Dr. Armando Ahued
Secretary of Health
Mexico City
View from the Top

Healthcare in the Capital: A Challenge and a Opportunity

Sat, 09/05/2015 - 12:34

Q: In your opinion, what would constitute the most significant challenges currently faced by the Mexican healthcare system?

A: The changing face of the healthcare industry within Mexico City presents complex issues requiring innovative strategies and solutions, which constitute both a challenge and an interesting opportunity. Demographic and epidemiologic transitions already represent a significant burden for both the public and private healthcare system in Mexico. Population aging directly impacts healthcare systems as a direct result of the rise of chronic and degenerative diseases such as diabetes, hypertension, cardiovascular and cerebrovascular diseases, cancer, and metabolic diseases. This generates a greater need for specialists, resources, and technology, exacerbating the strain on the Mexican healthcare budget and representing a significant challenge for the country due to its focus on a reactive treatment model rather than on the implementation of effective strategies for prevention. The healthcare system must undergo several transformations in order to address this shifting epidemiology. As a result, our strategy focuses on prevention, health promotion, early detection, and effective adherence of patients to treatments. We have implemented a more proactive model aimed at preventing chronic conditions and providing medical care in a timely way. In order for Mexican population to be able to comply with guidelines for healthy balanced lifestyles, education is a priority.

Q: What strategies have you implemented in order to address these aforementioned chronic healthcare issues?

A: An important factor in addressing this crisis is acknowledging that the responsibility for healthcare not only lies with the authorities; any strategy must be implemented at a grassroots level within the family. It is crucial to empower the public with the necessary knowledge and capacity for self-treatment by stimulating the modification of inherent lifestyle habits. One of my main agendas as Mexico City’s Secretary of Health has been the incorporation of obligatory healthcare education at schools. This way we are addressing the issue in an integral and intrinsic way at a young age, before unhealthy habits can become ingrained. For example, we have implemented a program called “SaludArte” aimed at demonstrating effective tooth brushing techniques since the principal pathology in the country, and a chronically overlooked issue, is oral health. We are also integrating education about healthy and unhealthy foods, as well as portion control. As part of this program, we have enforced guidelines to make schools cavities-free and we recently declared a school with 1,700 students free of cavities. The promotion of healthy eating habits and oral hygiene at a young age is invaluable to foster a generation of healthy grownups and to prevent chronic problems caused by an overwhelmingly overweight and obese population.

Q: In terms of the obesity crisis, what measures have been taken during your administration to tackle the growing strain placed on the healthcare system by chronic degenerative diseases?

A: Mexico currently has the highest level of childhood obesity and the second highest level of adult obesity, which constitutes a sanitary emergency due to its correlation to chronic and degenerative diseases. There is overwhelming evidence to suggest that seven of the ten main causes of death, including certain cancers, are associated with obesity. As a result, addressing this problem would greatly alleviate the strain on the healthcare system. Mexico City’s government is employing several measures, including traffic light guides on food packaging to indicate nutritional value and installing water fountains in schools to lower soft drink consumption. Subsequently, a law was issued specifying that water is to be offered in restaurants for free. To promote physical activity we are currently increasing the number of urban gyms in public spaces from 600 to 1,000. We also promoted small positive lifestyle changes with the installation of machines inside subway stations to dispense tickets to anyone who completes 10 squats. Within the subway system, we have another program called “Ola Blanca” to measure blood pressure. Finally, our program “Menos sal, más salud,” in collaboration with the Mexican Association of Restaurants, enforced the removal of salt from restaurant tables to combat consumption levels, a major cause of hypertension.

Q: The Mexican Genome Project found that unique genetics within the Mexican population create higher susceptibility to diabetes. Which implications does the disease have for the population?

A: Diabetes is the second highest contributory factor to mortality after cardiovascular diseases. Mexicans inherently carry some genes associated to type 2 diabetes, the onset of which is associated with an unbalanced diet, high sugar intake, and sedentary lifestyle. Treatment for consequences such as dialisis throughout the progression of the disease can cost up to MX$2,000 per session becoming a major burden for both private and public healthcare. Raising awareness of the disease among patients is crucial for alleviating risk factors during early stages through lifestyle changes and adherence to treatment. Unfortunately, studies have found that seven out of ten people neglect to make these changes despite being provided with information regarding potential complications. Concern rises only after the disease has progressed irreversibly, despite the fact that early interventions bear lower costs and are more effective.

