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AbstractBackground: Several studies have evaluated the relationship between social capital and health in North America and Western Europe, although data remain scarce in Latin America. We examined the associations between indicators of social capital and health outcomes in nine Latin American countries. Methods: Design: Cross‐sectional ecological and individual‐level analyses of the relationships between social capital and health outcomes. Setting: Nine Latin American countries (Argentina, Brazil, Chile, Colombia, Dominican Republic, Mexico, Peru, Uruguay, and Venezuela), included in the World Values Survey. Subjects: 14,591 adults over 18 years. Main outcome measures: life expectancy at birth, infant mortality rate, under‐5 mortality rate, and maternal mortality rate (ecological analyses), and odds ratios of reporting good (as opposed to poor) self‐rated health (individual‐level analyses). Results: Trust was significantly correlated with life expectancy at the cross‐national level (r=0.72, p=0.03), and marginally significantly correlated with the maternal mortality rate (r=−0.61, p=0.09). Neither voluntary group participation nor church attendance was correlated with aggregate population health indicators. At the individual level, higher trust was significantly correlated with better self‐rated health in five of the nine countries. Group membership was correlated with better health in three countries. Church attendance was correlated with worse health in Mexico and the Dominican Republic. Conclusions: Our findings provide preliminary support for the relevance of social capital as a determinant of health in the Latin American region. However, further research is warranted on refining the measurement of social capital in this region.

Stigma toward people with mental illness and substance use problems is a significant global concern, and prevents people with these conditions from accessing treatment, particularly in primary health care (PHC) settings. Stigma is a cultural phenomenon that is influenced by particular contexts and can differ by country and region. The majority of stigma research focuses on Europe or North America leading to a lack of culturally relevant stigma research instruments for the Latin American context. The present study describes and discusses the methodology for cross-culturally adapting four stigma measurement scales to the Chilean context. The cross-cultural adaptation process included nine phases: (1) preparation; (2) independent translations; (3) synthesis 1 with expert committee; (4) focus groups and interviews with researchers, PHC professionals, and PHC users; (5) synthesis 2 with expert committee; (6) independent back translations; (7) synthesis 3 with expert committee; (8) pilot with PHC professionals; and (9) final revisions. The adaptation process included an array of diverse voices from the PHC context, and met three adaptation objectives defined prior to beginning the process (Understandability, Relevance, and Acceptability and Answer Options). The resulting, culturally adapted questionnaire is being validated and implemented within PHC settings across Chile to provide in-depth insight into stigma among PHC professionals in the country. The authors hope it will be useful for future research on mental illness and substance use stigma in similar settings across Latin America.

Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People's Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26–96% declines). Total outpatient visits declined by 9–40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.