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Orozco-Núñez E, Ojeda-Arroyo E, Cerecer-Ortiz N, Guerrero-López CM, Ramírez-Pérez BM, Heredia-Pi I, Allen-Leigh B, Feeny E, Serván-Mori E. Gender and non-communicable diseases in Mexico: a political mapping and stakeholder analysis. Health Res Policy Syst 2024; 22:46. [PMID: 38605301 PMCID: PMC11007965 DOI: 10.1186/s12961-024-01125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/17/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Mexico and other low- and middle-income countries (LMICs) present a growing burden of non-communicable diseases (NCDs), with gender-differentiated risk factors and access to prevention, diagnosis and care. However, the political agenda in LMICs as it relates to health and gender is primarily focused on sexual and reproductive health rights and preventing violence against women. This research article analyses public policies related to gender and NCDs, identifying political challenges in the current response to women's health needs, and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care in Mexico. METHODS We carried out a political mapping and stakeholder analysis during July-October of 2022, based on structured desk research and interviews with eighteen key stakeholders related to healthcare, gender and NCDs in Mexico. We used the PolicyMaker V5 software to identify obstacles and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care, from the perspective of the political stakeholders interviewed. RESULTS We found as a political obstacle that policies and stakeholders addressing NCDs do not take a gender perspective, while policies and stakeholders addressing gender equality do not adequately consider NCDs. The gendered social and economic aspects of the NCD burden are not widely understood, and the multi-sectoral approach needed to address these aspects is lacking. Economic obstacles show that budget cuts exacerbated by the pandemic are a significant obstacle to social protection mechanisms to support those caring for people living with NCDs. CONCLUSIONS Moving towards an effective, equity-promoting health and social protection system requires the government to adopt an intersectoral, gender-based approach to the prevention and control of NCDs and the burden of NCD care. Despite significant resource constraints, policy innovation may be possible given the willingness among some stakeholders to collaborate, particularly in the labour and legal sectors. However, care will be needed to ensure the implementation of new policies has a positive impact on both gender equity and health outcomes. Research on successful approaches in other contexts can help to identify relevant learnings for Mexico.
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Affiliation(s)
- Emanuel Orozco-Núñez
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | - Enai Ojeda-Arroyo
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | - Nadia Cerecer-Ortiz
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | - Carlos M Guerrero-López
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | | | - Ileana Heredia-Pi
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico
| | - Betania Allen-Leigh
- Center for Population Health Research, The National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Emma Feeny
- The George Institute for Global Health, Sidney, Australia
| | - Edson Serván-Mori
- Center for Health Systems Research, The National Institute of Public Health, 62100, Cuernavaca, Morelos, Mexico.
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Serván-Mori E, Orozco-Núñez E, Guerrero-López CM, Miranda JJ, Jan S, Downey L, Feeny E, Heredia-Pi I, Flamand L, Nigenda G, Norton R, Lozano R. A Gender-Based and Quasi-Experimental Study of the Catastrophic and Impoverishing Health-Care Expenditures in Mexican Households with Elderly Members, 2000-2020. Health Syst Reform 2023; 9:2183552. [PMID: 37014089 DOI: 10.1080/23288604.2023.2183552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Latin America has experienced a rise in noncommunicable diseases (NCDs) which is having repercussions on the structuring of healthcare delivery and social protection for vulnerable populations. We examined catastrophic (CHE) and excessive (EHE, impoverishing and/or catastrophic) health care expenditures in Mexican households with and without elderly members (≥65 years), by gender of head of the households, during 2000-2020. We analyzed pooled cross-sectional data for 380,509 households from eleven rounds of the National Household Income and Expenditure Survey. Male- and female-headed households (MHHs and FHHs) were matched using propensity scores to control for gender bias in systematic differences regarding care-seeking (demand for healthcare) preferences. Adjusted probabilities of positive health expenditures, CHE and EHE were estimated using probit and two-stage probit models, respectively. Quintiles of EHE by state among FHHs with elderly members were also mapped. CHE and EHE were greater among FHHs than among MHHs (4.7% vs 3.9% and 5.5% vs 4.6%), and greater in FHHs with elderly members (5.8% vs 4.9% and 6.9% vs 5.8%). EHE in FHHs with elderly members varied geographically from 3.9% to 9.1%, being greater in less developed eastern, north-central and southeastern states. Compared with MHHs, FHHs face greater risks of CHE and EHE. This vulnerability is exacerbated in FHHs with elderly members, because of gender intersectional vulnerability. The present context, marked by a growing burden of NCDs and inequities amplified by COVID-19, makes key interlinkages across multiple Sustainable Development Goals (SDGs) apparent, and calls for urgent measures that strengthen social protection in health.
