Social determinants of health in Mexico

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Social determinants of health in Mexico are factors that influence the status of health among certain populations in Mexico. These factors consist of circumstances in which people grow, live, work, and age, as well as the systems put in place to deal with illnesses.

Contents

In Mexico, the health inequality among the population is influenced by such social factors. In the past decade, Mexico has witnessed immense progress within their health care system that has allowed for greater access to health care and a decrease in mortality rate, yet there are still various health inequalities caused by social factors.

Flag of Mexico Flag of Mexico.svg
Flag of Mexico

Definitions

Social determinants of health are useful when identifying risk factors that affect the health of an individual or group. Health is defined as "the overall condition of someone's body or mind". [1] As accessed by the World Health Organization, some major determinants of whether one is healthy or not include "the social and economic environment, the physical environment, and the person's individual characteristics and behaviours". [2] Social determinants of health, as described by the World Health Organization, include income and social status, education, social support networks, health services, gender, employment status and conditions, and race and ethnicity. [2]

Poverty

In Mexico, poverty is reported using the Multidimensional Poverty Index and the Human Development Index. Together, these indicators suggest the overall poverty gradient of Mexico. The government's social development agency reported a 0.6 percent drop of Mexico's poverty rate from 2010 to 2012, but there are still 53.3 million people under the poverty line. [3] A major effect of this poverty rate is the continuation of a huge wealth gap. [4] Although there is a huge gap between the top ten percent and the bottom ten percent, Mexico has seen an increase in the percentage of Mexicans who are within the middle-class category. [5] [6]

The poverty within Mexico can be separated into two categories: moderate and extreme. Both categories total to about 45.5 percent of the total population of 117.3 million people. [7] According to El Consejo Nacional de Evaluación de la Política de Desarrollo Social, also known as Coneval, there was a decrease in the percent of the Mexican population in extreme poverty, but an overall increase in the number of people that fall under the poverty line. [7] The study showed that the extreme poverty rate fell from 11.3 percent to 9.8 percent, while the moderate poverty rate increased from 34.8 percent to 35.6 percent.

The correlation between poverty and health can be described as a negative relationship in which as poverty increases, health decreases. [8] With a low income, families do not have the desired access to nutrition, resources, and health care as well as a means to reach these necessities.

Gender

Gender is a major factor that influences the health inequity among the Mexican population. There's a certain gender bias within general health and specific diseases. Gender inequality can be described as "the departure from parity in the representation of women and men in key dimensions of social life." [9] In Mexico, machismo still affects many parts of the country and the effect that it has on gender roles in a patriarchal society. According to the World Health Organization, a major step towards improving the overall health of the population would be gender empowerment. [10] According to the 2012 National Survey of Health and Nutrition (ENSANUT), 38 percent of Mexican women aged 20–29 suffer abuses at home with more than 34.9 percent in public. [11] With results like these, Mexico witnesses a huge gender bias that could explain major problems that emerge from within the household as well as those that partake in the work force. In the Mexican work force, women generally receive lower wages than men, even with educational levels taken into consideration. [12] The median wage for female skilled technicians is 97.3 percent of what their male counterparts make, teachers with 97.6 percent, and female industrial supervisors make 68.4 percent of what males make in that same field. [12] The gender inequity can be emphasized with the fact that there has not been "a female head of state and has had very few female cabinet members." [12] This explains the "26 percent of equality with men in the political sphere" and that of "42 percent within the economic and legal spheres." [9] This gender inequality produces a gender bias that favors men. Women then lack the necessary access to resources such as medical care, transportation, and nutrition. [8]

Education

Level of educational attainment is a major determinant of health in Mexico. More education generally leads to increased income, better employment opportunities, and improved living conditions; these, in turn, lead to improved health. [10] The educational system in Mexico has witnessed low enrollment as well as low student-achievement. [13] According to the United Nations Educational, Scientific, and Cultural Organization (UNESCO) Institute for Statistics, 99% of children are enrolled in pre-primary school. [14] Furthermore, 96% of girls and 95% of boys are in primary school. [14] Evaluating data on secondary schools across the nation, only 69% of girls and 66% of boys are enrolled in secondary education. [14] The data also shows that 28% of the population of tertiary age are in tertiary education. [14]

The low enrollment can be correlated with the need for Mexican families to utilize all means to an income and having the whole family seek employment, even at a young age. [13] A factor that can affect the low student-achievement is the matter of children lacking focus as a result of nutritional deprivation. [13] Health indirectly influences education in the same way that education indirectly influences the health of an individual.

