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Review
. 2025 Jul 14:13:1604424.
doi: 10.3389/fpubh.2025.1604424. eCollection 2025.

Shocks and health care in Latin America and the Caribbean

Marcia C Castro  1 , Jamie Ponmattam  1 , Emily A FitzGerald  1
Affiliations
Review

Shocks and health care in Latin America and the Caribbean

Marcia C Castro et al. Front Public Health. .

Abstract

Background: The Latin American and the Caribbean (LAC) is one of the most disaster-prone regions worldwide, and the frequency and intensity of disasters is expected to increase. We propose typologies of shocks considering healthcare resilience to examine how the risk of shocks varies across LAC and how previous shocks and their impacts in LAC fit into these categories.

Methods: We classify shocks into natural, anthropogenic and climate-related, and build on the literature to develop a 2×2 classification considering health care resilience and trust in government. Using the INFORM risk we categorize countries into risk groups considering indicators of governance and access to healthcare as proxies for trust in government and health care resilience, respectively. We discuss the 2×2 classification considering examples of health impacts of shocks, highlighting strengths and weaknesses of national responses, and use excess death ratios during the COVID-19 pandemic to demonstrate how health impacts correspond to the 2×2 typology.

Results: Based on the available literature, the proposed 2×2 classification reflects the recent consequences of shocks in LAC countries. Overall, areas where healthcare access and trust in government were weak had the most devastating impacts. However, strong access to healthcare is not a sufficient condition determining the impact of a shock, as evidenced during the COVID-19 pandemic. For the most part, countries lack a detailed shock management plan.

Discussion: Countries in the LAC region have historically been unprepared to manage shocks. In the absence of a comprehensive and multisectoral shock management plan, countries will continue to act in a reactive way, after a shock, as most of the examples discussed in our analysis illustrate. A shock management plan is an important step to build resilient health systems.

Keywords: Latin America and the Caribbean; disaster; health system resilience; healthcare; shock.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Type and categories of shocks. (A) Shocks classified by natural or anthropogenic causes and by possible relationships with climate change. Categories of shocks considering their onset and duration (B), local trust in government and health care resilience (C), and predictability and health care resilience.
Figure 2
Figure 2
INFORM risk index for LAC countries, 2015–2024. VCT = Saint Vincent and the Grenadines.
Figure 3
Figure 3
Typology based on excess Covid-19 death ratios. (A) 2×2 typology of countries using the INFORM index on Governance (proxy for trust in government) and Access to Health care (proxy for healthy system resilience) considering their excess Covid-19 death ratio. (B) Countries plotted by INFORM indices and their excess Covid-19 death ratio. INFORM indices range from 1 to 10 with 1 being the best and 10 being the worst.
See this image and copyright information in PMC

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