سرمایه اجتماعی، نابرابری درآمد و شیب اجتماعی در سلامتی در آمریکای لاتین Social capital, income inequality and the social gradient in self-rated health in Latin America: A fixed effects analysis

1. Introduction Socioeconomic inequality in Latin American countries (LAC) is the highest in the world (UNDP, 2010), and recently with the post-2015 sustainable development agenda, addressing health inequity in LAC has become a greater concern (Becerra-Posada, 2015). The Pan American Health Organization (PAHO) advocates health equity as essential to the sustainable development in the region and recommends universal access to health and universal health coverage along with health-in-all approach to tackle the issue (PAHO, 2014a, b). Additionally, in May 2016, PAHO launched a high-level commission on health inequity in the Americas, focusing on gathering evidence in the region aiming to propose targeted recommendations to address the problem (PAHO, 2016). Despite improvements to the overall health in LAC in the past 30 years, resulting in a marked increase in life expectancy and a decline in child mortality, the unfair distribution of health between and within countries remained (Barreto et al., 2012; PAHO, 2012), independent of the indicator used to assess the social gradient: e.g., income (Belon et al., 2012; Restrepo-Mendez et al., 2015), education (Belon et al., 2012; Haeberer et al., 2015; Hertel-Fernandez et al., 2007), or ethnicity/skin color (Chiavegatto et al., 2014; Lima-Costa et al., 2015; Perreira and Telles, 2014). The analyses of several socioeconomic position (SEP) indicators reflects multiple mechanisms implicated in the power distribution and in the social stratification in the region, which are further influenced by broader contextual health determinants, such as social capital and income inequality. In the past two decades LAC experienced steep economic growth, declining income inequality, and growing social investments (Tsounta & Osueke, 2014), yet little is known about the impact this development has had on the social gradient in health and the social capital’s role. Additionally, the investigation of which sociodemographic groups are mostly affected by income inequality and social capital could assist in clarifying the mechanisms behind the social gradient in health (Subramanian and Kawachi, 2004).