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PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Mexico is a representative and democratic republic
made up of 31 states and a Federal District . The third level of government
is comprised of 2,444 municipalities. In the 2000 elections, a political party
came to power different from that which had governed for the last seven decades,
creating changes in relationships among political groups within the federal
government structure.
Demography:
The total population in 2000 was 97.4 million, and the estimated population
growth rate was 1.4%. Population under 15 years of age was 33%, while those
65 and older were 5%, with a dependency ratio of 64. Fertility is the component
that most affected the dynamics of the population, with a total fertility rate
of 2.4, in 2000. Migration within the national territory showed an increase
compared with 1997; 19% of the population resided outside their birth place.
The population continues, in general, to be predominantly urban. It is estimated
that in the last five years nearly 1.5 million Mexican citizens migrated to
the United States . Life expectancy at birth increased 2 years 1994- 2000, reaching
75.3 years, women (77.6) and men (73.1).
Economy:
Between 1994-2000 the economic policy facilitated a greater expansion of productive
activity and employment, channeling greater resources to social spending, reducing
inflation, and bolstering the economy both fiscally and financially to safeguard
against crises. The gross domestic product (GDP) registered 7% growth in 2000,
while inflation was lower than 10%. The Mexican social scenario experienced
a growth of poor population that increased to 40 million. In 2000, the unemployment
rate was 2% and only 53% of the total salaried population had medical services.
According to the 2000 census, 91% of those over 15 years of age knew how to
read and write but in rural areas the number was little more than 20%. The percentage
of illiterate males and females 15 years or older was 7% and 11%, respectively.
Residents indicating affiliation to a Social Security Institution were 40%;
the lowest percentages were found in Chiapas and Guerrero (18 % and 20%, respectively).
The population that had access to public or private ealth services was 96%.
Mortality:
The leading causes of death in 1999 were heart disease (71 per 100.000), malignant
neoplasms (55), diabetes mellitus (47), accidents (36), diseases of the liver
(28), cerebrovascular diseases (26), and conditions arising in the perinatal
period (20). Although mortality from infectious disease has declines (5.7),
HIV/AIDS (4.3) and tuberculosis (3.3) continue to be public health problems.
SPECIFIC HEALTH PROBLEMS Analysis by Population group Children (0-4 years): The
infant mortality rate was 15 per 1,000 live births (lb) in 1999. The leading
causes were conditions originating out of the perinatal period, congenital malformations,
and infections from influenza and pneumonia. Deaths for males were 30% more
than for females. The national neonatal and postneonatal mortality rates were
9 and 6 per 1,000 lb in 1999. The rate of late fetal deaths was 6 and that of
early neonatal was 7 in 1999. In the age group 1-4 years-old, the mortality
rate was 1 per 1,000 in 1999. The leading causes of deaths were accidents (21
per 100,000); congenital malformations, deformities and chromosomal anomalies
(11) and intestinal infectious diseases (9). The crude rate of mortality in
children under 5 was 4 per 1,000 in 1999.
Schoolchildren (5-9 years): The
mortality rate for the age group 5-14 years was 34 per 100,000 in 1999 and rates
of leading causes of death were: accidents (11); malignant tumors (5) and congenital
malformations (2). The highest proportion of deaths for any cause occurred in
men, with H:M= 2:1. accidental traumas were the principal cause of morbidity
comprising 22% of hospital discharges of the SSA, while diseases of the respiratory
tract were (16%), 1999. In 1999, there were 128,819 minors doing marginalized
work of which a small proportion (< 8%) living in the streets.
Adolescents (10-14 and 15-19 years):In 1999, accidents were the leading cause of death
in the group of 15-24 year-olds with a rate of 31 per 100,000; homicide (14);
malignant neoplasms (6); and intentional self-harm (6). That same year, it was
estimated that males 15-19 years old died 2.5 times more from suicide than women,
3.8 times more from accidents, and 6.5 times more from homicides and injuries.
