José Campillo
Executive President
View from the Top

Diabetes and Obesity: Healthcare Priorities

Wed, 09/06/2017 - 18:12

Q: In 2016, FUNSALUD established diabetes, breast cancer, obesity and mental illnesses as priorities. Have these changed in 2017?

A: Our priorities remain the same because these conditions have a high incidence and involve a great cost to society and the country’s finances. At the end of 2016, Minister of Health José Narro declared diabetes a health emergency. It was an atypical statement because there was intention to take drastic action but only to emphasize that diabetes is a serious national public health problem. At the end of 2016, the ENSANUT survey was released. It measures obesity, overweight and diabetes prevalence among the Mexican population. In some segments, which vary between urban and rural communities, rates begin to stagnate rather than continue shooting upward. However, there is another hypothesis: we are reaching saturation levels where things cannot get any worse. In 2017, emphasis should be placed on the prevention of diabetes and its complications. Data from this survey show there has been a 175 percent increase in diabetic foot amputations.

Q: Are citizens more aware now than before of this type of complication?

A: I do not think the population has that information and if it does, it has not resulted in a lifestyle change. This is the main challenge of a problem that is multifactorial and that depends not only on food but on life habits. A change in the population’s mentality is required.

Q: The IMSS estimates that in the next 35 years the number of patients with diabetes in the country will double. Do you agree?

A: There are many possibilities. In addition to the 6.5 million diabetics diagnosed it is thought there is almost the same number undiagnosed, so the logical thing is for prevalence to increase. FUNSALUD has corroborated this number with its own studies. In 2013, we estimated that the cost of diabetes would be MX$362 billion (US$20.1 billion) per year or 2.3 percent of national GDP. This figure will continue to grow and there may come a time when the public sector does not have the economic, technical and human resources capacity to deal with this tsunami.

Q: Which countries can Mexico look to for a way to attack this epidemic?

A: Chile and Costa Rica are seeing good results, although the comparison in terms of population is different. European countries like the UK also have good models. However, we are seeing the problem in all countries, which is due to urbanization, lifestyle changes and consumption habits. I think Mexico, the country with the highest obesity rate after the US, could be the place to experiment with immediate action. One action should be to increase clinical research, especially for economic reasons. It is a gigantic global market in which Mexico does not even reach 0.1 percent and needs to be improved. Mikel Arriola, Director of IMSS, is convinced of this. The industry is also ready and COFEPRIS is at the best moment in its history, with great international recognition. Mexico can be an important crucible to start doing scientific research on diabetes that provides us a favorable cost/benefit ratio. In 2017, it would be desirable for the Ministry of Health to take the lead to carry out a concerted policy with the Ministry of Economy and the Presidency of the Republic. Ties with the industry exist thanks to the great work carried out by COFEPRIS.

Q: What has changed in the last 12 months in relation to conditions such as breast cancer or mental illness?

A: The capacity of care for these diseases has increased. However, budgetary or political considerations have meant that these are no longer priorities for the federal government. In terms of breast cancer, much progress has been made in perception and detection. The pharmaceutical industry is shielded from any political aggression by the current president of the US and the Ministry of Health is at the core of the solution. By improving the health of the working population, great savings will be made.

Q: Universal access to health is a goal of FUNSALUD. How is the Ministry of Health working toward that goal?

A: Universality is not a utopia but an obligation. Family wealth should not be affected by healthcare. It is an inalienable universal right that cannot be postponed. The conditions of the country in 2017, and perhaps for the next five years, are going to be very adverse, so we have to rethink proposals to reinterpret the reality and be precise in our aspirations. The most important part is to ensure prevention and first-level care. One of the main problems is that the model we followed was seen from the perspective of the disease and not from health; we have been curing and not conserving health. We need a policy of prevention.

Q: How will budget cuts affect the goal of achieving universal access to health?

A: Recently, an agreement for the protection of the family economy was signed and four strategies were proposed but the health sector, which should be the beginning of everything, appears in none of them. It is an element that is systematically forgotten but without a healthy population there can be no healthy economy. The priority for 2017 should be to place health at the heart of any strategy, which is not easy.

Q: To what extent are doctor’s consultancies in pharmacies a solution or an externalization of the problem of health access

A: Their existence tells us many things. It is a phenomenon that appeared spontaneously to solve problems that should have been resolved by the government. However, waiting times are shorter and care is personalized, inexpensive and close. They are a tool that depends on us to make them favorable or harmful. There are about 15,000 offices and they must be taken into account. Now, ethical principles have to be established as well as a register of patients and greater communication, among other elements. FUNSALUD wants to make a substantive proposal in this regard in 2017 in which we will try to bring together government, academia and industry to conclude a document in 2018. Emphasis should be placed on the first level of care.