Children’s Health and the 

Environment in North America

A First Report on Available 

Indicators and Measures 

Country Report: Mexico 

Prepared by Mexico’s Secretariat of Health 

December 2005
ii 
iii 

Table of Contents 

Executive Summary.............................................................................................. v

1 Introduction ................................................................................................1

1.1 Indicators of Children’s Health in Mexico ..................................................3

2 Asthma and Respiratory Disease...............................................................7

2.1 Outdoor Air Pollution .................................................................................8

2.2 Indoor Air Pollution ..................................................................................13

2.3 Asthma ....................................................................................................19

3 Lead and Other Chemicals, Including Pesticides.....................................26

3.1 Blood Lead Levels...................................................................................28

3.2 Lead in the Home ....................................................................................36

3.3 Industrial Releases of Lead.....................................................................37

3.4 Industrial Releases of Selected Chemicals .............................................38

3.5 Pesticides ................................................................................................38

4 Waterborne Diseases...............................................................................40

4.1 Drinking Water.........................................................................................41

4.2 Sanitation.................................................................................................45

4.3 Waterborne Diseases..............................................................................48

5 Opportunities for Improvement.................................................................55

References ......................................................................................................57

Appendix 1 Health of Indigenous Peoples........................................................63

Appendix 2 Components of the National Surveillance System.........................64

Appendix 3 Indicator Templates.......................................................................66

Appendix 4 Indicators Steering Group—Mexico...............................................97
iv 
v 

Executive Summary 

More than 40 percent of Mexico’s total population in the year 2002 (nearly 44 million people) was 

under the age of 19 and the general mortality rate was five per 1,000 inhabitants. The birth rate 

per 1,000 inhabitants has declined from 45 in 1960 to 17 in 2000 and Mexico’s life expectancy 

has increased progressively, jumping 25 years between 1950 and 2000. 

As a result, Mexico’s population has shifted demographically from a pyramidal outline whose 

broadest area corresponded to the child population (0–14 years old) to an elongated pyramid, the 

broad area of which encompasses both the child population and that of adults between 20 and 30 

years of age. The infant mortality rate in the first year of life, per 1,000 inhabitants, decreased 

from 19.1 in 1998 to 16.78 in 2002. 

Although there are various possible reasons for this demographic shift, rising levels of education 

among women in recent decades is surely a factor. The total female population with primary 

education has increased from 18.0 to 20.2 percent between 1970 and 2000. In the same period, 

the [percent of the] female population at all education levels has increased, with the greatest 

increase seen in post-secondary and higher education (4.9 to 26.3 percent). Data show that birth 

rates among women of reproductive age (from 15 to 44 years of age) decrease as education 

levels and age increase. 

In addition, from 2000, national coverage with the triple viral vaccine (measles, mumps and 

rubella) has remained above 95 percent. Progress in the National Vaccination Program 

(Programa Nacional de Vacunación) since 1992, as well as its sustained increase, is reflected in 

the decreased rates of morbidity and mortality from diseases preventable by vaccination. 

With the shift to a gradually aging population, the primary causes of death have changed radically 

as well, especially per age group. Transmissible diseases and reproduction-related problems, 

which had been the leading causes of death, were replaced by non-transmissible diseases and 

injury. 

In 2002, the leading causes of death in the population under 19 were, in the first years of life, 

perinatal conditions, congenital malformations, influenza and pneumonia; and in adolescence, 

accidents, intestinal infections, intentional injuries and cancer. The main causes of morbidity for 

the same age groups in that year were acute respiratory infections, undefined intestinal 

infections, intestinal amoebiasis, and urinary tract infections. 

Diarrheic illnesses persist as a serious problem among the child population. These diseases are 

transmitted by contaminated food and by drinking water. Data from 2003 indicate that 95 percent 

of drinking water is disinfected, although in that year, 17 percent of the population did not have 

water of appropriate bacteriological quality. Although national sewer system coverage and access 

to drinking water have increased significantly over the last 20 years, in 2000, one of every four 

inhabitants lacked sewer system access and one in ten lacked household potable water. In rural 

areas, the lack of access to both services continues to be a major problem. 

Due to specific health service actions and educational and basic sanitation activities, cases of 

giardiasis and cholera have decreased in the various age groups. For example, there have been 

no cholera deaths since 1998. 

Common infections and reproductive illnesses continue to cause significant harm to health in 

highly marginalized groups. There are states in southern Mexico in which the mortality rates from 

such causes are ten times higher than those of the more developed northern states. The same 

occurs with deaths from acute respiratory infections. These respiratory infections and asthma are 

most closely related with air pollution in rural and urban areas alike. Over the last ten years, ARI 
vi 

deaths among children younger than five decreased by 60 percent, while morbidity from acute 

respiratory infections and asthma has increased. 

Recent studies have looked at the health effects of exposure to outdoor air pollution. Some 

studies conducted in Mexico City show a close correlation between air pollution and lung disease, 

pulmonary aging processes and respiratory infections. Ground-level ozone and PM10 (particulate 

matter less than 10 micrometers in diameter [respirable particles]) are among the most worrisome 

air pollutants due to their potential health effects and the frequency with which their ambient 

levels exceed the air quality standards established to protect human health. 

Indoor air pollution caused by wood or coal burning for cooking or heating represents a public 

health problem for children under five and women of reproductive age, especially in the country’s 

marginalized areas. In the year 2000, 18 percent of Mexico’s total population continued to use 

such methods for home heating. 

Involuntary exposure to tobacco smoke is the cause of several illnesses, such as lung cancer 

and other respiratory diseases. Children exposed to tobacco smoke face a greater risk of 

disease, particularly in their early years, due to the immaturity of their immune systems. In 2002, 

there was a 36 percent national prevalence of passive smokers of 12 to 65 years of age, with the 

majority in urban areas. Mexico does not have the corresponding information on younger groups. 

The primary source for environmental exposure to lead in Mexico is the manufacture of glazed 

ceramic pottery and its use in food preparation and storage. Several studies conducted among 

urban populations, especially with school-age children and women of reproductive age, point to a 

significant link between high concentrations of lead in blood and the use of glazed pottery for 

cooking and serving food and beverages. 

Given the lack of a representative value of blood lead levels in the general population, but rather 

only isolated studies in industrial zones and certain pottery-making regions, two Mexican case 

studies are presented in this report. The first study refers to metallurgical activities in the northern 

region, while the second shows the impact of specific actions to reduce atmospheric lead 

emissions in Mexico City. Mexico’s pollutant release and transfer register is in the process of 

being developed, and therefore the respective information is not currently available. 

Mexico does not adequately record chemical poisoning. The Centralized Automated 

Epidemiological Oversight System (Sistema Único Automatizado de Vigilancia Epidemiológica) at 

the Secretariat of Health (Secretaría de Salud) records pesticide poisonings caused by 

occupational exposures, household accidents or suicide attempts among children under the age 

of 15. Poisonings of children under that age are mostly due to accidental causes. Significant 

under-recording is possible, which might have to due to problems in the reporting procedures. 

Notwithstanding the above, cases of pesticide poisoning decreased from 1998 to 2002. 

Poverty remains a problem for Mexican society, however, as households with per capita income 

below that required to satisfy basic food needs represented 18.6 percent in the year 2000. For 

nearly half of all households (45.9 percent), per capita income was below that required to satisfy 

basic food needs plus basic health, education, clothing, footwear, housing and public 

transportation needs. 
1 

1 Introduction 

General health conditions in Mexico have improved considerably over the last 50 years. This is 

clearly seen in life expectancy at birth. Between 1950 and 2000, the country added 25 years to 

this indicator. However, the respective differences among the states show the inequality 

prevailing in the country. 

The differences found per region are an important fact to consider in understanding the Mexican 

situation. In the modern and industrialized northern region, the population is concentrated mostly 

in urban zones. The southern region is clearly traditional, unindustrialized and with a high 

indigenous population living in small, dispersed rural communities. This explains why the health 

indicators for the northern region are similar to those of developed countries, while the same 

indicators for the southern region are similar to those of developing countries with social and 

economic problems. 

In 2002, there were 43,719,756 persons under 19 years of age in Mexico, representing just over 

40 percent of the total population. The birth rate per 1,000 inhabitants has decreased from 45 in 

1960 to 17 in 2000, while the child mortality rate in the first year of life decreased from 19.1 per 

1,000 inhabitants in 1998 to 16.78 per 1,000 inhabitants in 2002. The leading causes of death 

also changed radically over the past 50 years. Transmissible diseases and congenital illnesses 

were displaced as the primary causes of death by non-transmissible diseases and injuries. In the 

same period, the percentage of deaths due to intestinal infections decreased by a factor of 14 

(from 14.3 percent to 1 percent), while deaths from heart disease quadrupled (from 4 percent to 

16 percent). 

Another fact pointing to a clear epidemiological transition in the country is the changing pattern of 

causes of mortality among children under one year of age. Previously, infant deaths were 

concentrated in the postnatal period (between one month and one year of age), mostly caused by 

acute respiratory infections and diarrhea. Presently, infant deaths are concentrated in the first 28 

days of life, due to perinatal causes and congenital anomalies requiring high-technology 

intervention. 

Common infections and congenital events continue to cause major harm to health in highly 

marginalized groups. Over the last 10 years, deaths from diarrhea in children under five years of 

age have decreased by 85 percent. However, there are southern states with mortality rates from 

diarrhea above 40 per 100,000 inhabitants under five years of age, i.e., five times higher than the 

rates found in the more developed northern states. The same is found with deaths from acute 

respiratory infections, another clear example of the persistently lower quality of life. 

Despite the major progress in health systems, the problems of poverty, social inequality, 

marginalization, the lack of services, and environmental air, water and soil pollution constitute 

important factors associated with a poor quality of life for a high percentage of the child 

population, primarily in the country’s rural areas. 

Air pollution is a generalized problem in Mexico’s major metropolitan areas. However, current 

demographic growth, industrial concentration, greater numbers of vehicles, increased fuel 

consumption and inadequate urban mobility patterns have caused the problem to increase in 

other areas, such as medium-size cities. 

Ground-level ozone and PM10 [airborne particles less than 10 microns in diameter] are air 

pollutants of concern given their potential health effects and the frequency with which they 

exceed the air quality standards for health protection. In the Mexico City Metropolitan Area, the 

ground-level ozone standard is exceeded during 80 percent of the year, while the air quality 

standard for PM10 is exceeded during 30 percent of the year in certain metropolitan areas. 
2 

Indoor air pollution caused by the burning of wood or charcoal used for cooking or heating 

constitutes a public health problem with repercussions for the population under five years of age 

and women of reproductive age, especially in the country’s marginalized areas. In 1990, one of 

every three Mexicans (91 percent of rural inhabitants and 11 percent of urban inhabitants) used 

wood for cooking. In 1993, 25.6 million persons were estimated to use wood as household fuel, 

decreasing to 17.2 million inhabitants in 2000. 

Since 1988, with the first National Addictions Survey (Encuesta Nacional de Adicciones, applied 

throughout the country for persons in urban areas between 12 and 65 years of age), Mexico has 

begun to have an epidemiological oversight of tobacco addiction. This national survey has been 

conducted every five years (with the last such survey in 2002), which has enabled a detailed 

observation of the epidemic’s trends, which include stable use figures, a lower average starting 

age, increased use by minors, and increased use by women. 

As regards passive smokers, Mexico does not have specific information for child groups. 

However, the national index of passive smokers in the urban population is 36.1 percent, while the 

index for the rural population is 26.2 percent. The greatest [regional] involuntary exposure to 

tobacco smoke is found in the northern region, with 31.9 percent. 

In 2002, the prevalence of asthma in Mexican children under one year of age was 35 per 10,000 

inhabitants, while the rate for children between one and four years of age was 63 and the rate for 

children between 5 and 14 years of age was 35. Inhabitants of the coastal states were found to 

have a higher number of cases, probably due to the relative environmental humidity or perhaps 

because these regions have greater usage of air conditioning systems. These systems are known 

to keep a considerable amount of dust and fungus, which can set off asthma attacks. 

The main cause of environmental exposure to lead in Mexico derives from the manufacture of 

glazed pottery with lead oxide glazes and the use of these vessels in food preparation. Artisanal 

pottery making is carried on in 20 Mexican states by approximately five million potters, many of 

whom are members of indigenous groups. Most pottery workshops are family businesses, 

employing all family members between 7 and 70 years of age. Each person participates in some 

part of the pottery production process, using techniques inherited over the generations and 

employing no personal protection whatsoever. This activity constitutes the main source of 

exposure for the child population. 

Mexico lacks data on representative blood lead levels in the general population. Mexican 

authorities have data from isolated studies undertaken in industrial areas and in certain potterymaking regions. In lieu of this, a case study is presented on lead poisoning in the population of 

children in a northern Mexican community, caused by a mining-metallurgical company. . 

As regards pesticide poisoning, only partial information is available: in Mexico, only acute cases 

are reported, without identifying the type of pesticide involved. Cases of poisoning among 

children under 15 years of age dropped from 1,335 in 1999 to 672 in 2002. However, a ratio of 

1:5 underreporting is estimated, i.e., for every reported case there are five cases not reported. 

At present, Mexico lacks pollutant release and transfer register data because up until the present 

time, such information requested of businesses has been voluntary. However, current legislation 

has been enacted that now requires businesses to report their pollutant releases and transfers. 

The leading environmental and public health problems faced by Mexico include deficient basic 

sanitation and poor water quality (not to mention the insufficient availability of water for a 

numerous and growing human population). 

In countries such as Mexico, diarrheic illnesses persist as a serious problem among the child 

population. These diseases, caused by bacteria, viruses and protozoan pathogens dispersed 
3 

through the fecal-oral route, may be transmitted in water used for various household activities, 

including personal hygiene, and from contact with contaminated recreational water. 

In recent years, the principal emphasis in reducing mortality among children under five years of 

age has been on lowering the incidence of diarrheic illness. As a result, the rate of such illnesses 

in children under five years of age has decreased from 125.6 per 100,000 in 1990 to 20 in 2002. 

Water purification oversight has been undertaken with the periodic and ongoing monitoring of free 

residual chlorine in the distribution network. Despite the increased availability of chlorinated water 

in the country, the rate of sewer system coverage is below the average for Latin America, the 

Caribbean or North America. National sewer system coverage has increased 27 percent in 20 

years (from 49 percent to 76 percent, in accordance with the 1980 and 2000 censuses, 

respectively). The lack of access to such service is particularly notable in rural areas, however, 

especially in southeastern Mexico. Drinking water coverage is 95 percent in urban areas and 68 

percent in rural zones. 

The presence of giardiasis has decreased in the different age groups, as have cases of cholera 

(from which no deaths have been reported since 1998). This is fundamentally due to specific 

actions in healthcare and other sectors, particularly education and basic sanitation. 

1.1 Indicators of Children’s Health in Mexico 

1.1.1 Overview of Population Demographics 

Mexico’s total population in 2002 numbered 103,039,964, of whom 43.7 million were children of 

19 years of age or less, representing 42.4 percent. Ten percent were children at or below 4 years 

of age, according to the 2000–2050 Mexican Population Projection (Proyección de la población 

de México) of the National Population Council (Consejo Nacional de Población—Conapo), 

released in 2002. Furthermore, from 1970, when it had an enlarged population pyramid in the 

area corresponding to the child population (0 to 14 years old), in 2000 Mexico became a nation 

with an enlarged population pyramid for both the child population and the population between 20 

and 30 years of age (see Figure 1.1). 
4 

Figure 1.1: Population Pyramid of Mexico, 2000 

Source: CIES, based on XII General Census of Population and Housing (Censo General de Población y 

Vivienda XII, 2000) INEGI 2000. 

In Mexico, the birth rate in 1960 was 45 per 1,000 inhabitants, decreasing to 17 in 2000. The 

greatest decrease occurred in the decade from 1960 to 1970. The overall mortality rate 

decreased from 10 per 1,000 inhabitants to 5 in 2000 (see Figure 1.2). 
5 

Figure 1.2: Evolution of Birth and Mortality Rates in Mexico, 1960–2000 

Birth Rate

Mortality Rate

0

5

10

15

20

25

30

35

40

45

50

1960 1970 1980 1990 2000

Years

Rate per 1000

Source: Conapo. 

In 2002, Mexico’s life expectancy at birth was 74.62 years. The average life expectancy for 

women was 77.1, while men’s’ life expectancy was 72.1 years of age. Between 1950 and 2000, 

the country added 25 years to this indicator. 

1.1.2 Child Mortality and Morbidity 

The child mortality rate in the first year of life, per 1,000 inhabitants, decreased from 19.1 in 1998 

to 16.78 in 2002. In 2002, the three main causes of death in children under one year of age were 

conditions originating in the perinatal stage; congenital malformations, deformities and 

chromosomal anomalies; and influenza and pneumonia. For the population between 1 and 4 

years of age, the main causes of death were accidents; congenital malformations, deformities 

and chromosomal anomalies; and intestinal infectious diseases. In the case of the 5–9 and 10–14 

age groups, the three main causes of death were accidents; cancer; and congenital 

malformations, deformities and chromosomal anomalies. Lastly, in the 15 to 19-year-old age 

group, the leading causes of death were accidents; intentional injuries; and cancer, in that order. 

In 2002, the two main causes of morbidity in all population groups between 1 and 19 years of age 

were acute respiratory infections and undefined intestinal infections. The third cause of illness 

was intestinal amoebiasis for the population under four years of age, and acute urinary infection 

for the other age groups. 
6 

1.1.3 Socioeconomic Information and Other Determinants of Health 

Maternal Education 

Women’s levels of education have increased substantially in recent decades. In 1970, women 

without education represented 35.0 percent of the overall female population; this percentage had 

decreased consistently to 11.8 percent by the year 2000. During the same period, the proportion 

of the female population that had completed primary education1

 increased from 18.0 percent to 

20.2 percent. That which had completed secondary education2

increased from only 2.2 percent to 

18.5 percent in 2000, while the population with postsecondary3

 or bachelors degrees and other 

higher education4 increased from 4.9 percent to 26.3 percent in the period. 

According to the 1996 Mexican Fertility Survey (Encuesta Mexicana de Fecundidad), specific 

fertility rates per 1,000 women of reproductive age between 15 and 44 years old decreased as 

women’s education rates and ages increased. The highest fertility rate among all age groups was 

found at the lowest education levels. 

Poverty 

As regards the food/poverty threshold (homes with per capita income below the requirements to 

satisfy basic food needs, equivalent to 15.4 and 20.9 pesos per day in rural and urban areas), in 

2000, 18.6 percent of Mexican households and 24.2 percent of the total population had incomes 

below these levels.5

 The proportion of children lacking sufficient food, compared to the total 

number of children under 18 years of age, decreased from 32.7 percent in 2000 to 27.4 percent in 

2003. 

Lastly, the economic poverty threshold for 2000 (households with per capita income below the 

requirements to satisfy basic food needs and basic health, education, clothing, footwear, housing 

and public transportation needs) was calculated at 28.1 and 41.8 pesos per day per person in 

rural and urban areas, respectively. In the year 2000, 45.9 percent of Mexican households and 

53.7 percent of the total population had incomes below these levels. In the same year, the 

proportion of children in economic poverty, compared to all children under 18 years of age, was 

63.9 percent, with a minimal decrease to 62.7 percent for 2002. 

Vaccination coverage 

Rates of the vaccinations performed by the state health systems measure the immunization 

coverage among children less than one year old. The most important component in the basic 

vaccination plan for these children is the coverage attained with the triple viral vaccine (measles, 

mumps and rubella). Since 2000, national coverage rates with this vaccine have remained 

steady, at above 95 percent. 

Sustained progress in the National Vaccination Program (Programa Nacional de Vacunación) 

since 1992 is reflected in the decreased rates of morbidity and mortality from diseases 

preventable by vaccination. 

 

1 Primary: first official level of education, lasting six years. Education statistics come from 

http://biblioteca.itam.mx/docs/infogob02 on page 121. 2

 Secondary: second official level of education, lasting three years. 3

 Postsecondary: from the tenth through the thirteenth grades. 

4

 Higher education: from the fourteenth grade and higher. 5

 With respect to the capability/poverty threshold (referring to households with per capita income below the 

requirements necessary to satisfy food needs in addition to the income required to assume education and 

health expenses), this level was calculated at 18.9 and 24.7 pesos per day per person in rural and urban 

areas, respectively, for 2000. In that year, 25.3% of households and 31.9% of the total Mexican population 

had incomes below these amounts. In that same year, the proportion of children under 18 years of age in 

capability poverty, with respect to the total number of children in the same age group, was 41.6%. By 2002, 

the proportion had decreased to 35.1%.
7 

2 Asthma and Respiratory Disease 

Air pollution is a widespread problem in the large metropolitan areas of Mexico. Due to ongoing 

demographic growth, industrial concentration, increasing numbers of motor vehicles, high fuel 

consumption, and inadequate urban mobility patterns, this problem is beginning to be felt in other 

areas, such as mid-sized cities. 

In Mexico, standards exist for the following air pollutants: sulfur dioxide (SO2), carbon monoxide 

(CO), nitrogen dioxide (NO2), ozone (O3), total suspended particles (TSP), particles smaller than 

10 microns in diameter (PM10), and lead (Pb). These pollutants are called “criteria pollutants” and 

there is an air quality standard for each of them. The air quality standards establish the ambient 

pollutant concentrations that may not be exceeded more than once a year in the interests of 

guaranteeing adequate protection of public health. 

In Mexico as in other countries, easy-to-understand pollution indicators have been developed. 

Mexico uses the Metropolitan Air Quality Indicator (Indice Metropolitano de la Calidad del Aire—

Imeca), according to which the concentration set out in the air quality standard for each pollutant 

corresponds to an Imeca value of 100. The applicable air quality standards were published by the 

Secretariat of Health and are developed by it in coordination with the Secretariat of the 

Environment and Natural Resources (Secretaría del Medio Ambiente y Recursos Naturales—

Semarnat), with the participation of academics, environmentalists, and industry representatives. 