The fertility rate in this group was 70 per 1,000 women (15-44), 1999. In 1998,
23% of pregnant women 15-19 years old were attended by the SSA and 24% of attended
deliveries in hospitals were to those less than 20 years old. Consumption of
psychoactive substances is increasing among adolescents from 12-17 years with
an estimated prevalence of consumption of illegal drugs some time in life of
4%; 12% of the adolescents were tobacco smokers: males (16%) and females (7%).
Alcohol consumption increased among adolescents of both sexes, reaching 14%
in men and 2% in women, 1999.
Adults (20- 59 years): In 1999, the death rate
for the age group 15-64 years was 283 per 100,000, greater in males (361). In
1999, the leading causes of death were malignant neoplasms (40 per 100,000);
accidents (39); diabetes mellitus (31) and heart diseases (29). Of total hospitalizations,
67% were related to pregnancy, childbirth and the puerperium, followed by disorders
of the digestive system (6%) and traumas from accidents (6%). Mental illnesses
in adults 18-65 years-old - living in the capital - were estimated at 9%. Maternal
mortality was 51 per 100,000 lb in 1999.
Elderly (60 years and older): In
1999, total mortality was 4,763 per 100,000 or 49% of total of deaths. Leading
causes of death rates for 1999 were: heart disease (1,106 per 100,000), ischemic
heart disease (706), malignant neoplasms (612), particularly those of trachea,
bronchia, and lung (91), prostate (72), and stomach (63); diabetes mellitus
(584); and the cerebrovascular diseases (417).
The disabled: 2
% of the population suffered from physical or mental disability. According to
the 2000 census, 45% of the disabled had limitations related to their arms or
legs, 29% were blind or perceived only shadows, 17% were deaf or heard with
hearing aids, and 10% had some other type of disability.
Indigenous population: There
were 6 million inhabitants 5 years of age and older who spoke an indigenous
language as of 2000 . There are 92 different indigenous groups concentrated
in 15 states. The infant mortality rate (59 per 1000 lb) in indigenous populations
was twice that of the national level in 1997.
Workers health: The
number of cases of occupational disease was 29 per 100,000 workers in 2000 and
the mortality rate was 10 per 100,000 workers, 1999. The cumulative incidence
of work related accidents was 286 per 100,000 in 1999.
Analysis by type of health problem Natural disasters: It
was estimated that more than 150,000 km2 of territory was ravaged
by natural disasters and more than 6 million population affected. In 1998, floods
along the coast and Sierra Madre of Chiapas occurred that affected 650,000 population.
For 1999 there were 90 natural disasters reported, with emphasis on floods that
affected 594,883 inhabitants of several states. In 2000, floods were the most
frequent natural disaster and the effluviums of the volcano Popocatépetl caused
the displacement of thousands of people. In 1998, a fund of intermunicipal aid
fund was established to confront disasters, and the structural and functional
vulnerability of the main hospitals was assessed.
Vector-borne diseases: The
largest outbreak of malaria in the last four years occurred in Oaxaca (11,349
cases) in 1998. The incidence of classical dengue was 2 per 100,000, in 2000.
There were 1,424 reported cases of onchocerciasis between 1997 and the 2000.
Leishmaniosis occurred primarily in the states of Quintana Roo , Tabasco , Campeche
, and Chiapas , with 1,700 cases reported in 1999. With regard to the American
tripanosomosis in 2000, incidence ranged between 1 and 20 cases per 1000 population.
Only 13% of the donations received at the country's blood banks in 1999
were screened for Chagas' disease in 1999. In 1999, there were 108 deaths
from scorpion stings.
