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Mexico
1Lt S. Erin Elarton, USAF, MSC
HCA 5312 Issues in International Health
Agenda• Areas of responsibility• Peer nations • Topography • Climate• Water and natural resources• Natural disasters• Comparisons• Index of economic freedom• Wellbeing index• Transparency corruption index• Human development index• National demographics• Population pyramid • Aging• Muslim population • Poverty• Immigrants and refugees• Vaccinations
• Health status • Morbidity & mortality statistics • HIV/AIDS • Tuberculosis• National health services • Structure of health care system • Healthcare providers • Costs/financing of health care • Pharmaceutical expenditures• Health care reform• External debt • Politics and elections • Telecommunications • Utilization of technology promoting
health care • Size of military/armed forces • Military health services system• Implications for military planners
History• Ancient Civilizations• 1521 Spain conquered Mexico
– Brought diseases, caused pandemic
• 1821 Proclaimed Independence from Spain• 1836 Texas Declared its Independence • 1846-1848 Mexican-American War• 1910 Mexican Revolution• 1929 Mexican National Party (PNM) was created• 2000 President Fox elected (PAN)
http://en.wikipedia.org/wiki/Mexico
Geography & Environment• Terrain
– High, rugged mountains; low coastal plains; high plateaus; desert
• Land use– arable land: 12%
permanent crops: 1% permanent pastures: 39% forests and woodlands: 26%
• Climate– Varies from tropical to desert
• Natural resources– petroleum, silver, copper, gold, lead, zinc, natural gas, timber
• Environmental issues– Severe Air Pollution– Raw sewage polluting rivers– Deforestation– Widespread erosion
http://en.wikipedia.org/wiki/Geography_of_Mexico
http://www.countrywatch.com
Water Resources
• Population using improved drinking water sources (1999) – Total 86%, Rural 63%
• Population using adequate sanitation– Total 73%, Rural 32%
• Prolonged regional drought along US border– 1944 Treaty to share Rio Grande waters– US-Mexico Water Treaty Dispute
http://www.texaswater.org/press/us_mexico_dispute.pdf
http://www.prb.org/datafind/prjprbdata/wcprbdata.asp?DW=DR&SL
Natural Disasters
http://www.cred.be/emdat/profiles/natural/mexico.htm#top%20ten
Disaster Date KilledEarthquake 19-Sep-85 8,776Flood 1959 2,000Volcano 1949 1,000Wind storm 27-Oct-59 960Flood Oct-99 636Wind storm 1-Oct-76 600Wind storm 28-Sep-55 500Earthquake 28-Aug-73 500Wind storm 12-Nov-61 436
Extreme temp 30-Apr-90 380
Disaster Date AffectedWind storm 8-Oct-97 800,200Flood Oct-99 616,060Wind storm 23-Sep-02 300,000Wind storm 15-Jul-76 300,000Wind storm 1-Oct-76 276,400Wind storm Aug-67 271,000Wind storm Dec-83 257,500Flood 21-Sep-93 231,290Flood Aug-73 150,000
Earthquake 19-Sep-85 130,204
Comparisons
• Human Development Index #55• Well-being Index #150• Transparency International Corruptions
Perceptions Index #64• World Health Systems Rankings
– Overall health system attainment #51
– Overall health level #61
• Migration #132 in world -2.84– 8% of U.S. population is from Mexican origin
http://www.undp.org/hdr2003/pdf/presskit/HDR03_PKE_HDI.pdf
http://www.transparency.org/pressreleases_archive/2003/dnld/cpi2003.pressrelease.en.doc
http://www.iucn.org/info_and_news/press/wonrank.doc
http://www.who.int/whr2001/2001/archives/2000/en/statistics.htm
http://www.photius.com/wfb1999/rankings/migration_rate_0.html
http://www.metropolis2003.at/en/WS9.1Sanchez.pdf
U.S. Department of State Consular Information
• Crime
• Drug penalties and prescription medications
• Prison conditions
• Kidnapping
• Public Transportation
• Insufficient safety standards
http://www.travel.state.gov/mexico.html
Pan American Health Organization
• Vector-borne diseases
• Vaccine-preventable diseases
• Intestinal infectious diseases
• Communicable chronic diseases
• Acute respiratory diseases
• Human Rabies
• STDs
• AIDS
http://www.ops-oms.org/English/DD/AIS/cp_484.htm
Politics
• Representative and democratic republic• 31 states and Federal District (Mexico City)• 2,444 municipalities• 2000 elections – new political party• Bicameral National Congress (Congreso de la
Union)– Senate and Chamber of Deputies
– Women as percent of parliament 16% (US 14%)
http://www.prb.org/datafind/prjprbdata/wcprbdata.asp?DW=DR&SL
