The epidemiological transition from communicable diseases to non-communicable diseases is a reality in several countries. Health policies must take urgent measures to reduce the high incidence and mortality rates associated with the latter. This column looks at the experience of Mexico and proposes some intersectoral strategies that can help to promote prevention and control.
In 2019, the Lancet Commission described a ‘global syndemic’, referring to the interaction between three pandemics prevalent even before Covid-19 – obesity, undernutrition, climate change – and their clustering in time and place.
The term syndemic has also been defined as the aggregation of two or more diseases or other health conditions in a population that interact synergistically and converge with their social, economic, cultural, and socio-environmental determinants, exacerbating the negative health effects of any or all of the diseases involved. Among non-communicable diseases (NCDs) identified in this syndemic interaction are obesity, diabetes, cardiovascular diseases, and cancer.
According to the World Health Organization (WHO), NCDs tend to be long-term and result from a combination of multiple factors: genetic, physiological, environmental, and behavioral. These chronic diseases cause 71% of deaths globally, with a major impact on low-and middle-income countries.
Recommendations to accelerate countries’ responses have been incorporated in the WHO’s Global Action Plan for prevention of NCDs – for example, strengthening cooperation in public sector governance, multisectoral actions to accelerate responses at the national level, and actions to reduce risk factors and underlying social determinants.
But it is necessary to consider that the different countries and regions operate under very different contexts in relation to progress with their economic prosperity, human health, social equity, and environmental sustainability.
In Mexico, the 2018–19 national health and nutrition survey showed that overweight and obesity are highly prevalent in both rural and urban areas (see Table 1). In addition, 10.3% of the adult population have been diagnosed with diabetes, and the prevalence is higher among women (11.4%) than among men (9.1%); while the prevalence of high blood pressure is 18.4% among people aged 20 and above, and again higher in women (20.9%) than in men (15.3%).
Table 1: Prevalence (%) of overweight and obesity in the Mexican population
Figure 1 shows data from the Institute for Health Metrics and Evaluation (IHME) for the period from 1990 to 2019, indicating the increasing mortality rate associated with these three types of metabolic risk: high body mass index, high blood pressure, and high fasting plasma glucose.
Figure 1. Mortality rate associated with three metabolic risks in the Mexican population from 1990 to 2019.
Among strategies that have been implemented to diminish the high prevalence of NCDs at the national level, there is ‘front-of-pack’ labeling of food and beverages, which came into force from 2020. This consists of five black and white labels used to indicate whether a certain foodstuff is high in calories, sugars, saturated and trans fats, and sodium. It is similar to mandatory food labeling in Chile.
The strategy is complemented with ‘back-of-pack’ nutrition labeling, as part of an initiative among OECD countries where this is the most common form of labeling. But additional policies to promote health are needed, for example, community actions focused on influencing lifestyles through information and education.
The most recent reform of the Law of General Education in Mexico was implemented in 2021. The Article 75 states that educational authorities must prohibit the sale of foods with low nutritional value and high calorie content at school facilities.
In addition, they must promote healthy lifestyles that prevent and counteract overweight and obesity among students, including physical activities, school sports, physical education, and good nutritional habits. But these provisions must be actively monitored and evaluated to ensure compliance, and adjustments made based on the evidence and results obtained in the short, medium, and long term.
Moreover, strategies to prevent NCDs by reducing environmental risks are urgently required in key sectors, such as air pollution, water pollution, transport systems, and food and agriculture systems. These should include models that promote physical activity in public places, such as work centers, schools, hospitals, and parks, as has been recommended by the WHO and the US Centers for Disease Control and Prevention (CDC) to increase the resilience of affected communities and encourage a culture of prevention across society as a whole.
The CDC have identified four domains as priorities for prevention of NCDs: epidemiological and surveillance, socio-environmental approaches, healthcare system interventions, and community programs linked to clinical services. In the case of Mexico, these could be complemented by strengthening the healthcare system’s capacity for treatment of NDCs, training programs for health workers with a syndemic approach, prevention strategies, and development of new technologies for early detection.
Finally, intersectoral coordination through an integrative syndemic framework is crucial for tackling the impacts of the syndemic on vulnerable groups and the community, and to reduce the high prevalence of NCDs. The initiative might involve collaboration of different Mexican government ministries, such as Health, Education, Science and Technology, Economy, Work and Social Security, Environment and Natural Resources, Agriculture and Rural Development. It should also involve working together with non-government organizations (NGOs) and industry.