Q: Mexico has low cancer screening rates - what efforts are being made to create a more preventative mindset?

A: We have implemented sizable campaigns promoting prostate cancer detection as preemptory testing is not carried out in 85% of men and 99% of people never undergo a colonoscopy. Thus cancer is diagnosed at advanced stages when it has already metastasized. Early cancer detection increases treatment options and the possibility of curing it. As for breast and cervical cancer, 65% of women fail to be tested on a regular basis in Mexico despite the prevalence of units providing prostate-specific antigen tests, mammography studies, and ovarian ultrasounds for free. We have 12 clinics conveniently situated at subway stations and two in the Supply Center in Mexico City that carry out daily tests, but clearly there are more needs to be done to combat poor detection rates.

Q: What strategies have you implemented to increase access to healthcare services within Mexico City?

A: In Mexico City we have two complementary healthcare systems; the Law of Gratuity covers 90% of the public and Seguro Popular 80%. Seguro Popular covers costs accrued by catastrophic diseases with the national institutes of health and the hospitals of the Ministry of Health, while Gratuity offers primary and secondary level care in clinics and in the 32 secondary public hospitals in Mexico City. The Law of Gratuity states that those who live in Mexico City with no access to social security are automatically granted access to free medical consultations, medication, laboratory tests, medical imaging tests, hospitalization, and surgeries as well as to all health promotion, prevention, and early detection programs. In the medical units at subway stations checkups are performed, complemented by laboratory and medical imaging tests to detect the 66 most prevalent diseases in Mexico. Hematic biometry, blood chemistry, general urine examination, pharyngeal exudate, electrocardiogram, prostate-specific antigen test, mammography, Papanicolaou test, and ovarian ultrasound are provided at no cost. The challenge remains on increasing access to create a universal healthcare system.

Q: One of your most successful programs is “El médico en tu casa.” What gaps was this designed to address and what results has the program generated?

A: “El médico en tu casa” stemmed from an urgent need to reduce neonatal and maternal mortality in the delegations of Iztapalapa and Gustavo A. Madero. We began to map the demographic with a door-to-door initiative, and realized that the health problem in Mexico extended beyond pre- natal care. The program began with a staff of 3,000 medical professionals and later extended to the 16 delegations of Mexico City. Since the program started in September 2014 we have visited 1,660,000 homes and have provided treatment for 103,000 people in vulnerable conditions, 17,000 people living with disabilities, 90,000 elderly people confined to their homes, 900 bedridden patients, 140 terminal patients receiving palliative care, and 90 people who have been abandoned. Of the 19,618 pregnant women we have treated so far, 6,700 had previously never received pre-natal checkups, even on the second or third trimester, largely due to a lack of education about the importance of these visits. We also implemented the Law of Anticipated Will which allows terminal patients the option to die at home, provided with palliative care and medical staff. Recently, the National Polytechnic Institute (IPN) announced that 3,600 of its physicians will participate in this program. The government plans to audit every home in Mexico City, so even those with social security are not being overlooked. I am extremely optimistic this initiative will provide medical support to the most vulnerable members of society.

Q: In terms of your legacy, how would you characterize your mindset towards the Mexican healthcare sector?

A: While all issues related to health are multi-faceted, complex, and in constant flux, efforts to address them should be consistent and comprehensive. We are considering the possibility of opening two new general hospitals, a clinic for HIV/AIDS, a geriatric clinic, and remodeling ten health centers. We are committed to continue working to change the public mindset to incorporate healthy habits. Provided the public begin to lead a healthy, balanced, responsible lifestyle, the pressure on the healthcare system can be alleviated greatly. Our proactive healthcare model is setting the foundations for future administrations to focus on prevention and health promotion and we have been pioneers in issuing laws designed to protect vulnerable members of society and guaranteeing more comprehensive access to healthcare services.