NEW YORK — Latin America and the Caribbean enter the new century showing measurable gains in several health indicators such as life expectancy, infant survivability and the fight against several infectious diseases. Most countries in these regions, however, still face daunting challenges due to sprawling urbanization and environmental problems that affect all ages, but especially children. At the same time, cases of HIV/AIDS, malaria, dengue, tobacco and substance abuse, chronic diseases and physical and mental disabilities increase unrelentingly.

The Caribbean, with an HIV infection rate of more than 2 percent, is the second most heavily infected area in the world after sub-Saharan Africa.

With little change in maternal mortality rates during the last decade, the gap in this indicator between the Latin American and Caribbean countries, on one hand, and the United States and Canada, on the other, has increased. The risk of dying during pregnancy, childbirth and postlabor is 50 times greater in the developing countries than in the industrialized countries in the region. This situation is more evident in young women from indigenous and marginal sectors of the population. It reflects a glaring inequity, particularly when one considers that these deaths could be prevented by simple and cost-effective measures.

Infant mortality, meanwhile, has declined gradually in most countries in the region due to effective public health and sanitation policies.

The Latin American and Caribbean countries, however, still face problems associated with low average income, volatile growth, increasing wealth concentration and extreme poverty — all manifestations of social and economic disparities. As a result, a climate of unrest exists in countries such as Venezuela, Argentina, Uruguay, Paraguay, Colombia and Haiti. This climate threatens to negate some important gains achieved during the last decade. In addition, the benefits derived from the democratization process — individual liberties, judicial reforms, free press — and from the information revolution have not reached the majority of the population.

Governments in these regions are becoming acutely aware of the need to reduce the gap in access to health services. At the same time, they are paying more attention to the international dimensions of public health in the process of global integration. It is still necessary, though, to increase investment in infrastructure and in basic equipment and supplies, to assure the proper distribution of basic drugs, to make widely available safe blood supplies and to improve epidemiological surveillance. It is also important to address issues, such as violence, that plague an increasing number of victims and demand not only a political but a public health approach. In countries such as Colombia, violence has reached epidemic proportions and has translated into a climate of general insecurity in some areas, particularly those most affected by the conflict between the government and drug traffickers. In Argentina, urban crime has increased dramatically in the last few months as a result of sharply increasing poverty.

This is a crucial time for implementing a health-promotion model that addresses nonmedical determinants of health in recognition of the benefits of the life-cycle approach to investing in health, and for adopting new concepts of social protection to reduce the exclusion of wide sectors of the population.

Stronger alliances must be forged between the public health sector and the education, agriculture, labor, housing, and water and sanitation sectors, so that actions aimed at the more disadvantaged and vulnerable sectors of society can be planned and put into effect. At the same time, it is important to speed up creation of institutional networks and to improve the exchange of health information among countries. These actions will reduce burdens caused by disease and translate into a better quality of life for the populations of Latin America and the Caribbean.

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