Location

Location affects overall health and "chances of leading flourishing lives". [10] Location affects the daily living conditions that people endure which in turn affects health equity. There are various differences between urban and rural living conditions. [10] According to the 2011 Latin American Report on Poverty and Inequality, over the past decade, both national and urban inequality have decreased, yet rural inequality has increased. [15] World Bank data reports that about 61% of those living in rural areas live in extreme poverty. [15] The major causes for such social and economic gaps between these two sectors come from "a manifestation of spatially-differentiated patterns of economic development". [15] [16] A major factor to such disparity is the "absence of rural development policy planning", especially because the "highest public spending on rural development benefits the country's richest states". [15] [16]

Urban

Urban areas seem to be overpopulated with almost one-third of the population living in four major metropolitan areas-20 million people living in Mexico City alone. This major urbanization represents the differences in living standards as well as access to health and social services. The lack of adequate housing within urbanized cities represents a major problem.

According to research conducted by the Office of Population Research at Princeton University, the main causes of mortality in rural areas are infectious diseases and malnutrition. [17] Moreover, chronic disease and other health problems associated with industrialization dominate mortality within urban areas. [17] A report from the World Health Organization states that about 32% of the total urban population in Latin America dwell in slums. [10] Slums do not provide the best access to sufficient living conditions. The same report details "the shift in population levels of weight towards obesity" due to nutrition transition that begins in cities. [10]

Rural

Rural regions in Mexico comprise more than 80% of the land and house around 37 million people (36% of the population). [18] These statistics confirm that Mexico is the country with "the largest population [that lives] in predominantly rural areas" within the Organisation for Economic Co-operation and Development. [18] Additionally, the standards of living in rural populations are much lower than its urban counterpart and the gap is larger than OECD standards. [18] The major drawbacks are the lack of good shelter, adequate drainage, and access to electricity. [18] Within dispersed rural areas, about 68% of the houses had a solid floor, 52% had drainage, yet 87% had electricity. [18]

Malnutrition

In August 2020, Dr. Hugo López-Gatell, Undersecretary of Health Prevention and Promotion, criticized the poor diet of many Mexicans, emphasizing the need to cut down on or leaving out soft drinks and junk food. He said that good health is more dependent upon good nutrition than on going to health clinics for medicine, and he called soft drinks "bottled poison." [19]

Dr. Simón Barquera, director of Center for Research of Nutrition and Health of the Instituto Nacional de Salud Pública (National Public Health Institute, INSP) said that more sugary drinks are consumed than fruits and vegetables. He noted that 75.1% of Mexicans are overweight, and that obesity increases the severity of COVID-19 by 47%. "México se encuentra en medio de una sindemia de mala nutrición y COVID-19 que requiere acción inmediata" ("Mexico is in the midst of a poorly nutritioned syndemia and COVID-19 that requires immediate action"), he added. [20]

Oaxaca [21] and Tabasco [22] were the first two states to prohibit the sale of soft drinks and junk food to children and teens under 18. [23]

Steps for improvement

In the mid-1990s, the Secretaría de Desarrollo Social introduced the Oportunidades program (formerly known as PROGRESA), which is a multi-sector policy that brought upon conditional cash transfers. [18] Oportunidades dispenses money directly to poor households in return the families send their children to school, health services, and provide them with better nutrition by attending classes. [18] [24] [25] Results from a study published in 2004 show that there have been improvements in overall health associated with better outcomes in child health, growth, and development. [18] [24] [25] [26]

