in terms of income distribution and access to health, this pandemic has laid bare the core values on which societies have been built and exposed the inextricable interdependency between health, well-being and the economy. A healthy economy cannot exist without healthy people, and the health and well-being of people depend on an inclusive, sustainable economy and social development policies that benefit all within society. As we begin to realise that this health crisis may remain over time, there is a growing consensus on the need to critically look at the future in terms of health, social and economic policy.4–6 Fundamental changes are required in how we approach health and development objectives from the perspective of health and economic security, and on the basic principle of the guarantee of rights, protections and access to health, so that people and societies can be protected and survive in the face of multifaceted threats and risks—biological, natural or economic in nature.