Health transition in middle-income countries: new challenges for health care

Abstract

The health transition occurring in middle-income countries such as Mexico is characterized by competition for scarce health resources between people with leftover ills such as infectious diseases and malnutrition and emerging threats such as chronic diseases mental illness and AIDS. This epidemiologic transition can not be expected to occur in the same way as it did in the industrialized countries. Their model was a series of 3 eras: pestilence and famine with high mortality no population growth and life expectancy of 20-40; receding pandemias and falling mortality with population growth; degenerative and man-made diseases with life expectancy over 50. In middle-income countries however the 3 eras are not necessarily sequential but may be protracted with reverses for some diseases. The co-existence of pre- and post-transitional diseases leads to polarization of different populations in the country. Data from Mexican mortality statistics indeed show decreased overall mortality from malaria childhood diarrhea and whooping cough but increased mortality from heart disease cancer diabetes and motor vehicle accidents. Data from Mexico City reveal falling postneonatal deaths due to diarrhea and respiratory infections but rising neonatal deaths (1st month of age) due to low birth weight and prematurity. Another aspect of the epidemiologic transition model is that the decline in mortality from infectious diseases in industrialized countries was due to lower incidence. In Mexico the incidence of infections remains high but mortality is lower because of antibiotics vaccines and vector control all reversible measures. Examples are diarrhea treated by ORT malaria considered refractory dengue fever considered re-emerging and AIDS considered emerging. Resources to handle this continuing mixture of old and emerging diseases will be stressed to the limit with the coincident population growth due to momentum of the young population already born. 6 principles are presented to make primary health services equitable: population-based service delivery quality assurance community participation anticipatory care operation integrated with other social services and innovative models of health care.