In Latin America as in the wider world, corruption is rooted in our relationships

There is nothing natural about democracy [1]. There is nothing natural about living in communities with complete strangers. There is nothing natural about large-scale anonymous cooperation. Yet, this morning, I bought a coffee from Starbucks with no fear of being poisoned or cheated. I caught a train on London’s underground packed with people I’ve never met before and will probably never meet again. If we were commuting chimps in a space that small, it would have been a scene out of the latest Planet of the Apes by the time we reached Holborn station. We’ll return to this mystery in a moment.

Family-oriented cultures like those in Latin America are also high on corruption, particularly nepotism (Tio Feli, CC BY-NC-ND 2.0)

There is something very natural about prioritising your family over other people. There is something very natural about helping your friends and others in your social circle. And there is something very natural about returning favors given to you. These are all smaller scales of cooperation that we share with other animals and that are well described by the math of evolutionary biology. The trouble is that these smaller scales of cooperation can undermine the larger-scale cooperation of modern states. Although corruption is often thought of as a falling from grace, a challenge to the normal functioning state — it’s in the etymology of the word — it’s perhaps better understood as the flip side of cooperation. One scale of cooperation, typically the one that’s smaller and easier to sustain, undermines another.

When a leader gives his daughter a government contract, it’s nepotism. But it’s also cooperation at the level of the family, well explained by inclusive fitness [2], undermining cooperation at the level of the state. When a manager gives her friend a job, it’s cronyism. But it’s also cooperation at the level of friends, well explained by reciprocal altruism [3], undermining the meritocracy. Bribery is a cooperative act between two people, and so on. It’s no surprise that family-oriented cultures like Mexico and Brazil are also high on corruption, particularly nepotism.

Even in the Western world, it’s no surprise that Australia, a country of mates, might be susceptible to cronyism. Or that breaking down kin networks predicts lower corruption and more successful democracies. Part of the problem is that these smaller scales of cooperation are easier to sustain and explain than the kind of large-scale anonymous cooperation that we in the Western world have grown accustomed to.

The role of culture and institutions

So how is it that some states prevent these smaller scales of cooperation from undermining large-scale anonymous cooperation?

The typical answer is that more successful nations have better institutions. All that’s required is the right set of rules to make society function. But even on the face of it, this answer seems incomplete. If it were true, Liberia, which borrowed more than its flag from the United States, ought to be much more successful than it is [4]. Instead, these institutions are supported by invisible cultural pillars without which the institutions would fail.

For example, without a belief in rule of law — that the law applies to all and cannot be changed on the whim of the leader — it doesn’t matter what the constitution or legal code says, no one is listening. Without a long time horizon, decisions are judged on how well they serve our immediate needs making larger-scale projects, like reducing the effects of Climate Change, harder to justify [5].

Similarly, institutions often lack the punitive power to actually punish perpetrators. For example, most people in the US and UK pay their taxes, even though in reality the IRS and Her Majesty’s Revenue and Customs lack the power to prosecute widespread non-compliance; your probability of getting caught is low. The tax compliant majority may never discover that they can cheat or how to get away with it and they may not actively seek this information as long as the probability of getting caught is non-zero, the system seems fair, and it seems like everyone else is complying. Or in other words, it’s a combination of norms and institutions.

Not everyone plays by the same rules when it comes to taxes (Tom Hilton, CC BY 2.0)

But, it gets tricky — institutions are themselves hardened or codified norms [6] and the norms themselves evolve in response to the present environment and due to path-dependence of previous environments, past decisions, and the places migrants come from. Modern groups vary on individualism and even sexist attitudes based on their ancestors’ farming practices [7]. The science of cultural evolution describes the evolution of these norms and introduces the possibility of out-of-equilibria behavior (people behaving in ways that do not benefit them individually) for long enough for institutions to try to stabilise the new equilibria.

Modelling cooperation and corruption

How do we begin to understand these processes?

The real world is messy and before we start running randomised control trials or preparing case studies, it’s useful to model the basic dynamics of cooperation using a simpler form that gets at the core elements of the challenge. One commonly used model is called the “Public Goods Game”. The gist of the game is that I give you, and say 9 others, $10. Whatever you put into a pool (the public good), I’ll multiply by say 3, but then I’ll divide the money equally regardless of contribution. This is similar to paying your taxes for public goods that we all benefit from, like roads, clean water, or environmental protections.