In general, air pollution in Mexico has declined considerably in urban areas in the last ten years, 

including in Mexico City. This is undoubtedly due to the implementation and monitoring of a series 

of measures to improve the environment by decreasing pollutant emissions, including: 

• Switching from fuel oil to natural gas for a proportion of electricity production; the share of 

natural gas in the total primary energy supply rose to 21 percent, while the share of 

petroleum dropped to 62 percent. 

• Seven large metropolitan areas have adopted local air quality management programs aiming 

to counter pollution from industry, the service and transportation sectors, as well as 

environmental recovery. 

• Fuel quality improvement has been the cornerstone of these programs. The reduction of lead 

and sulfur content in motor vehicle fuels has helped to reduce certain mobile source 

emissions. 

• A regional surcharge has been applied to gasoline with the objective of financing measures to 

improve the environment of the Valley of Mexico City Metropolitan Zone (MCMZ, Zona 

Metropolitana del Valle de México—ZMVM) and internalize environmental externalities. 

• In addition, Mexican Official Standards have been established for CO, NOx and motor vehicle 

hydrocarbon emissions. 

• Vehicles with catalytic converters replaced after five years of operation, clean industrial 

facilities, and facilities using natural gas were exempted from the air quality contingency 

plans by recent regulations. 

• The number of companies voluntarily carrying out environmental audits has grown constantly. 

Significant progress has been achieved on the implementation of the OECD 

recommendations concerning the Pollutant Release and Transfer Register. 
8 

2.1 Outdoor Air Pollution 

Despite air quality improvement measures, exposure to air pollution continues to be a severe 

threat to public health. 

Figure 2.1 shows the peak levels of ground-level ozone for five major urban air monitoring zones. 

The Valley of Mexico City Metropolitan Zone (Zona Metropolitana del Valle de México—ZMVM) 

registered the highest levels during the whole reporting period. Lowest levels were reported by 

the metropolitan zones of Monterrey (ZMM) and Ciudad Juárez (CD Juárez). 

Figure 2.2 shows the annual mean levels for PM10 in five major urban air monitoring zones. The 

highest levels were observed in ZMM and CD Juárez. The annual average Mexican norm for 

PM10 is 50 μg/m3

. [NORMA OFICIAL MEXICANA NOM-025-SSA1-1993. "SALUD AMBIENTAL. 

CRITERIO PARA EVALUAR LA CALIDAD DEL AIRE AMBIENTE, CON RESPECTO A LAS 

PARTICULAS MENORES DE 10 MICRAS (PM10). VALOR PERMISIBLE PARA LA 

CONCENTRACION DE PARTICULAS MENORES DE 10 MICRAS (PM10) EN EL AIRE 

AMBIENTE, COMO MEDIDA DE PROTECCION A LA SALUD DE LA POBLACION."] 

Suspended particles are a significant concern, with 30 percent of the days per year in 

exceedance days of the PM10 standard in certain metropolitan areas; the other pollutant of 

particular concern is ground-level ozone, for which exceedance is 80 percent in the ZMVM. 

Given the number and percentage of air quality exceedance days indicated in national monitoring 

systems’ monthly reports, air pollution continues to be a serious problem in both the ZMVM and 

the Guadalajara Metropolitan Zone (Zona Metropolitana de Guadalajara—ZMG), while in the 

Toluca Valley Metropolitan Zone (Zona Metropolitana del Valle de Toluca—ZMVT) and the 

Monterrey Metropolitan Zone (Zona Metropolitana de Monterrey—ZMM) the problem is less 

severe. The situation in Mexicali is also worrisome as regards PM10 and CO levels (see Figure 

2.3). 
9 

Figure 2.1: Peak Levels of Ground-level Ozone for Five Mexican Urban Air 

Monitoring Zones, 1990–2002 

Source: Segundo almanaque de datos y tendencias de la calidad del aire en seis ciudades Mexicanas. 

(Second Almanac of Data and Air Quality Trends in Six Mexican Cities) Secretaría del Medio Ambiente y 

Recursos Naturales (Semarnat). Instituto Nacional de Ecología (INE). 2004 

<http://www.ine.gob.mx/publicaciones/descarga.html?cv_pub=419>.

Note: ZMVM = Valley of Mexico City Metropolitan Zone, ZMVG = Valley of Guadalajara Metropolitan Zone, 

ZMM = Monterrey Metropolitan Zone, ZMVT = Valley of Toluca Metropolitan Zone, CD Juárez = Ciudad 

Juárez 

0 

40 

80 

120 

160 

200 

240 

280 

1990 1992 1994 1996 1998 2000 2002 

Year

Parts 

per billon 

ZMVM

ZMVG

ZMM

ZMVT

CD Juárez 
10 

Figure 2.2: Annual Mean Levels of Particulate Matter (PM10) for Five 

Mexican Urban Air Monitoring Zones, 1995–2002 

Source: Segundo almanaque de datos y tendencias de la calidad del aire en seis ciudades Mexicanas. 

Secretaría del Medio Ambiente y Recursos Naturales (Semarnat). Instituto Nacional de Ecología (INE). 

2004 <http://www.ine.gob.mx/publicaciones/descarga.html?cv_pub=419>.

Note: ZMVM = Valley of Mexico City Metropolitan Zone, ZMVG = Valley of Guadalajara Metropolitan Zone, 

ZMM = Monterrey Metropolitan Zone, ZMVT = Valley of Toluca Metropolitan Zone, CD Juárez = Ciudad 

Juárez

0 

15 

30 

45 

60 

75 

90 

105 

1996 1998 2000 2002 

Years

μg/m3 

ZMVM 

ZMVG 

ZMM 

ZMVT 

CD Juárez 
11 

Figure 2.3: Metropolitan Areas in Mexico with Air Quality Programs 

Including Air Monitoring, 1999–2002* 

Mexicali 

Tijuana 

Guadalajara 

Monterrey 

Ciudad Juárez

Valle de México

Toluca

0

10

20

30

40

50

60

70

80

90

Ground-level ozone PM10

Percentage of days exceeding the standard

0

5

10

15

20

25

30

Ground-level ozone PM10

Percentage of days exceeding the 

standard 0

1

2

3

4

5

6

Ground-level ozone PM10

Percentage of days exceeding the 

standard

0

5

10

15

20

25

30

35

40

Ground-level ozone PM10

Percentage of days exceeding the 

standard

6.5

7

7.5

8

8.5

9

Ground-level ozone PM10

Percentage of days exceeding the 

standard

0

5

10

15

20

25

Ground-level ozone PM10

Percentage of days exceeding the 

standard

0

5

10

15

20

25

Ground-level ozone PM10

Percentage of days exceeding the 

standard

Source: Segundo almanaque de datos y tendencias de la calidad del aire en seis ciudades Mexicanas. 

Secretaria del Medio Ambiente y Recursos Naturales (Semarnat). Instituto Nacional de Ecología (INE). 2004 

<http://www.ine.gob.mx/publicaciones/descarga.html?cv_pub=419>. 

Note: *4-year arithmetic mean; but for Mexicali and Tijuana, 3-year arithmetic mean, 1997–99. Percentages 

of days in violation of the standards are calculated from the Imeca values. 

Key Observations: 

• Given the number and percentage of air quality exceedance days indicated in the 

national monitoring systems’ monthly reports, air pollution continues to be a serious 

problem in both the Mexico Valley Metropolitan Zone and the Guadalajara Metropolitan 

Zone. 

• Peak levels of ground-level ozone have decreased since 1990; however, the Mexican 

standard of 110 ppb has been violated in almost all years in the Mexico City Metropolitan 

Zone (with exceedance rates of over 80 percent). Guadalajara has reported violations for 
12 

1996 and 1997. Monterrey, Toluca and Ciudad Juárez have not reported any 

exceedances of the standard in the period from 1990 to 2002 (Figure 2.1). 

• Suspended particles are a significant concern in a number of metropolitan zones, with 

greater than 30 percent of days in exceedance for PM10 in Mexicali and greater than 20 

percent in Guadalajara, Ciudad Juárez and Monterrey.

• The situation in Mexicali is also worrisome with regard to PM10 and carbon monoxide 

levels. 

• The annual mean levels for PM10 exceeded the Mexican mean annual standard of 50 

micrograms per cubic meter in Guadalajara, Mexico City, and Ciudad Juárez in most 

years in the reporting period (1995 to 2002) (Figure 2.2). 

• The Mexican daily maximum standard of 150 micrograms per cubic meter for suspended 

particles (PM10) was exceeded on 20 percent or more days in the reporting period (1999–

2002) in Mexicali, Guadalajara, Ciudad Juárez and Monterrey. In Mexicali, exceedances 

occurred on approximately 35 percent of the days (Figure 2.3). [Note: In September 

2005, regulations were published lowering the daily maximum standard for PM10 to 120 

μg/m3

 (NOM-026-SSA1-1993).] 

• The standard for ground-level ozone was exceeded in the Valley of Mexico City 

Metropolitan Zone on more than 80 percent of the days during the reported period 

(Figure 2.3). 

• Although most of the metropolitan zones did not exceed the standard for carbon 

monoxide (11.00 ppm for a moving 8-hour daily average, not to be exceeded more than 

once per year [see NOM-021-SSA1-1993, “Salud Ambiental. Criterio para evaluar la 

calidad del aire ambiente con respecto al monoxido de carbono (CO) en el aire ambiente, 

como medida de protección a la salud de la población”]), in Mexicali, it was exceeded on 

19 percent of the days (data not shown). 

A National Air Quality Information System (Sistema Nacional de Información de Calidad del 

Aire—Sinaica) was established in the second half of 2002, based upon various antecedent air 

monitoring programs in Mexican metropolitan zones. Presently, 23 cities have permanent air 

monitoring systems, including the major urban areas (Mexico City, Guadalajara, Monterrey, and 

Toluca) and some cities along the northern border (Ciudad Juárez, Tijuana, and Mexicali). 
13 

2.2 Indoor Air Pollution 

Use of Biomass 

Indoor air pollution in homes caused by the burning of firewood or charcoal for cooking is a 

public health problem with impacts on children under five and reproductive-age women. The 

number of annual deaths in developing countries associated with domestic biomass combustion 

is estimated at 1,849,000. 

In 1990, one in three Mexicans used firewood for cooking, including 91 percent of rural residents 

and 11 percent of urban residents. It is estimated that 25.6 million people used this fuel in their 

homes in 1993 and that by 2000 this number had declined to 17,256,471.6

 

Because of this, the Federal Commission for Protection Against Sanitary Risks (Comisión 

Federal Para la Protection Contra Riesgos Sanitarios—Cofepris) initiated a project in 2004 to 

decrease indoor exposure to biomass smoke. This is intended to promote technological 

improvements in indoor emission control, reinforce community participation, promote interinstitutional and cross-sector participation, and communicate risks to the population. 

Figures 2.4 to 2.6, below, illustrate exposure to biomass smoke by percent of population in the 

various states of Mexico. 

Figure 2.4: Percentage of Mexico’s General Population Exposed to 

Biomass Smoke, by Region, 2000 

0 10 20 30 40 50 60 70

Oxaca

Chipas

Guerrero

Yucatan

Veracruz

Tabasco Campeche Hidalgo

Puebla

S.L.P

Michoacan Durango

Tlaxcala

Queretaro Nayarit Guanajuato

Sinaloa

Morelos

Colima

Zacatecas

Chihuahua

Mexico

Sonora Tamaulipas

Jalisco

B.C.S

Coahuila

Nuevo Leon Aguascalientes

Quintana Roo

Baja California

Distrio Federal

States

Percent (%)

Source: Diagnóstico Nacional de Salud Ambiental y Ocupacional 2002. Dirección General de Salud 

Ambiental

 

6

 Masera et al. 2003. 
14 

Key Observations 

• In 1990, one in three Mexicans used firewood/charcoal for cooking, including 91 percent 

of rural population and 11 percent of those living in urban areas. In 1993 25.6 million 

people used this fuel in their homes and by 2000 this number had declined to 17.3 

million. 

• Among the states with the highest use of firewood are Oaxaca and Chiapas, where it is 

estimated that 50–60 percent of the population uses this type of fuel. The general pattern 

is that a higher proportion of people are exposed to firewood and charcoal in the southern 

part of the country. These are largely rural states with some of the poorest populations; 

thus, exposure to firewood-related pollutants is more prevalent here. 

Figure 2.5: Population Under the Age of 19 Exposed to Biomass Smoke, by 

State, Mexico, 2000 

0 2000 4000 6000 8000 10000 12000 14000

Baja California Sur

Colim a

Campeche

Quintana Roo

Nayarit

Aguascalientes

Tlaxcala

Querétaro

Zacatecas

Durango

Morelos

Yucatán

Tabasco

Sonora

Hidalgo

Coahuila

Baja California

San Luis Potosí

Sinaloa

Tam aulipas

Chihuahua

Guerrero

Oaxaca

Nuevo León

Chiapas

Michoacán

Guanajuato

Puebla

Jalisco

Veracruz

Distrito Federal

México

Thousand

TOTAL POPULATION (all ages) UNDER 19

Source: XII General Census of Population and Housing (Censo General de Población y Vivienda XII, 2000)

INEGI 2000. 

Key Observations 

 The graph shows the percentage of the total population that is under the age of 19 and 

that may potentially be exposed to pollutants from biomass fuel usage. This age group 

corresponds to 43 percent of the Mexican population, with the highest proportion in the 

country’s southern region. 
15 

Figure 2.6: Percentage of Fuel Wood Users, at the Municipal Level, in 

Mexico, 2000 

Source: Masera, O.R, Drigo, R., and Trossero, M.A. 2003. Woodfuels integrated supply/demand overview 

mapping. Universidad Autónoma de México, FAO-EC Partnership Programme. Food and Agriculture 

Organization of the United Nations, p. 23. 

Key Observations 

• The heaviest biomass fuel usage by household is in southern and north central Mexico, 

where utilization may approach 90 to 100 percent in some locales. These are largely rural 

states with some of the poorest populations. 

Smoking Rates 

Mexico does not have specific information on passive smoker statistics in the population under 

12, where “passive smoker” or “involuntary smoker” is defined as any person not classified as an 

active smoker who is exposed to tobacco smoke (smokers in a given environment) at home, in 

the classroom and/or at the workplace. However, the National Addictions Survey (Encuesta 

Nacional de Adicciones—ENA-2002) finds that there are around 48 million Mexicans in this 

situation. 

Since 1998, the Secretariat of Health has been conducting the same survey every five years, 

creating a major repository of information on the subject. The National Addictions Survey (ENA2002) is the first survey conducted by the National Institute of Statistics, Geography and 

Information (Instituto Nacional de Estadística, Geografía e Informática—INEGI), although it does 

have an earlier background study entitled “Drugs and Users,” published in 1976. 
16 

According to data in the Anti-Tobacco Program prepared by the National Council Against 

Addictions (Consejo Nacional contra las Adicciones), there are approximately 13 million smokers 

in Mexico, 24.6 percent of whom are women and 75.4 percent are men.7

As regards passive smokers, 36.1 percent of the urban population is included in this category, 

with the highest percentage in the central region (43.7 percent) (Fig. 2.7 shows only information 

from urban areas). 

The highest involuntary exposure to tobacco smoke among the rural population (Figure 2.8) was 

found in interviewees’ homes in the northern region (31.9 percent). 

Figure 2.7: Prevalence of Passive Smoking in Urban Populations (Ages 12 

to 65) in Mexico, 2002 

Central 

Region 43.7% 

Southern 

Region 26.4% 

National Average 36.1% 

Northern 

Region 33.1% 

Source: ENA 2002, National Council Against Addictions (Consejo Nacional Contra las Adicciones—

Conadic), National Institute of Pediatrics (Instituto Nacional de Pediatría—INP), General Bureau of 

Epidemiology (Dirección General de Epidemiología—DGE), National Institute of Statistics, Geography and 

Information (Instituto Nacional de Estadística, Geografía e Informática—INEGI) 

Key Observations 

• With regards to age, young persons (12 to 17 years old) represented 19 percent of the 

total sample smoking population (urban and rural) and the rest of the sample smoking 

population was distributed among groups ranging from 18 to 65 years of age. The 

distribution of the rural population was similar, with 46 percent corresponding to men and 

54 percent to women, and with 22 percent being adolescents and the rest the adult 

population. 

With regards to passive smokers, Mexico does not have specific information on children. 

There is a 36.1 percent national prevalence of passive smokers in the urban population, 

with the highest percentage in the central region (43.7 percent). 

 

7

 Data taken from http://www.conadic.gob.mx/doctos/ena2002/ENA02-O.pdf, consulted in 

October 2005. 
17 

Figure 2.8: Prevalence of Passive Smoking in Rural Populations (Ages 12 

to 65) in Mexico, 2002 

 

Source: ENA 2002, National Council Against Addictions (Consejo Nacional Contra las Adicciones—

Conadic), National Institute of Pediatrics (Instituto Nacional de Pediatría—INP), General Bureau of 

Epidemiology (Dirección General de Epidemiología—DGE), National Institute of Statistics, Geography and 

Information (Instituto Nacional de Estadística, Geografía e Informática—INEGI) 

Key Observations 

• 26.2 percent of the rural population (between 12 and 65 years old) is exposed to passive 

smoke. 

• The highest percentage of the population exposed to passive smoke is in the northern region 

(31.9 percent) and the lowest percentage is in the southern region (20.4 percent). 

Northern Region 

31.9% 

Central Region 

30.2% 

Southern Region 

20.4% 

National Average 26.2% 
18 

Figure 2.9: Percentage of Smokers, Ex-smokers and Non-smokers among 

Adolescents (12–17 years old), by Gender, in Urban Locations in Mexico, 

2002 

0

10

20

30

40

50

60

70

80

90

Smokers Ex-Smokers Non-Smokers

Percent (%)

Males Females

Source: National Survey of Addictions, 2002 (Encuesta Nacional de Adicciones 2002) Secretaría de Salud.

Key Observations: 

• A recent study (the Mexico-Monterrey Global Youth tobacco survey, an initiative of WHO) 

performed in the city of Monterrey found very high environmental exposure to tobacco in 

first-, second- and third-year middle school students, among whom four of every ten live 

in homes where others smoke. Six out of ten are exposed to smoke in public places, 

while nearly half have parents who smoke. 
19 

Figure 2.10: Percentage of Smokers among Adolescents, by Age Group 

and by Gender, in Urban Locations in Mexico, 2002 

0

10

20

30

40

50

60

< 11 11-14 15-17

Age Groups

Percent (%)

Males Females

Source: National Survey of Addictions, 2002 (Encuesta Nacional de Adicciones 2002) Secretaría de Salud.

Key Observations: 

 With respect to the tobacco use starting age among urban youth, nearly half (47.6 

percent, with some variation between the sexes—46.1 percent for males and 52.3 

percent for females) began to smoke between 15 and 17 years of age. Note that while 

one of every ten adolescent males began to smoke before the age of 11, no women 

mentioned such an early starting age. 

 The frequency of smoking among rural youth is 6.1 percent (231,677), of whom 11.3 

percent are male and only 1 percent are female. The graph shows only the urban 

population. 

2.3 Asthma 

The health impacts of exposure to air pollutants have begun to be studied in recent years. Some 

studies in Mexico City have revealed a close correlation between urban air pollution and lung 

diseases, lung aging processes, and respiratory infections. 

An individual’s risk level is determined by various factors, including genetic predisposition, age, 

nutritional status, presence and severity of heart and respiratory conditions, and use of 
20 

prescription drugs, as well as type and place of work. In general, the highest-risk population 

consists of children under the age of 5, senior citizens (over the age of 65), persons with heart or 

respiratory diseases, and asthmatics. 

Ozone and particles are the pollutants of greatest importance, both for their potential health 

effects and the frequency of exceedances of the corresponding air quality standards. 

Acute respiratory infections (ARI), asthma, and chronic obstructive pulmonary disease (COPD) 

are considered to be the conditions most related to air pollution in both rural and urban areas. 

In Mexico, statistical data on morbidity and mortality is compiled and analyzed as an official 

source through the National Epidemiological Surveillance System (Sistema Nacional de 

Vigilancia Epidemiológica—Sinave), an action program made up of a set of strategies and 

activities to identify and detect harm and risks to health. 

Its importance resides in its capacity to generate information useful in guiding programs; diseases 

control interventions, and risk situations that seriously and frequently affect the community. 

Since the inception of Sinave in 1995, the Centralized Epidemiological Surveillance System 

(Sistema Único de Information para la Vigilancia Epidemiológica—SUIVE) has been established. 

It systematizes morbidity and mortality information with the participation of the whole sector. With 

the creation of SUIVE, criteria, formats, and notification procedures were standardized across the 

institutions of the National Health System (Sistema Nacional de Salud—SNS). 

SUIVE generates homogeneous information from the health services at their various 

technical/administrative levels. This information concerns the occurrence, distribution in time, 

place and person, risk factors, and consequences of diseases affecting public health. It is 

recorded in special formats for each level. From the local level it is sent to the jurisdictional level, 

where it is compiled and sent to the state level and, in turn, to the national level. The information 

from the corresponding levels is compiled and analyzed to guide and support decision-making for 

the design and application of health plans and programs throughout the country. 

The Centralized Automated Epidemiological Surveillance System (Sistema Unico Automatizado 

para la Vigilancia Epidemiológica—SUAVE) is a software package that compiles Sinave 

information generated by the institutions making up the SNS. This program contains information 

on the 109 diseases subject to weekly reporting and the 30 subject to immediate reporting, of 

which 96 are reported on form SUIVE-1-2000. SUAVE is a self-installing, user-friendly program. 

