‘Health is the milestone of any society’. The former minister of health and former dean of Mexico’s most important university discusses the vision behind the creation of thought-leading institutions such as FUNSALUD and Inmegen, his perspective about the upcoming healthcare reform and the challenges to overcome.
You are one of the most prominent personalities within the healthcare sector in Mexico: you propelled the creation of FUNSALUD (the Mexican Health Foundation) and became its president, were dean of the UNAM (the National Autonomous University of Mexico), and minister of health. How did you get so involved with public health issues and what keeps you busy these days?
That’s an excellent question! I started seeing health as an important issue to address because I noticed a severe scientific and technological lag going on in our country. After my study abroad experience in Wisconsin, which at the time was the epicenter of many biochemical breakthroughs, I wanted to bring back to Mexico everything I had absorbed and, to my surprise, had the great luck of being appointed as director of biomedical research at the UNAM to help our beloved university towards the pursuit of modernity and innovation in the medical field.
What keeps me busy nowadays is writing my memoirs, which are going to be published in 2015 by the UNAM. I used the little time I had over the past few years to start them and have to admit it has been a great hobby. In addition, since 2012 I have been working at ISSSTE (the Institute for Social Security and Services for State Workers) as president of the Medical and Scientific Advisory Council created in 2007 to monitor the evolution of the institution over time.
According to the University of Pennsylvania, today FUNSALUD is one of the best 30 think tanks worldwide with regard to health policy. What was the idea behind the creation of the foundation?
FUNSALUD’s mission – which has always been and will always be – is to contribute to the improvement of health in Mexico. The foundation is an autonomous non-profit civil association, which brings together government, private industry and academia and is at the service of the Mexican population. The foundation tries to develop and promote an understanding of the reciprocal relationship between the economy and health, for the purpose of raising the level of wellbeing of our country and, consequently, promote competitiveness, innovation, efficiency, as well as social and economic development. Indeed, its main focus is to provide practical solutions rather than theoretical rants. For this reason FUNSALUD has always supported research, the training of high-level human resources and technological development.
Since its creation in 1985 the Foundation has been a point of reference with regard to health and extremely active as an advisor within the Mexican decision making spheres. Only in recent times, it has been the breeding ground of three ministries of health along with vice ministers and projects, such as the public insurance scheme Seguro Popular, which was a tremendous reform and a great example of a state policy intended to increase health coverage. Fortunately, health programs in Mexico have had a lot of continuity over the last years, independently on the ruling government, so you will find great cohesion and consistency in the basic blueprints and ideas.
You were also actively involved in the Human Genome Project (HGP) and the creation of Inmegen (the National Institute for Genomic Medicine). How did this happen?
The HGP is the largest collaborative international research project to this day, which started back in 1990 funded by the US government to sequence and map all of the genes – together known as the genome – of members of the human species. The project was completed in 2003 and gave us the ability to read the nature’s complete genetic blueprint of a human being. Mexico got involved in the project at the end of the nineties and actively participated in some aspects of the decoding of the human genome.
When this revolutionary project finalized, at FUNSALUD we wanted to take advantage of the new discoveries in those unknown areas, so decided to gather 20 well-respected geneticists specialized in fields such as molecular and population genetics, and create a consortium of genomic medicine involving the ministry of health, the UNAM, CONACyT (the National Council for Science and Technology) and FUNSALUD. Thanks to grants and funding from private companies we launched a feasibility study on how to bring genomic studies to Mexico and the outcome in 2004 was the creation of Inmegen by the National Legislative Body.
The ministry of health, headed by Dr Mercedes Juan, has implemented a strong national strategy plan aimed at preventing overweight, obesity and diabetes and we have seen that also FUNSALUD is actively involved in these issues. What kind of project is the Foundation involved with?
Mexico is undergoing a fast and dramatic change in its epidemiological profile. According to the National Health Survey carried out in 2012, seven out of ten Mexicans are suffering from overweight and cardiovascular diseases while diabetes is among the leading causes of death. At FUNSALUD we have been particularly interested in joining the various efforts that have been undertaken for the study, treatment, control and prevention of child obesity, promoting child health through changes in lifestyle and including physical activity habits. Since 2007 we have worked along with Coca Cola, Pepsi, and Cadbury, which contributed with funding and resources for the creation of the ‘Child Obesity Project’, whose main objectives are: identify risk factors related with child obesity, analyze the supply of food and beverages in the establishments for school consumption at basic education facilities, study patterns of physical activity among schoolchildren, increase the knowledge regarding effective interventions at a national and international level for control and prevention of child obesity.
The project also consisted in documenting the factors related to overweight and obesity in the school environment. In the years that followed the documentation of this information and with the help of the previously mentioned companies, we developed several lines of research: study of genetic and environmental factors related to child obesity and availability of foods and drinks at Mexico City schools. In addition, two academic forums have been developed to foster the exchange of knowledge between Mexican and international scientists. The lectures presented in these forums have been published in a special supplement of the scientific journal ‘Advances in Nutrition’. As we speak, the project was renamed ‘Active and Healthy Child’ in order to adopt a preventive, inclusive and positive context.
Rumors has it that the next reform at the doors is the healthcare reform, thought to create a national health system where all Mexicans can take advantage of healthcare services, independently of their affiliation. As a key opinion leader of the healthcare sector in Mexico what would you recommend to the government for this upcoming reform?
There is a handful of things that I would recommend to the government – things to do and some to avoid. First and foremost, because every mistake that you make is a step back, you should seek for perfection, even if it is humanly impossible to reach it. The more you work hard towards perfection, the closest your system will be to being stable and functional. Back in the day we lost a lot of momentum and efficiency due to the lack of an adequate dialogue platform: we were always fighting and arguing instead of getting to a useful elucidation for national health problems. I hope that no one follows those steps. Fortunately, nowadays the ministry of health acts as a mediator and, unlike the old days, people have created better and more dynamic ways of communication.
What I recommend is to always stay alert and to call for compliance in all health-related matters because health is the milestone of any society. In the past there was a lot of inequality because half of the population was not affiliated to any healthcare institution; this unfairness was extremely poisonous and detrimental for our society. For this reason I strongly recommend to allocate more resources to health. In 1993 the World Bank published a book that, for all intents and purposes, acted as a benchmark; this book was called ‘Investing in health’ and pinpointed the importance of seeing health as an investment and not as an expenditure. When I was younger, the access to healthcare services was elevated to constitutional status and this is and should always the government’s commitment to its citizens.
What are some of the greatest challenges the Mexican healthcare sector has to overcome to become really universal and what is your vision about the healthcare sector in Mexico in future?
A great issue in Mexico is the segmentation of our system, a phenomenon, which occurs in a similar way in many of our Latin American neighbors. Three main institutions cover more than 90 percent of our population: if we let people choose among those three options through universal healthcare coverage, this will lead to a healthy competition to see who can provide the best service. I see that as something extremely positive that can take our health care system to a whole new level.
Also, people should have access to healthcare services just for being Mexicans and nothing else. There shouldn’t be aberrations such as first-class or second-class citizens based on their affiliation to a healthcare provider because we don’t have to think of health as an investment, but as a social right. In a system, as the name implies it, many variables and institutions converge to form a greater organization. The same should happen with the healthcare system in Mexico and we should look forward towards portability of healthcare services so that people can make an informed choice about where they want to receive appropriate healthcare services.
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