- Overall Context
- Leading Health Challenges
- Health Situation and Trends
- Full Article
The Argentine Republic covers an area of 3,761,274 km2 and consists of 23 provinces located in five geographic regions: Noroeste, Noreste, Cuyo, Centro or Pampeana, and Patagonia. The form of government is representative, republican, and federal.
Nearly 65% of the population is concentrated in the Centro region, particularly in the province of Buenos Aires, where 38.9% of the country’s population lives, and, more specifically, in the Autonomous City of Buenos Aires (Ciudad Autónoma de Buenos Aires, or CABA) and its surrounding area. In 2010, the country’s population was 40,117,096, of which 91% lived in urban areas, with a male-to-female ratio of 0.95:1. The population estimate for 2014 was 42,669,000.
As of 2010, the composition of the population by broad age groups varied significantly between provinces. The lowest percentage of children and young people was in CABA (16.3%), and the highest, in the province of Misiones (32.5%). CABA also had the highest proportion of adults aged 65 years and older (16.4%), while the province that includes Tierra del Fuego, Antarctica, and the South Atlantic Islands had the lowest (3.8%).
Figure 1. Population structure, by age and sex, Argentina, 1990 and 2015
Between 1990 and 2015, the country’s population increased by 32.7%. In 1990, the population pyramid was expansive in the over-15 age groups, with a trend toward stationary in the younger age groups. In 2015, this latter trend expanded to include the under-40 age groups, reflecting lower fertility and mortality rates and increasing life expectancy at birth over the last four decades.
Source: Pan American Health Organization, based on data from the United Nations Department of Economic and Social Affairs. Population Division. 2015 Revision.
According to the 2010 census, migrants accounted for 24.3% of the population, a figure comparable to that seen in the previous three censuses. Immigrants from bordering countries and from Peru accounted for 3.5% of migrants, with immigrants from elsewhere representing 0.9%.
The indigenous population is 955,032, or 2.38% of the total population; they belong to 31 groups who live in different parts of the country. Patagonian is the region with the highest proportion of persons who identify as indigenous (6.9% of that region’s population), while the highest absolute number of indigenous people (248,516) reside in the metropolitan region that includes CABA and the 24 administrative divisions (partidos) of greater Buenos Aires. Approximately 149,493 people identify as being of African descent ().
The main threats to public health in Argentina are volcanic eruptions, floods, earthquakes, landslides, and mudslides after major snowfalls, tornados and storms, heat waves, wildfires, toxic materials in facilities or in transit, disease outbreaks, epidemics, and pandemics.
The Health System
Argentina’s health system is one of the most fragmented and segmented in the Region of the Americas. It includes the public and private sectors and the social security sector. Such fragmentation is largely determined by the country’s federal structure, in that each of the 23 provinces functions independently and has constitutional responsibility for the leadership, financing, and delivery of health services. Historically, the social security system, which also has developed in a fragmented fashion, includes about a 100 different agencies.
The public sector comprises the national and provincial health ministries, plus a network of hospitals and public health centers that provide free care to anyone who needs it, particularly those in the lower income quintiles who lack social security coverage or who cannot pay for services (36% of the population) ().
The compulsory social security sector is organized around national and provincial obras sociales. There are more than 200 of such entities at the national level, accounting for expenditures of 1.59% of the gross domestic product (GDP); expenditures of the 23 provincial obras sociales, which cover civil servants in their own jurisdictions, represent 0.74% of GDP. National-level obras sociales are regulated by the Superintendency of Health Services (SSS, for its Spanish acronym), which is charged with ensuring that health services offered to its beneficiaries adhere to current policies and regulations.
The private sector consists of health professionals and facilities that offer services to private clients and to beneficiaries of the obras sociales and private insurers. This sector also includes more than 100 voluntary insurance entities known as medical prepayment companies; they are financed through premiums paid by families or companies and by funds from contracts with obras sociales. Private insurance entities serve 8% of the population.
The health system’s fragmentation falls into three broad areas: i) coverage, since not all the population has access to the same health benefits and services; ii) regulatory functions, since leadership and regulatory authority are spread throughout 24 jurisdictions and various subsectors; and iii) geographic disparities, given the extreme economic-development differences from region to region. The national health authority—given the resources it administers and the country’s federal structure—is limited in how effectively it can require provincial governments to adhere to new national legislation that involves structural change. The only way to effect such changes is through broad consensus, something that has been attempted through federal health plans and by strengthening the role of the Federal Health Council (COFESA). The 12 objectives of the national health sector include universal health coverage, development of an agency to evaluate health technology, and creation of a quality accreditation system.
Leading Health Challenges
Critical Health Problems
As of this writing, dengue, chikungunya, and Zika viruses are in circulation in Argentina (). Dengue transmission is characterized by sporadic major outbreaks, such as those in 2009 and 2013, interspersed with periods of low transmission. In 2016, the first autochthonous cases of chikungunya virus infection were reported; they occurred only in the provinces of Salta and Jujuy. Vector-borne autochthonous transmission of Zika in the province of Tucumán was also reported, with sexual transmission reported in the province of Córdoba.
Because large portions of the population have no immunity to these arboviruses, which are associated with the presence of the Aedes mosquito in extensive areas, there is a good likelihood that future outbreaks will occur, with potentially serious consequences for the country.