The databases captured can be sent by electronic mail. This program offers graphic reporting and 

mapping capabilities; it also contains historical morbidity information and compiles information on 

new disease cases. 

The National Epidemiological Surveillance System [Sinave] action plan has five components: 

• Weekly notification of new disease cases (SUAVE). 

• Hospital Epidemiological Surveillance Network (Red Hospitalaria para la Vigilancia 

Epidemiológica—Rhove). 

• Epidemiological and Statistical Death Reporting System (Sistema Epidemiológico y 

Estadístico de las Defunciones—SEED). 

• Special systems. 

• Centralized Laboratory Information System (Sistema Único de Information de 

Laboratorio—Suilab). 

These components are described in further detail in Appendix 2. 
21 

Prevalence of Asthma 

Asthma is a genetically based disease that is accompanied by immunological alterations. It is the 

most common chronic illness in children, generally diagnosed in the first years of life due to its 

early clinical manifestation. 

Exposure in open or closed spaces to sources of biological or chemical contamination has been 

shown to cause and/or exacerbate asthma. The greater the concentration of pollutants to which 

an asthmatic is exposed, including frequency and duration of exposure, the more severe the 

symptomatic and functional response. Particulate matter represents a significant public health risk 

due to its size and composition; the situation is particularly bad in metropolitan areas where the 

frequency of PM10 exceedance is approximately 30 percent. 

In Mexico, it has been observed that the residents of coastal states are more likely to exhibit 

asthma, possibly due to the ambient humidity, where dust in homes has a high probability of 

entering the respiratory tract in the form of suspended particles. Its greater frequency in these 

regions has also been attributed to the use of air conditioning systems, which harbor a large 

quantity of dust and molds that can trigger asthmatic episodes. In a recent study, an inverse 

relationship was found between altitude and asthma incidence (Mario H. Vargas et al., 1999). 

Figure 2.11: Incidence of Asthma in Children under Five Years Old, in 

Mexico 1995–2002 

0

10

20

30

40

50

60

70

1995 1996 1997 1998 1999 2000 2001 2002

Years

Number of New Cases/10 000

Source: Boletín de Información Epidemiológica 1998–2002. (Epidemiological Information Bulletin 1998–

2002). Dirección General de Epidemiología. Secretaría de Salud (Secretariat of Health) 

<http://www.dgepi.salud.gob.mx/suave/index.htm>. 
22 

Key Observations 

 The population of asthmatic children under the age of five is considered especially 

vulnerable to air pollutants. 

 The incidence of asthma morbidity increased in this age group between 1995 and 1999, 

but a 10-point decrease was observed in 2000. 

Prevalence of Acute Respiratory Infections 

There is a group of viral, allergic, and bacterial illnesses classified as acute respiratory infections 

(ARI). They include upper respiratory tract infection, laryngitis, and acute bronchitis. They present 

clinically with similar symptoms and it can be difficult to identify the cause of the pathology. They 

are important because of the high morbidity they cause. 

The ARI-related morbidity rates vary throughout the nation according to various mitigating or 

exacerbating factors, such as poverty; marginalization; malnutrition; lack of access to health 

services; physicochemical state of the pollutants and their concentration in the environment, 

mainly dependent on industrialization; and prevailing weather and geographical conditions. 

Figure 2.12: Incidence of Acute Respiratory Infections (ARI) in Children 

under Five Years of Age, in Mexico, 1993–2002 

0

20000

40000

60000

80000

100000

120000

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Years

Number of New Cases/100 000

Source: Boletín de Información Epidemiológica 1998–2002. (Epidemiological Information Bulletin 1998–

2002). Dirección General de Epidemiología. Secretaría de Salud (Secretariat of Health) 

<http://www.dgepi.salud.gob.mx/suave/index.htm>. 
23 

Key Observations 

• Figure 2.12 shows a nearly 100 percent increase in ARI-related morbidity between 1993 

and 2000. Meanwhile, ARI-related mortality rates are on the decline. Hence these figures 

are a reflection of the epidemiological transition our country is undergoing, in which 

mortality due to infections has tailed off while mortality due to chronic degenerative 

diseases is on the rise. 

Figure 2.13: Incidence of Asthma among Children, by Age Group, in 

Mexico, 1998–2002 

 < 1 year

1 to 4 years

5 to 14 years

0

10

20

30

40

50

60

70

1998 1999 2000 2001 2002

Years

Number of New Cases/10 000

Source: Boletín de Información Epidemiológica 1998–2002. (Epidemiological Information Bulletin 1998–

2002). Dirección General de Epidemiología. Secretaría de Salud (Secretariat of Health) 

<http://www.dgepi.salud.gob.mx/suave/index.htm>. 

Key Observations 

• The highest rates of asthma consistently appear in children aged 1 to 4 years, with an 

increasing trend from 54 cases per 10,000 in 1998 to 63 cases per 10,000 in 2002 

(Figure 2.13). 

• The asthma prevalence rate in children less than one year-old showed a decline since 

2000, and currently remains at 33 cases per 10,000. As opposed to a true change in 

disease prevalence, this decline was directly attributable to a change in the immediate 

notice form (Epi-1 2000) for medical unit reporting. This occurred due to the difficulty in 

diagnosing asthma in this age group. In the 5 to 14 year-old age group, the rates have 

grown slightly from 28 to 32 cases per 10,000 over the sampling period. 

• In Mexico, it has been observed that the residents of coastal states are more likely to 

exhibit asthma than populations elsewhere in the country. 
24 

Figure 2.14: Incidence of Acute Respiratory Infections (ARI) among 

Children in Mexico, by Age Group, 1998–2002 

 < 1 year

 1 to 4 years

5 to 14 years

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

1998 1999 2000 2001 2002

Years

Number of New Cases/100 000

Source: Boletín de Información Epidemiológica 1998–2002. (Epidemiological Information Bulletin 1998–

2002). Dirección General de Epidemiología. Secretaría de Salud (Secretariat of Health) 

<http://www.dgepi.salud.gob.mx/suave/index.htm>. 

Key Observations 

• For acute respiratory infections (ARI), children below one year of age constitute the most 

affected population, with annual rates averaging at 16,000 per 100,000 children (Figure 

2.14). Only in 1998 were fewer cases reported during this period. The population of 

children aged 1 to 4 years shows a slight increase in rates from 7,500 in 1998 gradually 

arriving at 8,100 per 100,000 children in this age group. The lowest rates were observed 

for children from 5 to 14 years old. 

• ARI and asthma in children and chronic obstructive pulmonary disease (COPD) in adults 

are considered to be the conditions most related to air pollution in both rural and urban 

areas. 
25 

Figure 2.15: Rate of Mortality by Acute Respiratory Infections (ARI) 

Infections of Five-year-old Children in Mexico, 1990–1999 

0

2000

4000

6000

8000

10000

12000

14000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Years

Rate/100 000

Source: Boletín de información epidemiológica 1990–1999/ Conapo national projections

Key Observations 

 The number of five-year-old children dying from ARI infections has been decreasing, from 

12,907 deaths per 100,000 in 1990 to 5,159 deaths per 100,000 in 1999 (Figure 2.15). 

This reflects the epidemiological transition, where the mortality rate due to infectious 

diseases has been decreasing and the mortality rate due to degenerative chronic 

diseases has been increasing in the last decade. 
26 

3 Lead and Other Chemicals, Including Pesticides 

In Mexico, the main source of environmental exposure to lead is the manufacture and use of 

glazed ceramics containing lead oxide. According to the National Crafts Fund (Fondo Nacional 

de las Artesanías—Fonart), ceramics are produced in 20 states of the country and there are 

approximately 5 million potters, a significant proportion of them indigenous. 

Various people and social groups of all ages participate in this activity. Workshops are familyrun, with father, mother, children and perhaps other relatives such as cousins, uncles, 

godparents, etc., all participating. They use processes handed down across the generations. 

Workshops are generally found in the yards of people’s homes; they are rudimentary and 

inadequate to prevent exposure to lead, which occurs primarily while the pots are being glazed 

with lead oxide. 

Pottery making has always been one of the primary sources of exposure to lead, and the glazing 

process represents the highest risk. In the 16th century, it was known that preparation and 

conservation of food and beverages in lead-glazed containers caused them to become 

contaminated, giving rise to increased blood lead levels which manifested themselves as acute or 

chronic lead intoxication. 

Prior to 1521 when it was introduced by the Spanish, lead was not used in this process in 

Mexico. The use of lead became widespread and continues to this day. 

When pots are fired at temperatures lower than 990°C, the lead from glazes can go into solution 

on contact with food, especially acidic foods such as vinegar, lemons, oranges, and tomatoes. 

In terms of health effects, starting in 1960, cases of acute lead intoxication due to the 

consumption of fruit drinks or juices from glazed containers were reported by health institutions in 

Mexico City. Studies conducted on urban populations, especially school children and women of 

reproductive age, have found a significant association between high blood lead levels and the 

use of glazed ceramics to serve food and drinks. In potters themselves, a case of endemic lead 

intoxication was reported in a population of potters in the state of Oaxaca as early as 1878; 

subsequent epidemiological studies have found high lead levels in potters in Oaxaca, Michoacán 

and Jalisco. 

The groups most likely to become intoxicated by lead are children and women of reproductiveage, although men and women of any age can be affected. 

Lead has a wide range of toxic effects on multiple body systems. Acute exposure to high levels 

causes severe intoxication, manifested by a highly lethal encephalopathy. Chronic exposure 

produces a range of symptoms and a heightened risk of neuropsychological disorders, 

neuropathy, peripheral neuropathy, anemia, and birth defects. Lead has toxic effects even at low 

levels of exposure, the most notorious being an insidious effect on cognitive development in 

children. There is no threshold indicating exactly when lead’s effects on health begin; however, 

levels as low as 10 μg/dL are known to produce clinical manifestations, and harm may occur at 

even lower levels. 

Actions to Address Lead Problems in Mexico

Lead exposure assessment and prevention program in mining and metallurgy areas 

Mexico, with its mineral wealth, has become one of the world’s foremost mining countries, with 

the bulk of the country’s production of lead coming from the northern state of Chihuahua.8

 The 

Secretariat of Health has taken various actions to reduce the risk of exposure, chief among them 

the regulation of its various sources and the issuance of an emergency standard establishing 

criteria for the determination of blood lead levels and health protection actions. In 1999, with a 

 

8

 See <http://www.mbendi.co.za/indy/ming/ldzc/am/mx/p0005.htm>. 
27 

view to generating exposure information useful in identifying the existence of health risks, the 

program was brought to the states in which the country’s main mining areas are located. This 

program made it possible to identify various companies that represent a risk to the health of their 

workers and the surrounding population. 

Program for eliminating exposure to lead oxide among Mexicans engaged in manufacturing and 

using glazed pottery to prepare, consume, or store food and beverages.

Legal Framework 

Within the framework of the Federal Law of Measurements and Standards (Ley Federal sobre 

Metrología y Normalization), 11 Mexican Official Standards were developed to regulate the use of 

lead: 

NOM-002-SSA1-1993 Environmental health, goods and services. Metal containers for food 

and beverages. Seam specifications. Sanitary requirements. 

NOM-003-SSA1-1993 Environmental health. Sanitary requirements for labeling of paints, 

dyes, varnishes, lacquers, and glazes. 

NOM-004-SSA1-1993 Environmental health. Sanitary limitations and requirements for the 

use of lead monoxide (litargirio), red lead oxide (minium) and basic 

lead carbonate (albayalde). 

NOM-005-SSA1-1993 Lead chromate and lead chromate molybdate pigments. Extraction 

and determination of soluble lead. Test procedure. 

NOM-006-SSA1-1993 Paints and varnishes. Preparation of acid extracts of dry paint 

layers for determination of soluble lead. Test procedures. 

NOM-008-SSA1-1993 Environmental health. Paints and varnishes. Preparation of acid 

extracts of liquid or powdered paint for determination of soluble lead 

and other methods. 

NOM-009-SSA1-1993 Environmental health. Glazed ceramics. Test procedure for 

determination of soluble lead and cadmium. 

NOM-010-SSA1-1993 Environmental health. Glazed ceramic items. Limits for soluble lead 

and cadmium. 

NOM-011-SSA1-1993 Environmental health. Limits for soluble lead and cadmium in 

glazed pottery. 

NOM-015-1/SCFI/SSA-1994 Bioavailability of metals in toys and school items 

NOM-199-SSA1-2000 Environmental health. Blood lead levels and actions as criteria for 

protection of the health of the non-occupationally exposed 

population. 

NOM-231-SSA1-2002 Glazed pottery, glazed ceramics and porcelain. Soluble lead and 

cadmium limits 

For approximately ten years there have been rules banning the use of lead-glazed pottery in food 

preparation, requiring that this type of pottery be used for decoration only and perforated to 

ensure it is not used for food preparation. As well, several initiatives may change the distribution 

of pottery-making activities, distinguishing between areas where there is still a significant 

production of pottery glazed with lead oxide at low temperatures and those areas where kilns 

have been changed to raise the glazing temperature and/or use of alternative glazing methods 

have been introduced so that lead oxide is not used. Despite these actions, Mexican potters 

continue to use lead oxide in traditional pottery and the general public continues to purchase 

these lead-containing products. 
28 

3.1 Blood Lead Levels 

Mexico has blood lead level data only from isolated studies conducted in industrial areas, as well 

as several regions in which pottery making is common; however, no baseline national information 

on blood lead levels is available. 

Because of this, the Federal Commission for the Prevention of Sanitary Risks (Comisión Federal 

para la Protección contra Riesgos Sanitarios—Cofepris) undertook a project entitled “Lead in 

Ceramics Fired at Low Temperatures” in which strategies are developed for the elimination of 

this risk. These include a risk communication program, a blood lead level monitoring system, and 

actions to prevent and control exposure and harmful health effects caused by exposure to lead in 

ceramics fired at low temperatures. 

Table 3.1 below summarizes several studies conducted on Mexicans exposed to lead 

occupationally and non-occupationally. 

Table 3.1: Blood Lead Levels of Children in Rural and Urban Populations, in 

Mexico 

Exposure to Ceramic 

Glazes 

Blood Lead 

Levels 

μg/dL 

Author 

and Year 

Place Community Population General

Public

Occ. N Mean SD

AzconaCruz, M., 

et al., 

2000 

Oaxaca Rural Children (9 years of 

age) 

Yes Yes (children of 

potters) 

220 10.50** ±7.0

Olaiz, 

F.G., et 

al., 1997 

Michoacán Rural Children (less than 16 

years old) 

No Yes 181 26.20** - 

Batres, 

L., et al., 

1994 

San Luis 

Potosí 

Rural Children (3 to 6 years 

old) 

Yes No 37 26.50* ±1.3

Carrizales 

et al., 

2005 

San Luis 

Potosí 

Rural Children (3 to 6 years 

old) 

Yes No 30 14.80* - 

Romieu, 

I., et al., 

1992 

Mexico 

City 

Urban Children (6 to 8 years 

old) 

(Living near vehicular 

traffic) 

Yes 

Yes 

No 

No 

40 

15 

12.60* 

15.10* 

±4.6

±3.9

Molina, 

B.G., et 

al., 1990 

Tonalá, 

Jalisco 

Rural Children (0 to 9 years 

old) 

No Yes 9 81.90* - 

DíazBarriga, 

F., et al. 

1997 

Ciudad 

Juárez, 

Chihuahua 

Semi-urban Children (5 to 13 years 

old) 

 Yes No 44 9.70** - 

Note: * Arithmetic mean. ** Geometric mean. N = Sample size; Occ. = Occupational; SD=Standard 

Deviation. Please see the Glossary for definitions of geometric mean and arithmetic mean. 

Sources: Azcona-Cruz et al. 2000; Batres et al. 1994; Carrizales et al. 2005; Díaz-Barriga et al. 1997; MolinaBallesteros et al. 1980; Olaiz et al. 1997; Romieu et al. 1992. 
29 

Key Observations 

• Studies indicate that some populations of Mexican children have very high levels of 

blood lead, in some cases more than five times the action level of 10 μg/dL (Mexico, 

Cofepris, Date unknown). 

Case Study 1: Effects of Lead Management Strategies on Ambient Lead Levels in 

the Mexico City Metropolitan Zone

Ambient lead levels and lead exposures were dramatically reduced through a series of initiatives 

to reduce lead in gasoline and consumer products in Mexico. These actions, which were 

supported with regulations and consumer education, have produced substantial reduction in 

childhood exposure to lead. 

In October 1990, it was agreed to establish the Integrated Program for Air Pollution Control in the 

Mexico City Basin (Programa Integral Contra la Contaminación Atmosférica en el Valle de 

México—PICCA). Lead levels in Mexican gasoline were reduced by 88 percent (average of 0.2 

g/L) by 1992.9 The transition to unleaded gasoline was assisted with a reduction of the price of 

lead-free gasoline to encourage its use. Over the course of the program a series of further 

reductions in the allowable levels of lead in gasoline were implemented across Mexico. These 

reductions resulted in an average annual and minimum recorded lead concentration in gasoline of 

0.001g/gal in the Mexican City Metropolitan Zone. 

 

9 See <http://www.hwwa.de/PersHome/Michaelowa_A/Lead.htm>.
30 

Figure 3.1: Atmospheric Monitoring of Lead and Principal Activities to 

Reduce Lead Emissions in the Mexico City Metropolitan Zone (MCMZ), 

1990–2000 Lead Ambient Air Concentration (

μg/m3

) 0.0

0.5

1.0

1.5

2.0

2.5

3.0

1990 1992 1993 1994 1995 1996 1997 1998 1999 2000

Years

Tlalnepantla Xalostoc Merced Pedregal Cerro de la estrella

Standard: 1.5 μg/m3

Prior to 1986, the maximum tetraethyl lead (TEL) content in nova and nova plus gasoline was 3.5 ml/gal (0.92 ml/L) 

and it was reduced to 0.5–1.0 ml/gal (0.13–0.26 ml/L). 

In June 1991, the specified range for TEL content was reduced and a new content range of 0.3–0.54 ml/gal 

(0.079–0.14 ml/L) was established for both gasolines. 

In October 1992, a new TEL content specification was established for nova and nova plus 

gasolines with a range of 0.2-0.3 ml/gal (0.05–0.08 ml/L). 

In 1994, the maximum TEL content in gasoline during the winter was reduced 

from 0.2–0.3 ml/gal to 0.1–0.2 ml/gal (0.03–0.05 ml/L). 

Distribution of premium gasoline with a fixed lead 

concentration of 2.64 mg/L began in 1996. 

End of distribution in MCMZ of nova 

gasoline with an average TEL 

concentration of 0.3 ml/gal (0.08 ml/L). 

Lead content of nova plus magna gasoline was 2.64 mg/L

Lowest annual average lead 

concentration for gasolines distributed in 

the MCMZ is 0.001 g/gal (0.26 mg/L). 

1991

Air monitoring stations:

Source: Programa para Mejorar la Calidad del Aire de la Zona Metropolitana del Valle de México 2002–

2010 (Proaire).

Note: Tetraethyl lead (TEL) is a liquid. Nova, nova plus, and nova plus magna are grades of 

gasoline, ranked according to increasing octane levels. 

Key Observations 

• Actions to eliminate lead from gasoline substantially reduced airborne emissions of lead 

in the Mexico City Metropolitan Zone. 
31 

Case Study 2 

Levels of Lead in Blood in a Child Population in Northern Mexico due to 

Metallurgical Activities—A Local Case Study 

The city of Torreón, Coahuila, located in northern Mexico, has a population of approximately 

530,000 inhabitants. Latin America’s largest, and the world’s fourth-largest, mining-metallurgical 

company, Met-Mex Peñoles, is located in this town, producing lead, silver and gold. The 

presence of this industry has led to the chronic environmental exposure to lead in the nonoccupational population, particularly in children. 

The results of formal studies performed since 1997 have shown a high concentration of lead in 

the soil and air, thereby documenting prolonged, historic pollution. One of these studies (García, 

et al. 2001) corroborated the presence of lead in the blood of school children in a relationship 

directly proportional to their proximity to the metallurgical plant. This problem gave rise to an 

environmental emergency situation, as it represented both public health and social problems. 

To handle this situation, the state Secretariat of Health (Secretaría de Salud), the Office of the 

Federal Attorney for Environmental Protection (Procuraduría Federal de Protección Ambiental—

Profepa) and the company Peñoles implemented a series of actions including, among others, 

emissions control and reductions and improved smelting processes in the facility, the oversight of 

the environmental authority by Profepa, and by the Secretaría de Salud of the medical care 

provided by the by the state secretariat of health for the environmentally exposed population. 

A trust was set up with funding (60 million pesos) provided by the company in 1999, creating a 

Metals Program (Programa de Metales) to coordinate health-related actions (detection, treatment 

and rehabilitation) for the population with environmental lead exposure. To remediate the 

environment, teams with high-efficiency vacuums cleaned the streets, building roofs and house 

interiors within a radius of four kilometers of the facility to reduce the accumulated concentration 

of lead on surfaces and in the soil. Contaminated soil was removed, thorough cleaning of public 

and private living spaces was aggressively conducted, and streets and patios near the facility 

were paved. 

On 31 May 2004, five years after its creation, the trust that originated the Metals Program ended, 

having accomplished its immediate goals of gradually reducing the risks and health effects of 

lead to the population. However, the success attained required vigilance and continuing efforts to 

assure the maintenance of good environmental quality and the health of the population, so the 

firm developed a new program for the protection and treatment of the population exposed to lead 

and other heavy metals in the ambient environment in Torreón, and funds it annually in the 

amount of 18 million pesos. 

