In Colombia, the health system has become a defining issue of the presidential runoff as out-of-pocket spending by households soared 57.3 per cent between 2022 and 2025. The poorest quintile bore the brunt, with costs jumping 63.4 per cent, while the wealthiest saw only a 15.3 per cent rise. Patients report months-long waits for specialist appointments and years-long surgical delays, especially within the largest private insurer, covering over a fifth of the population. Officials describe a structural crisis rooted in a 1993 privatisation that allowed insurers to contract with their own clinics, turning care into a business where payment disputes can halt medicine supplies for millions. Trust has collapsed: the share of low-income Colombians turning to their insurer when ill fell from 55.8 per cent to 43.1 per cent in three years, while self-medication doubled.

Viewed from Washington, the erosion of health affordability is not confined to emerging economies. A Gallup survey conducted in late 2025 found that only 49 per cent of Americans were “cost secure”—able to afford quality care and prescriptions—down from 61 per cent in 2022. Even among households earning over $180,000, one-fifth reported difficulty. The expiration of Affordable Care Act subsidies in early 2026 pushed more than a million people off insurance rolls. At the same time, debt collectors pursue surviving spouses for unpaid bills, tax authorities can seize inherited assets over outstanding liabilities, and older Americans are exploring bankruptcy to shield retirement accounts—signalling that financial safety nets are fraying across income brackets.

In Ghana and across Africa, the pressures take a different shape. The over-60 population is projected to triple to 6.3 million by 2050, yet social protection spending sits at just 0.23 per cent of GDP. A UNICEF report finds that children under five receive just 13 per cent of public spending on children; rebalancing towards early childhood could eliminate child poverty within three years. Meanwhile, eight million Ghanaians carry the sickle cell gene, and two in every hundred babies are born with the disease, which has long been neglected in national health data. In May, African Union states validated a continental sickle cell plan and the WHO issued its first paediatric guidelines. An implementation framework, IMARA, launched in Kenya and Uganda, aims to link screening, blood supply and care, tackling the fragmentation that has made the disease a silent killer.

The common thread is a widening gap between the design of social protection systems and the realities of ageing, childhood deprivation and chronic disease. From Bogotá to Accra to Washington, households are paying more out of pocket, trust in public institutions is waning, and the most vulnerable are falling through cracks that policy has failed to seal. Colombia’s presidential candidates pledge to expand elderly subsidies, but fiscal and legal hurdles remain. The sickle cell initiative offers a rare model of coordinated, patient-centred care, yet its success depends on sustained funding and political will. Without a fundamental rebalancing of spending towards the youngest and oldest, the crises across these three continents will only deepen.