Given the absence of autochthonous cases of malaria since 2010, transmission of this disease may be considered interrupted, although post-elimination surveillance is a significant challenge, especially in the border areas, where new cases must be detected in a timely manner to prevent reestablishment of the disease.
Neglected Diseases and Other Infections Related to Poverty
Addressing Chagas disease is considered to be a high priority for Argentina. In 2014, infection by Trypanosoma cruzi affected 2.5% of pregnant women and 5.7% of children through congenital transmission (). Action needs to be expanded to combat the vector and control congenital transmission, which is estimated to infect 0.21 infants per 100 live births (). The interruption of vector-borne transmission has already been achieved in 8 of the 19 endemic provinces¾Entre Ríos, Jujuy, La Pampa, Misiones, Neuquén, Río Negro, San Luis, and Santa Fe.
Visceral leishmaniasis is a new phenomenon in the Noreste region. Although there are few reported cases—an average of 11 per year over the past five years—the disease is a matter of concern, given the difficulties involved in controlling it.
In 2015, the maternal mortality rate for the country as a whole was 3.9 deaths per 10,000 live births, ranging from a high of 8.1 in Salta to a low of 1.9 in CABA, Santa Fe, and La Pampa; this disparity highlights the extreme inequalities that persist from province to province, even though the causes of death themselves remain the same (). Direct obstetric causes were responsible for over 50% of maternal deaths in 2010-2014 (Table 1). The high numbers recorded in 2015 in the provinces of Formosa (7.5 per 10,000), Chaco (7.3 per 10,000), Misiones (5.9 per 10,000), and San Juan (5.9 per 10,000) reflect these provinces’ precarious socioeconomic conditions, low levels of education, and access to basic information, and difficulties in accessing quality health services. Despite the existence of national and/or provincial plans designed to reduce the maternal mortality ratio, there is a need to implement comprehensive and sustained actions that reach all of society.
According to the 2009 and 2013 national risk factor surveys, the prevalence of overweight in the population older than 18 years rose from 35.4% in 2009 to 37.1% in 2013, while obesity rose from 18.0% to 20.8% in the same period. This calls for the development and implementation of public policies that deal with the regulation of food advertising directed at children, the taxation of sugar-sweetened beverages, and the prominent placing of package label warnings.
A 31.6% reduction in the consumption of salt between 2009 and 2013 attests to a cultural change that represents a victory for the Ministry of Health’s campaigns to change the use of saltshakers at table, such as the “Menos Sal, Más Vida” (“less salt, more life”) initiative. In addition to the decline in the amount of salt that consumers add to their food, the salt content of various processed foods has been reduced by between 5% and 18% through voluntary agreements with the relevant industries.
As part of the “Argentina 2014 Free of Trans Fats” campaign, the Ministry of Health; the Ministry of Agriculture, Livestock, and Fishing; representatives of provincial food protection agencies; and industry worked together to modify the Argentine Dietary Code (Código Alimentario Argentino). The new standards mandated that trans-fatty acids in industrially produced foods should not exceed 2% of total fats in vegetable oils and margarines intended for direct consumption, and not exceed 5% of total fats in other foods ().
There are 3.6 physicians and 3.2 hospital beds per 1,000 inhabitants in the country overall, with significant differences between jurisdictions. The Autonomous City of Buenos Aires, for example, has 10.2 physicians and 7.3 beds per 1,000 inhabitants, compared with 1.2 physicians and 1.1 beds in the province of Misiones ().
Health Knowledge, Technology, and Information
Argentina has a long tradition of human resource education and the development of basic research in the biomedical sciences. In recent years, private financing for scientific activity has steadily increased, though the public sector remains the most important source of funding; the National Scientific and Technical Research Council (CONICET) awards most of the country’s fellowships for basic and applied research. Currently, 30.3% of that institution’s researchers are working in the biomedical sciences, with their numbers having increased by more than 200% in the last 12 years.
Argentina ranks second among Latin American countries in terms of the number of national medical journals indexed by the Thomson Institute for Scientific Information (ISI), with six such publications. The National Health Sciences Information Network (Red Nacional de Información en Ciencias de la Salud, or RENICS), which is coordinated by the Library of the National Academy of Medicine of Buenos Aires, brings together 87 different documentation centers. The Virtual Health Library (VHL) is used to provide input for the database of the National Health Sciences Bibliography (Bibliografía Nacional en Ciencias de la Salud, or BINACIS) ().
The Scientific Electronic Library Online (SciELO) has a total of 128 journals that can be consulted through its website, of which 15 are in the health sciences ().
The Electronic Library of Science and Technology makes it possible for the country’s researchers to access the full text of books, scientific and technical journals, and reference databases through the Internet ().
The National Statistical System, which is coordinated by the National Institute of Statistics and Census, gathers all entities that produce statistics. Information relevant to health is coordinated at the national level by the Ministry of Health’s Directorate of Health Statistics and Information (Dirección de Estadísticas e Información de Salud, or DEIS), which is responsible for producing vital statistics, statistics on the population’s living conditions and health problems, and information on the availability and use of resources. DEIS is responsible for coordinating and regulating the collection of specific statistical data on health programs; since 1996 it has participated in the Pan American Health Organization (PAHO)/World Health Organization (WHO) initiative on basic health indicators, including Argentina in a common database for the Region of the Americas ().