The following graphs show the results of the intervention of the health and environmental 

authorities to abate the concentrations of lead in blood, as well as the decreased concentrations 

of lead in soil and air.
32 

Figure 3.2: Local Air Quality Data from Metallurgical Activities in Torreón, 

Mexico, 1999–2003 

Limit according to 

standard NOM-026-

SSA1-1993 

0

1

2

3

4

5

6

7

8

9

4/13/19997/13/1999

10/13/1999

1/13/20004/13/20007/13/2000

10/13/2000

1/13/20014/13/20017/13/2001

10/13/2001

1/13/20024/13/20027/13/2002

10/13/2002

1/13/20034/13/20037/13/2003

10/13/2003

1/13/2004

Dates

μg/m3 

Source: Programa de Metales, Secretaría de Salud del Estado de Coahuila, 1999–2003. 

Note: Red line indicates level of the air quality standard for lead (NOM-026-SSA1-1993) =1.5μg/m3. 
33 

Figure 3.3: Lead Content in Local Soil Samples Taken Around MET-MEX 

Peñoles, in Mexico, 1999–2003 

Source: Programa de Metales, Secretaría de Salud del Estado de Coahuila, 1999–2003. 
34 

Figure 3.4: Annual Average Blood Lead Levels in Children 15 and Under 

Who Participated in the Metals Program in Torreón, Mexico, 1998–2004 

0

5

10

15

20

25

30

1998 1999 2000 2001 2002 2003 2004

Years

μg/dl

Source: Programa de Metales, Secretaría de Salud del Estado de Coahuila, 1999–2003.
35 

Figure 3.5: Blood Lead Levels in Children, after Five Years’ Participation in 

the Metals Program, in Torreón, Mexico 

0%

0%

22%

71%

6%

1%

<10 mg/dL

10 to 14.9 mg/dL

15 to 24.9 mg/dL 

25 to 44.9 mg/dL 

45 to 69.9 mg/dL 

More than 70 mg/dL 

Source: Secretaría de Salud (SSA) Metals Program, 1999–2003

Key Observations 

• The average concentration of lead in the air around the mine changed from nearly 8 

μg/m3

 in April 1999 to less than 1 μg/m3 in December 2003 (the limit under Mexican 

Official Standard (Norma Oficial Mexicana) NOM-026-SSA1-1993 is 1.5 μg/m3

). Starting 

in August 1999, lead concentrations remained below the official standard (Figure 3.2). 

• The actions dictated by the environmental authorities enabled a decline in lead levels in 

both air and soil. Lead concentrations found in soil samples around the company Peñoles 

dropped from 50 mg/m2

 in 1999 to 9 mg/m2 in 2003. Since 2000, lead concentrations 

have remained below the standard’s limit of 34 mg/m2

 (Figure 3.3). 

• In 1998 the annual average lead level in children’s blood in the city of Torreón was 25 

μg/dL; the average five years later had dropped to 10 μg/dL. These numbers are below 

the standard (NOM-199-SSA1-2000, Environmental health—levels of lead in blood and 

actions as health protection criteria for the non-occupationally exposed population) 

(Figure 3.4). 

• After five years of operation of the Metals Program, the current situation may be deemed 

to no longer represent an environmental emergency, as the actions carried out have 

significantly reduced the population’s blood lead levels (Figure 3.4).

• Figure 3.5 demonstrates that 70 percent of the child population that has been attended to 

since the start of the Metals Program now have blood lead levels below 10μg/dL (Figure 

3.5).

• Although the population’s blood lead levels have declined, the risks of exposure persist. 

Children’s exposure to lead continues to be a public health problem (Figure 3.5).
36 

3.2 Lead in the Home 

The main cause of environmental exposure to lead in Mexico derives from the manufacture of 

pottery with glaze containing lead oxide. This artisanal craft is carried in 20 Mexican states, by 

approximately five million potters, many of whom are members of indigenous groups. 

Pottery workshops are family businesses, employing all family members between 7 and 70 years 

of age. Each person participates in some part of the pottery production process, using 

techniques inherited over the generations and employing no personal protection whatsoever. 

This activity constitutes the main source of exposure for the child population. 

Exposure to lead also comes from the use of lead glazed pottery. Studies have been conducted 

on urban populations, especially schoolchildren and reproductive age women, finding a 

significant association between high blood lead levels and the use of glazed ceramics to serve 

food and drinks. 

Mexico does not have a representative value of blood lead levels in the general population. It 

therefore presents information on the number of pottery activities occurring in Mexico. 
37 

Figure 3.6: Communities with Pottery Activities by State, in Mexico, 

October 2001 

Source: National Artisan Development Fund (Fondo Nacional para el Fomento de las Artesanías—

FONART), Lead Program <http://www.cofepris.gob.mx/bv/libros/l31.pdf>. 

Key Observations 

• Much of Mexico’s pottery production occurs in the heavily indigenously populated state of 

Chiapas in the south. 

• Epidemiological studies have also found high lead levels among potters in Oaxaca, 

Michoacán and Jalisco. 

3.3 Industrial Releases of Lead 

To date, Mexico has no information for this indicator, due to the fact that the contributions of 

information from Mexican companies to the pollutant release and transfer register are currently 

voluntary and there are a small percentage of companies reporting. Legislation was enacted in 

2001 for a mandatory, publicly accessible PRTR, and in June 2004 the implementing regulations 

were passed; thus Mexico will likely be in a position to furnish data for this indicator in future 

reports. 

Communities with Pottery 

Activities

Communities with Pottery Workshops 

October 2001 

 Without Potter’s Workshops (12 states) 

 1 to 5 (12 states) 

 6 to 7 (4 states) 

 11 to 20 (4 states)
38 

3.4 Industrial Releases of Selected Chemicals 

To date, Mexico has no information for this indicator such contributions of information from 

Mexican companies to the pollutant release and transfer register are currently voluntary and there 

are a small percentage of companies reporting. Legislation was enacted in 2001 for a mandatory, 

publicly accessible PRTR, and in June 2004 the implementing regulations were passed; thus 

Mexico will likely be in a position to present information on this indicator in future reports. 

3.5 Pesticides 

Intoxication caused by toxic substances is not adequately recorded in Mexico. The only available 

information is on those cases caused by pesticides. As in the rest of Latin America, the most 

urgent problems of acute intoxication occurring in both workers and the general public are due to 

pesticide exposure. Publications are available on the chronic effects of organochlorine insecticide 

accumulation in human milk and adipose tissue, as well as the neurotoxic effects of certain 

organophosphorus insecticides and the pulmonary effects of certain dipyridil-like herbicides. 

Figure 3.7: Cases of Pesticide Poisoning of Children (Under 15 Years Old) 

and the General Public in Mexico, 1998–2002 

Under 15 years old

General Population

0

1000

2000

3000

4000

5000

6000

7000

1998 1999 2000 2001 2002

Years

Total Number of Cases

Source: Secretaría de Salud (Secretariat of Health) Centralized Epidemiological Information System 

(Sistema Único de Información para la Vigilancia Epidemiológica—SUIVE) 

<http://www.dgepi.salud.gob.mx/suave/index.htm>. 
39 

Key Observations 

• The above figure shows that 6,422 pesticide poisonings were reported in 1998. A steady 

decline to 2,802 in 2002 was observed. 

• As regards cases recorded in children under the age of 15, the number decreased from a 

high of 1,335 in 1999 to a low of 672 in 2002. 

• It is believed that pesticide poisonings are under-recorded in Mexico for various reasons, 

including the relative inaccessibility of health services, under-reporting by physicians in 

private practice, lack of knowledge as to the real population at risk, inadequate diagnostic 

training for physicians visiting rural communities and lack of training in safe handling of 

toxic substances in the workplace. 
40 

4 Waterborne Diseases 

Among the environmental and public health problems facing the country are those relating to 

inadequate basic sanitation and poor water quality. Furthermore, the availability of water for the 

growing human population is limited. The availability of reliable and safe water sources is 

fundamental to the protection of public health, since many diseases are caused by chemicals and 

pathogens found in contaminated water. 

Water contamination is a health risk. Because of its social, economic, and political implications, 

water is one of the most fragile elements for the sustainable development of the social fabric. 

The risks related to the degradation and scarcity of water may be classified as: 

• those transmitted by water itself; 

• those transmitted by waterborne vectors; 

• those attributable to lack of water for personal and household hygiene; 

• those transmissible by parasites or pathogens spending part of their life cycle in water; 

and 

• the presence of chemicals in water. 

Mexico has made substantial progress toward the goals set in the National Water Plan (Plan 

Nacional Hidráulico—PNH) for 1995–2000. The goals of providing access to drinking water, 

sewerage, and wastewater treatment services were amply met in urban areas, although in rural 

areas efforts fell somewhat short. Today, more than 95 percent of the drinking water supply is 

disinfected. This has led to a dramatic decrease in the number of gastrointestinal disease cases, 

and cholera has been eradicated. 

Mexico has developed a practical water quality indicator (ICA) to describe the quality of its 

surface water. The ICA ranges from 0 (toxic) to 100 (pristine). The indicator is a composite of up 

to 18 variables (e.g., BOD, oxygen, coliforms, nutrients, and suspended solids). An extensive 

national monitoring network with 535 stations has been set up. Measurement frequency varies 

according to the importance of each station. Not all 18 parameters are measured at all stations. 

The results published by the National Water Commission (Comisión Nacional del Agua—CNA) 

show that 78 percent of monitoring stations recorded an ICA of 50 or better in 2001. The 

proportion of water bodies with ICA less than 50 rose from 17 percent in 1998 to 23 percent in 

2001. These figures may reflect the fact that the number of sewer hook-ups has increased faster 

than the rate of wastewater treatment. 
41 

Table 4.1: Water Quality of Mexican Water Bodies for 1998 and 2001 

% of water bodiesb ICA 

rangea

Water quality Use 

1998 2001 

100-85 Excellent All uses 4 6 

84-70 Acceptable Potable with conventional 

treatment 

21 20 

69-50 Slightly 

contaminated 

Potable with advanced 

treatment 

58 51 

49-30 Contaminated Not fit for most direct uses 13 16 

29-0 Highly 

contaminated 

Not fit for most direct uses 2 6 

Off the 

scale 

Presence of toxic 

substances 

Not fit for most direct uses 2 1 

a) ICA = Mexican water quality indicator (índice práctico de la calidad del agua), a 

composite of 18 water quality parameters such as pH, BOD5, and suspended solids. 

b) Measured in 535 surface water bodies of Mexico 

Source: PNH 2001–2006. 

4.1 Drinking Water 

The treatment of water for human use and consumption assures the destruction of most 

pathogens transmissible to human beings. 

Maintaining residual chlorination above 0.2 mg/L is effective in destroying pathogenic bacteria 

and viruses that reach the water supply system. Monitoring of water's bacteriological safety is 

achieved by ongoing periodic monitoring of free residual chlorine in the water supply system. 
42 

Figure 4.1: Segment of Mexico’s Population (in Thousands) with Access to 

Bacteriologically Safe Water by State, 2003 

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

AGUASCALIENTES

BAJA CALIFORNIA

BAJA CALIFORNIA SUR

CAMPECHE

COAHUILA

COLIMA

CHIAPAS

CHIHUAHUA

DISTRITO FEDERAL

DURANGO

GUANAJUATO

GUERRERO

HIDALGO

JALISCO

MEXICO

MICHOACAN

MORELOS

NAYARIT

NUEVO LEON

OAXACA

PUEBLA

QUERETARO

QUINTANA ROO

SAN LUIS POTOSI

SINALOASONORA

TABASCO

TAMAULIPAS

TLAXCALA

VERACRUZ

YUCATAN

ZACATECAS

NACIONAL

States

Population with formal system

Population with good water quality

7

Source: Bacteriological Water Quality Program (Programa de Agua de Calidad Bacteriológica), Federal 

Commission for the Protection against Health Risks (Comisión Federal para la Protección contra Riesgos 

Sanitarios—Cofepris)/SSA

Key Observations 

• The chart shows the proportional distribution of the population having access to 

bacteriologically safe water versus the population whose homes are equipped with formal 

systems for 2003. 
43 

Figure 4.2: Percentage of the Population without Potable Water, in Mexico, 

1980–2000 

Urban

Rural

National Total 

0

20

40

60

1975 1980 1985 1990 1995 2000 2005

Years

Percent (%)

Source: Based on database of XII General Census of Population and Housing, 2000, Instituto Nacional de 

Estadística, Geografía e Informatica (National Institute of Statistics, Geography and Informatics—INEGI) 

<http://www.inegi.gob.mx/est/default.asp?c=703>. 

Note: * There are no available separate data for urban and rural populations for 1980. 

Key Observations 

• The 1980 census reported only national figures. National data show a decrease from 29 

percent to 12 percent of the general population without access to potable water in the 

period from 1980 to 2000. 

• The percent of the population without access to potable water in urban areas decreased 

by 5.2 percent from 10.6 percent in 1990 to 5.4 percent in 2000. 

• The percent of the population without access to potable water rural areas decreased by 

approximately 17 percent, from 48.9 percent in 1990 to 32 percent in the 2000 census. 
44 

Figure 4.3: Percentage of the Population without Access to 

Bacteriologically Safe Water, in Mexico, 2000–2003 

% of population 

without a formal 

water system

% of population 

without access to 

safe bacteriological 

quality water

0

5

10

15

20

25

30

2000 2001 2002 2003

Years

Percent (%)

Source: Water Bacteriological Quality Program (Programa de Agua de Calidad Bacteriológica), 

Cofepris/SSA. 

Key Observations 

 The percent of the population without access to safe bacteriological safe water 

has decreased from 24 percent in 2000 to 17 percent in 2003 

 The percent of the population without a formal water system has remained stable 

at 16 percent from 2000 to 2003. 
45 

Figure 4.4: Percentage of the Population without Piped Water, by State, in 

Mexico, 2000 

Source: Comisión Nacional del Agua (National Water Commission—CNA) <http://www.cna.gob.mx>. 

Key Observations: 

• The highest percentage of Mexico’s population without piped water supply is in the 

southern states, with 30 to 50 percent of the population without coverage. 

4.2 Sanitation 

In late 2002, approximately 76.4 million people had access to sewer services. Therefore, the PNH 

1995–2000 goal for urban areas was attained, though progress in rural areas lagged seriously 

behind. In Mexico, the term alcantarillado, which translates directly as “sewer system,” generally 

covers drainage systems, septic tanks, and direct drainage into furrows, ravines, or bodies of 

water; it is important to keep this in mind when making comparisons with other countries. Sewer 

coverage in Mexico is below the average for Latin America and the Caribbean as well as North 

America. Lack of access is marked in rural areas, especially in southeast Mexico. 

% of Population 

0 to 20% 

20 to 30% 

30 to 50% 
46 

Table 4.2: Drinking Water and Sewer Coverage in Mexico, February 2000 

National Water Program, 2001–2006 

Population Potable water Sewerage 

type 

Population in private 

dwellings 

(in millions) 

Million 

inhabitants 

% Million 

inhabitants 

% 

Urban 71.1 67.3 94.6 63.7 89.6 

Rural 24.2 16.4 68.0 8.9 36.7 

Total 95.3 83.7 87.8 72.6 76.2 

Source: Based on the database of the XII General Census of Population and Housing (Censo General de 

Población y Vivienda XII, 2000) INEGI 2000 

Note: The census estimated the total population at 97.4 million, of whom 2.1 million lived in collective 

housing and it is unknown whether or not they have access to the service. 

Key Observations 

• A little over 72.6 million people had access to sewer services in 2000, approximately 76 

percent of the population. This includes 63.7 million in urban areas and 8.9 million in rural 

areas. These figures include hook-ups to drainage systems (81 percent), septic tanks (15 

percent) and other types of drainage. The number of persons without hook-ups fell from 

32.3 to 22.7 million during the same period. 

Figure 4.5: Percentage of the Population Not Served with Sewer Services, 

in Mexico, 1980–2000 

Urban

Rural

National Total 

0

20

40

60

80

100

1975 1980 1985 1990 1995 2000 2005

Years

Percent (%)

Source: Based on database of XII General Census of Population and Housing, 2000, Instituto Nacional de 

Estadística, Geografía e Informatica (National Institute of Statistics, Geography and Informatics—INEGI) 

<http://www.inegi.gob.mx/est/default.asp?c=703>. 

Note: * Data for 1980 for urban and rural populations not available.
47 

Key Observations 

• The population without sewer service coverage decreased approximately 27 percent 

nationally, from 50 percent to 23 percent as reported in the 1980 and 2000 censuses 

respectively. 

• Urban areas not covered by sewer services decreased from 21 percent to 10 percent, 

between 1990 and 2000 census data. 

• Rural areas without sewer service coverage decreased by approximately 19 percent, 

from 82 percent in the 1990 census to 63 percent in the 2000 census. 

Figure 4.6: Percentage of Homes without Sewer Services, by State, in 

Mexico, 2000 

Source: XII General Census of Population and Housing, 2000, Instituto Nacional de Estadística, Geografía 

e Informatica (National Institute of Statistics, Geography and Informatics—INEGI) 

<http://www.inegi.gob.mx/est/default.asp?c=2417>. 

Key Observations: 

• According to the INEGI population and housing census for 2000, the number of 

inhabitants with sewer services is 72,654,381, or 74 percent of the country’s total 

population. This means that one of every four inhabitants does not have sewer services. 

The number of homes with sewer services is 10,202,934, representing 63 percent of the 

country’s total. This means that one of every three homes does not have such service. 

• The majority of homes without sewer services are located in southern Mexico, with 40 to 

60 percent of households without coverage. 

Housing % by 

State 

0 to 20% 

20 to 40% 

40 to 60% 
48 

4.3 Waterborne Diseases 

According to the World Health Organization, 80 percent of gastrointestinal infections and parasitic 

diseases and one-third of deaths caused by these are due to the use and consumption of unsafe 

water. The WHO also acknowledges that only 41 percent of the world’s population drinks treated 

water that is sufficiently disinfected as to be considered safe.

Among the main environmental aspects that traditionally influence the causes of disease and 

death in our country are: 

• Poor water quality for human use and consumption 

• Inadequate disposal of human waste 

• Inadequate municipal solid waste management 

• Deficient pest control 

• Poor hygiene conditions in dwellings and public spaces 

The history of humanity has witnessed numerous disease outbreaks related to water, 

overcrowding, and deficient environmental conditions. These have been characterized by their 

high prevalence, high mortality, widespread nature, or unusual characteristics. 

In countries like Mexico, diarrheal diseases continue to be a serious problem in children. These 

diseases are caused by bacteria, viruses, or pathogenic protozoa. They are spread via the fecaloral route and are potentially transmissible through water used for various activities in the home, 

including personal hygiene, as well as through primary contact with contaminated recreational 

waters. 

A key challenge for Mexico is to halve the population that lacks access to safe drinking water and 

basic sanitation services. In late 2001, 10.8 million people (including 7.5 million in rural areas) did 

not have piped water supply. More than 22 million still lack access to any form of sanitary 

drainage. Access to basic services such as clean water, sanitation, electricity, health care, and 

education in less-developed regions is considerably lower than the national average. 
49 

Figure 4.7: Incidence of Shigellosis in Children under the Age of Five, in 

Mexico, 1998–2002 

0

2

4

6

8

10

12

14

16

18

20

1998 1999 2000 2001 2002

Years

Number of New Cases/10 000

Key Observations: 

• Further to the measures taken to improve water quality, the chart shows that the national 

incidence of shigellosis in children under the age of five declined from 18.6 per 10,000 

children in 1998 to 12.2 in 2002. 
50 

Figure 4.8: Incidence of Giardiasis in Children under the Age of Five, in 

Mexico, 1998–2002 

0

50

100

150

200

250

1998 1999 2000 2001 2002

Years

Number of New Cases/100 000

Source: Secretaría de Salud (Secretariat of Health) Centralized Epidemiological Information System 

(Sistema Único de Información para la Vigilancia Epidemiológica—SUIVE) 

<http://www.dgepi.salud.gob.mx/suave/index.htm>.

Key Observations: 

• As in the previous chart, the water quality improvement measures had an impact in 

decreasing the national incidence of this disease in children under the age of five; this 

chart shows that the incidence dropped from 204 per 100,000 in 1998 to 150 in 2002. 
51 

Figure 4.9: Incidence of Giardiasis among Children, by Age Group, in 

Mexico, 1998–2002 

< 1 years

1 - 4 years

5 - 14 years

0

5

10

15

20

25

1998 1999 2000 2001 2002

Years

Number of New Cases/10 000

Source: Secretaría de Salud (Secretariat of Health) Centralized Epidemiological Information System 

(Sistema Único de Información para la Vigilancia Epidemiológica—SUIVE) 

<http://www.dgepi.salud.gob.mx/suave/index.htm>. 

Key Observations: 

• The epidemiological evidence of giardiasis demonstrates that the most vulnerable group 

is that of the 1 to 4 years olds, showing a rate of incidence per 10,000 children for 1998 

of 21 and diminishing to 16 for 2002. 

• In the group of children below one year of age, the measures implemented for the 

diarrhea programs have decreased the incidence of giardiasis, from 18 to 13 per 10,000 

children for 1998 and 2002 respectively. 

• The incidence of giardiasis among 5 to 14-year-olds has dropped from 11 cases per 

10,000 children in 1998 to 8 cases per 10,000 children in 2002 
52 

Figure 4.10: Percentage of Cases of Cholera among Children, by Age 

Group, in Mexico, 1991–1999 

< 1 year

 1- 4 years

 5- 14 years

0

5

10

15

20

25

1991 1992 1993 1994 1995 1996 1997 1998* 1999*

Years

Percent (%)

Source: Secretaría de Salud (Secretariat of Health) Dirección General de Epidemiología. Manual de 

Vigilancia Epidemiológica de Cólera (Epidemiological Oversight Manual for Cholera).

<http://www.dgepi.salud.gob.mx/suave/index.htm>. 

Note: * Data for children under one year old not available for 1998 or 1999, nor for one to four year olds for 

1999. 

