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Characterisation of a region in transition
South America (figure 1) integrates 14 countries, 10 of which belong to the Latin American region and will be part of this analysis. As it happens with the rest of the region, South America has significant social inequities that are expressed in its demographics, health and educational indicators. This region had a historic relevant role in the development health thinking and its social determinants, even before WHO Commission was established, and expressed through the Latin American movement of Social Medicine.1
Between 1990 and 2010, all the countries have reduced their infant mortality rate (IMR) and under 5 mortality rate (U5MR) (table 1). As long as the IMR and U5MR reduction improves, the rank of the main causes of death and disease changes. In those countries with high IMR, perinatal health problems are followed by acute respiratory infections and congenital malformations. In those countries with lower IMR rates, prematurity, congenital malformations and complications during early neonatal period become the main causes. Significant U5MR reductions were achieved by Peru and Brazil as a consequence of the utilisation of measures that impact in life conditions and integrated management of childhood illnesses. Average country reductions mask the existing inequity gaps within countries. For example, the IMR ratio between indigenous and non-indigenous populations ranges from 1.11 in Chile to 2.3 in Ecuador.
Table 2 shows those health problems related to communicable, maternal, neonatal, and nutritional disorders …