The Ministry of Health has worked to strengthen health surveillance by implementing the National Health Surveillance System. The system, which operates through an online platform, integrates clinical and laboratory surveillance strategies and strategies involving sentinel units and specific programs, as a way to make information available online to various decision-making entities ().
The Environment and Human Security
Argentina’s geographic location and production profile makes the country particularly at risk for the effects of global warming. In the last 50 years, average temperatures rose an average of half a degree, and in the case of Patagonia, by one degree. If the current trend continues, forecasts for the 2080 decade call for possible increases of up to 4°C in the north and 2°C in the south, bringing higher levels of hydric stress and increased drought, and desertification. The incidence of waterborne diseases and the distribution of food and vectors could be affected by this change (). In recent decades, the spread of the Aedes aegypti vector in the country and the historical dengue outbreak in 2016 are examples of such changes ().
Of the nearly 43 million inhabitants, 84.4% have access to water provided by a public network; 58.4% have access to sanitation services. In the last decade, the increase in sanitation coverage (6%) exceeded the expansion of water coverage (4%), reducing the gap. For urban areas, the objectives for 2019, established in the National Water Plan launched in 2016, call for 100% coverage of drinking water and 75% sanitation coverage ().
With regard to solid waste, approximately four million people in Argentina have no regular collection, and over 20 million lack waste disposal service. Per capita generation of solid waste is 0.85 kg per day, which amounts to some 37,631 tons per day and 13,735,337 tons per year ().
Only 6.6% of the country’s land and marine areas are protected. Furthermore, between 2010 and 2015, Argentina ranked ninth worldwide in annual net loss (1.1%) of forested land. In 2010 alone, 301,000 hectares of forest were lost, all due to human activity. This phenomenon is caused by various factors, including intensification of productive systems, expansion of the agricultural area, mining of metals, and urbanization of forested areas ().
Over the last two decades, most of the spread of agricultural and livestock activity has occurred in the country’s Noroeste and Noreste regions, where land was cleared for productive activities, specifically for agriculture, particularly for growing soy (). These areas continue to bear the brunt of land clearing.
The country has a growing carbon footprint, associated with a pattern of rapid growth in sectors such as agriculture and transportation, as well as inefficient energy use. An increase of 149% is projected between 1990 and 2030, principally due to CO2 emissions in the energy sector from the burning of fuels and from automobile emissions (). In urban areas, air pollution is a significant challenge. In Buenos Aires, average particle pollution (PM2.5, particulate matter with a diameter < 2.5 µm) is almost six times higher than the limit of 10 µg/m3 recommended by WHO (); in Córdoba it is three times higher and in Mendoza twice as high. The estimated cost of the societal impact of air pollution is 1.8% of GDP ().
Monitoring the Health System’s Organization, Provision of Care, and Performance
Financing of public-sector health care (national and provincial ministries) accounts for 2.2% of GDP, with funds primarily derived from provincial taxation, with the social security system contributing when providing care to those enrolled in its system. Some of the public sector’s many programs are financed with international credits such as the SUMAR plan, the World Bank’s support for Essential Public Health Functions, and the Inter-American Development Bank’s REDES program, all of which aim to ensure coverage for the most vulnerable populations.
Most of the obras sociales operate through contracts with private providers and are financed with contributions from workers and employers. Together they insure and provide services to 42% of the population (workers and their families).
In addition, through the Comprehensive Medical Care Program, the National Institute of Social Services for Retirees and Pensioners provides coverage for retirees in the national pension system and their families; this covers 20% of the population and represents expenditures equivalent to 0.75% of GDP.
Total private health care expenditures represent close to 3% of GDP, of which approximately two-thirds is in the form of direct payments (particularly for the purchase of medications) by people at the time services are provided ().
The national obras sociales and the medical prepayment companies, under the supervision of the SSS, must meet the requirements of the Compulsory Medical Program (Programa Médico Obligatorio, or PMO), which include providing a broad package of services and associated drugs. The program covers 95% of outpatient, surgical, hospital, and dental services, as well as mental health, rehabilitation, and palliative care services (). It does not apply to the private sector, however, which lies outside the medical prepayment system and the public sector; the private sector is regulated at the provincial and municipal levels, and provides services that are set by the various provincial ministries of health. The National Drug, Food, and Medical Technology Administration plays a leading regulatory role, acting as the national authority charged with ensuring the efficacy and safety of drugs, food, and medical devices available to citizens.
Total health care spending constitutes over 8.5% of GDP, one of the highest in Latin America. And, although the entire population has access to the services provided by the public sector, there are significant gaps and problems in the health system, particularly with regard to access (). Further, deep inequities persist between various territories and population groups in terms of the level of expenditure and the human and material conditions for effective access to services ().
Health Situation and Trends
Health of Population Groups
Maternal and Reproductive Health
Between 2010 and 2015, maternal mortality declined from an annual total of 331 deaths to 298, for a decline from 4.4 to 3.9 maternal deaths per 10,000 live births. The leading causes of maternal death were direct obstetric causes (54%), indirect obstetric causes (27%), and miscarriage (19%). Most maternal deaths were due to hypertensive disorders (15.4%), followed by complications during the puerperium, including puerperal sepsis (12.2%) and hemorrhage (11.0%) (Table 1).