Key Observations 

• In the period from 1991 to 1998, children under one year of age had the lowest 

percentage of cases of cholera, with a general downward trend. No cases have arisen in 

this age group since 1998. 

• The age group most affected by cholera is from one to four years of age, with the 

percentage of cases ranging from 6 percent to 18 percent of all cases. 

• Cholera declined for the 5–14-year-old age group from 20 percent in 1991 to 7 percent in 

1998. The growing availability of disinfected drinking water and the prevention measures 

to limit cholera outbreaks were effective in controlling this public health problem. 
53 

Figure 4.11: Mortality Rate from Diarrheic Diseases in Children under five, 

in Mexico, 1990–2002 

0

20

40

60

80

100

120

140

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Years

Rate/100 000 

Source: INEGI, DGE, SSA. Statistical Information Bulletin 1990–2002. 

Key Observations: 

• The rate of mortality from diarrheic disease per 100,000 inhabitants under five decreased 

from 125.6 in 1990 to 33.32 in 1997, representing a reduction of 73.5 percent. This was 

above the original goal of 50 percent as stated in the World Children’s Summit. By 2002, 

the mortality rate for children under five decreased to 20 per 100,000 inhabitants. This is 

primarily due to specific healthcare actions and the actions of other sectors, principally 

education and basic sanitation. It should be noted that the phenomenon is worse in 

marginalized urban and rural areas. 
54 

Figure 4.12: Mortality from Cholera in the General Population in Mexico, 

1991–1998 

0

50

100

150

200

250

1991 1992 1993 1994 1995 1996 1997 1998

Year

Percentage (%)

Source: SSA National Cholera Oversight Program (Programa Nacional de Vigilancia del Cólera) 

Key Observations: 

• Recent decreases in mortality due to cholera (23 deaths over the period of 1996–1998 

compared to 34 deaths in 1991 the lowest previous year) reflect prevention measures 

and the control of cholera dissemination managed under the Epidemiological Oversight 

Manual for Cholera created by the Secretariat of Health, and the health authorities’ and 

field workers’ flagging of the pandemic. 

• The highest rate of mortality from cholera was in 1993 with 198 deaths. 
55 

5 Opportunities for Improvement 

Outdoor Air Pollution 

Opportunities for improvement:

Finding ways in which Mexico’s air quality monitoring network can support the future development 

of a population-based exposure indicator for outdoor air pollution is one area of opportunity. More 

information is needed on how pollutants that are monitored currently disperse in the environment, 

as this will be important to extending the estimates of exposure in regions where no monitoring 

exists. In addition, efforts to expand monitoring to include PM2.5 and other air pollutants of 

concern to human health and, in particular, children’s health, would be worthwhile. Data on 

population exposures are not available at this time; thus efforts to generate this indicator will 

require the development of methods to combine census data with air quality data. 

Indoor Air Pollution 

Opportunities for Improvement:

Work is underway in Mexico to develop a more direct measure of the percentage of children who 

are exposed to un-vented emissions from wood and charcoal use in the home. This indicator 

could provide further information on the regional distribution of these exposures in Mexico. In this 

report, Mexico presents some information on the exposure of children to environmental tobacco 

smoke (ETS) in the home. The ability to present a more complete ETS indicator in future reports 

will require increased monitoring, especially in the age groups most susceptible to adverse health 

effects from ETS exposure, from birth to three years. Further improvements could include the use 

of bio-monitoring of blood cotinine levels, coupled with additional information on socio-economic 

factors. 

Asthma 

Opportunities for Improvement:

Data from Mexico’s National Epidemiological Surveillance System is used in presenting the 

indicators in this section. Information on incidence and prevalence of respiratory conditions 

presented is collected through the medical system, thus access to medical care is an important 

factor in the collection of this information. Work to improve the consistency of definitions and the 

diagnosis of these respiratory conditions is ongoing. 

Blood Lead 

Opportunities for Improvement: 

Numerous studies have investigated blood lead in children and adults in Mexico. While these 

studies provide insights into lead exposures they do not provide nationally representative data on 

blood lead levels in children. National blood lead data from direct measures would provide better 

information on children’s exposures to lead, which could be used to identify populations at 

increased risk. 

Lead in the Home 

Opportunities for Improvement:

Children who live or work in close proximity to lead-based glazes are at increased risk of lead 

exposure, as are children who eat food that has come in contact with lead-based pottery glaze. 

The availability of national blood lead data would improve the identification of home-based 

exposure to lead-based glazes and aid in targeting preventive actions. 

Industrial Releases of Lead 

Opportunities for Improvement:

Lead is among the pollutants currently listed for reporting under Mexico’s Registro de Emisiones 

y Transferencia de Contaminantes (RETC). As the mandatory RETC system becomes 
56 

operational, Mexico will likely be in a position to report industrial emissions of lead in future 

reports. 

Industrial Releases of Other Chemicals, Including Pesticides 

Opportunities for Improvement:

Mexico’s pollutant release and transfer register tracks a number of pollutants in common with 

those tracked by Canada’s National Pollutant Release Inventory (NPRI) and the United States’ 

Toxics Release Inventory (TRI). Ensuring comparable reporting thresholds for those substances 

will be important in enabling tri-lateral comparability of data on industrial releases of selected 

chemicals. Future efforts could also focus on increasing the number of chemicals reported in 

common across North America. 

Pesticides 

Opportunities for Improvement: 

Mexico will review the availability of organophosphate pesticide residue measurements on fruits 

and vegetables to determine the feasibility of reporting on this indicator in the future. Surveillance 

programs for pesticide use as well as bio-monitoring programs may also be explored in 

preparation for future reports. 

Drinking Water 

Opportunities for Improvement: 

Mexico continues to increase the percentage of the population served with treated water. 

Measuring access to potable water for rural and remote communities will be considered as a 

possible focus for future indicators. Data tracking violations of water quality standards would 

contribute to improved reporting of indicators in this area for future reports. 

Sanitation 

Opportunities for Improvement: 

The availability of sewer services as a means of reducing exposure to contaminants has been an 

important step in the management of waterborne diseases in Mexico. Indicators in future reports 

can be improved by measuring the availability of sewage treatment. Furthermore, it is important 

to measure the lack of availability of sewer services and sewage treatment for children. 

Differentiating among levels of treatment would be useful in tracking efforts to prevent source 

water contamination. 

Waterborne Diseases 

Opportunities for Improvement:

Efforts to ensure that diseases associated with waterborne morbidity and mortality are 

differentiated from other sources such as food are a part of the ongoing efforts to improve this 

indicator. Future efforts may include the measurement of additional waterborne diseases and/or 

priority chemicals of concern to children’s health for which indicators can be developed. 
57 

References 

Azcona-Cruz, M.I., Rothenberg, S., Schnaas, L., Zamora-Muñoz, J., and Romero-Placeres, M. 

2000. Lead-glazed ceramic ware and blood lead levels of children in the city of Oaxaca, Mexico. 

Arch Environ Health May-June, 55(3): 217–22. 

Batres, L., Santos, M.A., Mejia, J.J., Yañez, L., Carrizalez, L., Díaz-Barriga, F. 1994. 

Caracterización del riesgo en salud por exposición a metales pesados en la ciudad de San Luis 

Potosí (Characterization of risks to health from exposure to heavy metals in the city of San Luis 

Potosí). Informe Interno reportado al grupo promotor de estudio “Consejo Ambiental A.C.” 

Batres L. et al. “Participación del barro vidriado en la exposición infantil al plomo en una 

comunidad industrial expuesta ambientalmente a este metal”. En: Intoxicación por plomo en 

México: Prevención y Control. Perspectivas en Salud Pública 21 INSP, DDF pág. 175–186. 

Briggs, D. (2003) Making a Difference: Indicators to Improve Children’s Environmental Health.

World Health Organization, Geneva. Available online at: 

http://www.who.int/phe/children/childrenindicators/en/. 

Carrizales, L., Razo, I., Tellez-Hernandez, J., Torres-Nerio, R., Torres, A, Batres, L., Cubillas, 

A.C., and Díaz-Barriga, F. 2005. Exposure to arsenic and lead of children living near a coppersmelter in San Luis Potosí, Mexico: Importance of soil contamination for exposure of children. 

Environ Res. In press.

Centres for Disease Control and Prevention. Screening Young Children for Lead Poisoning: 

Guidance for State and Local Public Health Officials. Atlanta: CDC, 1997. 

Centro Nacional de Investigación y Capacitación Ambiental (CENICA), Almanaque de Datos y 

Tendencias de la Calidad del Aire en Ciudades Mexicanas, 2000. 

Clasificación Internacional de Enfermedades, revisión CIE 10a. 

Cofepris. Date unknown. Norma oficial Mexicana. NOM-199-SSA1-2000, salud ambiental. 

<http://www.cofepris.gob.mx/mj/documentos/nom32.htm> (Date viewed: 6 September 2005). 

Comisión Ambiental metropolitana del Valle de México, Índice Metropolitano de la Calidad del 

Aire—Imeca, available online: http://www.edomexico.gob.mx/se/cam.htm. 

Commission for Environmental Cooperation (CEC) Steering Group on Children’s Health and 

Environment Indicators, CEC Secretariat (2 June 2003), Recommendations for the Development 

of Children’s Health and the Environment Indicators in North America. Available online at 

http://www.cec.org/files/pdf/POLLUTANTS/CHE-Recommendations_en.pdf. 

Comisión Federal Para la Protección Contra Riesgos Sanitarios—Cofepris, Dirección General de 

Salud Ambiental, Diagnóstico Nacional de Salud Ambiental y Ocupacional 2002, available online: 

http://www.cofepris.gob.mx. 

Comisión Federal Para la Protección Contra Riesgos Sanitarios—Cofepris, Comisión de 

Evidencia y Manejo de Riesgos, Proyecto de exposición intradomiciliaria a humo de leña 2004, 

available online: http://www.cofepris.gob.mx. 

Comisión Federal para la Protección contra Riesgos Sanitarios—Cofepris, Comisión de 

Evidencia y Manejo de Riesgos, Proyecto de agua de calidad bacteriológica, available online: 

http://www.cofepris.gob.mx. 
58 

Comisión Federal para la Protección contra Riesgos Sanitarios—Cofepris, Comisión de 

Evidencia y Manejo de Riesgos, Proyecto de eliminación de plomo en loza vidriada, available 

online: http://www.cofepris.gob.mx. 

Consejo Nacional Contra las Adicciones—Conadic, Encuesta Nacional de Adicciones—ENA2002, Secretaría de Salud, available online: http://www.conadic.gob.mx. 

Consejo Nacional Contra las Adicciones—Conadic, Encuesta Nacional de Adicciones—ENA1998, Secretaría de Salud, available online: http://www.conadic.gob.mx. 

Consejo Nacional de Población—Conapo, Proyección de la población de México 2000–2050, 

available online: www.conapo.gob.mx.

Consejo Nacional de Población—Conapo, Proyección de la población de México 1990–2010, 

available online: www.conapo.gob.mx.

Díaz-Barriga, F., Batres, L., Calderon, J., Lugo, A., Galvao, L., Lara, I., Rizo, P., Arroyave, M.E., 

and McConnell, R. 1997. The El Paso smelter 20 years later: Residual impact on Mexican 

children. Environ Res 74: 11–16. 

Díaz-Cossió A. y Álvarez F.J. “Algo sobre los orígenes” En: La cerámica colonial y 

contemporánea. FONART, SEP 1986 pág. 45-49. 

Encuesta Nacional de Fecundidad y Salud, Encuesta Mexicana de Fecundidad, Encuesta 

Nacional de la Dinámica Demográfica 1997. Instituto de Investigación social UNAM. Available 

online: www.ejournal.unam.mx/demos/no12/DMS01203.pdf. 

Fondo Nacional para el Fomento de las Artesanías—FONART. “Programa estratégico para la 

sustitución del plomo y combustible en la alfarería vidriada tradicional”. 1993. 

Food and Agriculture Organization of the United Nations 2003, Saturation of Fuel Wood Users at 

the Municipal Level in Mexico, 2000 

 

Garcia, V.G., Rubio, A.M., Del Razo, M.L., Borja, A.V., Vera, A.E., and Cebrián, M.E. 2001. Lead 

exposure in children living in a smelter community in Región Lagunera, México. Journal of 

Toxicology and Environmental Health. Part !, 62: 417–29. 

Haward Hu. “Revisión de la exposición al plomo sobre la salud.” En: intoxicación plomo en 

México. Prevención y Control. Perspectivas en Salud Pública 21 INSP, DDF 1995 pág. 25–46. 

Hernández Ávila M. Romieu I., Ríos C. Rivero A. Palazuelos E. Lead-glazed ceramics as major 

determinants of blood lead levels in Mexican women. Environ Health Perspect 1991, 94:117–120. 

Hernández Ávila, M.; Palazuelos Rendón, E. eds. Intoxicación por Plomo en México: Prevención 

y Control. Perspectivas en Salud Pública. No. 21. Instituto Nacional de Salud Pública. 

Departamento del Distrito Federal. México 1995. 

Howson Ch., Hernández-Ávila, Rall D. El Plomo en América. Estrategias para la Prevención. 

Instituto Nacional de Salud Pública. Instituto de Medicina. México.1996 

Howson C.P. et al. “El devenir de los procesos para reducir el plomo en América: Hitos 

Históricos.” En: El plomo en América Latina. Estrategias de Prevención. INSP, Instituto de 

Medicina EUA 1996, pág. 45–51. 
59 

Instituto Nacional de Ecología (INE), Sistema Nacional de Información de Calidad del Aire—

Sinaica, available online: http://sinaica.ine.gob.mx. 

Instituto Nacional de Estadística, Geografía e Informática, Censo Nacional de Población y 

Vivienda XII, INEGI 2000, available online: http://www.inegi.gob.mx. 

Instituto Nacional de Estadística, Geografía e Informática, Censo Nacional de Población y 

Vivienda XI, INEGI 1990, available online: http://www.inegi.gob.mx. 

Instituto Nacional de Estadística, Geografía e Informática, Conteo de Población y Vivienda, 

INEGI 1995, available online: http://www.inegi.gob.mx. 

Instituto Nacional de Salud Pública, Intoxicación por Plomo en México: Prevención y Control. 

Perspectivas de Salud Pública 21 1995, Editores Mauricio Hernández Ávila, Eduardo Palazuelos 

Rendón,1995. 

Masera, O.R., Drigo, R., and Trossero, M.A. 2003. Woodfuels integrated supply/demand 

overview mapping. Universidad Autónoma de México. FAO-EC Partnership Programme. FAOUnited Nations. p. 23. 

Matte T:D:, Props. D., Palazuelos E., Graef J., Hernández-Avila M. Acute High dose lead 

exposure from beverage contaminated by traditional Mexican pottery. LANCET 1994; 344:1064–

1066 

Molina-Ballesteros G., Zúñiga Ch MA, Cárdenas OA, Solís CR P, Solís CV: Concentración de 

plomo en sangre en niños de familias alfareras. Bol. Oficina Sanitaria Panamericana 1982; 

92:33–40. 

Molina-Ballesteros G. et al. Exposición a plomo en una población de alfareros. Arch Invest Med 

1980; 11:147–155. 

Muñoz I. et al. Blood lead levels and neurobehavioral development among children living in 

Mexico. Arch Environ Health 1993; 48: 132–139. 

Olaiz, F.G., Rojas, M.R., Fortoul, I.T., and Palazuelos, E. High lead levels in ceramic folk art 

workers. 1997. Arch Environ Health Jan-Feb, 52(1): 51–55. 

Olaiz G. Et al. “La alfarería en México. El arte del barro vidriado y el plomo”. En intoxicación 

plomo en México. Prevención y Control. Perspectivas en Salud Pública 21 INSP, DDF 1995 pág. 

163–179. 

Organización para la Cooperación y el Desarrollo Económico (OCDE) 2003, París y Secretaría 

del Medio Ambiente y Recursos Naturales (SEMARNAT), México, Evaluación del Desempeño 

Ambiental México, available online: http://www.semarnat.gob.mx. 

Procuraduría Federal de Protección Ambiental—PROFEPA, Secretaría de Salud, Programa de 

Metales 1999 – 2004 Torreón, Coahuila. http://www.profepa.gob.mx. 

Proposed Core Environmental Public Health Indicators for the US–Mexico Border XXI Program, 

20 de Julio del 2001, segunda versión, El Paso, Texas. 

Reynoso L. “Evolución de las técnicas”. En: La cerámica colonial y contemporánea. FONART, 

SEP 1986 pág. 15-24. 

Rojas-López M. et al. use lead glazed ceramics in the main factor associated to high lead in 

blood levels in two Mexican Rural communities. J Toxicol Environ Health 1994; 42:45–52. 
60 

Romieu I. et al “Fuentes de exposición al plomo en la Ciudad de México”. En: Intoxicación por 

plomo en México. Prevención y control. Perspectivas en Salud Pública 21 INSP, DDF 1995 pág. 

57–77. 

Romieu, I., Palazuelos, E., Meneses, F., Hernandez-Avila, M. 1992. Vehicular traffic as a 

determinant of blood-lead levels in children: A pilot study in Mexico City. Arch Environ Health JulAug, 47(4): 246–49. 

Secretaría de Salud. Dirección General de Epidemiología, Boletín de información epidemiológica 

1990–2003, available online: http://www.dgepi.salud.gob.mx/boletin/boletin.htm. 

Secretaría de Salud. Dirección General de Epidemiología, Sistema Único Automatizado para la 

Vigilancia Epidemiológica—SUAVE, Sistema Único de Información para la Vigilancia 

Epidemiológica—SUIVE, Sistema Nacional de Vigilancia Epidemiológica—Sinave, available 

online: http://www.dgepi.salud.gob.mx/sinave/sinave1.htm. 

Secretaría de Salud. Dirección General de Epidemiología. Sistema Nacional de Vigilancia 

Epidemiológica—Sinave, Sistema Epidemiológico y Estadístico de las Defunciones—SEED, 

available online: http://www.dgepi.salud.gob.mx. 

Secretaría de Salud. Dirección General de Epidemiología, Manual de Vigilancia Epidemiológica 

del Cólera, available online: http://www.dgepi.salud.gob.mx/publicaciones/mvcolera.htm. 

Secretaría de Salud. Dirección General de Salud Ambiental. “Programa conjunto para la 

sustitución del óxido de plomo en el vidriado de alfarería” 1999–2000. 

Secretaría del Medio Ambiente y Recursos Naturales (Semarnat), Programa para detener y 

revertir la contaminación del aire 2002–2006 (Proaire). 

http://portal.semarnat.gob.mx/semarnat/portal/. 

Secretaría del Medio Ambiente y Recursos Naturales (Semarnat), Comisión Nacional del 

Agua—CNA, Plan Nacional Hidráulico—PNH para 1995–2000. Indicador de Calidad de Agua 

(ICA) available online: http://portal.semarnat.gob.mx/semarnat/portal/ , http://www.cna.gob.mx. 

Secretaría del Medio Ambiente y Recursos Naturales (Semarnat), Comisión Nacional del Agua—

CNA, Plan Nacional Hidráulico—PNH para 2001–2006. Indicador de Calidad de Agua (ICA) 

available online: http://portal.semarnat.gob.mx/semarnat/portal/ , http://www.cna.gob.mx. 

Secretaría de Salud, NORMA Oficial Mexicana NOM-002-SSA1-1993, Salud Ambiental. Bienes y 

Servicios. Envases Metálicos para Alimentos y Bebidas. Especificaciones de la Costura. 

Requisitos Sanitarios. http://www.salud.gob.mx/unidades/cdi/nom/002ssa13.html. 

Secretaría de Salud, NORMA Oficial Mexicana NOM-003-SSA1-1993, Salud Ambiental 

Requisitos Sanitarios Que Deben Satisfacer el Etiquetado de Pinturas, Tintas, Barnices, Lacas y 

Esmaltes. http://www.salud.gob.mx/unidades/cdi/nom/003ssa13.html. 

Secretaría de Salud, NORMA Oficial Mexicana NOM-004-SSA1-1993, Salud Ambiental 

Limitaciones y Requisitos Sanitarios Para el Uso de Monóxido de Plomo (Litargirio), Oxido Rojo 

de Plomo (Minio) y del Carbonato Básico de Plomo (Albayalde). 

http://www.salud.gob.mx/unidades/cdi/nom/004ssa13.html. 

Secretaría de Salud, NORMA Oficial Mexicana NOM-005-SSA1-1993, Salud Ambiental. 

Pigmentos de Cromato de Plomo y de Cromomolibdato de Plomo. Extracción y Determinación de 

Plomo Soluble. Métodos de Prueba. http://www.salud.gob.mx/unidades/cdi/nom/005ssa13.html. 
61 

Secretaría de Salud, NORMA Oficial Mexicana NOM-006-SSA1-1993, Salud Ambiental. Pinturas 

y Barnices. Preparación de Extracciones Ácidas de las Capas de Pintura Seca para la 

Determinación de Plomo Soluble. Métodos de Prueba. 

http://www.salud.gob.mx/unidades/cdi/nom/006ssa13.html. 

Secretaría de Salud, NORMA Oficial Mexicana NOM-008-SSA1-1993, Salud Ambiental. Pinturas 

y Barnices. Preparación de extracciones ácidas de pinturas liquidas o en polvo para la 

Determinación de Plomo Soluble y otros métodos. 

http://www.salud.gob.mx/unidades/cdi/nom/008ssa13.html. 

Secretaría de Salud, NORMA Oficial Mexicana NOM-009-SSA1-1993, Salud Ambiental. 

Cerámica Vidriada. Métodos de Prueba para la Determinación de Plomo y Cadmio Solubles. 

http://www.salud.gob.mx/unidades/cdi/nom/009ssa13.html. 

Secretaría de Salud, NORMA Oficial Mexicana NOM-010-SSA1-1993, Salud Ambiental. 

