CHRONIC DISEASES INCREASING IN URUGUAY

UNCLAS MONTEVIDEO 000107 SIPDIS WHA/BSC FOR MDASCHBACH OES/IHB FOR LISA MILLER E.O. 12958: N/A TAGS: SOCI TBIO KPAO WHO UY SUBJECT: CHRONIC DISEASES INCREASING IN URUGUAY REF: STATE 002172 ¶1. SUMMARY: In response to reftel, post prepared the following report to examine the impact of chronic diseases (or Non-Communicable Diseases, NCDs) in Uruguay and to inform the Department about policy related developments and the capacity of the local health sector to address those diseases. Uruguay exhibits characteristics of a developed country, with its aging population and increasing percentage of deaths caused by chronic diseases, but its antiquated health care system impedes it from reacting to the changing needs of its citizens. With over 90 percent of the Ministry of Public Health's budget dedicated to health care services, programs in prevention and health care promotion are severely lacking. Still, Uruguay is a leader in cancer research, and is currently working to reform the system to better respond to the evolving needs of the population. End Summary. Background -------------- ¶2. Uruguay is a middle-income country with a population of approximately 3.33 million. Throughout most of the second half of the 20th century, Uruguay boasted high health status indicators compared to other developing countries. Today, according to GOU data, average life expectancy at birth is 76 years, the infant mortality rate is 13.34 per 1,000 live births, 99 percent of births are delivered in a hospital or clinic, and 98 percent of the population has access to an potable water. While it remains among the top-ranked countries of the Latin American and the Caribbean (LAC) region in the UNDP Human Development Report, Uruguay's relative position has slipped in the past few years from a ranking of 40 in 2000 to a ranking of 47 in 2007. Uruguay: An Aging Population with an Unhealthy Lifestyle -------------- -------------- ¶3. Uruguay's demographic structure has changed over the last decades. With 13.5 percent of the population being older than 65 and 54 percent of the population over 31 years of age, while only 23 percent are younger than 15, Uruguay has become the 'oldest' country in the Western Hemisphere. The estimated median age was 32.8 years in June 2008, putting it in line with almost every developed nation in the world. Population growth is almost flat. Several factors have contributed to the aging of Uruguay's population, including decreasing fertility and mortality rates, as well as a strong emigration flow during the last decades. ¶4. Concomitantly, Uruguay's epidemiological profile has completed its transition from infectious diseases to NCDs. The burden of disease has changed mainly due to the aging of the population, unhealthy lifestyles, risky behavior, and changes in the social and economic environment. Chronic illnesses are now the main health problem in Uruguay, currently claiming more deaths than infectious diseases. Health Sector Reform to Address NCDs -------------- ¶5. While Uruguay allocates a large portion of its income to the social sectors, the bulk of the social spending is concentrated in social security and health, largely driven by the aging of the Uruguayan population. Consolidated (private and public) health related expenditures were estimated at 8.1 percent of the country's GDP for 2005, according to the WHO. The high level of health expenditures is due to several factors including: technological change, an exceedingly complex institutional structure with overlapping responsibilities and inadequate incentives for efficiency, a highly regulated physician labor market that undermines the ability of health organizations to control their personnel costs, and a delivery system that is not well matched to the health needs of the population. ¶6. The examination of the allocation of the Ministry of Public Health's (MPH) budgetary resources points to the insufficient allocation of resources for health care prevention and promotion. Most resources are allocated to health care services (93.6 percent of the 2006 health budget). The remaining resources are absorbed by administrative costs (6.2 percent) with only a negligible amount being assigned to health promotion and preventive care (0.2 percent). In the medium and long term, the insufficient attention given to health prevention results in an increase in high-cost treatments for a large proportion of patients, thus generating additional health costs and consequences that could have otherwise been avoided. ¶7. Until now, health reform initiatives in Uruguay had concentrated on financial and design problems. Efforts were never focused on improving the health system's response to the areas where the disease burden was highest. As a consequence, the Ministry of Public Health (MPH) does not have a complete set of the basic tools to address NCDs effectively, including appropriate information systems, epidemiological surveillance and monitoring systems, and a health promotion and prevention policy. ¶8. The Vazquez Administration, with financial assistance from the World Bank (a USD 25.2 million Specific Investment Loan),is currently implementing a major health care system reform, the pillar of which