Table 1. Changes in maternal mortality by cause, Argentina, 2010-2014
|Cause||2010||2011||2012||2013||2014||Total||%||Difference 2010-2014 (%)|
Source: National Directorate of Maternity and Infancy, Ministry of Health. Maternal and child health: Situation assessment, 2005-2014. Buenos Aires: Ministry of health; 2016.
The maternal mortality ratio has not decreased equally in all provinces, however. A comparative analysis of the 2010-2014 period shows reductions in the maternal mortality ratio to levels below the national average in CABA, Córdoba, La Pampa, La Rioja, Mendoza, Neuquén, Santa Cruz, Santa Fe, and Santiago del Estero. Other areas (such as Corrientes, Chaco, Chubut, Entre Ríos, Formosa, Jujuy, Misiones, and Salta) saw their maternal mortality ratio increase to values above the national average (Table 2).
Table 2. Child, neonatal, and postneonatal mortality, by region, Argentina, 2014
|Mortality (per 1,000 live births)|
Source: Directorate of Health Statistics and Information, Ministry of Health. Vital statistics. Basic information, 2014. Buenos Aires: Ministry of Health; 2015.
The adolescent pregnancy rate remains high and has remained unchanged over the last decade, with an adolescent fertility rate of 68.1 ().
The country’s infant mortality rate in 2010-2014 declined by an average of 11%, from 12 per 1,000 live births in 2010 to 10.6 per 1,000 live births in 2014. This reduction occurred throughout the country, but was greatest in the Centro and Noreste regions.
The leading cause of infant mortality was disorders originating in the perinatal period (nearly 50% of total deaths), which, together with congenital malformations (28%), accounted for more than 70% of infant deaths in 2014. Other causes of infant deaths were respiratory infections (slightly more than 6% of deaths), infectious diseases (3%), and external causes (almost 3%) ().
In 2014, 325,539 deaths were recorded, for a total death rate of 7.6 deaths per 1,000 population; 52% of these were men. There were practically no changes in mortality from the 2010 rate (7.8 deaths per 1,000), but both years show major variations between provinces. CABA had the highest mortality rate, with an average of 10.7 deaths per 1,000 population, and Tierra del Fuego, the lowest, with 3.7 deaths per 1,000 population.
The age-standardized death rates for 2010 and 2014 were 6.9 and 6.5 per 1,000 population, respectively. The greatest reductions in mortality over this period were in the provinces of Chubut (a drop of 16% to 6.1 per 1,000 population) and Formosa (a drop of 13.7% to 7.1 per 1,000 population).
In 2014, nearly 40% of deaths were due to two groups of causes: cardiovascular disease and malignant neoplasms. The age-standardized death rates for cardiovascular causes and malignant neoplasms were almost four times greater than those for infectious causes, and six times greater than those for external causes. Compared with 2010, the steepest decline in the cause of mortality was for cardiovascular disease, which fell by 13%, followed by tumors, which declined by 2.5%. On the other hand, mortality rates from infectious diseases and external causes rose by 5.5% and 3.4%, respectively (Table 3).
Table 3. Mortality by region, province, and type of cause, Argentina, 2010 and 2014
|Sgo. del Estero||7.2||6.5||154.71||139.55||106.39||100.26||103.14||77.49||49.96||51.41|
|Tierra del Fuego||6.0||5.7||176.48||130.65||155.48||146.91||40.62||65.58||64.85||36.07||Total||6.9||6.5||204.00||177.42||136.14||132.72||73.80||77.88||44.82||46.37|
Note: Codes according to the International Classification of Diseases, tenth revision (ICD-10). Cardiovascular diseases: I00-I99, except for I46. Neoplasms: C00-D48. Infections: A00-B99; J00-J22; G00-G03. External Causes: V01-V99; W00-Y98 (includes accidents, suicides, and homicides).
a Age-adjusted rate.
Sourcee: Authors, based on data from the Ministry of Health and the National Institute of Statistics and Census.
Regional inequalities account for differences in the leading causes of death at the provincial level. In areas with greater poverty, mortality from infectious causes represents a major burden, in contrast to wealthier areas, where noninfectious causes predominate. In 2014, for example, mortality from infectious diseases in the province of Chaco (63.2 per 1,000 population) was twice the rate in CABA (28.1 per 1,000 population). Similarly, mortality from cardiovascular disease in Córdoba (221 per 1,000 population) is much higher than in Jujuy (90.8 per 1,000 population).
In 2014, the incidence of HIV was 13.5 per 100,000 population. In the provinces, values ranged between 4 per 100,000 population in Santiago del Estero to 25.5 per 100,000 population in Tierra del Fuego. The HIV epidemic in Argentina is concentrated among certain groups, including men who have sex with men, female sex workers, and transgender individuals. A survey conducted in 2010 among adolescents 14 and 15 years old indicated that 89% of that population had used condoms in their last sexual encounter with a casual partner. Between 2010 and 2014, mortality from HIV/AIDS rose from 3.2 deaths per 100,000 population to 3.4 deaths per 100,000 population ().