The dilemma is this: the best move is for everyone to put all their money in the pool. Then they’ll all go home with $30. But it’s in my best interests to put nothing in the pool and let everyone else put their money in. If I put in nothing and they put in $10 each, I’ll go home with almost $40 ($10*9*3 people / 10 = $37). What happens when we play this game?

Well, if we play it in a Western Educated Industrialised Rich Democratic (WEIRD) nation, where prosocial norms tend to be higher, people put about half their money in, but as they gradually realise they can make more by putting in less, contributions dwindle to zero. One way to sustain contributions is to introduce peer punishment — allow people to spend some portion of their money to punish other people. This is similar to the kind of punishment we might see in a small village. I know who you are or at least I know your parents or people you know. If you steal my crops, I’ll punish you myself or ruin your reputation.In the game, if we introduce the possibility of peer punishment, contributions rise again.

The problem is that this doesn’t scale well. As the number of people grows, we get second-order free-riding — people prefer to let someone else pay the cost of punishment. When someone cuts a queue, you grumble — someone ought to tell that person off! Someone other than me… And you can also get counter-punishment — revenge for being punished.

The best solution seems to be to create a punishment institution. Pick one person as a “Leader” and allow them to extract taxes that can be used to punish free-riders. This works really well and scales up nicely. It’s similar to a functioning police force and judiciary in WEIRD nations. In fact, the models suggest that the more power you give to the leader, the more cooperation they can sustain. Aha, problem solved!

Not quite. Models like these are very useful for distilling the core of a phenomenon, they can miss things. Recall where we started — smaller-scales of cooperation can undermine the larger-scale.

The addition of a punishment institution, like a judiciary, can improve cooperation (Jeff Kubina, public domain)

Getting into — and out of — the Bribery Game

In our recently published paper, we wanted to show just how easy it was to break that well-functioning institution. We did it by introducing the possibility of another very simple form of cooperation — you scratch my back, I’ll scratch yours — bribery. And then we wanted to show the power of invisible cultural pillars by measuring people’s cultural background and by trying to fix corruption using common anti-corruption strategies. We wanted to show that these strategies, including transparency, don’t work in all contexts and can even backfire.

Our “Bribery Game” was the usual institutional punishment public goods game with the punishing leader, but with one additional choice — players could not only keep money for themselves or contribute to the public pool, they could also contribute to the leader. And the leader could not only punish or not punish, they could instead accept that contribution. What happened? On average, we saw contributions fall by 25% compared to the game without bribery as an option. More than double what the pound has fallen against the USD since Brexit (~12%[8]).

Fine, bribery is costly. The World Bank estimates $1 trillion is paid in bribes alone; in Kenya, 8 out of 10 interactions with public officials involves a bribe, and as Manfred Milinski points out in his summary of our paper, most of humanity — 6 billion people — live in nations with high levels of corruption. Our model also reveals that unlike the typical institutional punishment public goods game, where stronger institutions mean that more cooperation can be sustained, when bribery is an option, stronger institutions mean more bribery. A small bribe multiplied by the number of players will make you a lot richer than your share of the public good!

So can we fix it? The usual answer is transparency. There are also some interesting approaches, like tying a leader’s salary to the country’s GDP — the Singaporean model [9]. So what happened when we introduced these strategies?

Well, when the public goods multiplier was high (economic potential — potential to make money using legitimate means — was high) or the institution had power to punish, then contributions went up. Not to levels without bribery as an option, but higher. But in poor contexts with weak punishing institutions, transparency had no effect or backfired. As did the Singaporean model [10]. Why?

When transparency confirms corruption

Consider what transparency does. It tells us what people are doing. But as psychological and cultural evolutionary research reveals, this solves a common knowledge problem and reveals the descriptive norm — what people are doing. For it to have any hope of changing behavior, we need a prescriptive or proscriptive norm against corruption. Without this, transparency just reinforces that everyone is accepting bribes and you’d be a fool not to.

People who have lived in corrupt countries will have felt this frustration first hand. There’s a sense that it’s not about bad apples — the society is broken in ways that are sometimes difficult to articulate. But societal norms are not arbitrary. They are adapted to the local environment and influenced by historical contexts. In our experiment, the parameters created the environment. If there really is no easy way to legitimately make money and the state doesn’t have the power to punish free-riders, then bribery really is the right option.