SEDESOL logo 2012 SEDESOL logo 2012.svg
SEDESOL logo 2012

In 2003, Mexico's Congress enacted reforms to Mexico's health legislation that aimed at making health care available nationwide. [27] Mexico's former Minister of Health, Julio Frenk, as the original architect, implemented Seguro Popular which has insured 52.6 million previously-uninsured Mexicans. [27] With the implementation of this universal health care, more Mexicans can now access the health services in their community. [27]

In 2008, the World Health Organization's Commission on Social Determinants of Health developed a plan of action to tackle the problems that social determinants of health have on health equity. The recommendations consist of "improving daily living conditions, tackle the inequitable distribution of power, money, and resources, and measure and understand the problem and assess the impact of action." [10]

See also

Related Research Articles

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Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. It is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle.

Feminization of poverty refers to a trend of increasing inequality in living standards between men and women due to the widening gender gap in poverty. This phenomenon largely links to how women and children are disproportionately represented within the lower socioeconomic status community in comparison to men within the same socioeconomic status. Causes of the feminization of poverty include the structure of family and household, employment, sexual violence, education, climate change, "femonomics" and health. The traditional stereotypes of women remain embedded in many cultures restricting income opportunities and community involvement for many women. Matched with a low foundation income, this can manifest to a cycle of poverty and thus an inter-generational issue.

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The social determinants of health (SDOH) are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk or vulnerability for a disease or injury. The distribution of social determinants is often shaped by public policies that reflect prevailing political ideologies of the area.

Diseases of poverty are diseases that are more prevalent in low-income populations. They include infectious diseases, as well as diseases related to malnutrition and poor health behaviour. Poverty is one of the major social determinants of health. The World Health Report (2002) states that diseases of poverty account for 45% of the disease burden in the countries with high poverty rate which are preventable or treatable with existing interventions. Diseases of poverty are often co-morbid and ubiquitous with malnutrition. Poverty increases the chances of having these diseases as the deprivation of shelter, safe drinking water, nutritious food, sanitation, and access to health services contributes towards poor health behaviour. At the same time, these diseases act as a barrier for economic growth to affected people and families caring for them which in turn results into increased poverty in the community. These diseases produced in part by poverty are in contrast to diseases of affluence, which are diseases thought to be a result of increasing wealth in a society.

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  2. Promote conditions and interventions that address these determinants, aiming for a healthier and more equitable society.

Conditional cash transfer (CCT) programs aim to reduce poverty by making welfare programs conditional upon the receivers' actions. The government only transfers the money to persons who meet certain criteria. These criteria may include enrolling children into public schools, getting regular check-ups at the doctor's office, receiving vaccinations, or the like. CCTs seek to help the current generation in poverty, as well as breaking the cycle of poverty for the next through the development of human capital. Conditional cash transfers could help reduce feminization of poverty.