There were no major changes in mortality from tuberculosis (TB) in 2010-2014, with the gross death rate from the disease at 1.5 per 100,000 population (640 deaths) in 2010 and 1.6 per 100,000 (702 deaths) in 2014. The differences from province to province are huge, however: Jujuy has a rate of 6.8 per 100,000 population, while the rate in La Pampa is 0.15 per 100,000 (). Mortality was greater in men than in women, and higher in the older age brackets. Between the ages of 35 and 44, over a third of deaths from tuberculosis (39.4%) were associated with HIV infection. The unequal distribution of mortality is reflected in a Gini coefficient of 0.48 for the 2010–2014 biennium, 14.2 times higher than the Gini for overall mortality (0.034). The trend differed between age groups, with a reduction of over 50% in children under 10 years old and in the 25-34 year olds, but an increase of 32.1% during the past decade among 15-19-year-olds. In 2013, the proportion of cases of tuberculosis detected and cured with Directly Observed Treatment, Short-Course (DOTS) was 77.9%, below the MDG target for 2015, which is 90%. In 2015, the estimated rate of TB infection was 22.6 cases per 100,000 population ().
In regards to vaccine-preventable diseases, poliomyelitis, measles, rubella, and congenital rubella syndrome have been eliminated in Argentina. Because clinical manifestations of measles and rubella are similar, surveillance for these two diseases is conducted in an integrated manner, as part of the program for surveillance of exanthematous febrile diseases. The expected rate of one suspected case per 10,000 unvaccinated individuals has held steady since 2012.
In 1997, Argentina included the quadrivalent vaccine (diphtheria, whooping cough, tetanus, and Haemophilus influenzae type b) in the national vaccination schedule, reducing the incidence of Haemophilus influenzae type b, which remains at a national rate of less than 0.1 case per 100,000 population.
Pertussis, or whooping cough, remains a public health problem, despite Argentina’s high vaccination coverage. During 2015, the reported rate was 2.2/100,000; 975 confirmed cases were recorded, 77.7% of which were in children under 1 year old, with 10 deaths in this age group. In light of this epidemiological situation, the DTaP vaccine was incorporated in the vaccination schedule for pregnant women starting in the 20th week of gestation.
After the introduction of the hepatitis A vaccine there was an abrupt decline in the rate at which this disease was reported. Since 2007, no cases of pediatric fulminant hepatitis or liver transplant due to hepatitis have been reported. Since 2012, the incidence of hepatitis A has remained stable at better-than-expected levels.
Universal vaccination against hepatitis B is recommended and is on the schedule for the entire unvaccinated population. Hepatitis B reporting rates remained stable (1.23 per 100,000) during 2011-2015.
In Argentina, between 150,000 and 180,000 annual cases of chickenpox are reported, but due to high rates of underreporting, it is estimated that the actual figure is on the order of 350,000 to 400,000 cases. In 2015, a single-dose vaccination for chickenpox was made mandatory for all 15-month-olds.
Also in 2015, the rotavirus vaccine was incorporated in the schedule for all 2-month-olds, with a series of two doses, in order to reduce hospitalizations and the most serious forms of the disease ().
Certain challenges are common to the surveillance of zoonoses in Argentina. Because of the country’s interdependence with animal health, it is essential that an agenda be designed in collaboration with the animal health sector. Factors such as decentralization of laboratory diagnosis, organization in monitoring different animal hosts or reservoirs, and monitoring of provincial programs are key for the country.
The last case of human rabies was recorded in 2008. Since then there have been sporadic reports of canine rabies, with three cases in 2015 in the provinces of Jujuy and Salta.
The principal risk factor for leptospirosis transmission consists of exposure during floods (). The provinces that have reported the highest number of cases are Entre Ríos, Santa Fe, and Buenos Aires.
In 2010-2014, the annual incidence of echinococcosis averaged 1.5 cases per 100,000 population, with the highest incidence in 2014, at 1.94 per 100,000 population. The average for children under 15 affected annually was 16%. The case-fatality rate declined by 30% during the period, with a total of 74 deaths from the disease.
In comparison with other countries, Argentina has one of the highest rates of incidence of hemolytic uremic syndrome in children under the age of 5. As the leading pediatric cause of acute renal failure, it is responsible for approximately 20% of kidney transplants in children and adolescents ().
Chronic, Noncommunicable Diseases
In 2012, there was a moderate to high incidence of cancer (from 172.3 to 242.9 per 100,000 population) according to estimates by the International Agency for Research on Cancer. This estimate is based on more than 100,000 new cancer cases annually, with similar percentages in both sexes.
According to the 2013 National Survey of Risk Factors, the prevalence of diabetes and/or self-reported high blood glucose in the population over the age of 18 was 9.8%, not significantly different from that in the 2009 survey. The prevalence of diabetes increases in older age groups, from 2.9% among 18-24 year olds to 20.3% among those 65 and over.
Accidents and Violence
With regard to road safety and its implications for the population’s health, there were 4,135 traffic accident fatalities per year, on average, in 2010-2014, with a rate of 9.9 deaths per 100,000 population and 2.1 deaths per 10,000 registered automobiles ().