Sometimes even Canadians go bad… (Frank Winkler, CC0)

So even among Canadians, admittedly some of the nicest people in the world, in these in-game parameters, corruption was difficult to eradicate. When the country is poor and the state has no power, transparency doesn’t tell you not to pay a bribe, it solves a different problem — it tells you the price of the bribe. Not “should I pay”, but “how much”?

There were some other nuances to the experiment that deserve follow up. If we had played the game in the Colombia instead of Canada, we suspect baseline bribery would have been higher. Indeed, people with direct exposure to corruption norms encouraged more corruption in the game controlling for ethnic background. And those with an ethnic background that included more corruption countries, but without direct exposure were actually better cooperators than the 3rd generation+ Canadians. These results may reveal some of the effects of migration and historical path dependence.

Of course, great caution is required in applying these results to the messiness of the real world. We hope to further investigate these cultural patterns in future work. The experiment also reveals that corruption may be quite high in developed countries, but its costs aren’t as easily felt. Leaders in richer nations like the United States may accept “bribes” in  the form of lobbying or campaign funding and these may indeed be costly for the efficiency of the economy, but it may be the difference between a city building 25 or 20 schools. In a poor country similar corruption may be the difference between a city building three schools or one. Five is more than three, but three is three times more than one. In a rich nation, the cost of corruption may be larger in absolute value, but in a poorer nation, it may be larger in relative value and felt more acutely.

New approaches, new insights

The take-home is that cooperation and corruption are two sides of the same coin; different scales of cooperation competing. This approach gives us a powerful theoretical and empirical toolkit for developing a framework for understanding corruption, why some states succeed and others fail, why some oscillate, and the triggers that may lead to failed states succeeding and successful states failing.

Our cultural evolutionary biases lead us to look for whom to learn from and perhaps whom to avoid. They lead us to blame individuals for corruption. But just as atrocities are the acts of many humans cooperating toward an evil end, corruption is a feature of a society not individuals. Indeed, corruption is arguably easier to understand than my fearless acceptance of my anonymous barista’s coffee.

Our tendency to favour those who share copies of our genes — a tendency all animals share — leads to both love of family and nepotism. Putting our buddies before others is as ancient as our species, but it creates inefficiencies in a meritocracy.

Innovations are often the result of applying well-established approaches in one area to the problems of another. We hope the science of cooperation and cultural evolution will give us new tools in combating corruption.

Cuando el descabezamiento del crimen organizado funciona: el caso del Clan del Golfo en Colombia

El 31 de agosto de 2017, las Fuerzas Armadas de Colombia dieron de baja a Roberto Vargas Gutiérrez, alias Gavilán, segundo hombre al mando del Clan del Golfo. Esta banda criminal se caracteriza por ser el principal grupo armado organizado (GAO) de Colombia, controlando más del 45% del narcotráfico nacional, explotando centenares de minas ilegales y haciendo una presencia fuerte en 22 de los 32 departamentos del país.

Los miembros del Clan del Golfo provienen en su mayoría de las extintas Auto-Defensas Unidas de Colombia (AUC) y de algunas guerrillas colombianas, como el Ejército Popular de Liberación; lo que evidencia que sus integrantes llevan una carrera criminal importante, basada en el negocio del narcotráfico y la intimidación directa contra la sociedad civil.

¿Será El Clan de Golfo el próximo grupo armado en bajar las armas? (Sylvain Liechti @ UN Photo, CC BY-NC-ND 2.0)

La evidencia empírica sugiere que, según el tipo de GAO, el descabezamiento de grandes líderes criminales, insurgentes o terroristas, produce escaladas de conflicto entre los actores involucrados. Este efecto se ve principalmente porque quedan cabezas pequeñas que luchan entre ellas para el liderazgo del grupo, o porque el gobierno central o local rompe con el status quo y esto produce una reacción bélica en los diferentes actores. Por lo anterior, es esperable que la muerte de Gavilán produzca un aumento de homicidios, extorsiones o explotación minera sin precedentes, entre otras acciones violentas por parte de este grupo armado.

Sin embargo, la respuesta de alias ‘Otoniel’ fue contraria a lo que sugiere la teoría. El máximo líder del Clan del Golfo solicitó que se estudiara la posibilidad de acoger su organización criminal a la justicia colombiana, con el objetivo de involucrar a las Autodefensas Gaitanistas (AGC) y, de esta manera, obtener la paz completa.

