How the epidemiological transition
            affects health policy isues in three Latin American countries
The authors focus on health policy
            issues associated with health reform needed to meet the
            health needs arising from the demographic and
            epidemiological transitions. They illustrate these policy
            issues by analyzing Brazil, Colombia, and Mexico, whose
            populations represent about 60 percent of Latin
            America's population. Brazil, Colombia, and Mexico are
            facing an important decline in mortality and fertility
            rates. New health problems have arisen related to rapid
            urbanization and industrialization - for example, injuries,
            accidental intoxication and poisoning, and the occupational
            and noncommunicable conditions (such as hypertension and
            diabetes) affecting an aging population. At the same time,
            these countries are not free of old health problems - such
            as infectious and parasitic diseases - although their
            mortality rates are declining. That is, old and new health
            problems coexist while wide social disparities persist in
            these developing Latin American countries. The
            epidemiological diversity and the speed of change in disease
            profiles makes the health transition in many developing
            countries more complex than the situation developed
            countries faced. Most of these countries also have
            inadequate health infrastructure and are unlikely to be able
            to afford to develop them in the next decade or so. Most
            governments are also being pressed to adopt the therapeutic
            medical model to deal with noncommunicable conditions. The
            authors arrive at the following seven conclusions about the
            implications of the epidemiological transition for health
            policy in developing Latin American countries. The
            transition offers an empirical framework for strategic
            planning for the health system, allowing policymakers to
            anticipate future trends and causes of mortality and
            anticipate disease scenarios. Since more disease is expected
            among the adult and elderly populations, the health
            system's mission should be revised with more emphasis
            on disease prevention and control and less on satisfying
            demand. Existing inequities in the geographical distribution
            of health resources and in the quality of care between
            health institutions should be corrected to avoid greater
            epidemiological polarization. The health care model should
            be reformed to strengthen the technical capacity to provide
            preventive and curative services at the first level of care
            to control the dual burden of disease. Efficiency and
            quality of care need to be substantially improved to
            accommodate the greater demand for clinical services,
            especially those provided at hospitals. Criteria for setting
            priorities in the health sector must be defined, so
            resources can be allocated among competing health needs and
            socioeconomic groups. These countries need to strengthen
            their ability to analyze the health status of populations,
            to evaluate the health system's performance, and to
            design cost-effective interventions to deal with
            noncommunicable diseases.