Mexico

1Lt S. Erin Elarton, USAF, MSC

HCA 5312 Issues in International Health

Agenda• Areas of responsibility• Peer nations • Topography • Climate• Water and natural resources• Natural disasters• Comparisons• Index of economic freedom• Wellbeing index• Transparency corruption index• Human development index• National demographics• Population pyramid • Aging• Muslim population • Poverty• Immigrants and refugees• Vaccinations

• Health status • Morbidity & mortality statistics • HIV/AIDS • Tuberculosis• National health services • Structure of health care system • Healthcare providers • Costs/financing of health care • Pharmaceutical expenditures• Health care reform• External debt • Politics and elections • Telecommunications • Utilization of technology promoting

health care • Size of military/armed forces • Military health services system• Implications for military planners  

History• Ancient Civilizations• 1521 Spain conquered Mexico

– Brought diseases, caused pandemic

• 1821 Proclaimed Independence from Spain• 1836 Texas Declared its Independence • 1846-1848 Mexican-American War• 1910 Mexican Revolution• 1929 Mexican National Party (PNM) was created• 2000 President Fox elected (PAN)

http://en.wikipedia.org/wiki/Mexico

Geography & Environment• Terrain

– High, rugged mountains; low coastal plains; high plateaus; desert

• Land use– arable land: 12%

permanent crops: 1% permanent pastures: 39% forests and woodlands: 26%

• Climate– Varies from tropical to desert

• Natural resources– petroleum, silver, copper, gold, lead, zinc, natural gas, timber

• Environmental issues– Severe Air Pollution– Raw sewage polluting rivers– Deforestation– Widespread erosion

http://en.wikipedia.org/wiki/Geography_of_Mexico

http://www.countrywatch.com

Water Resources

• Population using improved drinking water sources (1999) – Total 86%, Rural 63%

• Population using adequate sanitation– Total 73%, Rural 32%

• Prolonged regional drought along US border– 1944 Treaty to share Rio Grande waters– US-Mexico Water Treaty Dispute

http://www.texaswater.org/press/us_mexico_dispute.pdf

http://www.prb.org/datafind/prjprbdata/wcprbdata.asp?DW=DR&SL

Natural Disasters

http://www.cred.be/emdat/profiles/natural/mexico.htm#top%20ten

Disaster Date KilledEarthquake 19-Sep-85 8,776Flood 1959 2,000Volcano 1949 1,000Wind storm 27-Oct-59 960Flood Oct-99 636Wind storm 1-Oct-76 600Wind storm 28-Sep-55 500Earthquake 28-Aug-73 500Wind storm 12-Nov-61 436

Extreme temp 30-Apr-90 380

Disaster Date AffectedWind storm 8-Oct-97 800,200Flood Oct-99 616,060Wind storm 23-Sep-02 300,000Wind storm 15-Jul-76 300,000Wind storm 1-Oct-76 276,400Wind storm Aug-67 271,000Wind storm Dec-83 257,500Flood 21-Sep-93 231,290Flood Aug-73 150,000

Earthquake 19-Sep-85 130,204

Comparisons

• Human Development Index #55• Well-being Index #150• Transparency International Corruptions

Perceptions Index #64• World Health Systems Rankings

– Overall health system attainment #51

– Overall health level #61

• Migration #132 in world -2.84– 8% of U.S. population is from Mexican origin

http://www.undp.org/hdr2003/pdf/presskit/HDR03_PKE_HDI.pdf

http://www.transparency.org/pressreleases_archive/2003/dnld/cpi2003.pressrelease.en.doc

http://www.iucn.org/info_and_news/press/wonrank.doc

http://www.who.int/whr2001/2001/archives/2000/en/statistics.htm

http://www.photius.com/wfb1999/rankings/migration_rate_0.html

http://www.metropolis2003.at/en/WS9.1Sanchez.pdf

U.S. Department of State Consular Information

• Crime

• Drug penalties and prescription medications

• Prison conditions

• Kidnapping

• Public Transportation

• Insufficient safety standards

http://www.travel.state.gov/mexico.html

Pan American Health Organization

• Vector-borne diseases

• Vaccine-preventable diseases

• Intestinal infectious diseases

• Communicable chronic diseases

• Acute respiratory diseases

• Human Rabies

• STDs

• AIDS

http://www.ops-oms.org/English/DD/AIS/cp_484.htm

Politics

• Representative and democratic republic• 31 states and Federal District (Mexico City)• 2,444 municipalities• 2000 elections – new political party• Bicameral National Congress (Congreso de la