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Affiliation(s)
- Edson Serván-Mori
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca, Mexico
| | - Emanuel Orozco-Núñez
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca, Mexico
| | - Carlos M Guerrero-López
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca, Mexico
| | - J Jaime Miranda
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Stephen Jan
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- School of Public Health, The George Institute for Global Health, Imperial College London, London, UK
- Center for Health Economics and Policy Innovation, Business School, Imperial College London, London, UK
| | - Laura Downey
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- School of Public Health, The George Institute for Global Health, Imperial College London, London, UK
| | - Emma Feeny
- School of Public Health, The George Institute for Global Health, Imperial College London, London, UK
| | - Ileana Heredia-Pi
- Center for Health Systems Research, The National Institute of Public Health, Cuernavaca, Mexico
| | - Laura Flamand
- Center for International Studies, The College of Mexico, Mexico City, Mexico
| | - Gustavo Nigenda
- The National School of Nursing and Obstetrics, National Autonomous University of Mexico, Mexico City, Mexico
| | - Robyn Norton
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
- School of Public Health, The George Institute for Global Health, Imperial College London, London, UK
| | - Rafael Lozano
- Health Metrics Science Department. Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Koonin J, Mishra S, Saini A, Kakoti M, Feeny E, Nambiar D. Are we listening? Acting on commitments to social participation for universal health coverage. Lancet 2023; 402:1948-1949. [PMID: 37738996 DOI: 10.1016/s0140-6736(23)01969-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Justin Koonin
- The George Institute for Global Health, Newtown 2042, NSW, Australia; UHC2030, Geneva, Switzerland; Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia; ACON Health, Surry Hills, NSW, Australia.
| | - Shraddha Mishra
- The George Institute for Global Health, Newtown 2042, NSW, Australia; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Amandeep Saini
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Misimi Kakoti
- The George Institute for Global Health, New Delhi, India
| | - Emma Feeny
- The George Institute for Global Health, London, UK
| | - Devaki Nambiar
- Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, New Delhi, India; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Guerrero-López CM, Serván-Mori E, Miranda JJ, Jan S, Orozco-Núñez E, Downey L, Feeny E, Heredia-Pi I, Flamand L, Nigenda G, Norton R. Burden of non-communicable diseases and behavioural risk factors in Mexico: Trends and gender observational analysis. J Glob Health 2023; 13:04054. [PMID: 37326368 DOI: 10.7189/jogh.13.04054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Background There is scarce gender-disaggregated evidence on the burden of disease (BD) worldwide and this is particularly prominent in low- and middle-income countries. The objective of this study is to compare the BD caused by non-communicable diseases (NCDs) and related risk factors by gender in Mexican adults. Methods We retrieved disability-adjusted life years (DALYs) estimates for diabetes, cancers and neoplasms, chronic cardiovascular diseases (CVDs), chronic respiratory diseases (CRDs), and chronic kidney disease (CKD) from the Global Burden of Disease (GBD) Study from 1990-2019. Age-standardized death rates were calculated using official mortality microdata from 2000 to 2020. Then, we analysed national health surveys to depict tobacco and alcohol use and physical inactivity from 2000-2018. Women-to-men DALYs and mortality rates and prevalence ratios (WMR) were calculated as a measure of gender gap. Findings Regarding DALYs, WMR was >1 for diabetes, cancers, and CKD in 1990, indicating a higher burden in women. WMR decreased over time in all NCDs, except for CRDs, which increased to 0.78. However, WMR was <1 for all in 2019. The mortality-WMR was >1 for diabetes and cardiovascular diseases in 2000 and <1 for the rest of the conditions. The WMR decreased in all cases, except for CRDs, which was <1 in 2020. The WMR for tobacco and alcohol use remained under 1. For physical inactivity, it was >1 and increasing. Conclusions The gender gap has changed for selected NCDs in favour of women, except for CRDs. Women face a lower BD and are less affected by tobacco and alcohol use but face a higher risk of physical inactivity. Policymakers should consider a gendered approach for designing effective policies to reduce the burden of NCDs and health inequities.
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Affiliation(s)
- Carlos M Guerrero-López
- Center for Health Systems Research, the National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Edson Serván-Mori
- Center for Health Systems Research, the National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - J Jaime Miranda
- The George Institute for Global Health, UNSW, Sydney, Australia
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Stephen Jan
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Emanuel Orozco-Núñez
- Center for Health Systems Research, the National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Laura Downey
- The George Institute for Global Health, UNSW, Sydney, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Emma Feeny
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Ileana Heredia-Pi
- Center for Health Systems Research, the National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Laura Flamand
- Center for International Studies, College of Mexico A.C, Mexico City, Mexico
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, the National Autonomous University of Mexico, Mexico City, Mexico
| | - Robyn Norton
- The George Institute for Global Health, UNSW, Sydney, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
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Buse K, Bhaumik S, Miranda JJ, Hunnisett C, Batz CS, Feeny E. Individual responsibility: a red herring that lets the fossil fuel industry off the climate catastrophe hook. BMJ 2022; 378:o1656. [PMID: 35790224 DOI: 10.1136/bmj.o1656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kent Buse
- Healthier Societies Program, The George Institute for Global Health, Imperial College London
| | - Soumyadeep Bhaumik
- Meta-research and Evidence Synthesis Unit, The George Institute for Global Health, India
| | - J Jaime Miranda
- Health Working Group Systems Science, The George Institute for Global Health, UNSW, Sydney, Australia
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Chelsea Hunnisett
- Planetary Health Working Group, The George Institute for Global Health, Sydney, Australia
| | - Claudia Selin Batz
- Impact & Engagement, The George Institute for Global Health, Imperial College London, London, UK
| | - Emma Feeny
- Impact & Engagement, The George Institute for Global Health, Imperial College London, London, UK
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Affiliation(s)
- Emma Feeny
- The George Institute for Global Health, United Kingdom
| | | | | | - George A Atiim
- United Nations University-International Institute for Global Health, Malaysia
| | - Dag Rekve
- World Health Organization, Switzerland
| | - Hebe N Gouda
- World Health Organization, Switzerland
- School of Public Health, University of Queensland
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