On March 11, 2020, the World Health Organization (WHO) Director-General, Dr. Tedros Adhanom Ghebreyesus, officially characterized the 2019 novel coronavirus disease (COVID-19) as a pandemic [1]. One year later, COVID-19 had been reported in 219 countries and territories, accounting for over 117.8 million cases and 2.6 million deaths, with both cases and deaths continuing to rise [2]. The burden of COVID-19 is acutely felt in Latin America with Brazil, Mexico, Colombia, and Argentina representing countries with some of the highest numbers of confirmed COVID-19 cases and related deaths [2].
The enormous impact of the COVID-19 pandemic has disrupted the day to day life of populations, economies, and health systems. Countries are faced with the challenge of balancing the priorities of infection prevention, control, and treatment, while also ensuring that essential public health services continue to be safe and accessible. In Latin America, where public health systems are often overburdened, fragmented, and unequal [3], the COVID-19 pandemic has highlighted the failures of underfunding and exacerbated racial, gender, economic, and health disparities [4, 5].
Social determinants of health directly relate to health inequalities [6]. Indigenous people (10%) and people of African descent (21%) represent nearly a third of the population in Latin America and are more likely to live in poorer socioeconomic conditions with limited or no access to healthcare [7], contributing to negative health outcomes, especially during the COVID-19 pandemic. Females account for the majority (72.8%) of workers in healthcare settings in Latin America and have also taken on greater responsibilities at home to care for children during school closures due to COVID-19 [7], which may increase the risk of disease spread in the home and community. Informal and low wage workers have also felt the brunt of countries’ lockdown measures that have negatively impacted economies; these workers often have limited savings and little to no access to government subsidies [7]. In Latin America, the unemployment rate is anticipated to increase from 8.1% in 2019 to 13.5% in 2020, with the poverty rate increasing to 37.2% and extreme poverty to 15.5% [7].
Contributing to these inequities and structural barriers is the risk of severe disease or death from COVID-19 due to underlying health conditions, including noncommunicable diseases (NCDs) like cancers, cardiovascular disease (CVD), and diabetes [8]. In the Americas, NCDs are the leading cause of death, representing 81%, or 5.8 million, deaths in the Region [9]. Traditionally, NCDs and their risk factors have been described as consequences of aging populations, increased wealth, and urbanization that can be prevented through behavior change; in reality, NCDs carry a higher burden of morbidity and mortality among populations living in poverty without access to equitable health systems and do not discriminate by race, gender, or age [10]. The Lancet NCDI (noncommunicable disease and injury) Poverty Commission [10] refers to NCDIs as “under-recognized and poorly-understood” factors in the morbidity and mortality of low income and impoverished populations. NCDIs represent more than a third of the burden of disease among the poorest populations, accounting for approximately 800,000 annual deaths of those 40 years of age and younger [10].
Acknowledging the impact of NCDs on population health, in 2011 the United Nations High Level Meeting on NCDs and its Political Declaration [11] spearheaded discussion and commitments of NCD response that led to the development of Global [12] and Regional [13] Action Plans for the Prevention and Control of NCDs and the inclusion of NCDs in the 2030 Agenda for Sustainable Development [14]. While progress has been made, the plans do not adequately address challenges faced by the poorest of populations impacted by NCDIs and renewed commitments and strategies are needed to prioritize this population. The Lancet Commission [10] advocates for the expansion of goals to reflect the specific epidemiology and unique complexities of NCDIs, as well as increased funding, and the use of multisectoral support and integrated care to better address disparities and social determinants of health necessary to continue progress toward global and regional commitments of universal health coverage. In September 2020, the InterAmerican Task Force on NCDs [15] pledged to strengthen policies and interventions to promote the prevention and control of NCDs and their risk factors among all ages and populations, particularly in the wake of COVID-19 and recovery efforts.
The double burden of NCDs and COVID-19 and the urgent need to address these dueling public health emergencies has begun to gain momentum [16, 17]. In May 2020, the Pan American Health Organization (PAHO) conducted a rapid assessment of NCD service delivery in the Region of the Americas during COVID-19 [18] and reported that many NCD services have been disrupted by varying levels. Member States in the Region reported the types of NCD services disrupted during COVID-19 [18]. Diabetes and hypertension management were most commonly reported as services partially disrupted, while rehabilitation, palliative care, and urgent dental care services were more likely to be reported as completely disrupted [18]. In addition to service disruption, 43% (12/28) reported public health screening programs for NCDs were also postponed [18]. These service interruptions and the delay of critical activities used for the prevention and detection of NCDs can lead to increases in morbidity and mortality during the COVID-19 pandemic and in the future [17].
The negative effects of COVID-19 have been disproportionately experienced within Latin America [4, 5, 7], yet little is known about precisely how COVID-19 has affected access to health care services for those living with NCDs within the Region. Patient advocacy organizations are a critical point of contact for patients and caregivers, as many provide services, information, support, advocacy, and offer unique insight to the patient experience. The objective of this research was to assess the effects of COVID-19 on patient access to health services in Latin America as reported by patient advocacy organizations who act in the interests of individuals living with autoimmune, chronic, and noncommunicable diseases.