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References

  1. ↑ Merriam-Webster.com. "Health" . Retrieved 20 October 2013.
  2. 1 2 World Health Organization (2013). "The determinants of health" . Retrieved 19 October 2013.
  3. ↑ Cohen, Luc (July 29, 2013). "Mexico's poverty rate dips but little cheer for the needy: report". Reuters. Retrieved 19 October 2013.
  4. ↑ BBC News (October 26, 2004). "Mexico has 'giant wealth divide'". BBC News. Retrieved 18 October 2013.
  5. ↑ Canadian Centre for Policy Alternative (May 22, 2012). "Mexico's middle class gaining from economic growth; Canada and the U.S. trailing". Canadian Centre for Policy Alternatives News Releases. Retrieved 20 October 2013.{{cite news}}: |author= has generic name (help)
  6. ↑ William Booth; Nick Miroff (December 19, 2012). "As Mexico claws toward prosperity, some in middle class slide back". Washington Post. Retrieved 19 October 2013.
  7. 1 2 Redaccion Animal Politico (July 29, 2013). "1.4 millones de mexicanos dejan la pobreza extrema entre 2010 y 2012". Animal Politico. Retrieved 17 October 2013.
  8. 1 2 Mosley, W. Henry; Lincoln C. Chen (1984). "An Analytical Framework for the Study of Child Survival in Developing Countries". Population and Development Review. 10 (2). Population Council: 25–45. doi:10.2307/2807954. JSTOR   2807954. PMC   2572391 . PMID   12756980.
  9. 1 2 Frias, Sonia (2007). "Measuring Structural Gender Equality in Mexico: A State Level Analysis" (PDF). Springer Science+Business Media B.V. Retrieved 17 October 2013.
  10. 1 2 3 4 5 6 7 World Health Organization (2008). "Closing the Gap in a Generation- Health equity through action and the social determinants of health" (PDF). Geneva: World Health Organization. Retrieved 19 October 2013.
  11. ↑ JP Gutiérrez; et al. "Encuesta Nacional de Salud y Nutricion: Resultados 2012" (PDF). Instituto Nacional de Salud Pública.
  12. 1 2 3 Rhoda, Richard. "Female quality of life in Mexico" . Retrieved 19 October 2013.
  13. 1 2 3 Santibanez, Lucrecia; Georges Vernez; Paula Razquin (2005). Education in Mexico: Challenges and Opportunities. Santa Monica, CA: RAND Corporation.
  14. 1 2 3 4 United Nations Educational, Scientific; Cultural Organization. "Education (all levels) profile - Mexico" . Retrieved 20 November 2013.
  15. 1 2 3 4 IFAD (2012). Poverty and Inequality: Latin American Report 2011. Santiago, Chile: IFAD. ISBN   978-956-9153-03-7.
  16. 1 2 IFAD (2012). Rural poverty in Mexico (PDF). IFAD.
  17. 1 2 Smith, Kimberly; Goldman, Noreen (October 2007). "Socioeconomic differences in health among older adults in Mexico" (PDF). Social Science & Medicine. 65 (7): 1372–1385. doi:10.1016/j.socscimed.2007.05.023. PMID   17618717. Archived from the original (PDF) on 2007-06-10.
  18. 1 2 3 4 5 6 7 8 OECD (2007). OECD Rural Policy Reviews: Mexico 2007. OECD Publishing. ISBN   9789264011526.
  19. ↑ "López-Gatell carga en contra de los refrescos y comida chatarra (VIDEO)". Radio Fórmula (in Mexican Spanish). 19 July 2020. Retrieved August 21, 2020.
  20. ↑ "Mapa del coronavirus en México 21 de agosto: incrementan defunciones en Veracruz, Puebla y BC". infobae (in European Spanish). Retrieved August 21, 2020.
  21. ↑ "Oaxaca es el primer estado del país que prohíbe la venta de comida chatarra a niños". infobae (in European Spanish). Retrieved August 21, 2020.
  22. ↑ "Tabasco, segundo estado que prohíbe venta de comida 'chatarra'". Excélsior (in Spanish). 18 August 2020. Retrieved August 21, 2020.
  23. ↑ ""Son los motores de la epidemia de obesidad": López-Gatell rechazó que empresas de comida chatarra participen en creación de políticas públicas". infobae (in European Spanish). Retrieved August 21, 2020.
  24. 1 2 Levy, Santiago (2006). Progress Against Poverty: Sustaining Mexico's Progresa-Oportunidades. Brookings Institution Press. ISBN   9780815752219.
  25. 1 2 Rivera, JA; D Sotres-Alvarez (June 2004). "Impact of the Mexican Program for Education, Health, and Nutrition (Progresa) on Rates of Growth and Anemia in Infants and Young Children: A Randomized Effectiveness Study". JAMA. 291 (21): 2563–70. doi:10.1001/jama.291.21.2563. PMID   15173147.
  26. ↑ Fernald, Lia C.H.; Paul J Gertler; Lynnette M Neufeld (8 March 2008). "Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico's Oportunidades" (PDF). The Lancet. 371 (9615): 828–837. doi:10.1016/S0140-6736(08)60382-7. PMC   2779574 . PMID   18328930.
  27. 1 2 3 Frenk, Julio (August 16, 2012). "The quest for universal health coverage: achieving social protection for all in Mexico" (PDF). The Lancet. Retrieved 16 October 2013.
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