their health system. This Inertia reduces the flexibility of the health system to adapt to new challenges, as those posed by the epidemiological transition.

As Figure **_1_** illustrates, the current health system is related, In part, to the epidemiological profile, since it is supposed to control, prevent and treat the main diseases and injuries. However, the health system Is also determined by other social and economic factors, such as the market forces of drugs and medical equipment, technological innovation in diagnosis and treatment, the medical labor market, and political '-terests. Future health pcilcies should Ideally be oriented toward improving the capacity of the health system to respond to the changing demand due to the epidemiological transition.

The relationship between the epidemiological proflie and the health system Is depicted In Figure I as occurring directly and mediated through demand. Some health needs of the population elicit direct responses from the health system, as the case of Immunizations. Others are identified through demands from the population, like case management of noncommunicable diseases. Needs and demands are clearly not synonymous, as the demand depends on the health status and the perception of illness by the individuals and families. This is a critical element to consider in health planning because a large proportion of the rise in demand for health care is due to an increase in illness perception and not necessarily to higher prevalence of disease.

Health policy options are also affected by two other factors that are often ignored because they are resistent to change. These are: the leaal framework for health, environment, and health care; and the ideoloaical standpoints that governments and leading population groups hold regarding health and the role of the State in the provision of health services. These two factors often limit the options available in the formulation of policies. They can, of course, be changed and often are objects of policy. Since they are country-specific, it Is difficult to generalize on the restrictions they impose on health policy altematives.

All the factors described before, are influenced by macro social and economic characteristics of the country, as well as by their recent trends and the perception of policy-makers. To illustrate the most relevant ones, suffice to mention the rate of economic growth, the inflation rate, the size of extemal debt, the productivity and the political stability of the country.

# llI. Health Policy Context in Brazil, Colomioia and Mexico.

This section describes, for the three countries, the most important elements of the conceptual framework described in the previous section.

## 1. **_Social_** _and Economic Characteristics_

An overview of the main social and economic features of the three countries can contribute to a better understanding of the determinants of their neaith profiles and the structure of their health systems. Table I shows economic, social, and health status Indicators for the three countries. Wids disparities can be observed an economic data such as GNP per capita, ranging from US$ 1,200 in Colombia to US$ 2,540 in Brazil, and In average annual inflation, ranging from less than 24 % in Colombia to more than 200 % In Brazil. Nevertheless, all three countries share similar pattems of

**3**