Country Report: Mexico
Mexico is a democratic and representative republic located in southern North America. It borders the United States, Guatemala, and Belize. It has 32 autonomous states and 2,456 municipalities. In 2016, the population was 119.5 million, 77.8% of whom were living in urban areas.
The population grew by 39.6% between 1990 and 2016, with a marked increase in the aging population and a reduction in the under-20 population. Some 7.2% of the population is aged 65 or over, with projections for 2050 at 21.5%. Life expectancy at birth is 72.6 years for men and 77.8 for women; the inter-census survey of 2015 showed that 21.5% of the population is considered to be indigenous and 1.2% is of African descent.
Basic health and development indicators improved systematically between 1990 and 2015, with a Human Development Index score of 0.756 in 2013.
With a nominal gross domestic product (GDP) of 17.39 trillion Mexican pesos in 2015, the country’s economy is one of the 20 largest in the world. The service sector represents around 62.0% of GDP.
- Along with other sectors and institutions, the Secretariat of Health has developed effective policies and interventions designed to improve health determinants.
- The National Anti-Hunger Campaign, a strategy targeting people living in extreme poverty and those with food deficiencies, was implemented in 2013. This strategy consisted of 70 federal programs across 1,012 municipalities.
- An inter-secretarial commission, created to implement the strategy, includes 16 secretariats, the National Commission for the Development of Indigenous Peoples, the National Institute of Women, and the National System for Integral Family Development.
- Between 2013 and 2015, this strategy managed to increase access to health services from 9.2% to 32.9% and to reduce the rate of nutritional deficiencies in the target population to 42.5%.
- The social inclusion program “Prospera” targets the population living in extreme poverty. This program provides monetary transfers based on education, health, nutrition, and income levels. Various sectors and entities participate in the program.
- Launched in 1988, the name and objectives of this program have changed a number of times. In 2014, it was renamed “Prospera” and assumed the mandate of job creation and the inclusion of women in productive activities.
Figure 1. Distribution of the population by age and sex, Mexico, 1990 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2014
Source: Pan-American Health Organization, World Health Organization, and PAHO Health Information Platform (PHIP).
SELECT BASIC INDICATORS
Source: UN Population and Statistics Divisions, 1990; PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.
SOCIAL DETERMINANTS OF HEALTH
- The informal economy employs 57.8% of the economically active population, generates 24% of GDP, and is not covered by social security. In 2015, the wealthiest 1% of the population accounted for 21% of the national income, which causes inequalities.
- In 2015, mean schooling was 9.1 years. The percentage of the population living in poverty in 2014 was 46.2% (61.1% in rural areas and 41.7% in urban areas) and the percentage living in extreme poverty was 9.5%.
- In 2010, 76.4% of the population were homeowners, a proportion that had declined to 67.7% by 2015.
- In 2010, some 86,357 tons of urban solid waste were collected. A full 93.0% of the country’s solid waste is sent to treatment plants; however, there still are dumps in open areas such as roads, glens, ravines, and streambeds.
- In 2014, 26.6% of immigrants in the United States were of Mexican origin. Mexico is also a transit country for Central Americans heading to the United States.
- The majority of disasters are caused by tropical storms and hurricanes, which have major economic and health impacts. In 2013, tropical storms Ingrid and Manuel combined to produce an intense and prolonged storm. Economic losses totaled US$ 4,816 billion, the second highest figure since the 1985 earthquake.
- Approximately 500,000 hectares of forest and jungle area are degraded annually, especially by changes in land use and illegal logging.
- Air pollution constitutes a public health problem. This is why the country has established 176 stations for monitoring atmospheric particles, ozone, sulfur dioxide, nitrogen dioxide, and carbon monoxide.
- Total health expenditure represented 6.2% of GDP in 2012; however, in 2015 it declined to 5.6%.
- According to the the Mexican Social Security Institute (IMSS), some 35.4 million people were affiliated with the IMSS, 7 million with Institute of Safety and Social Services for Government Workers (ISSSTE), and 49.8 million with the System for Social Protection in Health (SPSS). Nevertheless, the National Council for the Evaluation of Social Development Policy reported in 2014 that 18.2% of the population experienced difficulty accessing health services.
- Mexico has 12 free trade agreements with 46 countries, the United States being its principal trading partner.
HEALTH SITUATION AND THE HEALTH SYSTEM
- In 2015, maternal mortality was 34.6 deaths per 100,000 live births. In states with the highest levels of marginalization (Chiapas, Guerrero, and Oaxaca), maternal mortality was at least 55 deaths per 100,000 live births.
- Some 95.6% of births are attended by trained personnel; from 2009 to 2014, 46 out of every 100 deliveries were by cesarean section.
- In 2015, mortality in children under 1 year of age was 12.5 deaths per 1,000 live births, and 15.1 in children under 5. Half of deaths during the first year of life are caused by disorders in the perinatal period and a quarter are caused by congenital malformations.
- The national vaccination schedule includes vaccines against 14 diseases. In 2015, 87.0% of the population was covered. In 2012, the National Population Council adjusted population projections and increased its figure for the number of children under 5 who should be immunized. With this change in the denominator, the coverage figure for 2013 fell to 83.0% for the third dose of the diphtheria-pertussis-tetanus (DPT) vaccine. Since then there has been an increase in coverage, reaching 87.0% in 2015.