Artículos de cerámica vidriados, límites de Plomo y Cadmio Solubles. 

http://www.salud.gob.mx/unidades/cdi/nom/010ssa13.html. 

Secretaría de Salud, NORMA Oficial Mexicana NOM-011-SSA1-1993, Salud Ambiental. Limites 

de Plomo y Cadmio Solubles En Artículos de Alfarería Vidriados. 

http://www.salud.gob.mx/unidades/cdi/nom/011ssa13.html. 

Secretaría de Salud, NORMA Oficial Mexicana PROY-NOM-231-SSA1-2002, Artículos de 

alfarería vidriada, cerámica vidriada y porcelana. Límites de plomo y cadmio solubles. Método de 

ensayo. http://www.salud.gob.mx/unidades/cdi/nom/231ssa13.html. 

Secretaría de Salud, NORMA Oficial Mexicana NOM-015/1-SCFI/SSA-1994, Seguridad e 

información comercial en juguetes - Seguridad de juguetes y artículos escolares. Límites de 

biodisponibilidad de metales en artículos recubiertos con pinturas y tintas. Especificaciones 

químicas y métodos de prueba. http://www.salud.gob.mx/unidades/cdi/nom/0151scfissa14.html. 

Secretaría de Salud, 30 de Octubre 2002 Modificación de la NORMA Oficial Mexicana NOM-020-

SSA1-1993, Salud Ambiental. Criterio para evaluar la calidad del aire ambiente con respecto al 

Ozono (O3). Valor normado para la concentración de Ozono (O3) en el aire ambiente como 

medida de protección a la salud de la población. 

http://www.sma.df.gob.mx/simat/proteccion/nom-020-ssa1-1993.pdf. 

Secretaría de Salud, 23 de Diciembre de 1994 NORMA Oficial Mexicana NOM-021-SSA1-1993, 

Salud ambiental. Criterio para evaluar la calidad del aire ambiente con respecto al Monóxido de 

Carbono (CO). Valor permisible para la concentración de Monóxido de Carbono (CO) en el aire 

ambiente como medida de protección a la salud de la población. 

http://www.sma.df.gob.mx/simat/proteccion/nom-021-ssa1-1993.pdf. 

Secretaría de Salud, 23 de Diciembre de 1994 NORMA Oficial Mexicana NOM-022-SSA1-1993, 

Salud ambiental. Criterio para evaluar la calidad del aire ambiente con respecto al Dióxido de 

Azufre (SO2). Valor normado para la concentración de Dióxido de Azufre (SO2) en el aire 

ambiente como medida de protección a la salud de la población. 

http://www.sma.df.gob.mx/simat/proteccion/nom-022-ssa1-1993.pdf. 

Secretaría de Salud, 23 de Diciembre de 1994 NORMA Oficial Mexicana NOM-023-SSA1-1993, 

Salud ambiental. Criterio para evaluar la calidad del aire ambiente con respecto al Dióxido de 

Nitrógeno (NO2). Valor normado para la concentración de Dióxido de Nitrógeno (NO2) en el aire 

ambiente como medida de protección a la salud de la población. 

http://www.sma.df.gob.mx/simat/proteccion/nom-023-ssa1-1993.pdf. 
62 

Secretaría de Salud, 23 de Diciembre de 1994 NORMA Oficial Mexicana NOM-024-SSA1-1993, 

Salud ambiental. Criterio para evaluar la calidad del aire ambiente con respecto a Partículas 

Suspendidas Totales (PST). Valor permisible para la concentración de Partículas Suspendidas 

Totales (PST) en el aire ambiente como medida de protección a la salud de la población. 

http://www.sma.df.gob.mx/simat/proteccion/nom-024-ssa1-1993.pdf. 

Secretaría de Salud, 23 de Diciembre de 1994 NORMA Oficial Mexicana NOM-025-SSA1-1993, 

Salud ambiental. Criterio para evaluar la calidad del aire ambiente con respecto a partículas 

menores de 10 micras (PM10). Valor permisible para la concentración de Partículas Menores de 

10 micras (PM10) en el aire ambiente como medida de protección a la salud de la población. 

http://www.sma.df.gob.mx/simat/proteccion/nom-025-ssa1-1993.pdf. 

Secretaría de Salud, 23 de Diciembre de 1994 NORMA Oficial Mexicana NOM-026-SSA1-1993, 

Salud ambiental. Criterio para evaluar la calidad del aire ambiente con respecto al Plomo (Pb). 

Valor normado para la concentración de Plomo (Pb) en el aire ambiente como medida de 

protección a la salud de la población. http://www.sma.df.gob.mx/simat/proteccion/nom-026-ssa1-

1993.pdf. 

Secretaría de Salud, 18 de enero de 1996 NORMA Oficial Mexicana NOM-127-SSA1-1994. 

Salud ambiental, agua para uso y consumo humano. Límites permisibles de calidad y 

tratamientos a que debe someterse el agua para su potabilización. 

http://www.salud.gob.mx/unidades/cdi/nomssa.html. 

Secretaría de Salud, NORMA Oficial Mexicana NOM-179-SSA1-1998, Vigilancia y evaluación del 

control de calidad del agua para uso y consumo humano, distribuida por sistema de 

abastecimiento público. http://www.salud.gob.mx/unidades/cdi/nomssa.html. 

Secretaría de Salud, NORMA Oficial Mexicana NOM-199-SSA1-2000, Salud ambiental. Niveles 

de plomo en sangre y acciones como criterios para proteger la salud de la población expuesta no 

ocupacionalmente. http://www.salud.gob.mx/unidades/cdi/nomssa.html. 

Secretaría de Salud, Programa Nacional de Vacunación 2000–2006, disponible en línea: 

http://www.ssa.gob.mx. 

Secretaría de Salud. Subsecretaría de Innovación y Calidad. Dirección General de Información y 

Evaluación del Desempeño. Salud: México 2002, información para la rendición de cuentas, 

disponible en línea: http://www.salud.gob.mx. 

Vargas M. H. et al., relationship between altitude and asthma incidence (1999) 

Viniegra G. y Escobar M. R. el riesgo del saturnismo por la cerámica folklórica mexicana. 

(Estudio preliminar). Salud Pública de México 1996; VIII (1): 69-77. 

Viniegra G. et al. El saturnismo en un pueblo alfarero. Boletín de la Dirección de Higiene 

Industrial. Secretaría de Salubridad y Asistencia. México. D. F. 1966. 

World Health Organization (WHO). Environmental Health Indicators: Framework and 

Methodologies. Sustainable Development and Healthy Environments. Protection of the Human 

Environment Occupational and Environmental Health Series. Geneva 1999. 

World Health Organization, the Mexico - Monterrey Global Youth tobacco survey. 

World Health Organization. Guia para la Calidad del Agua Potable. Vigilancia y control de los 

abastecimientos de agua de la comunidad, Segunda edición, vol. 3 OMS Ginebra. 
63 

Appendix 1 Health of Indigenous Peoples 

The Mexican population consists of approximately 10 percent indigenous peoples (one of the 

criteria for determining whether individuals or communities are indigenous or not is whether they 

refer to themselves as indigenous). There exist more than 50 ethnic groups and various 

languages and dialects. Nearly 72 percent of the indigenous population lives in southern and 

southeastern Mexico. The indigenous communities tend to be socially and economically 

marginalized with little access to basic environmental, health, and education services. 

Frequently, areas with indigenous settlements have high environmental value and biodiversity. 

Indigenous communities are located in and around more than 30 percent of Mexico’s main 

protected areas. The population of marginal (e.g., extremely arid or mountainous) lands is more 

than 50 percent indigenous. Nearly 90 percent of the forest resources of the state of Oaxaca are 

situated on land where indigenous communities are located. 

In 1995, the indigenous population was estimated at 9.17 million. The growth rate was 1.23 

percent with respect to 1990, nearly half that of the rest of the population (2.13 percent). The life 

expectancy at birth of indigenous people was estimated for 1995 at 69.5 years (67.6 for men and 

71.5 for women), more than three years lower than the rest of the population. The infant mortality 

rate is nearly double that of the country as a whole (54 versus 29 deaths per 1,000 live births). 

The average number of children born to indigenous women was 4.1, versus 2.9 for nonindigenous women. 

In 1995, the potential years of life lost (PYLL) per capita for the three main groups of causes of 

death showed premature mortality of 19.0 years for indigenous men versus 15.3 for nonindigenous men, and corresponding figures of 15.4 and 11.2 for women. There are differences 

between indigenous peoples that have yet to be sufficiently explained. For example, a lower rate 

of infant mortality is found for mothers who speak Chontal (33 per 1,000 live births), Maya (36), 

Chinanteco (40) and Zapoteco (40) as compared with those who speak Chatino (77), Popoluca 

(79), Tarahumara (79), Tepehuán (80), Tzotzil (81) and Tojolabal (87). Differences in the number 

of children are also found, with a minimum of 3.7 for Chontal speakers and a maximum of 4.5 for 

Tojolabal speakers. 

Semarnat’s special program for indigenous peoples promotes the sustainable use of natural 

resources and the conservation of biodiversity in areas where indigenous people live. It values 

their traditional knowledge and protects their intellectual property rights. Indigenous communities 

participate in drafting, implementing, and evaluating plans and programs that may affect them 

directly (e.g., land use planning, designation of protected natural areas and/or national parks, 

ecotourism projects). 

Public authorities, NGOs and indigenous communities have formed corporations to promote 

innovative models of production and mobilization for indigenous communities, combining 

traditional values with modern technology and marketing. Successful examples include organic 

agriculture, coffee cooperatives, community-owned forestry companies, and natural/cultural 

tourism. 
64 

Appendix 2 Components of the National Surveillance 

System 

CONAVE-CEVE The National Committee for Epidemiological Surveillance is a national standards 

body that facilitates, promotes and guides the country’s epidemiological work. It is composed of 

the directors of each institution of the SNS. In each state of the Republic, CONAVE is 

represented by another collegiate body called the State Committee for Epidemiological 

Surveillance (CEVE) that coordinates the state-level efforts of all the institutions. It is composed 

of the directors of each SNS institution in that state. 

SIGMESA The Mexican Georeferenced Health Information System is an information tool that 

provides morbidity and mortality data from the municipal to the national level in the form of 

thematic maps based on the digital cartography of Mexico. 

Rhove The Hospital Epidemiological Surveillance Network operates in general and specialty 

hospitals to cover the information requirements regarding reportable diseases and nosocomial 

infections. It currently operates in more than eighty hospitals and in the National Health Institutes. 

SEED The Epidemiological and Statistical Death Reporting System compiles death certificate 

information with the objective of keeping a record of causes of death. This makes it possible to 

detect risks and take timely action to prevent the public from dying from such causes. 

Special systems There are diseases which, because of their magnitude, consequence, 

characteristics, or the severity of the harm they cause, are given special attention by SUIVE. For 

epidemiological surveillance of these diseases, SUIVE has special information systems and 

specific operational strategies. 

Communicable diseases Non-communicable diseases 

Vaccine-preventable 

Vector-borne and zoonotic 

HIV-AIDS and STDs 

Epidemiological emergencies and cholera 

outbreaks 

Microbacteria, tuberculosis and leprosy 

Influenza 

ARI/ADD 

Simplified Epidemiological Surveillance System 

International surveillance 

Histopathological Registry of Malignant 

Neoplasias 

Birth defects 

External lesions 

Addictions 

Pesticide intoxication 

Breast cancer (in process) 

Diabetes 

Cardiovascular diseases 

Oral health 
65 

Suilab The Unified Laboratory Information System is an automated laboratory system for the 

identification of clinical or environmental samples or isolations from the local level. It makes it 

possible to maintain the confidentiality and continuity of the diagnostic process at all stages of 

analysis of the sample through the use of advanced technology. This ensures efficacy in the 

delivery of quality results. The system also generates searchable historical data. Suilab is 

composed of 3 modules: NETLAB records and tracks samples and allows for Internet 

transmission of results; the Internal Laboratory Information System (SILAB) tracks, captures and 

produces results from the various laboratories; and the National Public Health Laboratory 

Performance Information System tracks the performance of the laboratory network. Suilab is a 

modern system whose design and implementation is based on cutting-edge technology. 
66 

Appendix 3 Indicator Templates 

Percentage of days that exceed the Imeca air quality index in Mexico, 

1999–2002 

Type of indicator: 

Exposure 

INDICATOR 2.- Description 

Definition Mexico presents annual average peak levels of ground-level ozone 

concentration for five major cities in the country from 1990 to 2002; and 

mean annual concentrations for PM10 for the same period and cities. 

Mexico, like other countries, has developed more easily understandable 

pollution indices. Mexico uses the Metropolitan Air Quality Index (Índice 

Metropolitano de la Calidad del Aire—Imeca*), whereby each pollutant’s 

concentration under the Air Quality Standard is equal to 100 Imeca points. 

*Imeca: Converts pollution levels to a number on a numerical scale (see 

below, “Computation”), so that the population-at-large can understand it. 

Rationale and role This is an indirect measure of exposure to air pollution at levels that may 

cause negative health effects, such as asthma and other respiratory 

illnesses. 

Data Range 1999–2002 

Data sources, 

availability and quality 

National Institute of Ecology (Instituto Nacional de Ecología—INE) through 

the National Air Quality Information System (Sistema Nacional de 

Información de la Calidad del Aire—Sinaica) 

Valley of Mexico City Metropolitan Environment Commission (Comisión 

Ambiental Metropolitana del Valle de México—CAM)

Units of 

measurement 

Parts per billion (ppb) for ground-level ozone and μg/m3

 for PM10 (for Figure 

2.3, the percentage of days [y-axis values] is calculated from Imecas) 

Computation Air quality per annual average for ground-level ozone and PM10 for each 

year during the period 1990 to 2002. 

Imeca index: An Imeca score of 100 points represents air quality within the 

Mexican Official Standard (Norma Oficial Mexicana—NOM) for a given 

pollutant. Multiples of 100 are developed through simple algorithms, taking 

into account environmental health criteria. 

Imeca score Air quality

100 Satisfactory 

101–200 Unsatisfactory 

201–300 Poor 

301 or more Very poor 

First, the average is determined by dividing the total number of days that air 

quality was deemed Satisfactory, Unsatisfactory, Poor or Very Poor

under by the Imeca index, by the total number of days in the year. Then, 

the percentage of averages exceeding the levels per standard is calculated 

for each. 

Sources of further 

information 

INE: http://www.ine.gob.mx

CAM: http://www.edomexico.gob.mx/se/cam.htm

Sinaica: http://www.sinaica.ine.gob.mx. 

Scale of application Metropolitan areas: Valley of Mexico City (Mexico City and surrounding 

areas); Guadalajara; Monterrey; Valley of Toluca; Ciudad Juárez; TijuanaRosarito; Mexicali. 
67 

Useful references Secretariat of the Environment and Natural Resources (Secretaría de 

Medio Ambiente y Recursos Naturales—Semarnat): 

http://www.semarnat.gob.mx

Strengths of the 

Indicator 

Monitoring information includes the country’s primary metropolitan areas. 
68 

Metropolitan areas with air quality programs including air monitoring, 

Mexico, 2004 

Type of indicator: 

Exposure 

INDICATOR Description 

Definition Metropolitan areas with air quality improvement programs (programas de 

mejoramiento de la calidad del aire—Proaire): Includes short- and mediumterm goals to improve air quality and identify specific responsibilities for 

industry and the transportation sector. 

Environmental Monitoring Network (Red de Monitoreo Ambiental): Series of 

automatic or manual tracking stations to collect, analyze and systematically 

monitor environmental air samples. 

Rationale and role Map shows the principal metropolitan areas with an Environmental 

Monitoring Network, enabling the location of such areas in national territory. 

Data Range 1999–2002 

Data sources, 

availability and quality 

Semarnat 

INE through Sinaica <http://www.sinaica.ine.gob.mx> 

CAM 

Units of 

measurement 

Value on the Imeca scale for all pollutants, ppb for ozone, NO2, SO2, and 

CO; 

μg/m3

 for PM10

Computation Number of cities or metropolitan areas with an environmental monitoring 

network and a regular system for recording air pollution measurements. 

Sources of further 

information 

INE: <http://www.ine.gob.mx> 

CAM: <http://www.edomexico.gob.mx/se/cam.htm> 

Scale of application Metropolitan areas: Valley of Mexico; Guadalajara; Monterrey; Valley of 

Toluca; Ciudad Juárez; Tijuana-Rosarito; Mexicali. 

Useful references Semarnat: <http://www.semarnat.gob.mx> 

Strengths of the 

Indicator 

Exact location of the metropolitan area on the map of Mexico. 
69 

Percentage of the general population exposed to biomass smoke, by 

region, Mexico, 2000 

Percentage of population under 19 years exposed to biomass smoke, 

by region, Mexico, 2000 

Type of indicator: 

Body burden 

INDICATOR Description: 

Definition Proportion of general population exposed to the use of biomass as 

household fuel. 

Proportion of population under 19 years of age exposed to the use of 

biomass as household fuel. 

The exposed population refers to all inhabitants of households that use 

biomass as cooking or heating fuel. 

Biomass: Wood and coal 

Rationale and role Household indoor air pollution caused by the burning of wood or coal for 

cooking constitutes a public health problem with repercussions for the child 

population, especially for children under 5 and women of reproductive age. 

Data Range 2000 

Data sources, 

availability and quality 

The National Institute of Statistics, Geography and Information (Instituto 

Nacional de Estadística, Geografía e Informática—INEGI) conducts the 

National Population and Housing Census (Censo Nacional de Población y 

Vivienda) every 10 years. The information on this indicator was obtained 

from the 12th national census, conducted in 2000. The two main units 

analyzed in the census were habitual residents and households. 

Information was obtained from direct interviews with appropriate 

interviewees, defined as persons of at least 15 years of age who live in the 

household and know the information for all residents thereof. 

Two types of questionnaires (basic and extended) were used. The 

extended questionnaire was applied to a probability sample of households, 

while the basic questionnaire was applied exhaustively to all households. 

For further information on census methodology, see 

http://www.inegi.gob.mx

Units of 

measurement 

Percentage 

Computation The population of interest for evaluation living in households using biomass 

as fuel divided by the overall population living in households using biomass 

as fuel X 100 

Population under 19 living in households using biomass as fuel divided by 

the overall population living in households using biomass as fuel X 100 

Sources of further 

information 

National Population Council (Consejo Nacional de Población—Conapo): 

www.conapo.gob.mx

Scale of application National 

Useful references Semarnat: http://www.semarnat.gob.mx

Strengths of the 

Indicator 

Population and housing censuses provide the most complete information 

as to the geographic breakdown enabling an awareness of the national 

situation. With this information, various national sectors may prepare 

development plans and programs, analyze human settlement conditions 

and carry on a range of research, among other things. 
70 

Percentage of Users Consuming Wood as a Fuel at the Municipal 

Level in Mexico, 2000 

Type of indicator: 

Effect 

INDICATOR Description 

Definition Proportion of population per state that used wood and coal as fuel during 

2000 

Rationale and role This is an indicator of potential risk to health, showing the predominantly 

rural states, with the most at-risk population, where wood and coal are 

most often used as fuel. 

That states that use the most wood include Oaxaca and Chiapas, where 

between 50 and 60 percent of the population is believed to use this kind of 

fuel. In general, Mexico’s southern states have the greatest proportion of 

persons exposed to wood and coal use. 

Data Range Dates: 2000 

Data sources, 

availability and quality 

XII General Census of Population and Housing (Censo General de 

Población y Vivienda XII, 2000) INEGI 2000. 

Units of 

measurement 

Percent 

Computation Number of inhabitants living in homes that use biomass fuel/Total 

population X 100 

Sources of further 

information 

XII General Census of Population and Housing (Censo General de 

Población y Vivienda XII, 2000) INEGI 2000.http://www.inegi.gob.mx

Scale of application National 

Useful references Semarnat: http://www.semarnat.gob.mx

Strengths of the 

Indicator 

These states are representative of the rural areas inhabited by the most atrisk populations most susceptible to exposure to pollutants from wood use. 
71 

Prevalence of Passive Smoking in Urban Populations (Ages 12–65) in 

Mexico, 2002 

Prevalence of Passive Smoking in Rural Populations (Ages 12–65) in 

Mexico, 2002 

Type of indicator: 

Risk 

INDICATOR Description 

Definition “Passive smoker” or “involuntary smokers” are those persons not classified 

as active smokers and exposed to tobacco smoke (environmental smoke) 

at home, the classroom or workplace. Around 48 million Mexicans are so 

classified. 

Urban area: Urban population: Living in towns with a population of more 

than 2500 inhabitants. 

Rural area: Rural population: Living in towns with a population of no more 

than 2500 inhabitants 

Rationale and role Mexico is a country with a predominantly young population and has a 

certain social tolerance for tobacco addiction. The regulation of the tobacco 

trade and protection for nonsmokers are still deficient, in both enforcement 

and compliance. Thus, the country may be highly vulnerable to the will of 

tobacco companies, with the resulting promotion of tobacco smoking and 

an increased number of smokers. 

Involuntary smoking causes a number of illnesses, such as lung cancer, 

various respiratory illnesses such as pneumonia and bronchitis, and 

cardiovascular disease. However, children exposed to tobacco smoke are 

at the greatest risk of illness, especially at an early age, given the 

immaturity of their immune systems. 

 

There is a potential health risk for passive smokers to suffer premature lung 

damage or begin a smoking habit. 

Data Range Date: 2002 

Data sources, 

availability and quality 

The information for this indicator was obtained from the National Addictions 

Survey (Encuesta Nacional de Adicciones—ENA), composed of two parts. 

The first part summarizes the general aspects, methodology and 

organization of the survey, while the second part provides an executive 

summary of the most important indicators obtained from the information 

collected, as well as statistical precisions for the key variables. 