Union)– Senate and Chamber of Deputies

– Women as percent of parliament 16% (US 14%)

http://www.prb.org/datafind/prjprbdata/wcprbdata.asp?DW=DR&SL

http://en.wikipedia.org/wiki/Mexico#Politics

The Pew Research Center• Mexico’s view of U.S. slips

– From 1999 to 2002, slipped from 68% to 64%

• Personal concerns – Economic problems as top personal concern (65%)– Crime (17%)– Personal satisfaction rated similar to Western Europe

• Satisfaction with State of the Country– 79% dissatisfied

• Top 4 national problems– Crime, AIDS & disease, corrupt political leaders, terrorism

http://people-press.org/reports/pdf/165.pdf

Economy

• World’s ninth largest economy

• Index of Economic Freedom (2003) – Ranked #63

• Labor Force– 39.8M (2000)

• Exports $1.58B (2002)– US 82.7%, Canada 5.4%, Japan 1.1% (2002)– Commodities: manufactured goods, oil and oil

products, silver, fruits, vegetables, coffee, cotton

http://cf.heritage.org/index2004test/country2.cfm?id=Mexico

http://www.odci.gov/cia/publications/factbook/geos/mx.html

National Demographics Mexico United States

Population Total 104,907,991 285,318,000 Population Growth Rate (annual %) 1.43% 1.1%

0 – 14 Years (% of total) 32.3% 20.9 15 – 64 Years (% of total) 63.1% 66.7

65+ Years (% of total) 4.6% 12.4 Total Fertility Rate 2.53 2.07

Adolescent Fertility Rate (births per 1,000 women age 15-19)

64

48

Female Life Expectancy at Birth 75.49 80.05 Male Life Expectancy at Birth 69.26 74.37

http://devdata.worldbank.org/hnpstats/HnpAtaGlance.asp?sCtry=MEX,Mexico

Ethnicity: Mestizo 60.0%

Indigenous 30.0%

European descent 9.0%

Other 1.0%

Religions: Roman Catholic 89.0%

Protestant 6.0%

Other 5.0%

Muslim 0.26%

http://www.odci.gov/cia/publications/factbook/geos/mx.html http://www.islamicpopulation.com/america_general.html

Population Pyramid

http://www.census.gov/cgi-bin/ipc/idbpyrs.pl?cty=MX&out=s&ymax=250

Common Diseases According to AFMIC & CDC

• Diseases carried by insects – Dengue

– Filariasis

– Leishmaniasis – cutaneous

– Malaria

– Onchocerciasis

– American trypanosomiasis (Chagas disease)

– West Nile Virus

• Foodborne & waterborne diseases– Bacterial diarrhea

– Hepatitis A

– Typhoid / paratyphoid fever

• Water-contact diseases– Leptospirosis

• Direct or indirect personal contact– Hemorrhagic Conjunctivitis

http://www.cdc.gov/travel/camerica.htm

https://mic.afmic.detrick.army.mil/osis/search/sitesearch/filetest.php?query=mexico

Socioeconomic IndicatorsSOCIOECONOMIC

INDICATORSYEAR MEXICO YEAR U.S

GNI PPP Per Capita 2001 $8,240 2001 $34,280 Adult Female Literacy Rate

(% age 15+)2003 90.50% 1979 97%

Adult Male Literacy Rate (% age 15+)

2003 94% 1979 97%

GDP 2002 $924B 2002 $10.5TGDP real growth rate 2002 0.70% 2002 2.40%

GDP per capita 2002 $8,920 2002 $36,300 External Debt 2001 $191B 2001 $862B

Inflation 2002 6.40% 2002 1.60%Population below poverty

line2001 40% 2001 12.70%

Unemployment Rate 2001 3% urban 2002 6%

http://www.nationmaster.com/country/mx

http://www.cia.gov/cia/publications/factbook/geos/mx.html

http://www.prb.org/datafind/prjprbdata/wcprbdata.asp?DW=DR&SL

Morbidity & MortalityHEALTH STATUS

INDICATORSYEAR MEXICO YEAR U.S.

