Research Article: Subnational Burden of Disease Studies: Mexico Leads the Way

Date Published: June 17, 2008

Publisher: Public Library of Science

Author(s): Martin Tobias

Abstract: Martin Tobias discusses a new study that estimates the burden of disease for Mexico as a whole and for each of the country’s 32 states.

Partial Text: The goal of any health system is to improve the level and distribution of health of its eligible population. This goal implies an ability to measure population health (including differences between subgroups and trends over time) and to assess the contribution of different diseases, injuries, and risk factors to health outcomes.

A study by Gretchen Stevens and colleagues in this month’s PLoS Medicine reports on the burden of disease in Mexico [9]. Estimates of burden are reported for Mexico as a whole and for each of the countryapos;s 32 states (although for presentation in PLoS Medicine the results have largely been aggregated into six regions). Only Australia has previously reported subnational burden of disease estimates [4]. The “value added” by such studies reflects the reality that in many countries, state or provincial rather than national governments hold jurisdiction over health.

Mexico is fortunate in having invested for many years in high-quality health statistical systems. Most impressive is the National Health and Nutrition Survey, which collected subnationally representative measured data from some 95,000 participants in 2006. Even so, chronic disease incidence and survival data (needed to calculate the morbidity component of the DALY) are largely lacking—as in most countries, few chronic disease registries exist other than for cancer.

From a health policy perspective, burden of disease studies are clearly not the whole story. Nevertheless, as every clinician knows, diagnosis must come before treatment. To give one example from Stevens and colleaguesapos; study: the unacceptable burden of childhood malnutrition and infection (diarrhoea and pneumonia in particular) in Chiapas state calls for urgent and sustained action to improve water supplies, sanitation, housing, and access to high-quality primary health care—especially for disadvantaged, largely indigenous, and rural communities within that state.



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