En respuesta a este comunicado, el presidente Juan Manuel Santos le solicitó al Ministro de Justicia y al Fiscal General que se estudie la posibilidad presentada por ‘Otoniel’; aclarando que este proceso sería un sometimiento, más no una negociación. La diferencia es importante, si se considera que una negociación exige un tiempo mayor y una implementación de los acuerdos, como en el caso de las negociaciones de paz con las Fuerzas Armadas Revolucionarias de Colombia (FARC) en La Habana, mientras que un sometimiento requiere menores detalles: se acuerda la entrega de armas, la información de la organización, el tipo de justicia que se aplicará y el pago de la pena.

Dado el contexto anterior, surge la pregunta: ¿qué podría pasar en el futuro con este grupo criminal?

Al igual que otros investigadores, vemos con pesimismo el sometimiento a la justicia del Clan del Golfo, principalmente por tres características que evidencian su heterogeneidad:

  1. las diversas proveniencias de sus integrantes – ex paramilitares, ex soldados, ex guerrilleros, delincuencia común, entre otros – que forma un grupo sin ideología clara y con intereses y pasados sumamente complejos de afrontar
  2. su variada distribución por el territorio colombiano, pues aunque tengan fuerte presencia en el Urabá, gran parte de su organización se sitúa en cabeceras municipales y ciudades intermedias
  3. la disparidad de negocios que tienen los frentes de la GAO, mientras que algunos se concentran en el negocio del narcotráfico, otros se focalizan en explotación minera o extorsión a grandes compañías ganaderas y petroleras.

Por otro lado, vemos con preocupación las dificultades legales de entrar a un proceso de paz con una banda criminal. El Fiscal General ha insistido en el vacío jurídico que posee el código penal colombiano, para llevar a cabo un sometimiento a la justicia de un GAO.

Primero, por la dificultad de hacer un reconocimiento individual de sus integrantes, pues la mayoría no cuentan con una cédula de identificación que ayude a su reconocimiento.

Segundo, por la necesidad de unas actas de sometimiento, en la que los integrantes del Clan del Golfo reconozcan su participación en actividades criminales y, de esta manera, la Fiscalía pueda hacer su respectiva orden de captura.

Tercero, por las demoras del proceso judicial colombiano, en los cuales un caso puede durar más de dos años sin arrojar mayores resultados.

Cuarto, dado que las víctimas tomaron un rol importante en la política colombiana tras el acuerdo de paz con las FARC, un posible sometimiento a la justicia por parte del Clan del Golfo implicaría una incertidumbre sobre cuál sería la forma de reparación de las víctimas y si aplicaría la reparación y el perdón y olvido de otros procesos.

El sometimiento del Clan del Golfo podría contribuir al silenciamiento general de las armas en Colombia (Thomas Tucker, CC0)

A pesar de los retos jurídicos y políticos, los costos de perder esta oportunidad para acabar con el grupo criminal más grande del país son altos. Estamos frente a la posibilidad de ingresar a la legalidad a más de dos mil colombianos, los cuales en su mayoría son hombres jóvenes que viven en condiciones de marginalidad y con altos riesgos de continuar en la ilegalidad. En el marco de un posconflicto, el fin del Clan del Golfo abre la oportunidad de acabar con muchas fuentes de violencia que se presentan en las regiones; asimismo facilitaría procesos como la sustitución de los cultivos ilícitos o la entrada del Estado colombiano a rincones del país donde tradicionalmente no ha tenido una presencia.

Sin embargo, para que el desarme, la desmovilización y la reintegración de esta banda criminal se realicen correctamente, debe tenerse en cuenta varios de factores de riesgo. La presencia de otros GAO, como los frentes disidentes de las FARC, por ejemplo, dificulta que haya total adherencia a los acuerdos de todos los integrantes del Clan del Golfo, pues continuará el incentivo de seguir en la criminalidad o la presión para no dejar su negocio. Por otro lado, el limitado capital político del Presidente Juan Manuel Santos, el cual – a pesar de haber recibido un premio Nobel de Paz y poseer varios reconocimientos internacionales – cuenta con una desaprobación del 72% de los colombianos, lo que dificulta tener un respaldo de los partidos políticos y la sociedad civil.

En conclusión, el crimen organizado, en particular el Clan del Golfo, representa una amenaza fundamental para el proceso de paz con las FARC y para la estabilidad social y política de Colombia. Ha sido muy difícil contrarrestar su accionar delincuencial, dadas unas políticas antidrogas mal enfocadas y la dificultad de tener presencia estatal en todos los lugares del país.