Vaccine-preventable diseases: There
were no cases of diphtheria and poliomyelitis. There were 370 cases of acute
flaccid paralysis syndrome reported annually. In 2000, there were 30 cases of
measles reported in population <1 year and in young adults. Reported cases
of rubella were 21,173 in 1999; the number declined by 45% in 2000. Mumps dropped
from 124,189 cases in 1997 to 27,911 in the 2000. There were 593 reported cases
of whooping cough in 1997 and 53 in 2000; tetanus cases were 169 in 1997 and
103 in 2000; neonatal tetanus cases fell from 44 in 1997 to 9 in 2000. Tubercular
meningitis was 119 in 2000. There were 219 cases of Haemophylus influenza type
b between 1997 and 1999. There were 838 cases of hepatitis B reported in 2000,
where blood bank screening is 100% for this virus. In 1999, the coverage of
vaccine-preventable diseases was: BCG 99%, DPT 98%, OPV 96% and MMR 96%.
Intestinal infectious diseases: There
were 2,263 cases of cholera reported in 1997 and 5 in 2000. Children under one
year of age continue to be those most affected with cumulative incidences of
intestinal infectious diseases higher than 28,000 per 100,000. Mortality from
these diseases in children under 5 years was 25 per 100,000 in 1999. The average
annual incidence of paratyphoid was 128 cases per 100,000, 1997-2000; shigellosis
(35) and other bacterial infections (34). Few more than 200 reported deaths
per year were due to food poisoning, 1997-1999.
Communicable chronic diseases:The
cumulative annual incidence of all forms of tuberculosis during 1997-2000 was
16 per 100,000, with some 16,000 reported cases per year and little more than
3,000 annual deaths. In 2000, the global prevalence of leprosy was 0.42 per
10,000.
Acute respiratory diseases: The
cumulative incidence of pneumonia and influenza was 184 per 100,000, 1997-2000.
Registered mortality from respiratory diseases, including pneumonia and influenza
was 43 cases per 100,000, 1999.
Zoonoses: There
were 51 reported deaths from human rabies, 1997-2000. In 2000, the incidence
of brucellosis reported in humans was 5.2 per 100,000; taeniasis (1.1), and
cysticercosis (0.7). The number of deaths in the period 1997-1999 of cysticercosis
was 200.
HIV/AIDS: In
1999, there were 40,744 reported cases of HIV/AIDS. In 2000 the cumulative incidence
of the disease was 1 per 100,000. In 1999, AIDS was 16th among leading
causes of death with 4 per 100,000.
Sexually transmitted diseases (STD): In 2000,
the cumulative incidence of STDs was 4 per 100,000. In 2000, non congenital
syphilis showed a downward trend, 2 cases per 100,000. The reported number of
deaths from sexually transmitted diseases was 19 in 1999.
Emerging and re-emerging diseases: In
1999, 37 cases of meningococcal meningitis were recorded. Outbreaks of venezuelan
equine encephalitis and yellow fever were not reported. Also, hantavirus infection,
bovine spongiform encephalopathy and foot-and-mouth disease were not reported
in the country.
Nutritional and metabolic diseases: Low
weight for age in children under 5 was 8% in 1999. Low height-for-age was 18%,
while low-weight-for-height was 2%. Anemia was 27% in the under-5, 26% in pregnant
women aged 12-49 years and 20% in women of the same age range, but not pregnant.
Women overweight were 31% and obese 22%. Total mortality from nutritional deficiencies
was 10 per 100,000. in 1999. while mortality from this cause in children under
5 was 16 in 1999. Registered cases of diabetes mellitus were 292 per 100,000
and mortality was 47 per 100,000, 1999.
Diseases of the circulatory system: The
incidence of cardiovascular diseases was 294 per 100,000, 1997-2000. In 2000,
hypertension was 402 per 100,000. and ischemic heart disease (61). Mortality
from heart diseases was 71 per 100,000, 1999.
Malignant neoplasms: There
were 90,605 malignant tumors reported with a cumulative incidence of 92 per
100,000 in 1999; women had 66% of these tumors. The most frequent tumor sites
among women were: cervix (34%), breast (17%) and skin (12%) and among the men:
skin (20%), prostate (17%) and stomach (6%). In 1999 the mortality rate was
55 per 100,000.
