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At The Intersection of Health, Health Care and Policy
At The Intersection of Health, Health Care and Policy
At The Intersection of Health, Health Care and Policy
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Vladimir Canudas-Romo is an
associate professor at the
Max-Planck Odense Center on
Biodemography of Aging,
T
he second half of the twentieth cen- from 9.5 homicides per 100,000 people in 2005
University of Southern
Denmark, in Odense.
tury was marked by major improve- to more than 22.0 per 100,000 people in 2010.6
ments in health, living standards, As a result, there was a reduction of about 0.6
and mortality in most Latin Ameri- year in male life expectancy in the period
can countries.1 But these improve- 200010.5
ments have been reversed in recent years, as Importantly, the stagnation in life expectancy
Latin American countries have experienced a occurred during a time of substantial changes in
marked increase in homicide rates in the 2000s.2 national public policies to improve the health
After six decades of sustained improvement in status of the Mexican population. Mexico imple-
life expectancy, Mexico experienced stagnation mented an ambitious and comprehensive health
in this indicator between 2000 and 2010 as a care reform in 2004, called the Seguro Popular
result of an unexpected increase in homicides de Salud (Popular Health Insurance). The pro-
(particularly of people ages 1550) and an antic- grams goal is to provide universal coverage to
ipated increase in deaths due to diabetes3 the uninsured population.7 Empirical evidence
(among people ages forty and older). However, suggests that the Seguro Popular has led to im-
these changes were accompanied by reductions provements in the equitable distribution of
in mortality from causes of death at young ages health resources, with increased coverage for
(for example, perinatal conditions).4,5 the uninsured.8 These improvements were ac-
The increase in homicides is at the heart of life companied by reductions in catastrophic and
expectancy stagnation for males in Mexico be- out-of-pocket expenditures9 and increases in fi-
tween 2000 and 2010. Homicide rates increased nancial protection for the beneficiaries in the
population (see Appendix Table 2).18 curity) and private health institutions and partly
Limitations Our study had several limita- due to changes in health risk factors (for exam-
tions. First, there are likely to be inaccuracies ple, smoking status and diet).22 However, the
in cause-of-death mortality figures because of substantive increase in health care coverage
coding practices.19 To reduce these inaccuracies, through the Seguro Popular8 also probably
we focused on deaths before age seventy-five and played a major role in this period.
used broad cause-of-death categories from the Fourth, our estimated effects of homicide mor-
most recent ICD classification (ICD-10). tality on life expectancy are likely to be a lower
Second, we used the concept of avoidable mor- bound instead of the actual impact of homicide
tality as a proxy to capture the effect of the Se- on the average length of life because of the un-
guro Popular on a set of causes of death. This derestimation of homicide deaths resulting from
The authors thank Sergio Aguayo for his Population Research at the University of analysis, and interpretation of data, or
comments on an earlier version of the California, Los Angeles (Grant No. R24- the writing of the article and the
article. Jos Manuel Aburto was HB041022), and the Center for decision to submit the article. Beltrn-
supported by funding from the National Demography of Health and Aging at the Snchez and Aburto were responsible
Council of Science and Technology. He University of WisconsinMadison (Core for the conception and design of the
and Victor Garca-Guerrero were Grant Nos. R24HD047873 and study and for the analysis and
supported by funding from the Center P30AG017266). Vladimir Canudas-Romo interpretation of the data, and they
of Demographic, Urban and was supported by the European wrote the first draft of the article.
Environmental Studies at El Colegio de Research Council (Grant No. 240795). Garca-Guerrero and Canudas-Romo
Mxico. Hiram Beltrn-Snchez was The funding sources had no influence on participated in the revision of the draft
supported by the California Center for the study design, data collection, and approved the final version.
NOTES
1 World Health Organization. The la violencia en Mxico. Mexico City: scape. 2015,17(1):3550.
world health report 2000health Secretara de Seguridad Pblica; 13 National Institute of Statistics and
systems: improving performance 2012. p. 51103. Spanish. Geography. Administrative registers
[Internet]. Geneva: WHO; 2000 7 Frenk J. Sistema de proteccin social of deaths [Internet]. Aguascalientes:
[cited 2015 Nov 3]. Available from: en salud, elementos conceptuales, The Institute; [cited 2015 Nov 3].
http://www.who.int/whr/2000/en/ financieros, y operativos. Mexico Available from: http://www.inegi
2 United Nations Office on Drugs and City: Secretara de Salud; 2005. .org.mx/est/contenidos/proyectos/
Crime. Global study on homicide Spanish. registros/vitales/mortalidad/default
2011 [Internet]. Vienna: UNODC; 8 Parker S, Ruvalcaba LN. Identifica- .aspx. Spanish.
2011 [cited 2015 Nov 3]. Available cin y anlisis de los efectos en las 14 Nolte E, McKee CM. Measuring the
from: https://www.unodc.org/ condiciones de salud de los afiliados health of nations: updating an ear-
documents/congress/background- al Seguro Popular. Mexico City: lier analysis. Health Aff (Millwood).
information/Crime_Statistics/ Centro de investigacin y docencia 2008;(27)1:5871.
Global_Study_on_Homicide_2011 econmicas; 2011. Spanish. 15 Nolte E, McKee M. Does health care
.pdf 9 King G, Gakidou E, Imai K, Lakin J, save lives? Avoidable mortality re-
3 Barquera S, Tovar-Guzmn V, Moore RT, Nall C, et al. Public policy visited [Internet]. London: Nuffield
Campos-Nonato I, Gonzlez- for the poor? A randomised assess- Trust; 2004 [cited 2015 Nov 3].
Villalpando C, Rivera-Dommarco J. ment of the Mexican universal Available from: http://www.nuffield
2003. Geography of diabetes melli- health insurance programme. Lan- trust.org.uk/sites/files/nuffield/
tus mortality in Mexico: an epide- cet. 2009;373(9673):144754. publication/does-healthcare-save-
miologic transition analysis. Arch 10 vila-Burgos L, Servn-Mori E, Wirtz lives-mar04.pdf
Med Res. 2003;34(5):40714. VJ, Sosa-Rub SG, Salinas-Rodrguez 16 Elo IT, Beltrn-Snchez H, Macinko
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Conciliacin demogrfica de Mxico el gasto en salud en hogares mexi- and other interventions to black-
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cides and diabetes mellitus. J Epi- (24)6:146776. Appendix link in the box to the right
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