This is an exclusive preview of the 2015 edition of Mexico Health Review. If you want to get all the information, plus other relevant insights regarding the Mexican health and pharmaceutical industry, get your copy of Mexico Helath Review 2015.
Exclusive interview with María Eugenia Bonilla-Chacín, Senior Economist for Health of the World Bank
Q: The World Bank’s mission is to eradicate poverty. In many ways, health is wealth, so 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: 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 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: 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.
Q: Of the Mexican population, 16% have no access to any kind of medical insurance. What strategies should be undertaken to solve this problem and to reduce out–of–pocket spending in general?
A: A knock-on effect generated by fragmentation of the health system is the major inequality in entitlements and quality of care across the different state health insurance schemes such as IMSS, ISSSTE, Seguro Popular, and so on.Despite improvements in financial protection against ill health, about half of spending on health constitutes out-of-pocket (OOP) expenditure, given the weaknesses in the quality of care provided by public health facilities. This latter failurerelates especially to early detection and control of NCDs. In principle, the population with no access to social security coverage is eligible for Seguro Popular insurance. However, even universal insurance coverage would not fully eliminate OOP spending. This would require an increase in the range of services offered by Seguro Popular, which would currently be problematic given the current fiscal situation. Reducing OOP payments also requires health facilities to provide prescribed pharmaceutical products covered by insurance schemes.