Risk and Protective Factors
At the national level, the rate of regular alcohol consumption in the population for the quinquennium was 7.8%, similar to the level found in the preceding periods (2005 and 2009). The rate of regular consumption posing risk was higher in men than in women (11.7% versus 4.4%), and higher overall in the 18-24-year age group (10.7%) and the 25-34-year age group (9.6%). According to the 2011 National Survey on Prevalence of Psychoactive Substance Use conducted by the Ministry of Health and the National Institute of Statistics and Censuses, half the population between the ages of 16 and 65 reported having consumed alcohol at least once in the 30 days prior to the survey, and 26.4% reported episodic excessive alcohol use. Among 12-65-year-olds, the most commonly used substances were alcohol (70%) and tobacco (47.3%), which are legal, followed by marijuana (8.1%), tranquilizers without medical prescription (3.1%), and cocaine (2.6%). Among 12-65-year-olds, 3.6% reported having used at least one illicit drug during the last year ().
In light of the new challenges brought about by demographic and epidemiological changes, Argentina, as do other middle-income countries in the Region, faces health challenges related to the implementation of sustainable, effective strategies to combat poverty-related problems. Improvements in living conditions, along with developments in vaccines and antibiotics and implementation of control programs, will help reduce indicators of morbidity and mortality from various communicable diseases.
Certain diseases remain challenging, such as AIDS and tuberculosis, whose interaction poses an obstacle to control. The risk of outbreaks of certain known viral diseases, such as influenza, dengue, Zika, and chikungunya, along with potential risks from new pathogens and zoonotic diseases, call attention to the need to adapt and strengthen the surveillance system at all levels. Strengthening the nation’s basic capabilities within the framework of the International Health Regulations (IHR) is of key importance.
Diseases that subsist in pockets of poverty and among marginal populations also remain on the health agenda. In order to deal with those diseases and achieve better results from the implementation of public health programs, efforts must be made to establish human development projects to address poverty-related factors. “Toward Universal Health in the South American Chaco Population 2016–2019,” a joint project developed by Argentina, Bolivia, Brazil, and Paraguay, is an example of such an initiative, and an effort that has useful lessons for its subsequent application in other areas of the country where social and environmental factors affect public health. This is relevant primarily among indigenous, native, rural, and mestizo populations, where there is growing demand for participation in strategic decision-making.
Along with the incomplete agenda for addressing communicable diseases, and the fact that the MDG maternal and child health indicators have not yet been achieved, the problems associated with chronic, noncommunicable diseases (NCDs) pose the greatest burden for the Argentine health system. The real possibility of preventing NCDs makes it essential to strengthen existing preventive programs targeting them in Argentina, as well as programs that target their risk factors, such as measures to control tobacco use and to promote healthy eating and an active lifestyle.
In contrast to the challenges Argentina faces, both old and new, the country has the advantage of a rich history of social policy, great human capacities and talent, solid institutions, and a level of health spending higher than the regional average. Despite these considerable strengths, however, Argentina must overcome remaining obstacles. The country has the most segmented and fragmented health system in the Americas, a problem whose solution calls for enormous governance efforts in the sector and strong leadership in order to bring together a wide range of stakeholders in pursuit of shared health objectives. These objectives currently focus on achieving universal coverage and providing effective, nondiscriminatory access to quality services for the entire population.
A central component of this challenge is updating the benefits package in the Compulsory Medical Program, given the evidence of its impact and effectiveness, while working to make the program universal, thus strengthening the primary health care strategy and the integrated services networks. This effort will require reaching agreements and consensus on such important issues as the distribution and competencies of human resources, problem-solving capacity at the primary care level, and access to health technologies and cost-effective drugs.
With its rich history, Argentina is well aware of the goals it must meet in order to address the needs of its people and communities. As a nation with vast natural resources and exceptional human capital, it shares with other countries in the Region the challenge of solving the health problems caused by socioeconomic inequities and social exclusion. Given the sharp contrasts within the health system itself, major efforts will have to be made to more efficiently and effectively foster cooperation among different sectors, making the right to health a reality for all, without discrimination.
1. National Institute of Statistics and Censuses (Argentina). Censo 2010. Buenos Aires: INDEC; 2015. Available from: http://www.indec.gob.ar/nivel4_default.asp?id_tema_1=2&id_tema_2=41&id_tema_3=135 Accessed on 21 October 2016.
2. Arce HE. Organización y financiamiento del sistema de salud en la Argentina. Medicina, Buenos Aires 2012;72(5):414–418. Available from: http://www.scielo.org.ar/pdf/medba/v72n5/v72n5a11.pdf.
3. Ministerio de Salud (Argentina). Boletín integrado de vigilancia. No. 331–SE 41, Oct 2016. Buenos Aires: MSAL; 2016. Available from: http://www.msal.gob.ar/images/stories/boletines/boletin_integrado_vigilancia_N331-SE41.pdf Accessed on 21 October 2016.
4. Ministerio de Salud (Argentina). Programa nacional de Chagas: diagnóstico de situación [Internet]. Buenos Aires: MSAL; 2016. Available from: http://www.msal.gob.ar/chagas/index.php/institucional/diagnostico Accessed on 21 October 2016.
