PURPOSE

Community initiatives for healthy aging in Mexico.

BACKGROUND
At first we shall define healthy aging as the process of promoting and
maintaining a functional capacity that allows welfare in old ages.
Nevertheless is not easy to reach such concept, we need to deal with the
main problems in health systems that are not only from Mexico but
throughout the world, this challenges fall within three major categories:
demographic transition, epidemiological transition and the
current economic status on health.

Demographic transition
Mexican people is living longer, life expectancy at birth increased from
41.5 years in 1940 to 74.3 years in 2012. The amplified longevity
frequency, together with a significant diminution in the fertility rate
(which decreased from 6.1 children per woman in 1939 to 2.2 children
per woman in 2012) are both causes to have a population ageing.
Taking into account the previous statement and having in mind that
Mexico is a growing, heterogeneous, multifaceted and complicated
society, not only for its population, customs, religion or ethnicity but also
for its miscellaneous geographic and climatic conditions, makes
irrefutable that Mexico has several societies within one.
Its complicated to establish a uniform health policy to try to
homogenize what is unequal.

Epidemiological transition
Transition from infectious to chronic degenerative diseases.
Mexico still suffers from diseases befitting of poor countries,
characterized by the coexistence of malnutrition and infectious diseases
(gastrointestinal and respiratory), consequence of high levels of
marginalization in entities such as Oaxaca, Chiapas and Guerrero.
(CONAPO 2013b)

Chronic diseases begins to cause a significant number of deaths as of 20

years old people and has a stronger rate in 65 or older people. The
prevalence of overweight and obesity, as well as an unhealthy life style
are the root of diabetes mellitus and ischemic heart diseases being the
main cause of death among the adult population. Other great impact
illnesses in this life stage are liver cirrhosis and chronic obstructive
pulmonary disease which can be caused for an excessive consumption of
alcohol and tobacco respectively.

Current economic status on health

Mexico allocates to health matter 6.2% of its GDP compared to and
OECD average of 8.9%. That said, our country has the important task to
generate policies that offset the high inflation in medical supplies.
The reality about the social health protection EL SEGURO POPULAR
is that it only covers the Universal Catalog of Health Services CAUSES
(for its acronym in Spanish), this include 275 consult interventions,
urgencies, hospitalizations and nine catastrophic health expenditures.
This means that the patient must pay for the treatment of all not
included diseases in the catalog. Furthermore, a big amount of people do
not have access to the healthcare given by El Seguro Popular due to
the inexistence of such services nearby their addresses and travel costs
are not covered by the institution.
Most hospitalizations covered by the policies are related to childbirth and
newborn and those due to urgencies, but some principal causes of death
such as strokes, cirrhosis, nephrosis and nephritis, and serious trauma
injuries are not included in this matter. As for the surgery issue, the
service includes abdominal hernias, gynecological and prostatic
procedures, some orthopedic disorders and minor surgeries.
The seven catastrophic health expenditures in adults are cataract,
antiretroviral treatment for HIV, non-Hodgkin lymphoma and cervical,
breast and testicular cancers which are, in terms of death from cancer,
less relevant that the ones in the respiratory tract, liver or
gastrointestinal system. Along with the listed 7 catastrophic health
expenditures we also find heart attacks but this only applies to people
under 60 years old, leaving out 80 percent of the victims. The catalog
also considers bone marrow and corneal transplantation taking them as
interventions not sicknesses.
This places Mexico among the countries that has and provides most
healthcare coverage, but out-of-pocket spending is twice as much as the

ones registered in most of the countries enumerated in OECD, which is

close to the 50% of the outlays.
If we add to this profound demographic, epidemiological and nutritional
transition, the lack of population responsibility and the fact that our
health system has prioritized the medic attention over the promotion of
healthcare and disease prevention, its not hard to deduct that all this
resulted in the intensification of chronic non-communicable diseases,
forming one of the main public healthcare financial challenge as this
kind of illnesses are much more expensive and hard to treat than the
common communicable diseases.

ANALYSIS

1st Initiative: Implement the National Initiative for prevention,

treatment, attention and rehabilitation of chronic degenerative
diseases in the elderly people through their community.
Actions:
1.1
Develop permanent educative campaigns about prevention
of chronical non-communicable diseases with national, statal and
local coverage.
1.2
Promote a proper alimentation in an individual, family and
community level through innovative social marketing strategies.
1.3
Promote the importance of exercise in an individual, family
and community level.
1.4
Promote the creation of new places for recreation and
physical activities.
1.5
Adapt surveillance systems for type 2 diabetes mellitus,
hypertension, dyslipidemia, overweight and obesity.
1.6
Promote activities for an early detection of overweight and
obesity.
Due to the rise in the prevalence of chronic degenerative diseases which
are stressed in ages above 65, is mandatory to propose community
initiatives focused in prevention, attention and rehabilitation of such
illnesses in elderly people.

This initiative has a big value considering the high existing levels of
margination in Mexico, however, the condition of scalability would be a
problem due to the fact that the more marginalized the zone could be
the more difficult to implement this initiative would be. The time
execution for this operation would take more than 6 years as result of
the big marginalization some populations have and that our health
system is not universal. Mexico has an obligation to allocate a bigger
GDP percent in healthcare systems and part of this money should be
used to the application of such initiative.
Having in mind that Mexico is progressing day by day, one of the
principal things Mexico will need to do is create the basis of a UNIQUE,
UNIVERSAL, FREE AND PUBLIC system that allows the implementation of
this initiative.

2nd Initiative: Promote a dignified, active, healthy aging and

improve the life quality of elderly people.
Actions:
2.1
Implement actions for the appropriate attention and care of
seniors, coordinated between the community and social programs.
2.2
End up gaps between communities through appropriate
training and multiplier effect in order to ensure a healthy aging.
2.3
Reinforce community programs of prevention, detection and
early diagnosis of diseases making stress in fragility, geriatric and
osteoporosis syndromes and accidents by falls.
2.4
Enlarge community programs of prevention, detection,
diagnosis and early treatment in mental health.
2.5
Increase actions in health promotion in order to achieve
older people to practice self-care.
2.6
Implement mechanisms to ensure that the seniors who
receive universal pension fulfill their part of responsibility.
This initiative is very important because of the fast tendency to be an
old people country that is why is necessary to generate activities to
reduce healthcare spending among the communities. Also, like
mentioned in the first initiative, because of the margination of some

populations, the absence of a universal healthcare system and the lack

of an adequate budget makes difficult to implement this initiative, which
is why this would take more than 6 years to reach the goals.

3rd Initiative: Promote the recruitment and employability of seniors

in their community
Actions:
3.1
Integrate
the
elderly into roles of identity and autonomy (being independents
and capable of making their own decisions) within their
community.
3.2
Generate proper
conditions of security inside their community which allows them to
enjoy and interact with their fellow citizens.
3.3
Generate
potential opportunities for personal growth in their community.
This initiative does not exclude the limitations already described,
however, it can be apply in a period no shorter than 3 years being
directly affected by the budget designated for such task.