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Letters to the Editor
Public health in Argentina
Saúde pública na Argentina
Vicente E. Mazzafero, Diego F. Wyszynski
Department of Public Health, School of Medicine, University of Buenos Aires. Argentina (V.E.M.), Department of Epidemiology, School of Hygiene and Public Health, The Johns Hopkins University. Baltimore, USA (D.F.W.)
Sir - The financial crises that face Latin American countries led governments to reformulate the goals that States will assume in the future. Under high inflation rates and unprecedented levels of unemployment, growth in their economies is perceived as a difficult objective. The free-market, often used in these countries as a decision-making tool, requires that "non-productive costs" be cut5. This circumstance is particularly serious for those professionals who are directly involved in the public health field.
The administration and management of public health in Argentina have experienced, for the last decades, a series of frustations and disappointments. Thus, a diagnosis of the situation is necessary for the design of a sucessful program of intervention. There are 34.6 million inhabitants in Argentina, of which 88% live in urban areas2. Approximately 24% of the total population lives in the surroundings of Buenos Aires. This area has suffered an explosive and unplanned growth in the last fifty years. It is not uncommon to observe that the pluvial and sewages systems are insufficient for such a large population. It is believed that 54% of the population living in the province of Buenos Aires is living under conditions of extreme health risk1.
Nativity and mortality rates have been stable for the last years, however, neonatal and maternal mortality rates do not show signs of improvement3. Poverty and extreme poverty in some urban areas reached 20%. Cardiovascular diseases, cancer, and injuries are as common as infections, malnutrition, and tuberculosis, mainly in the provinces of the northeast and northwest. Deficient sanitary conditions have resulted in recent autbreaks of cholera in northwest Argentina4.
The expenditure in health, over US $5 billion, represents approximately 8% of the gross national product4. However, most of this budgest is spent on medical drugs. The social security system, the province and local states, and the nation and armed forces provide health coverage to 21 million people. Thus, about twelve million people (36,9% of the total population), is either covered by private health insurance companies or virtually uncovered by the current health care system4.
Although this is a rough description of the conditions of public Health in Argentina, politicians and managers may find it useful as a general framework for the organization and pursuing of public health goals. Following the principles of universal coverage, equity, efficacy and community participation, the state in Argentina must face the needs of its community. To accomplish this goal, the sate has to provide universal availability of drinking water, protection of the environment, and health protection for the homeless, the poor, and the old.
1. Instituto Nacional de Estadísticas y Censos. Censo Nacional de Población y Vivienda 1991. Buenos Aires, 1993, (Série B, Número 25).
2. Instituto Nacional de Estadísticas y Censos. Estimaciones demográficas del período 1950-1990: proyeciones por sexo y edad del período 1990-2050. Buenos Aires, 1994. (Documentos de trabajo número 19).
3. Mazzafero, V. E.; Wyszynski, D. F.; GiaComini, H. Health conditions in Argentina: facing the twenty-first century. J. Public Health Med., 18(2), 1996.
4. Mazzafero, V. E.; Wyszynski, D. F.; Marconi, E., Giacomini, H. Epidemic of cholera among the aborigines of northern Argentina. J. Diarr. Dis. Res., 13:95-8, 1995.
5. United Nation's Children's Fund. The state of the children 1995, Oxford, 1995. Oxford University Press, 1995.