Pablo Kuri Morales
Undersecretary of Prevention and Health Promotion
Ministry of Health (SPPS)
View from the Top

Public Health Central to National Wealth

Sat, 09/05/2015 - 13:33

Q: What is the most concerning aspect of Mexico’s epidemiological profile?

A: The major challenge in Mexico seems to be the rise in non-communicable diseases, as well as the prevalence of emerging and reemerging diseases, meaning that resources within the health sector must be optimized. The Mexican public health system registers 44 million diagnoses per year, of which about 26 million constitute respiratory diseases and five million gastrointestinal diseases, while urinary tract infections are the third most prevalent. Despite the fact that chronic diseases such as hypertension and diabetes account for only the fourth highest diagnostic rate, they are the leading cause of death in the country. While the SPPS identifies and addresses the problems, these conditions often arise because of a lack of communication, education, or finances, and as a result it is necessary to develop comprehensive approaches to alleviate the impact of these problems.

Q: What actions are required in order to address these problems effectively?

A: We must ensure that universal coverage becomes a reality, which means creating a system where people have comprehensive access to treatment instead of being insured in name only. Preventive medicine, quality of medical care, and effective access to healthcare services must be developed in order to support universal coverage to all services, devices, and medicines. The main objective is to work alongside medical professionals, doctors, nurses, and social workers, providing constant training while providing motivation through new incentives. Physicians and nurses are generally concentrated in large cities, with little incentive to move and work in rural areas, a personnel shortage which is exacerbated by the fact that we do not have a proper evaluation system to analyze the quality of work and provide adequate incentives.

Q: What are the actions that need to be carried out in order to increase the diagnosis of chronic diseases?

A: Mexico does not have a diagnostics problem, the main issue is that we have to secure universal coverage, where people have real access to the system instead of being insured in name only. Three pillars are needed to support universal coverage of all necessary services, devices, and medicines: preventive medicine, quality of medical care, and effective access to healthcare services. The objective is to work alongside medical professionals, doctors, nurses, and social workers, who have to be constantly trained. Physicians and nurses are generally concentrated in large cities for several reasons, such as financial gain, access to proper training and facilities, and recognition, so there is no encouragement to move and work in rural areas. Also, we do not have a proper evaluation system to analyze the quality of their work and properly incentivize them.

Q: What would such an evaluation system look like?

A: Since many people work in rural communities, it is more difficult for us to evaluate their performance and measure the impact of the healthcare policies that we are implementing. In order to provoke change, we are working to establish an independent system, which will be operated and coordinated by the Autonomous University of Nuevo Leon (UANL). The university is currently finalizing the three strict indicators that will be applied to all the policies implemented by the government and when complete, these will be applied comprehensively across the Mexican states. While Mexican states are decentralized, their health strategies are aligned to the national strategy and since July 2014, when this program became a priority, we have become aware of the contributions of each Mexican state to the national goal. We published a baseline for this information at the end of the second quarter of 2015, which will now be updated every six months.

Q: In what other ways can communication be facilitated in order to ensure resources are not squandered?

A: There is a problematic lack of communication between states and between different levels of government, such as Secretariats of Health in each state and federal authorities, as well as information breakdowns between the managerial level and operational level within the states. This is why we are making an integral effort to improve our communication strategy, and since communication greatly depends on individual authority, this problem can be solved by strong leaders. We hold meetings every 45 days to communicate the necessary guidelines that the states must follow, and these meetings are complemented by national annual or bi-annual conferences. Current technologies also allow us to hold meetings remotely.

Q: What prevention programs is the SPPS currently implementing, and how are they structured?

A: One of our famous media campaigns is named “Chécate, Mídete, Muévete” (Check Yourself, Measure Yourself, Move Yourself), which constitutes the first phase of an awareness raising project about the importance of monitoring health indicators, and will be complemented by a second phase in which we offer implementation techniques. Another program included changes to Article 3 of the Mexican Constitution to prohibit the sale of unhealthy products in schools. We are also developing care networks for diabetic patients, with demonstrative projects in 21 states, and while these only cover primary or secondary care, they also work as an outreach program for people in remote communities. Moreover, there is a pilot program underway to create electronic registrations for all patients and we have also changed regulations to prohibit all advertisements of sugary beverages to children while creating a new tax structure for these products.

Q: On what basis are the prevention programs created?

A: Public healthcare policy requires consistency as each administration inherits the legacy of that which precedes it, and this government has certainly built upon the experiences of previous ones. Due to feedback from international forums provided by organizations such as the WHO, the majority of health programs may be reinvented or relaunched, using experiences from national and global best practice. However, addressing healthcare challenges is not solely a government responsibility and requires a considerable contribution from society as a whole.

Q: How are the funds collected from the sugar tax being distributed to promote health?

A: Due to previous issues with similar public programs, general taxes such as these cannot be earmarked for a specific purpose. A small percentage of the proceedings collected from the sugar tax were given to public schools, a contribution that must be complemented by municipalities acting to enforce federal regulations and monitor the products sold in schools. Article 114 of the Mexican Constitution stipulates the duties of municipalities, and these terms include protecting the health of their citizens, which is an issue that presently lacks a committed approach. For example, the prevalence of obesity in children would be greatly reduced if families were adequately educated about healthy eating, and the nutrition problem tends to be a more concentrated in urban areas, where many parents are not at home for meals and cannot consistently monitor the products consumed by their children. In large cities, it is also difficult for children to walk to school due to a complex number of factors, making them more reliant on cars, and although there have been initiatives to solve this, more attention is required.

Q: What are the most challenging issues when implementing prevention programs?

A: The main problem is a lack of personal responsibility and we must educate the public to take responsibility for their health and that of their families. For instance we provide information about risks associated with vector- borne diseases, and its pervasiveness within unhygienic environments with accumulation of garbage. We have also observed that implementation varies greatly from program to program and easier initiatives to implement are generally those for which only environmental changes are required, such as using insecticides to kill mosquitoes carrying dengue fever, and due to administration of a single injection, vaccination programs tend to be straightforward. We find that is it more difficult to impact ingrained habits and influence people to make long-term, significant lifestyle changes, even to the detriment of their health.

Q: Which strategies will be implemented to prevent chronic diseases from consuming the public health budget?

A: We already allocate a significant proportion of the healthcare budget to treatment of chronic diseases and addressing their further reaching implications. We know that 70% of Mexicans are overweight, the majority of whom will subsequently present symptoms of chronic diseases at some point in their lives. At the current rate, it appears that complications caused by these diseases will consume the budget and even require exponentially increased healthcare expenditure. Although the problem has existed for many years, Mexico is only now beginning to react by changing healthcare guidelines, but several decades are required in order to truly have positive impacts and invert the trends. Our current strategies are modest but we have formulated three realistic and comprehensive goals, the results of which can only be measured over the long term. We want to reduce the speed at which these diseases grow, increase the number of people receiving adequate treatment, and implement prevention strategies across Mexico. Other groups have tried to launch strategies to combat chronic diseases, but providing medicine alone will prove an ineffective method without the cooperation of the Mexican public in changing inherent lifestyle habits, and the incorporation of environmental and social determinants.