5. National Council for the Coordination of Social Policies (Argentina). Objetivos de desarrollos sostenible. Buenos Aires: CNCPS; 2016. Available from: http://www.odsargentina.gob.ar Accessed on 21 October 2016.
6. Ministerio de Salud, Dirección de Estadísticas e Información de Salud (Argentina). Indicadores básicos. Buenos Aires: DEIS; 2017. Available from: http://deis.msal.gov.ar/index.php/indicadores-basicos Accessed on 4 February 2017.
7. Pan American Health Organization. Grupo de Trabajo de la OPS/OMS “Las Américas libres de grasas trans”: conclusiones y recomendaciones, 26 y 27 de abril de 2007, Washington, D.C. Buenos Aires: PAHO; 2007. Available from: http://www.msal.gob.ar/ent/images/stories/ciudadanos/pdf/Grasas_trans_Conclusiones_Task_Force.pdf Accessed on 21 October 2016.
8. Pan American Health Organization. Transformando los servicios de salud hacia redes integradas: elementos esenciales para fortalecer un modelo de atención hacia el acceso universal a servicios de calidad en la Argentina. Buenos Aires: PAHO; 2017. Available from: http://iris.paho.org/xmlui/bitstream/handle/123456789/34027/9789507101281_spa.pdf Accessed on 20 May 2017.
9. Pan American Health Organization. Biblioteca Virtual en Salud de Argentina [Internet]. Buenos Aires: PAHO; 2016. Available from: http://www.bvs.org.ar Accessed on 21 August 2016.
10. SciELO Argentina. Colección de la biblioteca [Internet]. Buenos Aires: SciELO; 2016. Available from: http://www.scielo.org.ar/scielo.php?script=sci_subject&lng=es&nrm=iso Accessed on 21 August 2016.
11. Ministerio de Ciencia, Tecnología e Innovación Productiva (Argentina). Biblioteca Electrónica de Ciencia y Tecnología. Características de la colección de la Biblioteca Electrónica de Ciencia y Tecnología. Buenos Aires: MINCYT; 2016. Available from: http://www.biblioteca.mincyt.gob.ar/estadisticas/coleccion Accessed on 21 August 2016.
12. Pan American Health Organization; Ministerio de Salud (Argentina). Vigilancia epidemiológica en Argentina: tutoriales para la notificación en el Sistema Nacional de Vigilancia de la Salud (SNVS) y otros documentos de interés. Buenos Aires: PAHO/MSAL; 2016. Available from: http://publicaciones.ops.org.ar/publicaciones/publicaciones%20virtuales/SNVS/C2/evaluacionLocal1.html Accessed on 21 August 2016.
13. Berberian G, Rosanova MT. Impacto del cambio climático en las enfermedades infecciosas. Archivos Argentinos de Pediatría 2012;110(1):39–45. Available from: http://dx.doi.org/10.5546/aap.2012.39.
14. Ministerio de Salud (Argentina). Boletín integrado de vigilancia. No. 316–SE 26, July 2016. Buenos Aires: MSAL; 2016. Available from: http://www.msal.gob.ar/images/stories/boletines/Boletin-Integrado-De-Vigilancia-N316-SE26.pdf Accessed on 21 August 2016.
15. Ministerio del Interior, Obras Públicas y Vivienda, Unidad de Agua Potable y Saneamiento (Argentina). Plan nacional de agua potable y saneamiento: lineamientos y principales acciones. Buenos Aires: MIOPV; 2016. Available from: http://www.mininterior.gov.ar/plan/docs/PNSAPyS-2016-03-16.pdf Accessed on 21 August 2016.
16. González GL. Residuos sólidos urbanos en Argentina: tratamiento y disposición final, situación actual y alternativas futuras. Buenos Aires: Cámara Argentina de la Construcción; 2010. Available from: http://www.igc.org.ar/megaciudad/N3/Residuos%20Solidos%20Urbanos%20CAMARCO.pdf Accessed on 21 August 2016.
17. Economic Commission for Latin America and the Caribbean. CEPALSTAT: Argentina—national environmental profile [Internet]. Santiago: ECLAC; 2016. Available from: http://interwp.cepal.org/cepalstat/Perfil_Nacional_Ambiental.html?pais=ARG&idioma=english.
18. Observatorio Nacional de Degradación de Tierras y Desertificación (Argentina). Gacetilla ONDTyD: October 2014. Mendoza: ONDTyD; 2014. Available from: http://www.desertificacion.gob.ar/wp-content/uploads/2014/10/Gacetilla_ONDTyD_oct14.pdf Accessed on 21 August 2016.
19. Ludeña C, Wilk D, Quiroga R. Argentina: gestión del riesgo de desastres y adaptación al cambio climático. Technical note 621. Washington, D.C.: Inter-American Development Bank; 2012. Available from: https://publications.iadb.org/bitstream/handle/11319/6030/Argentina%20-%20IDB-TN-%20621%20Agosto%2031.pdf Accessed on 21 August 2016.
20. World Health Organization. WHO Air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulfur dioxide: global update 2005—summary of risk assessment. Geneva: WHO; 2006. Available from: http://apps.who.int/iris/bitstream/10665/69477/1/WHO_SDE_PHE_OEH_06.02_eng.pdf Accessed on 21 August 2016.