The information was collected using standardized questionnaires applied 

through face-to-face interviews by trained surveyors. The questionnaires 

used the basic indicators proposed by the World Health Organization 

(WHO) to assess substance use/abuse and dependence and the 

associated problems. 

The survey was designed as a random stratified sampling (probability 

sample) with a selection of conglomerates at various sampling stages. 

ENA 2002, National Council Against Addictions (Consejo Nacional Contra 

las Adicciones—Conadic), National Institute of Pediatrics (Instituto Nacional 

de Pediatría—INP), General Bureau of Epidemiology (Dirección General de 

Epidemiología—DGE), INEGI 

Units of 

measurement 

Rate 
72 

Computation Number of inhabitants who smoke at homes/the number of exposed 

persons between 12 and 65 years of age. 

Divided into three zones: Northern, Central and Southern 

Sources of further 

information 

Conadic: http://www.conadic.gob.mx

INEGI: http://www.inegi.gob.mx

DGE: http://www.dgepi.salud.gob.mx

Scale of application National and regional, urban and rural 

Useful references National Institute of Public Health (Instituto Nacional de Salud Pública—

INSP): http://www.insp.gob.mx

Strengths of the 

Indicator 

Every four years starting in 1988, the Secretariat of Health (Secretaría de 

Salud—SSA) has conducted this survey, which represents an important set 

of topical data that will doubtless support the performance of studies 

analyzing this area in greater depth. 
73 

Percentage of smokers, ex-smokers and non-smokers among 

adolescents (Ages 12–17), by gender, in urban locations in Mexico, 

2002 

Type of indicator: 

Exposure 

INDICATOR Description 

Definition Population of adolescent smokers, ex-smokers, and non-smokers in urban 

areas. 

Rationale and role This indicator expresses the tobacco smoking habits of the adolescent 

population in urban areas, indicating the potential risk to health in early 

stages of life. 

According to data from the Anti-Tobacco Program developed by the 

National Council Against Additions, there are around 13 million smokers in 

Mexico, of whom 24.6 percent are women and 75.4 percent are men. 

In Mexico, studies have shown that adolescents begin smoking at 

increasingly early ages. At present, the average starting age is around 13. 

The prevalence of smokers in the adolescent age group in urban areas was 

10.1 percent, equal to nearly one million individuals. The prevalence of exsmokers in the urban population between 12 and 17 years of age was 7.1 

percent, or 705,963 young people. 

Data Range Date: 2002 

Data sources, 

availability and quality 

ENA 2002, Conadic, INP, DGE, INEGI 

Units of 

measurement 

Percentage 

Computation Number of adolescent smokers, ex-smokers, and non-smokers in urban 

areas/number of exposed population between 12 and 17 years of age X 

100 

Sources of further 

information 

Conadic: http://www.conadic.gob.mx

INEGI: http://www.inegi.gob.mx

DGE: http://www.dgepi.salud.gob.mx

Scale of application National, urban 

Useful references INSP: http://www.insp.gob.mx

Strengths of the 

Indicator 

Every four years starting in 1988, the SSA has conducted this survey, 

which represents an important set of topical data that will doubtless support 

the performance of studies analyzing this area in greater depth. 
74 

Percentage of smokers among adolescents, by age and gender, in 

urban locations in Mexico, 2002 

Type of indicator: 

Exposure 

INDICATOR Description 

Definition Percentage of population per age group of children under 17, by gender, 

who smoke and live in urban locations. 

Rationale and role This indicator expresses the tobacco smoking habits of the under-17 

population in urban areas, indicating the potential risk to health in early 

stages of life. 

Data Range Date: 2002 

Data sources, 

availability and quality 

ENA 2002, Conadic, INP, DGE, INEGI. 

Units of 

measurement 

Percentage 

Computation Number of adolescents per gender and age group who smoke in urban 

households/total exposed population X 100 

Sources of further 

information 

Conadic: http://www.conadic.gob.mx

INEGI: http://www.inegi.gob.mx

DGE: http://www.dgepi.salud.gob.mx

Scale of application National, urban 

Useful references INSP: http://www.insp.gob.mx

Strengths of the 

Indicator 

Information obtained from national surveys conducted every four years. 
75 

Incidence of asthma in children under five years of age in Mexico, 

1995–2002 

Type of indicator: 

Health effects 

INDICATOR 3.- Description 

Definition Number of cases with a clinical diagnosis of asthma in children under 5, 

during 1995–2002 

Morbidity rate: Number of cases handled in health centers for a given 

illness in a given year, for a given age group, per 100,000 inhabitants. 

Asthma: Any individual with an allergy history having attacks of thoracic 

oppression, dyspnea and sibilance, accompanied by an intense cough with 

heavy expectoration. In accordance with IDC 10th Review, includes: J45, 

J46 

Asthma is a genetic illness with immunological alterations. It is the most 

common chronic illness among children, with early clinical manifestations, 

and thus its diagnosis is generally made in the first years of life. 

Rationale and role This indicator shows the extent of change in incidences of asthma, which 

may be related to exposure to indoor and outdoor air pollution. Although air 

pollution is only one of the several risk factors, it has been shown that 

respiratory symptoms are exacerbated by high pollution levels, especially in 

vulnerable groups. 

An asthmatic will have a greater symptomatic and functional response from 

being exposed to greater concentrations of pollution, including the 

frequency and duration of exposure. 

In Mexico, residents of coastal states have been found to show a greater 

number of asthma cases, possibly due to environmental humidity. These 

regions also are believed to have a higher frequency due to the use of air 

conditioning systems that hold a considerable amount of dust and fungus, 

which may trigger asthma attacks. 

Data Range Dates: 1995–2002 

Age: Under 5 

Data sources, 

availability and quality 

In Mexico, statistical data on morbidity and mortality are compiled and 

analyzed as an official source through the National Epidemiological 

Oversight System (Sistema Nacional de Vigilancia Epidemiológica—

Sinave), which is an action program involving a set of strategies and 

actions enabling the identification and detection of harms and risks to 

health. The system is managed by the DGE. 

From its creation in 1995, Sinave has established the Centralized 

Epidemiological Oversight Information System (Sistema Único de 

Información para la Vigilancia Epidemiológica—SUIVE), which systemizes 

morbidity and mortality information with the involvement of the entire health 

sector. 

SUIVE created uniform notification criteria, forms and procedures for the 

various institutions within the National Health System (Sistema Nacional de 

Salud—SNS), generating uniform health services information at the 

different technical-administrative levels. This information refers to the 

occurrence, distribution in terms of time, place and persons, risk factors 

and results of illness affecting human health, and is reported on special 
76 

forms for each level. Local information is forwarded to the jurisdictional 

level, which is concentrated and forwarded to the state level, and the state 

levels forward information to the national level. Information is concentrated 

at each corresponding level and analyzed to guide and support decisionmaking in the design and application of nationwide health plans and 

programs. 

The Centralized Automated Epidemiological Oversight System (Sistema 

Único Automatizado para la Vigilancia Epidemiológica—SUAVE) is a 

software package concentrating Sinave information generated by SNS 

institutions. 

The weekly reporting covers a total of 110 illnesses, of which 47 are 

nontransmittable and 63 are transmittable; 29 require immediate notification 

and a specific epidemiological study for final confirmation and final 

classification. Specific diagnostic criteria and procedures are applied for a 

more complete clinical and epidemiological characterization. Illnesses are 

reported on form SUIVE-1-2000. 

SUAVE is self-installing program that allows the user to operate it with 

limited knowledge of computing. It also provides for the emailing of entered 

data. This software offers graphical and mapped reporting with historical 

information on morbidity and concentrates information on new cases of 

illnesses. 

Epidemiological Information Bulletin 1995–2000, Population Projections 

1990–2010/Conapo 

Units of 

measurement 

Morbidity rate 

Computation Number of cases of asthma reported for children between 0 and 5 years of 

age in a year/total population of same age group in same year 

Rate per 10,000 inhabitants 

Sources of further 

information 

SSA: http://www.ssa.gob.mx

DGE: http://www.dgepi.salud.gob.mx

Conapo: http://www.conapo.gob.mx

Scale of application National. Epidemiological Information Bulletin 1995–2000, Population 

Projections 1990–2010/Conapo 

Useful references INSP: http://www.insp.gob.mx

Strengths of the 

Indicator 

This illness is reported in SUIVE for all first-, second- and third-tier care 

facilities. 
77 

Incidence of Acute Respiratory Infections (ARIs) in children under five 

years of age in Mexico, 1993–2002 

Type of indicator: 

Health effects 

INDICATOR 4.- Description 

Definition There is a series of acute respiratory illnesses determined as being caused 

by virus, allergens and bacteria such as rhinopharyngitis, laryngitis, acute 

bronchitis, etc., with similar clinical diagnoses, the pathological causes of 

which are often difficult to identify. These are important given their 

extensive morbidity. 

Incidence rate: Number of new cases of illness / Exposed population 

Acute respiratory infections (ARIs): All children under five that are clinically 

diagnosed with sudden onset of obstruction or nasal secretion, throat pain 

or burning, dysphony, coughing with or without expectoration, fever, back 

pain, dyspnea or cyanosis. In accordance with IDC 10th review, including: 

J00, J01, J02.8, J02.9, J03.8, J06, J20, J21. 

Rationale and role This indicator shows the extent of changes in the prevalence of respiratory 

infections by age group, which may be related to the exposure to indoor 

and outdoor air pollution. 

The rate of incidence of ARIs varies throughout national territory due to 

factors influencing the increase or decrease of cases, such as poverty, 

marginalization, malnutrition, access to health services, the 

physicochemical conditions and concentration of air pollution, and the 

meteorological and geographical conditions of the country’s different 

regions. 

Data Range Date: 1990–2003 

Age: Under 5 

Data sources, 

availability and quality 

Data obtained by DGE’s Sinave, which is an action program involving a set 

of strategies and actions enabling the identification and detection of harms 

and risks to health. 

Epidemiological Information Bulletin 1995–2000, Population Projections 

1990–2010/Conapo 

Units of 

measurement 

Rate 

Computation Number of new ARI cases reported for children between 0 and 5 years of 

age/Exposed population 

Rate per 100,000 inhabitants 

Sources of further 

information 

SSA: http://www.ssa.gob.mx

DGE: http://www.dgepi.salud.gob.mx

Conapo: http://www.conapo.gob.mx

Scale of application National. Epidemiological Information Bulletin 1995–2000, Population 

Projections 1990–2010/Conapo 

Useful references INSP: http://www.insp.gob.mx

Strengths of the 

Indicator 

This illness is reported in SUIVE for all first-, second- and third-tier care 

facilities. 
78 

Prevalence of asthma among children, by age group, Mexico, 1998–

2002 

Type of indicator: 

Health effects 

INDICATOR Description 

Definition Prevalence of asthma among children, by age group, Mexico, 1998–2002 

Asthma: Any individual with an allergy history having attacks of thoracic 

oppression, dyspnea and sibilance, accompanied by an intense cough with 

heavy expectoration. In accordance with IDC 10th Review, includes: J45, 

J46 

Prevalence rate: Number of new and old cases/Total exposed population. 

Rationale and role This indicator shows the extent of change in the prevalence of asthma, 

which may be related to exposure to indoor and outdoor air pollution. 

Although air pollution is only one of the several risk factors, it has been 

shown that respiratory symptoms are exacerbated by high pollution levels, 

especially in vulnerable groups. 

An asthmatic will have a greater symptomatic and functional response from 

being exposed to greater concentrations of pollution, including the 

frequency and duration of exposure. 

Data Range Dates: 1998–2002 

Age: Under 1, 1 to 4 and 5 to 14 years. 

Data sources, 

availability and quality 

Data obtained by DGE’s Sinave, which is an action program involving a set 

of strategies and actions enabling the identification and detection of harms 

and risks to health. 

Units of 

measurement 

Prevalence rate 

Computation Number of cases (new and old) of ARIs in children under 1, from 1 to 4, 

and from 5 to 14/Total exposed population. 

Rate per 100,000 inhabitants. 

Sources of further 

information 

SSA: Epidemiological Information Bulletin 1995–2000: 

http://www.dgepi.salud.gob.mx

Conapo: Population Projections 1990–2010/Conapo: 

http://www.conapo.gob.mx

INEGI: http://www.inegi.gob.mx

Scale of application National 

Useful references SSA: http://www.ssa.gob.mx

INSP / Health Atlas: http://www.insp.gob.mx

Strengths of the 

Indicator 

This illness is reported in SUIVE for all first-, second- and third-tier care 

facilities. 
79 

Incidence of Acute Respiratory Infections (ARI) among children, by 

age group, Mexico, 1998–2002 

Type of indicator: 

Health effects 

INDICATOR Description 

Definition Prevalence rate of ARIs in children per age group, in 1998–2002 

ARIs: All children clinical diagnosed with sudden onset with obstruction or 

nasal secretion, throat pain or burning, dysphony, coughing with or without 

expectoration, fever, back pain, dyspnea or cyanosis. In accordance with 

IDC 10th review, including: J00, J01, J02.8, J02.9, J03.8, J06, J20, J21. 

Rationale and role This indicator shows the extent of changes in the prevalence of respiratory 

infections by age group, which may be related to the exposure to indoor 

and outdoor air pollution. 

Data Range Dates: 1998–2002 

Age: Under 1, 1 to 4, and 5 to 14 years of age. 

Data sources, 

availability and quality 

Data obtained by DGE’s Sinave, which is an action program involving a set 

of strategies and actions enabling the identification and detection of harms 

and risks to health. 

Epidemiological Information Bulletin 1995–2000, Population Projections 

1990–2010/Conapo 

Units of 

measurement 

Prevalence rate 

Computation Number of cases (new and old) of ARIs in children under 1, from 1 to 4, 

and from 5 to 14/Total exposed population. 

Rate per 100,000 inhabitants. 

Sources of further 

information 

SSA: http://www.ssa.gob.mx

DGE: http://www.dgepi.salud.gob.mx

Conapo: http://www.conapo.gob.mx

Scale of application National 

Useful references INSP: http://www.insp.gob.mx

Strengths of the 

Indicator 

This illness is reported in SUIVE for all first-, second- and third-tier care 

facilities. 
80 

Rate of mortality by Acute Respiratory Infection (ARI) of children 

under five in Mexico, 1990–99 

Type of indicator: 

INDICATOR Description 

Definition Mortality rate in children under five years of age from acute respiratory 

infections (ARIs), 1990–99. 

Mortality rate: Number of deaths from a specific cause among the total 

population in a given period of time. 

Rationale and role This indicator represents the declining mortality rate from ARIs in the stated 

age group, from 1990 to 1999. 

Data Range Date: 1990–99 

Age: children under five 

Data sources, 

availability and quality 

Illness reported in the Epidemiological and Death Statistics System 

(Sistema Epidemiológico y Estadístico de las Defunciones—SEED). 

SEED compiles information from death certificates to record causes of 

death among the population, thereby detecting risks in order to develop 

health measures and prevent deaths from such causes. 

Population Projections 1990–2010/Conapo 

Units of 

measurement 

Mortality rate 

Computation Total deaths per age group, from ARIs in children under five/Total 

population of age group 

Rate calculated per 100,000 inhabitants 

Sources of further 

information 

SSA: http://www.ssa.gob.mx

DGE: http://www.dgepi.salud.gob.mx

Conapo: http://www.conapo.gob.mx

Scale of application National 

Useful references INSP: http://www.insp.gob.mx

Strengths of the 

Indicator 

This illness is reported in Sinave through SEED, for all first-, second- and 

third-tier care facilities. 
81 

Blood lead levels in rural and urban populations Type of indicator: 

Action 

INDICATOR Description: 

Definition Mexico has data on the blood lead levels only from isolated studies in 

industrial zones and some pottery-making regions, and not national basal 

information on blood lead levels. 

Rationale and role Lead has a wide range of toxic effects on several body systems. Elevated 

acute exposure leads to severe poisoning manifested by highly lethal 

encephalopathy. Chronic exposure produces a range of constitutional 

symptoms and a heightened risk of neuropsychological deficiencies, 

nephropathy, peripheral nephropathy, anemia and reproductive alterations. 

Lead has toxic effects even at low levels of exposure, with a notable, 

insidious effect on children’s cognitive development. There is no threshold 

precisely indicating when lead begins to affect health, although clinical 

manifestations are believed to arise at 10 μg/dL, even though damage may 

occur at lower levels. 

Data Range Studies conducted between 1960 and 2000. 

Data sources, 

availability and quality 

Data obtained from studies published in indexed journals 

Units of 

measurement 

Micrograms per deciliter of blood 

Computation For further information, look up the respective study by author. 

Sources of further 

information 

See Table 3.1

Scale of application Regional, urban and rural 

Useful references As specified in Table 3.1 

Strengths of the 

Indicator 

Studies published in indexed journals 
82 

Atmospheric monitoring of lead and principal activities to reduce lead 

emissions in the Valley of Mexico Metropolitan Area, 1990–2000 Type of indicator: 

INDICATOR Description 

Definition Atmospheric monitoring of lead and principal activities to reduce lead 

emissions in the Valley of Mexico Metropolitan Area. 

Quarterly trends in lead monitoring, considering 1.5 μg/m3 as the standard 

level for the metropolitan area. 

Tracking stations located at Tlalnepantla, Xalostoc, Merced, Pedregal, and 

Cerro de la Estrella, pertaining to the Environmental Monitoring Network. 

Series of automatic or manual tracking stations to collect, analyze and 

systematically environmental air samples. 

Rationale and role Lead has a wide range of toxic effects on several body systems. Elevated 

acute exposure leads to severe poisoning manifested by highly lethal 

encephalopathy. Chronic exposure produces a range of constitutional 

symptoms and a heightened risk of neuropsychological deficiencies, 

nephropathy, peripheral nephropathy, anemia and reproductive alterations. 

Lead has toxic effects even at low levels of exposure, with a notable, 

insidious effect on children’s cognitive development. There is no threshold 

precisely indicating when lead begins to affect health, although clinical 

manifestations are believed to arise at 10 μg/dL, even though damage may 

occur at lower levels. 

Data Range Date: 1990–2000 

Data sources, 

availability and quality 

Mexico City Air Monitoring System (Sistema de Monitoreo Atmosférico de 

la Ciudad de México): http://www.sima.com.mx

Units of 

measurement 

μg/m3

Computation Standard quarterly average value of 1.5 μg/m3

Sources of further 

information 

INE: http://www.ine.gob.mx

CAM: http://www.edomexico.gob.mx/se/cam.htm

NOM-026-SSA1-1993, “Environmental health. Criteria for assessing 

ambient air quality with respect to lead (Pb). Standard value for lead (Pb) 

concentration in ambient air as a public health protection measure.” 

Scale of application Valley of Mexico Metropolitan Area 

Useful references Semarnat: http://www.semarnat.gob.mx

Strengths of the 

Indicator 

Establishes the reference for decision-making in developing control and 

assessment programs. 
83 

Local Air Quality Data from Metallurgical Activities Type of indicator: 

INDICATOR Description: 

Definition Quarterly trends in lead monitoring, considering 1.5 μg/m3 as the standard 

level for the area neighboring the company MET-MEX Peñoles, under 

NOM-026-SSA1-1993). 

Rationale and role The city of Torreón, Coahuila, located in northern Mexico, has a population 

of approximately 530,000 inhabitants. Latin America’s largest, and the 

world’s fourth-largest mining-metallurgical company, MET-MEX Peñoles, is 

located in this town, producing lead, silver and gold. The presence of this 

industry has led to the chronic environmental exposure to lead in the nonoccupational population, particularly in children. 

Data Range Date: December 1999–January 2004 

Data sources, 

availability and quality 

Metals Program (Programa de Metales)/Coahuila State Secretaríat of 

Health 

Units of 

measurement 

μg/m3

Computation Quarterly average of 1.5 μg/m3, for values found at all tracking stations 

neighboring the company 

Sources of further 

information 

NOM-026-SSA1-1993, “Environmental health. Criteria for assessing 

ambient air quality with respect to lead (Pb). Standard value for lead (Pb) 

concentration in ambient air as a public health protection measure.” 

Office of the Federal Attorney for Environmental Protection (Procuraduría 

Federal de Protección Ambiental—Profepa): http://www.profepa.gob.mx

Scale of application State of Coahuila 

Useful references Semarnat: http://www.semarnat.gob.mx 

INE: http://www.ine.gob.mx

Strengths of the 

Indicator 

To address this situation, the state Secretariat of Health, Profepa and the 

company Peñoles implemented a series of actions including, among others, 

emissions control by the company, the oversight of the environmental 

authority and the medical care of the environmentally exposed population 

by the state Secretariat of Health. 
84 

Annual average lead in children’s blood in the city of Torreón, 1998–

2004. 

Blood lead levels in children following five years of attendance in the 

metals program in Mexico, 2000. 

Type of indicator: 

health effects 

INDICATOR Description 

Definition Annual average lead in blood of children under 15 years of age. 

Total population of children under 15 recorded in the Metals Program with 

blood lead levels above the NOM-199-SSA1-2000 standard, setting a limit 

value of 10 μg/dL, as well as the blood lead value categories for 

intervention. 

Category BLL 

I < 10 μg/dL 

II 10 to 14.9 μg/dL 

III 15 to 24.9 μg/dL 

IV 25 to 44.9 μg/dL 

V 45 to 69.9 μg/dL 

VI More than 70 μg/dL 

Rationale and role The results of formal studies performed since 1997 have shown a high 

concentration of lead in the soil and air, thereby documenting prolonged, 

historic pollution. One of these studies (García V.G. & coll., 2001) 

corroborated the presence of lead in the blood of school children, having a 

directly proportional relationship to their proximity to the metallurgical plant. 

The presence of this industry has led to the chronic environmental 

exposure to lead in the non-occupational population, particularly in children. 

