From Measurement to Transformation
Astrid Berena Herrera López · Antonio Bernabé Ortiz · Ana Stock · Carlos A. Torres Luque ·
· Cinthya Mendoza León · Diana Jimenez Cano Rosales · Francisco Arancibia · Ignacio Zabert
· Juan Eugenio Hernández Ávila · Laura Mendoza · Lina Sofía Palacio Mejía · María Felicia
Montero · Migdalia Denis · Rafael de Jesús Hernandez Centeno · Rafael Silva · Ricardo Correa
· Martin Sivori · William Checkley
Latin America has an entire body of evidence capable of changing the lives of millions of people with chronic respiratory diseases.
The problem is that it never translates into public policy.
Imagine a disease that affects one in ten adults over the age of 35 across an entire region. That kills more people than road accidents in several countries. That devours hospital budgets through emergency visits that could have been prevented with spirometry, a 15-to-30-minute test. Imagine, furthermore, that 89% of those who have it do not know they have it.
This is the reality of chronic obstructive pulmonary disease (COPD) in Latin America. And alongside it, with fewer headlines but equal ferocity, is severe asthma – a condition still insufficiently distinguished from general asthma in many Latin American health systems. Asthma is the most common chronic respiratory disease in childhood: a condition that traps patients in an endless cycle of corticosteroids, emergency visits, and biological therapies that have yet to reach those who need them. Two diseases, one shared pattern of neglect.
To guide evidence-based decisions, the Respiratory Health Initiative at the Copenhagen Institute for Futures Studies (CIFS) has developed two fundamental tools: the COPD Index and the Severe Asthma Index. Their 2025 editions include, for the first time, six Latin American nations (Argentina, Chile, Colombia, Costa Rica, Mexico, Peru). Brazil was included in 2024.
Tools for Change: the Respiratory Health Indices
The COPD Index and the Severe Asthma Index assess each country across five equally weighted dimensions (20% each):
• Policy context and legal frameworks.
• Healthcare access and coverage.
• Health system characteristics and capacity.
• Disease burden.
• Environmental factors (fuel use, biomass, air quality).
The indices are built from document reviews of official sources, structured surveys of clinical specialists, and in-depth interviews with regional experts. Quantitative indicators are normalized on a 0-to-10scale using min-max transformation; qualitative ones are coded using evaluation criteria validated by an expert panel. The final score is expressed on a 0-to-100 scale. This structure makes it possible to identify not only where the gaps exist, but in which specific system dimension they are concentrated, enabling more targeted public policy interventions.
Now more than ever, it is necessary to allocate specific budgetary resources to chronic respiratory diseases. The data is there. The gaps are clear. The solutions, known. What is missing is the decision to turn them into action.
This editorial proposes going beyond diagnosis. We will spell out what needs to happen for the indices to stop being academic exercises and become genuine tools for public policy.
Contact
Adela Bisak
Advisor & Futurist
ab@cifs.dk
Aron Szpisjak
Director, Head of Health
as@cifs.dk