Accidents and violence:
Injuries due to accidents were 36 per 100,000, in 1999 - of which motor vehicle
accidents had the greatest frequency (25%). Deaths caused from injuries were
a little over 12% of total of deaths each year: accidents (65%), homicides (23%),
and suicides (6%). Men have experienced higher death rates than women (H:M=
3:1), 1999. Homicide was 12 per 100,000, in 1999. Deaths predominated in the
men. Suicide was 3.4 deaths per 100,000, in 1999 (H:M = 6:1).
Oral Health: A
preliminary survey shows a DMFT of 3 at 12 years of age. More decayed teeth
(76%) were found than filled (20%) and missing teeth were 2%. Table salt is
fluoridated.
RESPONSE OF THE HEALTH SYSTEM Policies and national health plans: The
"National Development Plan, 1995-2000" established as priority combating inequity
among persons, gender, productive sectors, and geographical regions. The health
policies implemented along the same lines were oriented toward the reorganization
of the system to expand its coverage and provide more efficient and effective
services; and to deal with prevalent diseases and the new health challenges
that have arisen from the changes in the epidemiologic and demographic profile.
The "National Health Sector Program 1995-2000" responds to the first objective.
The provisions of this plan include free choice of family physician, family
health insurance for those who can pay, decentralization of services, a basic
health care package at the municipality level, reorganization of the system
under the Secretariat of Health and separation of financing and service delivery
within the IMSS. To meet the second objective, eleven program areas were established
for disease prevention and health promotion and in-service research.
Health sector reform: In
fulfillment of the National Health Sector Reform Program 1995-2000, the system
was opened to the population with the capacity to pay and resulted in an increase
of insured population from 48 to 55 million. Population without regular access
to health services was reduced to 0.5 million. The Secretariat of Health has
concentrated more on regulation of the sector and less on direct delivery of
services. Extensive managerial training has been provided and measures have
been taken to improve quality control. In 2000, the Specialized Health Insurance
Institutions were created to provide comprehensive private health insurance
and new financing systems were tested.
The health system: The
social security system, which covers workers in the formal economy (58 million
in 2000), is comprised of several institutions, each of which is funded by contributions
from employers, employees, and the government. The IMSS is the largest institution
in the system and serves about 80% of the covered population. The system also
includes the State Workers' Social Security and Services Institute (ISSSTE),
Petroleos Mexicanos (PEMEX), the Armed Forces (SEDENA), and the Navy. The legal
framework of the sector is based on two general laws: the General Health Law
and the Social Security Law. Several States have their own legislation. Within
the framework of the North American Free Trade Agreement, intergovernmental
groups of the U.S, Mexico , and Canada work to harmonize legislation concerning
products and health-related services. The SSA provides the leadership of the
health system. Private health services are fragmented - 48% of the 31,241 beds
of private hospitals in 1999 were located in establishments with less than 15
beds, they provide care of unequal quality and with variable prices. The Nongovernmental
Organizations reach an important development in certain areas as reproductive
health, domestic violence, AIDS and other diseases, working increasingly in
way coordinated through networks.
Organization of regulatory actions: The
Secretariat of Health is responsible for overseeing the quality, safety, and
efficacy of drugs, reagents, immunobiologicals, and medical equipment. It maintains
national registries for all health supplies, regulates marketing by issuing
licenses and health product registrations, and oversees advertising that appears
in the mass media. The verification, analytical control, and evaluation of drugs
and supplies is performed by Secretariat of Health laboratories or authorized
third-party institutes. Potable water supply and sanitation services are the
responsibility of municipalities. Each state has its own law or code on potable
water, as well as a water commission that provides the municipalities with technical
and financial support. Private enterprise provides water on a very small scale.