- The last case of rubella was reported in 2010 and the last confirmed case of neonatal tetanus occurred in 2011. Between 2011 and 2015, annual cases of whooping cough in children under 5 ranged between 252 and 1,107.
- In 2014, the group of circulatory system diseases caused 25% of deaths, endocrine system diseases caused 17%, and neoplasms caused 13%.
- From 2010 to 2015, some 364,014 cases of dengue were reported, with a case-fatality rate of 0.52% in 2015. Around half the cases occurred in three states (49% of the cases).
- In the first nine months of 2016, there were 514 confirmed cases of chikungunya and 4,306 confirmed cases of Zika virus (of which 2,087 were pregnant women).
- In 2013, 184 cases of cholera were reported and in 2011, 1,106 cases of malaria.
- A total of 538 cases of leishmaniasis were reported in 2010, and 6 cases of human rabies transmitted by vampire bats were recorded between 2010 and 2011.
- A total of 980 diagnosed cases of Chagas disease were reported in 2015. The number of diagnosed cases has increased due to the epidemiological surveillance strategy implemented in blood banks.
- Each year, more than 19,000 cases of tuberculosis occur, 80% of which is pulmonary TB.
- In 2014, there were 15,885 confirmed deaths (13.3 deaths per 100,000 population) caused by road crashes; 51.7% of them involved motor vehicles and pedestrians.
- In 2015, there were 14.0 homicides per 100,000 population. Guerrero had the highest homicide rate: 56.5 per 100,000 population.
- The most prevalent illnesses among older people were hypertension (40.0%), diabetes (24.3%), and hypercholesterolemia (20.4%). Mental health problems, including depression, are also more prevalent in that age group.
- Diabetes mellitus, ischemic cardiopathy, and cerebrovascular diseases are the leading causes of years of healthy life lost.
- 5.1% of the population suffers from some degree of disability, primarily due to disease (39.4%), old age (23.0%), and congenital factors (16.0%). In 2014, 54.1% of people with disabilities lived in a state of poverty and, as a result 51.1% showed a low educational level.
- In 2012, the national prevalence of low height-for-age in children under 5 was 13.6%, with 0.4% severe malnutrition.
- 16.7% of men and 18.1% of women do not meet the minimum levels of physical activity recommended by WHO. In all age groups, women had a higher prevalence of physical inactivity.
- The Secretariat of Health, through the General Health Counsel, which includes the Secretariats of Education and Finance, is the entity responsible for creating and executing national policy on social welfare, medical services, and public health. The National Health Council oversees coordination with the states.
- The public sector has different social security institutions, such as the Mexican Social Security Institute (IMSS), the Institute of Safety and Social Services for Government Workers (ISSSTE), Petróleos Mexicanos, the Secretariat of National Defense, the Secretariat of the Navy, and others. These institutions provide services to workers in the economy’s formal sector.
- In addition, the System for Social Protection in Health (SPSS), the Secretariat of Health, the State Health Services, and the IMSS Prospera program serve the population not covered by social security. The private sector provides services to the population that is able to pay.
- Total health expenditure represented 5.6% of GDP in 2015. Public spending was 51.0% of this amount. Out-of-pocket expenditures represented 4.0% of household spending.
- In 2015, Mexico had 2.2 physicians and 2.6 professional nurses per 1,000 population, including professionals in the private sector. There is a significant disparity in the distribution of human health resources in the country.
- The various health system institutions provide diverse health information, although they still lack a unified and consolidated system of information that can integrate health information among the different states and institutions.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- The National Agreement toward Universalization of Health Services reflects the political will to improve access to health services for the entire population. Its implementation will require institutional strengthening in health and health information systems, in addition to guaranteeing the distribution of resources throughout the country, with emphasis on primary care.
- Maternal mortality will continue to be a high-priority problem. Care should be taken to ensure monitoring and evaluation of current programs, such as community transportation brigades, maternal shelters, access to and coverage of family planning methods, best practices in prenatal care and delivery, and surveillance of cesarean section births. This will also require an intercultural approach to obstetric issues, a focus on gender equality, and action to promote empowerment and exercise of the right to health as a basic human right.
- As a result of the efforts made and the trends observed, we hope to achieve the elimination of some neglected diseases, such as leprosy, malaria, and rabies, by establishing common objectives among the sectors involved in addressing social determinants of health, national development goals, and the Sustainable Development Goals.
- Intersectoral policies have been formulated for the purpose of preventing and controlling noncommunicable chronic diseases. These policies integrate the promotion of healthy practices, quality of care, regulation, and legislation.
- The National Agreement to Combat Obesity and Overweight; the National Strategy for the Prevention and Control of Overweight, Obesity, and Diabetes; the implementation of front labeling for high-caloric-content foods; and regulations on the advertising of unhealthy foods during peak viewing hours for children all require mechanisms to evaluate their success, along with a stronger regulatory framework for sanctioning noncompliance.
- Given the rapid growth in the older population, preserving functional capacity is a priority concern. This requires incorporating specialized services for older people and providing long-term sustainable care.
- The General Directorate of Health Information established a Technological Platform for the formation of the National Basic Health Information System, in order to standardize the criteria and procedures used in processing health data. This initiative was in the implementation phase in 2016.
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