Data Range Date: December 1999–January 2004 

Data sources, 

availability and quality 

Epidemiological oversight system under the Metals Program/Coahuila State 

Secretariat of Health 

Units of 

measurement 

μg/dL in blood 

Computation The state lead oversight system is based on the criteria and actions 

provided in the standard, which specify and categorize the values of lead in 

blood required for health authority intervention. 

Sources of further 

information 

NOM-199-SSA1-2000, Environmental health–levels of lead in blood and 

actions as health protection criteria for the non-occupationally exposed 

population. 

SSA: http://www.salud.gob.mx

Scale of application Local 

Useful references García et al. 2001 

Strengths of the 

Indicator 

To address this situation, the state Secretariat of Health, Profepa and the 

company Peñoles implemented a series of actions including, among others, 

emissions control by the company, the oversight of the environmental 

authority and the medical care of the environmentally exposed population 

by the state Secretariat of Health. 
85 

Cases of pesticide poisonings in children (under 15 years old) and the 

general public in Mexico, 1993–2002 

Type of indicator: 

Health effects 

INDICATOR 5.- Description

Definition Annual pesticide poisoning cases in the overall population and in 

children under 15 years of age. 

Pesticide poisoning: Any person showing bradycardia, hypotensión, 

dizziness, increased salivatin, myosis or one or more of the following 

symptoms: convulsions, tremors, nausea, vomiting, increased 

sweating, pulmonary edema, hepatic degeneration, relaxation of 

sphincters, depression and coma. In accordance with IDC 10th review, 

includes: T60. 

Rationale and role Children may be especially vulnerable to the effects of pesticide, given their 

particular susceptibility and because they may be exposed to higher 

pesticide levels than adults. In proportion to their body mass, children eat 

more than adults and may be more exposed to certain pesticides by reason 

of their different, less varied diets than adults. 

Data Range 1993 to 2002 for the overall population, and 1998 to 2002 for children under 

15. 

Data sources, 

availability and quality 

Data obtained by DGE’s Sinave, which is an action program involving a set 

of strategies and actions enabling the identification and detection of harms 

and risks to health. 

National Health Information System (Sistema Nacional de Información en 

Salud—Sinais): http://www.sinais.gob.mx

SSA: http://www.salud.gob.mx

INEGI: http://www.inegi.gob.mx

Units of 

measurement 

Cases reported 

Computation Number of cases of pesticide poisoning in children under 15/Overall 

population 

Sources of further 

information 

DGE: http://www.dgepi.salud.gob.mx

INEGI: http://www.inegi.gob.mx

Scale of application State and federal information available 

Useful references SSA: http://www.salud.gob.mx

Federal Commission for Protection Against Health Risks (Comisión Federal 

de Protección Contra Riesgos a la Salud—Cofepris): 

http://www.cofepris.gob.mx

Strengths of the 

Indicator 

National coverage. Information processed in SUIVE. Poison control centers 

are being integrated to improve reporting. 
86 

Population (in thousands) with access to bacteriologically safe water, 

by state, Mexico, 2003 

Percentage of the population without access to bacteriologically safe 

water in Mexico, 2000–2003 

Type of indicator: 

Exposure 

INDICATOR Description 

Definition Population receiving chlorinated water: Inhabitants with water from a supply 

network to which chlorine has been applied as a disinfection treatment. 

Bacteriologically safe water: Water suitable for human consumption and not 

containing microorganisms endangering health, in accordance with NOM127-SSA1-1994 

The disinfection of water intended for human use and consumption ensures 

the inactivation or destruction of most pathogens that may be transmitted to 

humans. 

Rationale and role The primary environmental and public health problems faced by the country 

are those relating to a lack of basic sanitation and poor water quality. 

Furthermore, limited water is available for its growing population. Therefore 

the availability of safe and reliable supply sources is fundamental to ensure 

adequate public health, since may illnesses are caused by chemical agents 

and pathogenic organisms living in polluted water. 

This indicator presents an overview of the population with water from a 

disinfected supply network. Not all piped water is bacteriologically safe. 

Data Range 2003 

2000–2003 

Data sources, 

availability and quality 

Water disinfection oversight is carried on with the periodic and ongoing 

tracking of free residual chlorine in the distribution network. Keeping 

residual chlorine above 0.2 mg/L is effective to inactivate pathogenic 

bacteria and viruses in the network. 

State Health Services; National Water Commission (Comisión Nacional del 

Agua—CNA): http://www.cna.gob.mx

INEGI: http://www.inegi.gob.mx

Conapo (population projections by gender, age groups and states, 1995–

2005): http://www.conapo.gob.mx

Units of 

measurement 

Thousands of inhabitants 

Percentage 

Computation Overall population receiving bacteriologically safe water. 

Overall population with bacteriologically safe water/Total population. 

Overall population with formal supply system/Total population. 

Sources of further 

information 

Modification to NOM-127-SSA1-1994, Environmental health. Water for 

human use and consumption. Allowable quality limits and treatment for 

drinkability. 

CNA: http://www.cna.gob.mx

INEGI: http://www.inegi.gob.mx

Conapo: http://www.conapo.gob.mx

Scale of application State and national information available 

Useful references SSA: http://www.salud.gob.mx
87 

Cofepris: http://www.cofepris.gob.mx

Strengths of the 

Indicator 

Representative, including the 32 Mexican states and information from 

official sources. 
88 

Percent of the population without potable water in Mexico, 1980–2000 

Percent of the population without piped water, by State, Mexico, 2000 

(map) 

Type of indicator: 

Exposure 

INDICATOR Description 

Definition Population receiving drinking water: Inhabitants with water from a 

supply source. This indicator refers to urban and rural zones. 

Population censuses conducted from 1980 to 2000. 

Drinking water: Free of physicochemical and biological pollutants, under 

the modification to NOM-127-SSA1-1994. 

Rationale and role This indicator presents an overview of the differences between rural and 

urban populations in the availability of piped water, and the population 

most at risk from waterborne illness, given the access to treated 

(chlorinated) water. 

Data Range Date: 1980–2000 

Census 2000 

Data sources, 

availability and quality 

Database of the XII General Population and Housing Census, 2000 

Counting of Population and Housing, 1995 

Database of the XI General Population and Housing Census, 1990 

Database of the X General Population and Housing Census, 1980 

Modification to NOM-127-SSA1-1994, Environmental health. Water for 

human use and consumption. Allowable quality limits and treatment for 

drinkability. 

Units of 

measurement 

Percentage 

Computation Overall population receiving piped household water/Total population x 100. 

Sources of further 

information 

INEGI: http://www.inegi.gob.mx

Conapo: http://www.conapo.gob.mx

SSA: http://www.salud.gob.mx 

CNA: http://www.cna.gob.mx 

Scale of application Urban, rural and national 

Regional map: Central, northern and southern 

Useful references Semarnat: http://www.semarnat.gob.mx

National Water Program: 

http://www.imacmexico.org/ev_es.php?ID=5876_201&ID2=DO_TOPIC

Strengths of the 

Indicator 

Population and housing censuses provide the most complete information 

as to the geographic breakdown enabling an awareness of the national 

situation. With this information, various national sectors may prepare 

development plans and programs, analyze human settlement conditions 

and carry on a range of research, among other things. 
89 

Percent of the population not served with sewer services in Mexico, 

1980–2000 

Type of indicator: 

Exposure 

INDICATOR Description 

Definition Population with a drainage or sewer system for carrying and/or 

discharging sewage. 

Households per state with a drainage or sewer system for carrying and/or 

discharging sewage. 

In Mexico, the term “sewer” (alcantarillado) refers to drainage networks, 

septic tanks and direct drainage into trenches, ditches or bodies of water; 

this is important when comparing with other countries. 

Rationale and role This measure reflects the percentage of the population that may be 

exposed to untreated sewage and contract waterborne illnesses. May be 

expressed in terms of type of sewer or sewage treatment system (latrines, 

septic systems). 

Data Range 1980–2000 

2000 

Data sources, 

availability and quality 

Database of the General Population and Housing Census, 1980–2000 

Database of the General Population and Housing Census, 2000 

Units of 

measurement 

Percentage 

Computation Population (households) with drainage or sewer systems/Total population X 

100 

Households with drainage or sewer systems/Counted households X 100 

Sources of further 

information 

National Population Council: http://www.conapo.gob.mx

Scale of application National – Database of the XII General Population and Housing Census, 

2000 

State – (map) 

Useful references CNA: http://www.cna.gob.mx

INEGI: http://www.inegi.gob.mx

Cofepris: http://www.cofepris.gob.mx

National Water Program: 

http://www.imacmexico.org/ev_es.php?ID=5876_201&ID2=DO_TOPIC

Strengths of the 

Indicator 

Coverage; information obtained from census 
90 

Percent of homes without sewer services, by state, Mexico, 2000 Type of indicator: 

Exposure 

INDICATOR Description 

Definition Population per state with a drainage or sewer system for carrying and/or 

discharging wastewater, based on the 2000 census. The indicator provides 

information on the increase in services in rural and urban areas. 

Rationale and role This measure reflects the percentage of the population that may be 

exposed to untreated sewage and contract waterborne illnesses. May be 

expressed in terms of type of sewer or sewage treatment system (latrines, 

septic systems). 

Data Range 2000 

Data sources, 

availability and quality 

XII General Census of Population and Housing 2000 

Units of 

measurement 

Percentage 

Computation Overall population (households) with drainage or sewer system/Total 

population 

Sources of further 

information 

National Population Council: http://www.conapo.gob.mx

Scale of application National and state 

Useful references CNA: http://www.cna.gob.mx

INEGI: http://www.inegi.gob.mx

Cofepris: http://www.cofepris.gob.mx

National Water Program: 

http://www.imacmexico.org/ev_es.php?ID=5876_201&ID2=DO_TOPIC

Strengths of the 

Indicator 

Coverage; information obtained from census 
91 

Incidence of shigellosis in children under 5 years old in Mexico, 1998–

2002 

Type of indicator: 

Health effects 

INDICATOR Description 

Definition Shigellosis: Acute intestinal bacterial infection caused by the bacteria 

shigella, characterized by first watery and then bloody stools, accompanied 

by abdominal pain and fever, nausea and vomiting, lasting for 4 to 7 days. 

In accordance with IDC 10th review, includes: A03. 

Incidence rate: Number of new cases of illness in children under 5/total 

exposed population. 

Rate per 10,000 inhabitants. 

Rationale and role According to WHO, 80 percent of infectious and parasitic gastrointestinal 

illnesses, and a third of deaths caused thereby, are due to the consumption 

of insalubrious water. WHO further notes that only 41 percent of the world’s 

population drinks water that is treated and disinfected to be deemed safe. 

The primary environmental aspects that traditionally influence the causes of 

illness and death in Mexico include: 

• Poor water quality for human use and consumption 

• Inadequate sewage disposal 

• Inadequate handling of municipal solid waste 

• Insufficient pest control 

• Poor hygiene conditions in homes and public areas 

In countries such as Mexico, diarrheic illnesses continue to be a serious 

problem for the child population. These illnesses are caused by bacteria, 

viruses and protozoan pathogens passed by the fecal-oral route and 

potentially transmitted by drinking water used in various household 

activities, including personal hygiene, and through primary contact with 

contaminated recreational waters. 

Data Range Date: 1998–2002 

Data sources, 

availability and quality 

Data obtained by DGE’s Sinave, which is an action program involving a set 

of strategies and actions enabling the identification and detection of harms 

and risks to health. 

Sinais: Statistical Information Bulletin: http://www.sinais.gob.mx

SSA: http://www.salud.gob.mx

INEGI: http://www.inegi.gob.mx

Units of 

measurement 

Incidence rate 

Computation Number of new shigellosis cases in children under 5/Total exposed 

population of children under 5 

Sources of further 

information 

DGE: http://www.dgepi.gob.mx

Scale of application National 

Useful references Conapo: http://www.conapo.gob.mx

SSA: http://www.salud.gob.mx

Strengths of the 

Indicator 

This illness is reported in SUIVE for all first-, second- and third-tier care 

facilities. 
92 

Incidence of giardiasis in children under 5 years old in Mexico, 1998–

2002 

Type of indicator: 

Health effects 

INDICATOR Description 

Definition Giardiasis: Inflammatory intestinal condition caused by the proliferation of 

the protozoan Giardia lamblia, characterized by chronic diarrhea (more than 

14 days), esteatorrhea, abdominal cramps, feeling of distension and the 

expulsion of loose, pale and fatty stools. In accordance with IDC 10th review, 

includes: A07. 

Rationale and role As mentioned for the preceding indicator, this infectious, parasitic 

gastrointestinal illness is caused by the consumption of contaminated water 

and deficient hygiene, passed by the fecal-oral route and potentially 

transmitted by drinking water used in various household activities, including 

personal hygiene, and through primary contact with contaminated 

recreational waters. 

Data Range Date: 1998–2002 

Data sources, 

availability and quality 

Data obtained by DGE’s Sinave, which is an action program involving a set 

of strategies and actions enabling the identification and detection of harms 

and risks to health. 

Sinais: Statistical Information Bulletin: http://www.sinais.gob.mx

SSA: http://www.salud.gob.mx

INEGI: http://www.inegi.gob.mx

Units of 

measurement 

Incidence rate 

Computation Number of new giardiasis cases in children under 5/Total exposed 

population of children under 5. 

Sources of further 

information 

DGE: http://www.dgepi.gob.mx

Scale of application National 

Useful references Conapo: http://www.conapo.gob.mx

SSA: http://www.salud.gob.mx

Strengths of the 

Indicator 

This illness is reported in SUIVE for all first-, second- and third-tier care 

facilities. 
93 

Incidence of giardiasis among children, by age group, Mexico, 1998–

2002 

Type of indicator: 

Health effects 

INDICATOR Description 

Definition Inflammatory intestinal condition caused by the proliferation of the 

protozoan Giardia lamblia, characterized by chronic diarrhea (more than 14 

days), esteatorrhea, abdominal cramps, feeling of distension and the 

expulsion of loose, pale and greasy stools. In accordance with IDC 10th

review, includes: A07. 

Prevalence: Number of cases (new and old)/Total exposed population. 

Rationale and role This indicator shows the impact on the prevalence in children under 5 years 

of age. The illness is caused by the consumption of contaminated water 

and deficient hygiene, passed by the fecal-oral route and potentially 

transmitted by drinking water. 

Data Range Date: 1998–2002 

Data sources, 

availability and quality 

Data obtained by DGE’s Sinave, which is an action program involving a set 

of strategies and actions enabling the identification and detection of harms 

and risks to health. 

Sinais: http://www.sinais.gob.mx

SSA: http://www.salud.gob.mx

INEGI: http://www.inegi.gob.mx

Units of 

measurement 

Prevalence rate 

Computation Number of giardiasis cases (new and old) in children under 5/Total exposed 

population of children under 5. 

Sources of further 

information 

DGE: http://www.dgepi.gob.mx

Scale of application National 

Useful references Conapo: http://www.conapo.gob.mx

SSA: http://www.salud.gob.mx

Strengths of the 

Indicator 

This illness is reported in SUIVE for all first-, second- and third-tier care 

facilities. 
94 

Percentage of cases of cholera among children, by age group, Mexico, 

1991–99 

Type of indicator: 

Health effects 

INDICATOR Description 

Definition Cholera cases: All cases isolating toxogenic V. cholerae 01 or V. cholerae 

139 in fecal matter or gastrointestinal contents or showing seroconversion 

of vibriocidal antibodies or cholera antitoxin. 

Outbreak: Association of two or more cases sharing original source of 

infection. 

Rationale and role This indicator shows the impact of cholera outbreaks in Mexico in different 

years. Epidemiological oversight of this illness is needed because the 

climate and sanitary conditions enabling such outbreaks are present in the 

country. For this reason, there is a special cholera oversight system in 

which all institutional and international health authorities cooperate. 

Data Range Date: 1991–99 

Age: Under 1; 1–4 and 5 to 14 years of age. 

Data sources, 

availability and quality 

Data obtained by DGE’s Sinave, which is an action program involving a set 

of strategies and actions enabling the identification and detection of harms 

and risks to health. 

This is one of the 29 illnesses requiring immediate notification and a 

specific epidemiological study for final confirmation and final classification. 

Specific diagnostic criteria and procedures are applied for a more complete 

clinical and epidemiological characterization. 

Epidemiological information on transmittable diseases is also obtained from 

active oversight in first- and second-tier healthcare facilities, nominal case 

reporting, the review of death certificates and health surveys, as required. 

Given their epidemiological importance some mandatory-reporting illnesses 

require comprehensive study and exhaustive tracking. In recent years, 

special epidemiological oversight systems have been established, 

supported by an increasingly broad infrastructure of human resources and 

laboratories, increasing the sensitivity and specificity of epidemiological 

oversight. 

DGE: Source: Epidemiological Oversight Manual for Cholera (Manual de 

Vigilancia Epidemiológica del Cólera/SSA): http://www.dgepi.salud.gob.mx

Units of 

measurement 

Percentage 

Computation Number of cases of cholera per under-14 age group / total exposed 

population X 100. 

Sources of further 

information 

DGE: http://www.dgepi.salud.gob.mx

SSA: http://www.salud.gob.mx

Scale of application National 

Useful references Sinais: http://www.sinais.gob.mx

Strengths of the 

Indicator 

Illness subject to epidemiological oversight with immediate notice. This 

illness is covered by the special ADI/ARI program system, with a specific 

laboratory diagnosis procedure. 
95 

Mortality rate from diarrheic diseases in children under 5 years old in 

Mexico, 1990–2002 

Type of indicator: 

Health effects 

 

INDICATOR Description 

Definition Diarrhea: Under the program for children under 5, diarrhea is the presence 

of liquid, watery or formless stools and more than 3 evacuations in 24 

hours. 

Death from diarrhea: Death where diarrhea is the primary cause of death 

in children under 5. 

Total population of children under 5: Number of living children under 5 

years of age. 

Rationale and role Acute diarrheic illnesses (ADIs) represent an important public health 

concern worldwide; these illnesses affect all age groups, although children 

under 5 are most vulnerable. 

ADIs are almost always infectious and self-limiting. The disease agents are 

generally transmitted in the fecal-oral route and may potentially be 

transmitted through drinking water. They adopt various modalities 

depending on the vehicles and means of transmission. 

According to WHO and UNICEF studies, the two primary complications in 

ADIs are dehydration and malnutrition. 

SEED records deaths from diarrheal and gastrointestinal infections, 

although the proportion caused by water contamination is not known. 

Data Range Date: 1990–2002 

Age: Under 5 

Data sources, 

availability and quality 

Data obtained by DGE’s Sinave, which is an action program involving a set 

of strategies and actions enabling the identification and detection of harms 

and risks to health. 

Illness reported in SEED. 

SEED compiles information from death certificates to record causes of 

death among the population, thereby detecting risks in order to develop 

health measures and prevent deaths from such causes. 

INEGI, DGE, SSA. Statistical Information Bulletin 1990–2002 National 

Conapo, Population Projections 1990–2002 

Units of 

measurement 

Specific mortality rate 

Computation Total number of deaths from diarrhea in children under 5 in a given year. 

Total population of children under 5 in the same year. 

Sources of further 

information 

DGE: http://www.dgepi.salud.gob.mx

SSA: http://www.salud.gob.mx

Scale of application National 

Useful references SSA: http://www.salud.gob.mx

DGE: http://www.dgepi.salud.gob.mx

Strengths of the 

Indicator 

Consistency of information; reported to SEED; methodology includes verbal 

autopsies. 
96 

Mortality from Cholera in Mexico, 1991–98 Type of indicator: 

Health effects 

INDICATOR Description 

Definition Cholera cases: All cases isolating toxogenic V. cholerae 01 or V. cholerae 

139 in fecal matter or gastrointestinal contents or showing seroconversion 

of vibriocidal antibodies or cholera antitoxin. 

Mortality from cholera: Death with a diagnosis of cholera in either listed 

serotype. 

Rationale and role The indicator represents the impact on cholera deaths in its different 

outbreaks in Mexico from 1991 to 1998. 

Data Range Date: 1991–98 

General population 

Data sources, 

availability and quality 

Illnesses reported in SEED. 

SEED compiles information from death certificates to record causes of 

death among the population, thereby detecting risks in order to develop 

health measures and prevent deaths from such causes. 

DGE: http://www.dgepi.salud.gob.mx

Source: SSA Epidemiological Oversight Manual for Cholera. 

Units of 

measurement 

Percentage 

Computation Number of cholera deaths/Total exposed population 

Sources of further 

information 

DGE: http://www.dgepi.salud.gob.mx

SSA: http://www.salud.gob.mx

Scale of application National 

Useful references Sinais: http://www.sinais.gob.mx

Strengths of the 

Indicator 

Illness subject to epidemiological oversight with immediate notice. This 

illness is covered by the special ADI/ARI program system, with a specific 

laboratory diagnosis procedure. 
97 

Appendix 4 Indicators Steering Group—Mexico 

MEXICO 

 

Matiana Ramírez, 

Country Lead 

Rocio Alatorre, 

Observer 

Martha Plascencia, Observer 

Cofepris, Secretaría de 

Salud 

Cofepris, Secretaría 

de Salud 

Cofepris, Secretaría de Salud 

Monterrey #33, Col. 

Roma 

Monterrey #33, Col. 

Roma 

Monterrey #33, Col. Roma 

Delegación Cuauhtémoc Delegación 

Cuauhtémoc 

Delegación Cuauhtémoc 

México, DF 06700 México, DF 06700 México, DF 06700 

T: (52 55) 5208 3032 T: (52 55) 5514 8572 T: (52 55) 5208 3032 

F: (52 55) 5208 3032 F: (52 55) 5514 8557 F: (52 55) 5208 3032 

mramireza@salud.gob.mx rocioal@salud.gob.mx marthaleonor_plascencia@yahoo.com.mx 

Antonio Barraza Vasquez served as country lead for Mexico until August 2005.