Mortality Rate – under 5 per 1,000 live births

2001 29 2001 8

Adult Male Mortality Rate

2000 180 2000 141

Adult Female Mortality Rate

2000 101 2000 83

Maternal Deaths per 100,000 live births

2002 65 2002 12

Low-birth weight Babies 1995 9.2 2001 7

TB incidence 2000 38.1 2001 5.4

People Living with HIV/AIDS

2001 150,000 2001 900,000

Infant Mortality Rate (deaths per 1,000 live

births)

Malnutrition prevalence (% children under 5)

2003 6.9

2001 7.5 1995 1.4

2003 25

http://devdata.worldbank.org/hnpstats/HnpAtaGlance.asp?sCtry=MEX,Mexico

http://www.prb.org/datafind/prjprbdata/wcprbdata.asp?DW=DR&SL http://www.cia.gov/cia/publications/factbook/geos/mx.html

Vaccinations

http://www.who.int/vaccines/globalsummary/immunization/CountryProfileResult.cfm

2002 Immunization Profilles

Mexico U.S.

DTP1 92 97

HepB3 91 88

Hib3 91 93MCV 96 91Pol3 92 90

BCG

DTP3 91 94

99 -

Mexico’s Health System

• Public Health Care– Secretariat of Health and Assistance– Institute of Social Security and Government

Workers– Mexican Social Security Institute

• Less than 10% of the Mexican population has private coverage

http://open.imshealth.com/webshop2/IMSinclude/i_article_20040105.asp

https://mic.afmic.detrick.army.mil/osis/search/sitesearch/filetest.php?query=mexico

Healthcare Costs & Finance

http://devdata.worldbank.org/hnpstats/HnpAtaGlance.asp?sCtry=MEX,Mexico

HEALTH CARE FINANCE

YEAR MEXICO YEAR U.S.

Total Health Expenditures (% of GDP)

2001 5 2001 13.9

Public health expenditures as % of total expenditures

2001 44.3 2001 44.4

Private health expenditures as % of total expenditures

2001 55.7 2001 55.6

Social Security Expenditures as % of health expenditures

2001 66.5 2001 32.9

Physicians per 1,000 people

2000 1.8 2000 2.8

Hospital Beds per 1,000 population

200 1.1 2000 4

2000 $4,499 Health Care Expenditures per capita ($US)

2000 $311

http://www.who.int/country/mex/en/

Health Care Aid

• OECD – Aid from U.S.– 1990-92 US$60M– 1993-95 US$103.3M– 1996-98 US$241.7M

• Inter-American Development Bank– Summary of IDB Financing ($US)

• 2002 Lending $1B• 1961-2002 Lending $16B• 2002 Disbursements $993B• 1961-2002 Disbursements $13.2B

http://www.oecd.org/dataoecd/22/31/25503059.pdf

http://www.iadb.org/exr/country/eng/mexico/index.cfm

Telecommunications

• Telephones: main lines in use: 12.32M (2000)

• Mobile cellular: 2.3M (1998)

• Radio broadcast stations: 1465 (2000)

• Television broadcast stations: 236 (1997)

• Internet Service Providers (ISPs): 51 (2000)

• Internet users: 3.5M (2002)

http://www.odci.gov/cia/publications/factbook/geos/mx.html

Military ForcesArmed Forces

Personnel Strength

World

Ranking

Army 130,000 #18

Air Force 8,000 #33

Navy 37,000 #15

http://www.nationmaster.com/country/mx/Military

Military Spending Mexico United States Military Expenditures per % GDP

(FY99, Mexico & US) 1% 3.2%

Military Expenditures Dollar Figure (FY99, Mexico & US)

$4B $276.7 B

Military Health Care

• Secretariats of National Defense and Navy operate separate health care services– Mexico City

• The Central Military Hospital• Naval Medical Center

– Physicians are well trained and well regarded by civilian authorities

– Training of nursing and paramedical personnel is substandard compared to the U.S.

• Blood supply is safe

https://mic.afmic.detrick.army.mil/osis/search/sitesearch/filetest.php?query=mexico

Implications for Military Planners

• Viral or bacterial diarrhea could occur among personnel consuming local food, water, or ice

• Water Resources

• Disease Prevalence

• Field conditions (including lack of hand washing and primitive sanitation) may facilitate person-to-person spread of epidemics