Health in the Americas 2026

In 2023 life expectancy in the Region was 77.1 years, surpassing its pre-pandemic 2019 peak of 76.7 years. Healthy life expectancy has also improved, although more slowly.

Regional averages mask meaningful inequities across countries and population groups. These inequities are shaped by income, geography, education, access to care, and other social determinants.

Universal health coverage remains an unfinished task: essential service coverage has expanded, but out-of-pocket spending still accounts for nearly one-third of current health expenditure in the Region.

Aging populations, declining fertility, and migration are reshaping both the volume and the composition of the demand for health services. The shift toward chronic and disabling conditions adds further pressure on already strained health systems.

Slower economic growth, limited health budgets, and inequality restrict the resources available to respond, sharpening the imperative to prioritize maximum health impact.

Healthy life lost due to disability or ill health, as a proportion of total disability-adjusted life year (DALY) burden, has increased over time. This signals growing needs for integrated chronic disease management, mental health services, rehabilitation, disability support, and continuity of care, alongside continued action to prevent premature deaths, violence, and injuries.

Although age-standardized disease burden has improved over time, crude disease burden remained elevated in 2023. This indicates increased demand for services overall associated particularly with aging and chronic conditions.

Cardiovascular diseases, cancers and other neoplasms, diabetes and kidney diseases, musculoskeletal disorders, and mental health conditions dominate the burden profile.

A small set of modifiable risk factors drives multiple high-burden outcomes simultaneously. These risks include high blood pressure, high blood sugar, excess bodyweight, unhealthy diets, physical inactivity, tobacco and alcohol use, and drug use. These shared risk factors create opportunities to address several leading causes of health loss through cross-cutting action.

As opposed to a uniform target, this estimate indicates the scale of improvement possible across various highlighted disease categories. However, the actual scope of achievable improvement will vary by country and depend on disease patterns, institutional capacity, and available resources. The gap is largest in countries with less favorable health, service coverage, and enabling conditions.

High burden and high improvement potential are related but not identical: priority-setting requires considering both where burden is greatest and where demonstrated gains are most achievable.

Many health systems remain organized around episodic, fragmented, and hospital-centered care. This approach is poorly matched to a burden profile that is shifting toward overlapping chronic and disabling conditions. Many of these conditions require continuous care through service delivery centered around primary health care (PHC) supported by referral-linked hospital services. A meaningful part of the resulting delivery gap is therefore a mismatch between community needs, burden patterns, service organization, continuity of care, referral systems, and delivery network readiness.

Experience shows that countries with similar levels of health spending can differ markedly in the share of total disease burden that remains potentially avertable, suggesting that some of the remaining gaps may be reduced through priority-setting and better organization, targeting, and use of existing resources.

Priority-setting is most effective when transparent, updated regularly, and based on burden, cost-effectiveness, affordability, feasibility, equity, financial protection, and delivery capacity. Priority-setting must also protect past gains and sustain established programs. Health benefit packages add value when priority interventions are translated into PHC-centered, hospital-linked service bundles backed by financing, workforce, medicines, diagnostics, data systems, and accountability mechanisms. Regional experience shows that explicit packages must be matched by institutional, financing, and delivery arrangements capable of sustaining implementation at scale.

Under standardized 2025–2030 assumptions across five Latin American and Caribbean countries, scaling up the service bundle was projected to avert approximately 300–3400 cardiovascular deaths in total. The number depends partly on population size and other country-specific factors. Cumulative additional costs were estimated at about USD 2 million – USD 29 million.

These results illustrate the importance of country context and should be treated as a planning aid, not as a direct estimate of closing the potentially avertable DALY gap. Priority packages should also be assessed according to who benefits and whether they reduce financial hardship – not only by overall health gains.

Five core capacities can address common health system challenges, including unclear or unintegrated priorities, weak alignment between service packages and budgets, institutional silos, and failure to translate evidence into actionable decisions.

Across the Region, uneven implementation capacity – both health workforce capacity to meet current needs and institutional capacity to embed and adapt priorities at national and subnational levels – remains a critical constraint.

Political will is an essential enabler: sustained political, technical, and administrative commitment enables countries to make explicit choices, protect financing, coordinate actors, and overcome implementation barriers.

1. Identify and close avertable burden gaps, using total and potentially avertable DALYs, risk attribution, equity evidence, and country-specific data to locate the greatest feasible and equity-enhancing health gains.

2. Build and assure the quality of PHC-centered service bundles for high-impact priorities, moving from long lists of interventions to prioritized, implementable services organized around community health needs and integrated health service delivery networks.

3. Align financing, purchasing, and regulation with priority service bundles through effective stewardship and governance, translating priorities into budget lines, purchasing rules, provider payment, essential medicines and diagnostics lists, quality standards, workforce planning, information systems, and public reporting.

4. Pursue intersectoral action and community engagement on shared behavioral, environmental, commercial, and social drivers of health, including tobacco and alcohol use, unhealthy diets, obesity, physical inactivity, air pollution, road safety, violence, climate-sensitive risks, water and sanitation, social protection, and healthy aging.

5. Strengthen accountability and leverage regional cooperation for implementation and learning, tracking whether priorities are funded and implemented, reach intended populations, and improve access, quality, equity, financial protection, and health outcomes.

The Pan American Sanitary Bureau – PAHO’s secretariat – can support Member States by:

• Generating regional evidence on disease burden, risk factors, financing, service readiness, social determinants, and equity;
• Strengthening health technology assessment and explicit priority-setting;
• Translating priorities into costed benefit packages, service bundles, financing arrangements, and implementation road maps;
• Leveraging regional platforms for pooled procurement, knowledge exchange, workforce capacity, digital tools and information systems, surveillance, regulatory strengthening, and cooperation among countries;
• Convening regional learning collaboratives and providing technical solutions around priority service bundles and implementation challenges;
• Supporting monitoring of implementation and adaptive course correction; 
• Shaping regional implementation science, research, and innovation agendas.
   

Across different country contexts, the common agenda is to support equitable implementation through PHC-centered delivery, aligned stewardship and governance, intersectoral action, and continuous learning – mobilizing additional resources where needed while achieving greater value from existing investments.