Asimismo, es sorprendente la respuesta de ‘Otoniel’ a la muerte de su segundo al mando, ofreciendo la posibilidad de terminar su conflicto con el Estado. Pues como se presentó anteriormente, la evidencia demuestra que en conflictos con bandas criminales o narcotraficantes, suele incrementar los índices de violencia tras el descabezamiento de un gran líder.

Sin embargo, consideremos que la posibilidad de realizar un proceso de desmovilización con este grupo armado es una oportunidad que no debe perderse, aprovechando la salida de las FARC y el proceso de paz con el ELN, es la forma de llevar presencia estatal a todas las regiones del país y concretar el camino hacia la paz en Colombia.

Caribbean ‘Citizenship by Investment’ is becoming a dangerous race to the bottom

In most OECS nations, citizenship is available at a cost. It can be purchased by almost anyone who can afford it. There is no qualifying period and no residential requirement. All that is needed is a one-off payment into either an agreed form of investment or to a government development fund, plus background checks on the individual concerned

Depending on the location and scheme chosen, the basic cost is now between US$0.1m and US$0.4m plus fees.  Not only does this confer a passport, but it also offers free movement within CARICOM, and visa free entry to many other countries. At further cost, citizenship can be extended to families and relatives.

Grenada, St Kitts & Nevis, Dominica, Antigua & Barbuda, and St Lucia offer Citizenship by Investment (Kurious, mix by Asa Cusack)

The creation of such Citizenship by Investment (CBI) programmes has been mainly driven by the the Caribbean governments concerned need to find new ways to raise revenue because of their otherwise limited capacity to compete globally.

St Kitts and Nevis, Grenada, Dominica, Antigua and Barbuda, and St Lucia have such arrangements, but St Vincent has not. Belize suspended its controversial programme in 2002.

For the most part, such schemes showed early promise. Slides shown in June this year, by Trevor Alleyne, the IMF Division Chief for the Caribbean, at a conference on global mobility and tax strategies, suggest that taken together, the contribution made to GDP by Caribbean CBI programmes peaked in 2014. Then, for example, St Kitts earned 14% of it GDP from citizenship, enabling it to substantially offset what otherwise would have been negative growth. However, seen since then its programme earnings has gone into a slow decline.

In a probable reflection of this and the need to stimulate renewed interest, its government recently announced a new route to citizenship at a basic rate of US$0.15m, ‘a proportion of which’, it said, would be paid into a hurricane relief fund.  The decision appears to make redundant a part of its existing programme which offers citizenship for a minimum contribution of USD$0.25m to the country’s National Development Fund

To be fair, it may also reflect a comment made recently by the Governor of the Eastern Caribbean Central Bank (ECCB), Dr Timothy Antoine.  Launching the ECCB’s strategic plan earlier this month, he urged OECS Governments to consistently set aside a portion of citizenship revenues to use as leverage to attract climate finance under the Paris Climate Accord.

In contrast, in Dominica, and to a much lesser extent in Grenada, the contribution made by citizenship programmes to GDP has been increasing. In Dominica’s case, its National Development Programme earnings before Hurricane Maria struck, had reportedly reached US$50m per month: sums that were being used to pay down debt, support public works, as well as to provide budgetary support and employment.

In an indirect confirmation of the value of Dominica’s low basic fee of US$0.1m, and the fierce competition now existing between OECS nations for citizenship applications, Antigua this month reduced its basic fee for citizenship to the same US$0.1m level.

The least successful CBI programme has been St Lucia’s. Earlier this year, its government halved the previous cost of citizenship for individuals, also to US$0.1m, and adjusted downwards the fee for all other categories, making the country’s programme for a short time the cheapest in the region. It also lifted a self-imposed limit on the number of applications that could be processed annually, and revoked previous requirements relating to an applicant’s net worth on the basis that other countries were offering discounts or incentives.

What is emerging from this apparent race to the bottom are several issues:

  1. First, well conceived, well administered programmes linked to national development programmes, where judiciously applied and with clear outcomes, appear to offer the best avenues for government and countries to reap the greatest rewards.
  2. Second, global and inter-regional competition suggests the emergence of a zero-sum game in which nations may seek to offset a decline in income by further reducing pricing. If this happens, it follows that a higher number of successful applicants will be required if income from citizenship is to sustain or enhance GDP growth.
  3. Third, if governments are unable to significantly grow applicant numbers through price reductions, or through encouraging greater citizenship related investment in real estate or bonds, they may have to turn again to tourism to increase revenue, and to new tax breaks to spur investment.

