miércoles, 8 de febrero de 2012

Health trends in South America: Changes are accelerating as countries get richer

By: Fernando Prada

The epidemiologist profile of the countries of South America is undergoing trough important changes that will put pressure on the existing health systems. Planning for what it comes is the correct strategy.

Every four years, the Pan-American Health Organization (PAHO) publishes “Health in the Americas”, a comprehensive report on regional health trends. The most recent edition,(1)  published in 2007 with data up to 2004, concluded that: “the slowing of population growth, the lengthening of life spans, and the stemming of deaths from communicable diseases and perinatal conditions are among the foremost advances in health in the [Latin American] region.” The future prospects were cause of alarm: “the epidemiological profile in the Americas has undergone significant changes in recent decades (…) and over the next 10 years, deaths from chronic diseases will increase by 17 percent and deaths from diabetes will increase by over 80 percent. [This] is attributable to aging of the population as well as to unhealthy behavior and choices that individuals (…) make related to poor nutrition, overweight and obesity, tobacco and alcohol.” In this article we argue that these trends are accelerating for South American countries, and the impact of changes of the region’s epidemiological profile require urgent policy measures in the next five years.

The average mortality rate fell significantly in most South American countries from 1995 to 2008 (figure 1). The mortality rate in 1995 was 6.9 deaths per 1,000 people and 6.1 in 2008. The decreasing trend is even more pronounced in the case of infant mortality, passing from 43.3 per 1,000 live births in 1995 to 25.7 in 2010. Nevertheless, these improvements are not uniform between all countries. Peru, Chile and Argentina have experienced the most drastic reductions; while the mortality rate in Venezuela, by contrast, rose due to more homicides. In the case of infant mortality, Ecuador and halved the mortality rate of children under the age of 5 during a 15-year period. Despite this progress, their rates in 2010 are still far from those of Chile and Uruguay (Peru=30.6; Ecuador=23.7; Chile=8.3 and Uruguay=14.6).

FIGURE 1. General mortality rate (1995-2008) and under-5 mortality rate (1995-2010)

Source: Pan-American Health Organization http://ais.paho.org/phip/viz/mfr_indicatorserietable.asp 

Changes in epidemiology profiles have two causes: first, a reduction in mortality from communicable diseases such as intestinal infectious diseases, tuberculosis and mother-child transmitted diseases; and second, an increase in chronic diseases like diabetes mellitus, malignant neoplasm and cardiovascular conditions (see figure 2 in next page). These two trends and overall improvements in life expectancy and falling mortality rates mirror previous experiences in developed countries. South American countries need to prepare to make the transition from an epidemiology profile of communicable diseases towards one of chronic diseases, aging population and more complex and expensive treatments.


Source: Pan-American Health Organization http://ais.paho.org/phip/viz/mfr_indicatorserietable.asp

Cheap and widely available treatments and improvements in basic sanitation and health systems have helped reduce the incidence of and deaths from communicable diseases.(2) Moreover, as households in South America are covering a growing share of health expenses, the increase in per capita income has also had a positive effect.(3) Nevertheless, coping with this new epidemiology profile requires long-term reforms like promoting healthier lifestyles, preventing care to detect chronic diseases at the outset and cost-effective treatments to reduce strain on public and household budgets. Countries like China and India are making this transition too, and their response has been to promote the design and adaptation of medical technologies to provide low-cost care.(4)

During the next five years, the incidence of complex diseases will increase. Yet, as health care systems reform to cope with this new epidemiology profile, their mortality related to these diseases will fall, as they already have in Argentina and Chile in the case of diabetes mellitus (figure 2). In addition, costs to the health care system and households will increase since most chronic diseases require long treatments and expensive drugs. Insurance and other coverage schemes currently cover only a small proportion of the population, so public health systems will have to make up for these gaps in order to avoid a high cost in human lives.

International cooperation actors have played an essential role in fostering health policies that focus on reducing communicable diseases (e.g. MDGs), and financing cost-effective solutions to cope with them, especially in the most vulnerable communities. Most countries in South America have now the capacity and knowledge to mobilize resources to tackle this challenge. Thus, cooperation actors future role should pivot to raising awareness about the new epidemiological profile and finding cost-effective solutions to coping with these new challenges.

[1] PAHO (2007), “Health in the Americas 2007”, Scientific and technical publication No. 622, Washington D.C.: PAHO.
[2] Nevertheless, data of incidence of most common communicable diseases (number of cases) is scarce because of underreporting.
[3] There is no available data about household expenses in health treatments. A good proxy is the share of public/private expenses: while the public sector spent 2.6 percent of the GDP in 2008, the private sector contributed with 2.0 in South America (PAHO). 
[4] “Frugal healing: Inexpensive Asian innovation will transform the market for medical devices”, The Economist Jan. 20, 2011.

FIGURE 2. Mortality rates: intestinal infectious diseases and diabetes mellitus (1997-2008)

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