# V. Concluding Remarks

In the past seven years many developing countries and most of the intemational agencies that work In the health field, have become Increasingly aware of the importance of the epidemlological transition. The policy implications of the transition have attracted the attention of scholars and health specialist from wide variety of disciplines, including medicine, demography, epidemiology, health planning and policy, health economics, and other social sciences. As a consequence of this renewed interest in the transition, four maJor positive changes In the conceptual model to examine health can be identified: 1) the need to examine health policy through a multidisciollnarv approach has been reemphasized; 2) health policies deal Increasingly with outcomes in the health status of Ropulations, and the evaluations of the health system are linking more often resources with health improvements; 3) the epidemiological profiles of populations are now described more comprehensively to include health problems of all aae arouws and not only children, to analyse the burden of disease with mortality and morbidity data, and to include noncommunicable diseases and iniurv In the spectrum of preventable causes of ill-health; and 4) the scope of health Interventions has been broaden to encompass social oolicies, mainly intersectoral, aimed at reducing environmental risk factors and to modify negative life styles.

The analysis of the health policies in Brazil, Colombia and Mexico has led us to conclude that there are five main implications of the epidemiological transition to health policy in developing countries. First, the transition offers an empirical framework for strategic planning of the health system, since it allows to anticipate future trends of mortality and its causes, and it suggests some of the future scenarios in the burden of disease. Second, since the transition anticipates a greater burden of disease in the adult and elderly population, the mission of the health system need to be revised, giving more emphasis to disease prevention and control, and less to demand satisfaction. Third, the current defficiencies of the health system, organizational and operational, must urgently be corrected, as they would be major obstacles in the Implementation of other health policies intended to improve the health status of the population. Fourth, explicit criteria to set priorities in the health sector need to be defined, so that resources can be distributed between competing socioeconomic groups and health needs. And fifth, the capacity to analyse the health status of populations, to evaluate the performance of the health system, and to design cost-effective interventions to deal with noncommunicable diseases needs to be strenghtened.

Most of the policy issues identified in this paper deal with the current defficlencies of the health system, and propose ways in which they can be corrected within the existing legal and financial constraints existing in these countries. A second group of issues suggest ways to deal with the growing burden of disease due to noncommunicable diseases and injury. Special efforts were made to construct a coherent health system with the proposed recommendations. Most of them can be implemented without extra financial resources, but rather call for a substantial reallocation of the available resources.

Only the nationa **l** evel was analysed, and this clearly lead to some generalizations that can not be sustained when provinces or districts are examined. The intra-country variations on the health profiles and the performance and organization of the health system Is substantial In the three countries, and warrants a more detailed analysis of the Issues and recommendations made In this paper. Finally it is worth remembering that immediate political interests have not been considered as they were beyond the purpose of the analysis.

One question summarizes the challenge that all developing countries will have to face in the next century: how to define realistic and feasible strateaies able to avoid the Increasing burden of 12