The use of chemical substances is authorized by the General Directorate of Environmental
Health under the Secretariat of Health, and the Intersecretaria Commission on
Pesticide, Fertilizer, and Toxic Substance Control is responsible for their
regulation and marketing as well as for controlling their effects on health
and the environment. Air quality is monitored in 14 cities of the country by
stations that measure the most critical atmospheric contaminants. The General
Directorate for the Sanitary Quality of Goods and Services, in collaboration
with the National Public Health Laboratory, is responsible for monitoring health-related
products and services. Between 1998-2000, 24% of the water samples packaged
for human consumption had microbiological problems.
Organization of public health care services: Public
health care services are provided by the Secretariat of Health with support
from the social security institutions, especially the IMSS. P rograms of community
health include health promotion and disease prevention activities in homes,
schools and workplaces. The SSA and the Secretariat of Public Education offered
a health program for schoolchildren and adolescents in 30,000 schools, and they
also carried out the Healthy Schools initiative. Since 1998 all health institutions
utilize the ICD-10 for classification of mortality. The drinking water infrastructure
covered 88% of population in 2000; 23 States had coverage higher than 85%, while
5 States has coverage lower than 70%. In the year 2000, 95% of the drinking
water was disinfected. Sewerage disposal service covered 76% of the population
in 2000 and 5 States had coverage higher than 85%, 17 States had between 70%
and 85 % coverage and the remaining 10 had coverage lower than 70%. In 2000,
76% of the population had access to sewerage services and excreta disposal,
urban population (90%) and rural (37%). There is an official standard for handling
hospital waste; the majority of waste is incinerated.
Organization of individual health care services:The organization of individual health services is
structured by levels of care. The first level includes actions of health promotion,
disease prevention, and outpatient care. It also includes basic sanitation,
family planning, prenatal care, puerperium and newborn care, surveillance of
nutrition and growth of the child, immunization, case management of diarrhea,
antiparasitic treatment, care for respiratory infections, prevention and control
of pulmonary TB, prevention and control of hypertension and diabetes mellitus,
accident prevention and initial management of lesions, social involvement, and
prevention and control of cervical cancer. The second level provides basic specialties
at general or specialized hospitals. Outpatient care and hospitalization are
available, and in general, diagnostic imaging and laboratory support services
are also provided. The third level provides specialized care of greater complexity
as well as clinical and basic research of specialized physicians with support
of specialized nursing and other professionals. In 1997, the Program of Education,
Health and Feeding was launched for families in extreme poverty, that provides
a monetary support, educational fellowships, nutritional supplement to children
under 5, pregnant women and women in period of lactation. In 2000, some 2.6
million families from 31 States benefited.
Health supplies: The
national and international pharmaceutical industry is made up of more than 150
companies. In 2000, they produced more than 95% of the drugs of domestic consumption.
The sixth edition of the official Mexican pharmacopoeia was published in 1994,
followed by supplements in 1995, 1997, and 2000 updating the specifications
for drug manufacturing for marketing in the country.
Human resources:In
1999 the rates of physicians, nurses, and dentists per 100,000 have not varied
from recent years; in 1999, they were 131; 182 and 9 respectively. In that same
year, 62,951 physicians and 29,365 nurses worked in private hospital units.
There were 1,033 programs of health sciences. In terms of largest numbers, 545
of them are at the specialized level and 297 at the bachelor's degree level.
By area of knowledge, the largest numbers were medicine (509) and dentistry
(167). There were 79,524 students in the 78 Schools of Medicine in 1999, with
77% at public schools and 23% in private.
Health sector expenditure and financing: The
per capita health expenditure was US$ 461 in 1999. Private expenditure as a
percentage of total health expenditure was 53% in 1999. The out-of-pocket expenditure
in health was 48% in 1998. The percentage of total public spending in health
allotted to social security was 71% in 1999.
External technical cooperation and financing:
As of 1998 the Secretariat of Health had signed
technical and scientific cooperation agreements with 56 countries and was carrying
out joint activities with more than 20 multilateral agencies. During 1997-2000,
20 specific agreements were signed in the health area. Financial and technical
cooperation resources amounted to US$ 6,655,000 in 2000.
