SummaryBackgroundLatin American and Caribbean populations include three main ethnic groups: indigenous people, people of African descent, and people of European descent. We investigated ethnic inequalities among these groups in population coverage with reproductive, maternal, newborn, and child health interventions.MethodsWe analysed 16 standardised, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean that provided information on ethnicity or a proxy indicator (household language or skin colour) and on coverage of reproductive, maternal, newborn, and child health interventions. We selected four outcomes: coverage with modern contraception, antenatal care coverage (defined as four or more antenatal visits), and skilled attendants at birth for women aged 15–49 years; and coverage with three doses of diphtheria-pertussis-tetanus (DPT3) vaccine among children aged 12–23 months. We classified women and children as indigenous, of African descent, or other ancestry (reference group) on the basis of their self-reported ethnicity or language. Mediating variables included wealth quintiles (based on household asset indices), woman's education, and urban-rural residence. We calculated crude and adjusted coverage ratios using Poisson regression.FindingsEthnic gaps in coverage varied substantially from country to country. In most countries, coverage with modern contraception (median coverage ratio 0·82, IQR 0·66–0·92), antenatal care (0·86, 0·75–0·94), and skilled birth attendants (0·75, 0·68–0·92) was lower among indigenous women than in the reference group. Only three countries (Nicaragua, Panama, and Paraguay) showed significant gaps in DPT3 coverage between the indigenous and the reference groups. The differences were attenuated but persisted after adjustment for wealth, education, and residence. Women and children of African descent showed similar coverage to the reference group in most countries.InterpretationThe lower coverage levels for indigenous women are pervasive, and cannot be explained solely by differences in wealth, education, or residence. Interventions delivered at community level—such as vaccines—show less inequality than those requiring access to services, such as birth attendance. Regular monitoring of ethnic inequalities is essential to evaluate existing initiatives aimed at the inclusion of minorities and to plan effective multisectoral policies and programmes.FundingThe Bill & Melinda Gates Foundation (through the Countdown to 2030 initiative) and the Wellcome Trust.

Objetivo. Analizar las desigualdades en comportamientos de riesgo en adolescentes de 10 a 19 años en México y documentar los cambios en las brechas y la magnitud de la desigualdad. Material y métodos. Análisis de las encuestas nacionales de salud de 2000 y 2012 estimando para ambas la brecha absoluta y relativa en indicadores de comportamiento de riesgo, así como el índice de desigualdad de la pendiente. Resultados. Para comportamientos sexuales, el uso de métodos anticonceptivos muestra un índice de desigualdad elevado e incrementado entre 2000 y 2012 tanto para hom­bres como para mujeres; esto es, menor probabilidad de uso para menor nivel socioeconómico. Para el consumo de tabaco y alcohol, la probabilidad es mayor entre quienes cuentan con mayores recursos. Conclusiones. El análisis presentado señala retos importantes en términos de la atención de comportamientos que comprometen la salud de los adoles­centes mexicanos y su bienestar futuro. Comprender mejor los elementos asociados a las desigualdades identificadas es necesario para el desarrollo de acciones preventivas eficaces.

Objetivo. Analizar la tendencia entre 2000 y 2012 en des­igualdades socioeconómicas para indicadores de diabetes e hipertensión en México, así como el gradiente de desigualdad, por sexo, ámbito de residencia y condición indígena. Ma­terial y métodos. Análisis de las encuestas nacionales de salud de 2000, 2006 y 2012, estimando para los tres momentos la brecha absoluta y relativa entre quintiles, en indicadores de diabetes e hipertensión, así como el índice de desigualdad de la pendiente. Resultados. En México, entre 2000 y 2012 se ha reducido la brecha en la prevalencia de diabetes e hipertensión por diagnóstico previo. Asimismo, se han reducido de forma importante las brechas relacionadas con la atención de diabetes e hipertensión, persistiendo diferencias por gradiente de desigualdad, en particular en lo que se refiere a la presencia de complicaciones de diabetes. Conclusión. Los resultados identifican avances importantes en la disminución de la desigualdad para la atención adecuada de diabetes e hipertensión, si bien persisten diferencias de consideración. Si se toma en cuenta la relevancia de estas condiciones de salud en México es necesario fortalecer la calidad de la atención en los servicios públicos para avanzar hacia el acceso efectivo.

Mexico's system is dominated by corporatist, social insurance organizations governed by employer and employee trade unions in close relationship to the federal government, supplemented with government services for the uninsured, and a thriving private sector. Social insurance covers about half the population, although coverage for most is sporadic. Furthermore, these organizations have divergent service, financing, and governance structures, posing inequities and barriers in responding to beneficiary needs. Profiting from a growing capacity gap, the private sector now provides almost half of total outpatient consultations. Major public health challenges include obesity and diabetes, and social and health inequalities. Fiscal policy and improved preventive programs across institutions have had some effect on reducing health risks. Health policy has aimed towards universal coverage through coordinating government providers and strengthened public health programs. Since 2004 Seguro Popular had made progress toward universal health coverage, protecting about 85% of the population, reducing catastrophic expenses, and increasing coverage of high-cost interventions. However, to address health care package limits, attain universal financial protection and respond to corruption, President Lopez Obrador's administration canceled Seguro Popular from 2020 and established the National Health Institute for Wellbeing (INSABI). INSABI aims to equalize benefits across the insured and uninsured and re-centralize health authority by establishing the federal government as sole funder and provider of coverage for the uninsured. The separation of funding and provision, a hallmark of Seguro Popular, was replaced with supply-side funding, following the social insurance model. While these policies have challenges, they could facilitate integrating social insurance and tax funding into a single-payer capable of increasing efficiency and continuity of care as well as achieving greater equity.

The health reform in 2003, aiming to increase health insurance, resulted in the virtual elimination of socioeconomic inequality in financial protection, but there is still inequality in access to healthcare. Actions to eliminate access barriers related to quality of health services are urgent to promote effective access to healthcare.