has been the creation of an Integrated National Health System (INHS). Such a system was designed to identify a basic package of comprehensive health services to be provided by public and private health care providers alike. An important component of the health reform focuses on strengthening the MPH's ability to carry out the essential public health functions: regulation and stewardship, health promotion and prevention, and epidemiological surveillance and monitoring. The Prevalence of NCDs in Uruguay -------------- ¶9. In Uruguay, 100 percent of deaths are recorded, and all death certificates are completed by a physician. According to the latest (2004) GOU figures, almost 32,000 people died in the country in ¶2002. NCDs were responsible for an estimated 80 percent of those deaths. The major NCDs affecting the Uruguayans were cardiovascular diseases (32.8 percent of all deaths),cancer (24.4 percent), chronic respiratory diseases (3.5 percent),and diabetes mellitus (2.1 percent). In fact, Uruguay has already reached the level of NCDs projected by the WHO for Latin America in 2020. ¶10. In 2006, Uruguay's MPH conducted a national survey aimed at identifying the main risk factors that lead to NCDs in Uruguay. The study focused on four behavioral risk factors (tobacco consumption, over consumption of alcohol, unhealthy diet habits, and lack of physical activity) as well as four biological risk factors (overweight, high blood pressure, high blood sugar level, and abnormal blood lipids level). ¶11. The survey found that many Uruguayan smoke regularly, are relatively inactive, are overweight, have high blood pressure and high cholesterol, and most do not eat as many fruits and vegetables as they should. Only 1% of Uruguayans were found to have low risk of NCDs. Thirty eight percent of the adults 25-44 years old present an elevated risk (at least three risk factors). Adults 45-64 years old present an elevated risk also (63 percent). In other words, while any Uruguayan strategy to combat NCDs should have as its immediate, highest priority the middle-aged segment of the population, the young adults segment also demands urgent attention. Addressing the Impact of NCDs -------------- ¶12. The Government has already begun to implement several outreach and health care programs to improve coverage of NCDs in public hospitals, including programs for: diabetes, hypertension, and cervical and breast cancer prevention. ¶13. New initiatives are also being implemented as a result of international cooperation. For example, Uruguay had no chronic disease surveillance capacity in the past. In 2002 Uruguay sent a team of physicians to be trained at the CDC in Atlanta. Upon their return, an Epidemiology Surveillance Unit was established. The Unit is in the process of designing a national chronic disease surveillance system for Uruguay. ¶14. Also, Uruguay has been selected to take part in NCI's Office of Latin American Cancer Program Development's pilot initiative to advance relevant cancer research and training programs. Uruguay's selection to participate is notable given the size of the other participation countries: Brazil, Argentina, Mexico, and Chile. Its participation will elevate Uruguay's visibility as a country capable of cutting edge technology. ¶15. The GOU has also taken regulatory measures to prevent harm from tobacco through the legislative approval and implementation of "The Framework Convention on Tobacco Control (FCTC)." Uruguay became the first country in Latin America to pass anti-smoking legislation, perhaps an unsurprising step considering that President Vazquez is a practicing oncologist. Prior to the law's implementation, GOU data indicated that smoking was causing 5,500 tobacco-related deaths a year. "Passive smoking is also linked to chronic disease and premature deaths. Since there's not a secure level of exposure, the best thing to do is to ban cigarettes in enclosed places," argued Vazquez. To help promote his smoke-free plan, the president launched a campaign called "A Million Thanks," which is a reference to the number of Uruguayan smokers (31 percent of the population). A Long Road Ahead -------------- ¶16. Despite the changes in its epidemiological profile and the higher prevalence of NCDs, Uruguay's health system has made only a few adaptative changes. The health care system is still organized to attend acute illnesses rather than chronic illness. The World Bank estimates that 22 percent of all deaths and 32 percent of the deaths among those younger than 65 years old are avoidable. ¶17. As a result of limited health promotion activities, general knowledge about NCDs is relatively low, particularly among low-income population groups. The intensive use of basic public health tools to address NCDs could render rapid improvements in health status. Massive public health campaigns aimed at promoting healthy lifestyles and the early detection of high-risk diseases such as diabetes, hypertension and high cholesterol could have a considerable impact on reducing health care costs and increasing the quality of life of many Uruguayans. Support for prevention measures is likely to be broad, as the population views an increased focus on promotion and prevention as positive. MATTHEWMAN