In practice, so-called technology transfer has been the most widespread mechanism for incorporating technological development in less industrialized countries. However, in most cases, this transfer consists rather of the massive, wholesale and indiscriminate acceptance and acquisition of technology, more than of knowledge, regardless of its real possibilities for use, adaptation, efficiency and effectiveness.
Limitations in the availability of resources of all kinds for the development of scientific and technological capacity are manifested above all in the weakness of the system to respond to pressures. These pressures arise as a result of the commercialization and marketing of health technologies in the international context, and from the interests of scientific and professional groups within the country itself, whose behavior may be strongly influenced by the health systems of more developed countries.
In Latin American countries, there is growing interest in the analysis of problems related to technological dependence. Greater investment is needed in research that clarifies issues of this nature and encourages the search for appropriate solutions. Among the wide range of matters that should be studied in greater depth and detail are the proliferation and apparent overuse of pharmaceutical products, as well as the incorporation and use of high-cost medical technologies in the provision of health services, bearing in mind that the population’s access to them is limited by economic, geographic, social or institutional factors.
Latin America is characterized as a region in which children and women of childbearing age predominate. This demographic element, closely related to socioeconomic and cultural factors, gives a particular character to production, employment, family structure and health needs. Demographic peculiarities thus constitute the backdrop to the population’s health situation and, to a large extent, determine the actions needed to meet health expectations.
The well-known deficiencies in the registration of vital events in Latin America should encourage a critical analysis of the situation, rather than prevent the use of the information they provide. If interpreted rationally, these data acquire special importance, since they make it possible to establish a starting point for undertaking new actions.
In order to achieve the goal of health for all by the year 2000, the governments of the Americas adopted minimum regional objectives. These objectives require not only that levels of health and well-being be raised, but also that a fair distribution of this social good be achieved.
The purposes of this work are to provide a demographic frame of reference; to analyze the level of health in relation to the goals proposed for the year 2000, which largely correspond to the maternal and child area; to outline the current situation regarding the extension of coverage of service systems, immunization systems, water supply and sewerage; and to visualize the possibility of reaching the goals within the proposed period.
Demographic Factors
At the end of the 1970s, the Region of the Americas had a population of 612 million inhabitants: 364 million in Latin America and 248 million in North America. According to the medium variant of the projections prepared by the United Nations, between 1980 and the year 2000 the population will increase by 249 million, or 41%, meaning that by the end of this century 861 million people would inhabit this continent.
In 1980, 59% of the population of the Americas lived in Latin America, and by the year 2000 that percentage will rise to 66%. The high population growth rates are due above all to the persistence of high birth rates, which are accentuated by the decline in mortality.
Birth rates have declined considerably in all subregions from the five-year period 1950–1955 to the present, and the decline is projected to continue. However, these rates remain high, especially in the subregions of Mesoamerica and Tropical South America.
The declines in mortality rates that occurred simultaneously in all subregions determine the high annual population growth rates shown in Table 1. Drastically altering this situation would require major changes in prevailing fertility patterns, which are rooted in social and cultural conceptions that make them difficult to modify in the short term.
The population of Latin America is very young, with a median age of 19.7 years in 1980, which will increase to 23.0 by the year 2000. The population of the Mesoamerica subregion is the youngest in Latin America, with a median age of 17.5 years in 1980 and 21.1 in the year 2000. At the other extreme is Temperate South America, with values of 27.0 and 29.9 years.
These differences among subregions, as well as the enormous weight represented by children under 15 years of age and women of childbearing age, are reflected in the percentage distribution of the population by broad age groups. In Latin America as a whole, in 1980 almost 40% of the population was under 15 years of age.
This group, together with women aged 15 to 49, accounted for between 54% and 67% of the population in the Latin American subregions. Temperate South America, however, presents a very different picture from the other subregions: only 26% of its population will be under 15 years of age by the year 2000.
It is obvious that these population characteristics have important implications for the health sector, since they require actions that respond to the needs of a young population. A change in age structure creates a problem with multiple facets, not only for the health sector but also for other development sectors, such as education and employment.
This situation becomes even more complex when one takes into account that the economically active population is composed mainly of men, and that during the next two decades a much greater incorporation of women into the labor market is expected.