In short, Caribbean CBI programmes may not have as a bright a revenue earning future as they have had in the past.

While many high net worth people continue to seek second or third citizenships, it appears likely that the numbers of applicants per Caribbean country may decrease as global competition grows, at worst accelerating the sector’s decline.

Harmonisation could prevent a race to the bottom, but the region’s recent record is weak in this regard (Wdcf, CC BY-SA 3.0)

In theory OECS nations with CBI programmes could consider some sort of approach involving harmonisation. However, in the real world of multiple unresolved sub-regional ideological, economic, and personality differences, it is hard to imagine achieving a consensus that lasts.

Unfortunately, OECS governments have shown little willingness to address questions about the sustainability of their citizenship programmes, or to indicate whether they have fresh ideas about the ways in which they might redesign existing schemes to ensure continuing income without lowering fees any further.

All of which is to say nothing about the sometimes-questionable comments and defensive public relations exercises undertaken by some agents selling CBI programmes, about the questions that remain about the due diligence processes some governments pursue, or the serious international concern that has arisen about the issuance of diplomatic passports.

Almost every nation in the world provides a path to citizenship. Despite this, many citizens and some governments in principle object to the idea that nationality is something that can be sold.  In this the Caribbean is no exception.

As long as citizenship programmes exist, questions will also remain about the granting of rights and free movement within CARICOM to those who are not required to reside, make no long-term economic or personal contribution, and who have no historic or cultural affinity to the region.

Poor health outcomes amongst Afro-Colombians are driven by discrimination as well as economic disadvantage

We have long known that poverty has a negative impact on health. People living in economic disadvantage are at higher risk of experiencing illness and receive medical care when needed. However, the causal chain from disadvantage to disease is hard to disentangle. Living in poverty reduces access to nutritious food, clean water and sanitation. But there are many other pathways by which disadvantage impacts health. Poverty steeply increases stress, which in turn impacts physical and mental health. It also decreases the access to education and key information that can help prevent disease.

Clearly, the relationship between poverty and poor health is not straightforward, but rather a dense web of interrelated factors constantly shaping each other.

“With very few exceptions, ethnic-minority populations tend to be economically disadvantaged” (Danielb77, public domain)

Our research looks at one rarely explored aspect of this relationship: health disparities in relation to ethnic-minority status. With very few exceptions, ethnic-minority populations tend to be economically disadvantaged. As a result, one of the main challenges of studying health disparities between minority and majority populations is disentangling the effect of socio-economic marginalisation on health and the “minority” effect on health. We take the case of Afro-Colombians to whether minority status itself can affect health or if instead the differences relate to socio-economic disparities between Afro-Colombians and the general population.

Isolating the effect of ethnic-minority status

Disentangling socio-economic disadvantage and ethnicity in relation to health outcomes in Colombia (and other Latin American countries) is particularly challenging.

Latin America is one of the most ethnically diverse regions in the world. People in the region tend to think of themselves as mestizos, a concept of ethnicity that is “mixed” at its core. The region is also one of the most unequal in the world, and research on health disparities has thus tended to focus on the health effects of class and poverty.

The question of ethnicity and its relation to poor health outcomes is certainly a difficult question to address, as different sources of marginalisation are deeply embedded. Yet, since members of ethnic minorities face chronic discrimination, with knock-on negative effects for health, it is a question that needs to be asked. And the case of Afro-Colombians, who continue to have a fairly cohesive ethnic identity, makes a particularly appropriate case study.

We first sought to determine the nature of health disparities between Afro-Colombians and the general population. To do this, we used nationally representative survey data to evaluate health differences affecting adults and children of African descent. This showed that Afro-Colombian adults are less likely to report “good” or “excellent” health. Adults and children are also more likely to say they were sick in the past month and to have a chronic condition. Afro-Colombian adults are less likely than their counterparts to seek treatment if they feel ill. However, when they seek medical treatment, there are as likely as non-Afro Colombians to receive it.