21. World Bank. Argentina: análisis ambiental de país. Serie de informes te´cnicos del Banco Mundial en Argentina, Paraguay y Uruguay. No. 9, 2016. Washington, D.C.: International Bank for Reconstruction and Development/World Bank; 2016. Available from: http://documentos.bancomundial.org/curated/es/552861477562038992/pdf/109527-REVISED-PUBLIC-AR-CEA-An%C3%A1lisis-Ambiental-de-Pa%C3%ADs-Segunda-Edici%C3%B3n.pdf Accessed on 21 August 2016.
22. Ministerio de Salud (Argentina). El acceso a la salud en Argentina: III encuesta de utilización y gasto en servicios de salud, 2010. Buenos Aires: MSAL; 2010. Available from: http://www.msal.gob.ar/fesp/images/stories/recursos-de-comunicacion/publicaciones/estudio_carga_enfermedad.pdf Accessed on 21 August 2016.
23. Cetrángolo O, San Martín M, Goldschmit A, Quintana L, Aprile M. El sistema de salud argentino y su trayectoria de largo plazo: logros alcanzados y desafíos futuros. Buenos Aires: United Nations Development Programme; 2011. Available from: http://www.ar.undp.org/content/dam/argentina/Publications/Desarrollo%20Humano/El%20sistema%20de%20salud%20argentino%20-%20%20pnud%20ops%20cepal%20version%20final.pdf Accessed on 21 October 2016.
24. Cetrángolo O. Financiamiento fragmentado, cobertura desigual y falta de equidad en el sistema de salud argentino. Revista de Economía Política de Buenos Aires 2014;13:145–183. Available from: http://bibliotecadigital.econ.uba.ar/download/ecopoli/ecopoli_v8_n13_05.pdf.
25. World Health Organization.World health statistics 2017: monitoring health for the SDGs, sustainable development goals. Geneva: WHO; 2017. Available from: http://www.who.int/gho/publications/world_health_statistics/2017/en/# Accessed on 15 March 2017.
26. Ministerio de Salud, Dirección Nacional de Maternidad e Infancia (Argentina). Salud materno infantil: diagnóstico de situación, 2005–2014. Buenos Aires: MSAL; 2016. Available from: http://www.msal.gob.ar/images/stories/bes/graficos/0000000787cnt-lecturas-del-anuario-2014.pdf.
27. Ministerio de Salud (Argentina). Boletín sobre el VIH-sida e ITS en la Argentina. No. 32, December 2015. Buenos Aires: MSAL; 2015. Available from: http://www.msal.gob.ar/images/stories/bes/graficos/0000000852cnt-2015-11-18_boletin-vih-sida-2015.pdf Accessed on 21 October 2016.
28. Instituto Nacional de Enfermedades Respiratorias “Dr. Emilio Coni” (Argentina). Mortalidad por tuberculosis en la República Argentina: periodo 1980–2014. Santa Fe: INER; 2016. Available from: http://www.anlis.gov.ar/iner/wp-content/uploads/2016/04/Mortalidad-TB-1980-2014-.pdf Accessed on 21 October 2016.
29. Instituto Nacional de Enfermedades Respiratorias “Dr. Emilio Coni” (Argentina). Notificación de casos de tuberculosis en la República Argentina: período 1980–2015. Santa Fe: INER; 2016. Available from: http://www.anlis.gov.ar/iner/wp-content/uploads/2016/11/Notificacion-de-casos-de-Tuberculosis-en-la-Republica-Argentina-Periodo-1980-2015.pdf Accessed on 21 February 2017.
30. Ministerio de Salud (Argentina). Enfermedades infecciosas: leptospirosis—gui´a para el equipo de salud no. 9. Buenos Aires: MSAL; 2014. Available from: http://www.msal.gob.ar/images/stories/bes/graficos/0000000489cnt-guia-medica-leptospirosis.pdf Accessed on 21 August 2016.
31. Ministerio de Salud (Argentina). Boletín integrado de vigilancia. No. 222–SE 30, July 2014. Buenos Aires: MSAL; 2014. Available from: http://www.msal.gob.ar/images/stories/boletines/Boletin%20Integrado%20De%20Vigilancia%20N222-SE30.pdf Accessed on 21 August 2016.
32. Ministerio de Transporte (Argentina). Seguridad automotriz [Internet]. Buenos Aires: MT; 2016. Available from: http://observatoriovial.seguridadvial.gov.ar/infraestructura-vial-automotor.php Accessed on 21 August 2016.
33. Ministerio de Salud (Argentina). Encuesta nacional sobre prevalencias de consumo de sustancias psicoactivas: ENPreCoSP año 2011. Buenos Aires: MSAL; 2015. Available from: http://www.msal.gob.ar/saludmental/images/stories/info-equipos/pdf/2015-01-05_encuesta-nacional-sobre-prevalencias1.pdf Accessed on 21 August 2016.
1. Obras sociales are entities charged with overseeing medical care for Argentine workers.
2. This acronym refers to the expansion of an earlier program, called “NACER,” that provides coverage for mothers and infants, children and adolescents between the ages of 6 and 19, and adults up to the age of 64.
3. The MDG target was 8.5 per 1,000 live births.