María Eugenia Bonilla-Chacín
Senior Economist for Health
World Bank
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Sustainability Reducing Poverty Through Public Health Investment

Sat, 09/05/2015 - 12:50

Q: The World Bank’s mission is to eradicate poverty. Few would argue with the sentiment that health is wealth - what role does health promotion play in reaching your objectives?

A: Increased income growth improves health outcomes, and improvements in health have a positive impact on wealth. Both are required for the sustainable reduction of poverty. Investments in public health, childhood nutrition programs, and early childhood development have important positive impacts on cognitive and non-cognitive skills. The knock-on effects include improved learning capacities, increased school completion rates, better labor market outcomes, and greater productivity. Moreover, the latter two increase individual incomes, society’s incomes, and adult health outcomes.

Q: What are the highlights of the Country Partnership Strategy for Mexico?

A: The Mexico Country Partnership Strategy (CPS) covers the fiscal years from 2014 to 2019 and is aligned with the goals of Mexico’s National Development Plan (NDP) for 2013-2018. It suppports the Mexican government’s development agenda for increased productivity and inclusive and sustainable growth. The CPS fosters the corresponding goals of ending extreme poverty and promoting sustainable, shared prosperity. To promote an integrated social protection system, the CPS not only fosters integration of the health sector, but the plan extends to improving the functioning of the health system, especially primary care, as concerns the shift from acute illness response to the prevention and control of chronic conditions. The latter tend to be non-communicable diseases (NCDs), such as diabetes and heart disease, which relate in particular to obesity.

Q: How would you summarize the current health situation in Mexico, and what are the main challenges to ensuring the right quality of care for all its citizens?

A: Mexico has achieved important gains in health outcomes over the last decades, with reductions in maternal and child mortality, and the control of communicable diseases. Between 1960 and 2012, average life expectancy in Mexico increased by 17 years, according to data from CONAPO. Challenges remain, however, and the aging of the population and the burden of NCDs, such as diabetes, cardiovascular diseases, and cancers, is quickly intensifying. Disability-adjusted life years lost (DALYs) are a measure of overall disease burden, referring to the life expectancy years lost due to ill-health, disability, or early death. According to our research in 2013 with the Institute for Health Metrics and Evaluation (IHME), the three leading causes of DALYs are diabetes, ischemic heart disease, and chronic kidney disease. Thanks to the creation of Seguro Popular, the country has also made significant development in access to health services and in financial protection against catastrophic health expenditure. Regardless, the country faces important challenges to ensure better health outcomes and financial protection in case of ill health. Large inequalities in outcomes and healthcare resources exist across federal entities and the health system as a whole remains fragmented, causing inefficiencies in the use of resources. Internal organization is subject to the same inefficiency.

Q: What specific strategies should Mexico implement to eradicate poverty and promote health?

A: Mexico already has experience with programs aimed at eradicating poverty, particularly through Prospera, the renowned conditional cash transfer program, where cash transfers provided to poor families are contingent upon children going to school and receiving preventive health care services. In addition, Seguro Popular was created to improve health outcomes and ensure financial protection against the costs of illness among those with no social security coverage, who are more likely to be poor. This program has been successful in improving health insurance coverage, health care utilization, and financial protection among its beneficiaries. However, there are still significant gaps in improving effective coverage of services by enhancing the quality and thus the effectiveness of the services provided to improve health outcomes among the poor. In addition, there is a need to generate fiscal space to be able to progressively increase the package of services covered by this program, particularly those covered by the Fund for Protection against Catastrophic Health Expenditure.

Q: Mexico’s epidemiological profile has switched from infectious to chronic degenerative diseases. What is the World Bank’s strategy to tackle this problem?

A: Our knowledge base and financial services, as well as our ability to bring various stakeholders together, mean that the World Bank can support health systems in preventing and controlling NCDs. As a multisector institution, the World Bank can support countries in the design and implementation of population-based interventions. These strategies focus on NCD-related risk factors such as unhealthy diets, physical inactivity, tobacco use, and alcohol abuse. The World Bank also supports several countries around the world to strengthen health surveillance systems which monitor NCDs and their risk factors. Finally, the World Bank supports several countries in reforming health care networks to ensure early detection and control of these conditions. Many health systems in the developing world were designed to respond to acute episodes of illness and to provide maternal and child care, but not to be proactive in ensuring the health of the population under their responsibility, a model that is unsuited to early detection of chronic conditions, clinical prevention, or to coordinated care across health providers. In this context, the World Bank Group supports several countries in changing the care model to one which adheres to these conditions, as well as supporting chronic patients in their self-treatment.

Q: Mexico’s obesity crisis is causing a spike in chronic diseases. What can be done to improve nutrition education amongst poor communities?

A: Mexico’s obesity crisis is playing a major role in the rise of chronic diseases and many developing countries are facing this issue. There is no magic pill to prevent and control obesity. Nevertheless, a number of promising policies have proven to be effective in improving diets and promoting physical activities with some directly affecting Body Mass Index. The Mexican government has implemented many promising policies aimed at halting the increasing prevalence of obesity in the country, including a comprehensive national strategy for the prevention and control of overweight, obesity, and diabetes.

This strategy has three pillars. The public health aspect includes surveillance, health promotion, education, and prevention. The other batch of policies seeks to improve access to services for the prevention and control of NCDs. Finally, cultural change requires regulation and fiscal policy, including new food-labeling regulations, controls on marketing foods to children, and taxing sugar-sweetened beverages and high-calorie foods of low nutritional value. The World Bank Group is prepared to support these and any other activities aimed at helping to halt the increase in obesity in Mexico.