Importantly, we identified key socio-economic disadvantages affecting Afro-Colombians that could explain the disparities in health. Afro-Colombians adults are less wealthy, have less access to sanitation and are less likely to be insured. Afro-Colombian children live in poorer households, have mothers with less education, and have less access to sanitation than their non-Afro counterparts. They are also less likely to have health insurance.

Because our findings reveal both socio-economic and health disparities between Afro-Colombians and non-Afro Colombians, the next step was to determine which factors best explain identified differences in health. This might be observable (socio-economic status, level of education, access to health care, etc.) or unobservable.

We re-analysed the data using a method that equalises the observable factors and tells us if the differences are still there after “levelling the ground” for everyone. A finding that health differences are not sufficiently explained by observed factors would support the hypothesis of a discrimination effect driving health disparities against the Afro-Colombian population.

Afro-Colombian children face numerous socio-economic disadvantages that could affect health (Felipe Canova, CC BY-NC 2.0)

What role for discrimination?

Ultimately, we found that health disparities are largely explained by observable variables (i.e. socio-economic status, education, insurance, etc.), but with some important exceptions. Higher perceived morbidity, less treatment-seeking, and lower enrolment in subsidised health-insurance schemes were not successfully explained by observed factors only. This means that the experience of worse general health among Afro-Colombians could also be driven by a discrimination effect.

We also find that Afro-Colombian children are more likely than their non-Afro counterparts to have poor growth. The disparity is not explained by observable variables. Therefore, we found a potentially strong discrimination effect for disparities in height at a given age.

Taken together, our results paint a picture of an Afro-descendant population with increased morbidity, less treatment-seeking, and less enrolment in a health-insurance system that is free to those who qualify.

While the results suggest a discrimination effect behind these disparities, determining the mechanism by which discrimination operates is more challenging. The observational data does not allow us to identify cause-effect relationships. Nevertheless, we explore some possible explanations based on what we know about the relationship between discrimination and health.

Difference, discrimination, and health outcomes

We believe that our results are driven by both structural and internalised forms of discrimination. As such, strategies looking to tackle health disparities amongst this population should address these issues in an integrated manner.

Take for example the finding that Afro-Colombians are less likely to enrol in health-insurance schemes for which they are eligible at no cost. An intervention targeting this problem could focus on increasing the willingness of Afro-Colombians to sign up for health insurance. This would entail tackling individual choice while accounting for the link between discrimination, social identity, and health behaviour. Afro-Colombians face ethnic discrimination in various settings on a regular basis. Chronic experiences of ethnic discrimination are progressively internalised by the individual. Because the person self-identifies as member of the stigmatised ethnic group, some aspects of his/her identity will also be stigmatised. Stigmatised social identities can influence behaviour to a considerable extent. Under certain circumstances, they can impair the group’s ability to respond to available opportunities even after these have been equalised across groups. It is likely that the stigmatised identity negatively affects enrolment for free health insurance among Afro-Colombians. Interventions should thus be designed to address the effect of discrimination on behavioural patterns that have negative health effects.

Yet, the lower enrolment rate of Afro-Colombians can also be studied from an institutional angle that considers the social and structural aspects of discrimination. For instance, it is possible that areas with a higher proportion of Afro-descendants are not prioritised by the enrolment efforts of the health system or may simply lack a nearby enrolment office.

Afro-Colombian households may be less likely to receive subsidised insurance. While indigenous populations, demobilised combatants, or homeless individuals are classified as “special populations” for the purposes of subsidies, the Afro-Colombian population is not. There is evidence that the assignment of subsidies to non-special populations may be discretionary in some circumstances, which could suggest implicit dynamics of institutional discrimination.

More research is required if we are to understand the role of discrimination – both structural and internalised – in the health disparities affecting Afro-Colombians. The more we know, the better equipped we will be to design means of overcoming these disparities. Our study contributes by showing that the ethnicity factor is distinct and adds to the cumulative effect of exclusion. We demonstrate this with indications of objective poorer health (height for age) and reports of subjective experience of poorer health (perceived morbidity) by Afro-Colombian individuals.

We know that those belonging to minority groups across Latin America consistently report poorer health. Building a better understanding of the multiple facets of disadvantage and their distinct impact on health is no small task. However, the production of knowledge from and about Latin America has grown exponentially in the last decades.

It is time for researchers and policy makers in the region to engage in productive discussions to find innovative solutions to these problems. This is a challenging but achievable mission: creativity has never been a scarce resource in Latin America.