# **II. Context: Population health in Mexico between 1997 and 2017.**

The last two decades in Mexico have been marked by large changes in population health as a consequence of extensive policy change, economic development, and demographic and epidemiological transitions. These changes have not only affected the PROSPERA target population, but the population of Mexico at large.

According to the National Population Council (CONAPO), in 1997 Mexico had a population of 97.2 million where 50.5% were women. In 1997, the average life expectancy at birth was 72.7 years (69.8 for men and 75.6 for women). The infant mortality rate was 23.8 per 1,000 live births (26.2 in boys and 21.3 in girls), and the crude mortality rate was 5.1 per 1,000 inhabitants. The fertility rate was 2.8 children per woman.

Twenty years later, in 2017, we see important changes in many of these indicators: 51.2% of the 123.5 million inhabitants were women, life expectancy at birth was 75.3 years, an increase in 2.7 years from 1997: 3.1 years among men and 2.2 years among women. In twenty years, the infant mortality rate dropped to 11.4 per 1,000 live births, a reduction of 52.2% for both boys and girls. Furthermore, the crude mortality rate increased by 12.5% to 5.8 per thousand inhabitants, and the fertility rate decreased by 23% to 2.2 children per woman.<sup>4</sup> This brief summary of population health indicators describes a generally positive trend: an increase of life expectancy and a reduction in infant mortality. However, it is important to place the gains in perspective: over the same time period, global life expectancy at birth increased by 5.1 years, from 66.9 in 1997 to 72.0 in 2016. Restricting the analysis to upper-middle income countries (of which Mexico is one), life expectancy at birth increased by 5 years, from 70 to 75, similar to the increase observed in Latin America and the Caribbean,<sup>5</sup> suggesting that Mexico’s increase of 2.7 years is relatively low.

Mexico has experienced a dissonant epidemiological transition process. Although infant and maternal mortality rates were reduced, mortality among adults associated with noncommunicable diseases and violence has increased, resulting in an increase in the crude mortality rate (Gómez-Dantés _et al_ ., 2016). This is due to social inequalities in health that are manifested as differential access to health, and health outcomes related to socioeconomic conditions of the population (Gutiérrez and García-Saisó, 2016).

Global burden of disease studies capture the national epidemiological profile and its evolution over time. Between 1997 and 2016, changes were observed in the main causes of disabilityadjusted life years (DALYs). In 1997, the top five causes were: lower respiratory infections, neonatal preterm birth, diabetes mellitus type 2, ischemic heart disease, and diarrheal diseases. By 2017, they were: diabetes mellitus type 2, ischemic heart disease, physical violence by other means, physical violence by firearm, and migraine. Diabetes moved from 3<sup>rd</sup> to 1<sup>st</sup> place. In 1997 three of the top five were infectious/neonatal and two were chronic disease. By 2017 none were infectious/neonatal and two were violence.<sup>6</sup>

> 4 CONAPO. Demographic Indicators in Mexico 1990 to 2050. Consulted on 09/15/2018 in http://www.conapo.gob.mx/work/models/CONAPO/Mapa_Ind_Dem/index_2.html

> 5 World Bank. Data from the World Bank. Consulted on 09/15/2018 in https://datos.bancomundial.org/indicador/sp.dyn.le00.in?end=2016&start=1997&year_low_desc=true

> 6 Global Burden of Disease Study. Results for Mexico. Consulted on 09/15/2018 in https://vizhub.healthdata.org/gbdcompare/

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