http://en.wikipedia.org/wiki/Mexico#Politics
The Pew Research Center• Mexico’s view of U.S. slips
– From 1999 to 2002, slipped from 68% to 64%
• Personal concerns – Economic problems as top personal concern (65%)– Crime (17%)– Personal satisfaction rated similar to Western Europe
• Satisfaction with State of the Country– 79% dissatisfied
• Top 4 national problems– Crime, AIDS & disease, corrupt political leaders, terrorism
http://people-press.org/reports/pdf/165.pdf
Economy
• World’s ninth largest economy
• Index of Economic Freedom (2003) – Ranked #63
• Labor Force– 39.8M (2000)
• Exports $1.58B (2002)– US 82.7%, Canada 5.4%, Japan 1.1% (2002)– Commodities: manufactured goods, oil and oil
products, silver, fruits, vegetables, coffee, cotton
http://cf.heritage.org/index2004test/country2.cfm?id=Mexico
http://www.odci.gov/cia/publications/factbook/geos/mx.html
National Demographics Mexico United States
Population Total 104,907,991 285,318,000 Population Growth Rate (annual %) 1.43% 1.1%
0 – 14 Years (% of total) 32.3% 20.9 15 – 64 Years (% of total) 63.1% 66.7
65+ Years (% of total) 4.6% 12.4 Total Fertility Rate 2.53 2.07
Adolescent Fertility Rate (births per 1,000 women age 15-19)
64
48
Female Life Expectancy at Birth 75.49 80.05 Male Life Expectancy at Birth 69.26 74.37
http://devdata.worldbank.org/hnpstats/HnpAtaGlance.asp?sCtry=MEX,Mexico
Ethnicity: Mestizo 60.0%
Indigenous 30.0%
European descent 9.0%
Other 1.0%
Religions: Roman Catholic 89.0%
Protestant 6.0%
Other 5.0%
Muslim 0.26%
http://www.odci.gov/cia/publications/factbook/geos/mx.html http://www.islamicpopulation.com/america_general.html
Population Pyramid
http://www.census.gov/cgi-bin/ipc/idbpyrs.pl?cty=MX&out=s&ymax=250
Common Diseases According to AFMIC & CDC
• Diseases carried by insects – Dengue
– Filariasis
– Leishmaniasis – cutaneous
– Malaria
– Onchocerciasis
– American trypanosomiasis (Chagas disease)
– West Nile Virus
• Foodborne & waterborne diseases– Bacterial diarrhea
– Hepatitis A
– Typhoid / paratyphoid fever
• Water-contact diseases– Leptospirosis
• Direct or indirect personal contact– Hemorrhagic Conjunctivitis
http://www.cdc.gov/travel/camerica.htm
https://mic.afmic.detrick.army.mil/osis/search/sitesearch/filetest.php?query=mexico
Socioeconomic IndicatorsSOCIOECONOMIC
INDICATORSYEAR MEXICO YEAR U.S
GNI PPP Per Capita 2001 $8,240 2001 $34,280 Adult Female Literacy Rate
(% age 15+)2003 90.50% 1979 97%
Adult Male Literacy Rate (% age 15+)
2003 94% 1979 97%
GDP 2002 $924B 2002 $10.5TGDP real growth rate 2002 0.70% 2002 2.40%
GDP per capita 2002 $8,920 2002 $36,300 External Debt 2001 $191B 2001 $862B
Inflation 2002 6.40% 2002 1.60%Population below poverty
line2001 40% 2001 12.70%
Unemployment Rate 2001 3% urban 2002 6%
http://www.nationmaster.com/country/mx
http://www.cia.gov/cia/publications/factbook/geos/mx.html
http://www.prb.org/datafind/prjprbdata/wcprbdata.asp?DW=DR&SL
Morbidity & MortalityHEALTH STATUS
INDICATORSYEAR MEXICO YEAR U.S.
Mortality Rate – under 5 per 1,000 live births
2001 29 2001 8
Adult Male Mortality Rate
2000 180 2000 141
Adult Female Mortality Rate
2000 101 2000 83
Maternal Deaths per 100,000 live births
2002 65 2002 12
Low-birth weight Babies 1995 9.2 2001 7
TB incidence 2000 38.1 2001 5.4
People Living with HIV/AIDS
2001 150,000 2001 900,000
Infant Mortality Rate (deaths per 1,000 live
births)
Malnutrition prevalence (% children under 5)
2003 6.9
2001 7.5 1995 1.4
2003 25
http://devdata.worldbank.org/hnpstats/HnpAtaGlance.asp?sCtry=MEX,Mexico
http://www.prb.org/datafind/prjprbdata/wcprbdata.asp?DW=DR&SL http://www.cia.gov/cia/publications/factbook/geos/mx.html
Vaccinations
http://www.who.int/vaccines/globalsummary/immunization/CountryProfileResult.cfm
2002 Immunization Profilles
Mexico U.S.
DTP1 92 97
HepB3 91 88
Hib3 91 93MCV 96 91Pol3 92 90
BCG
DTP3 91 94
99 -
Mexico’s Health System
• Public Health Care– Secretariat of Health and Assistance– Institute of Social Security and Government
Workers– Mexican Social Security Institute
• Less than 10% of the Mexican population has private coverage
http://open.imshealth.com/webshop2/IMSinclude/i_article_20040105.asp
https://mic.afmic.detrick.army.mil/osis/search/sitesearch/filetest.php?query=mexico
Healthcare Costs & Finance
http://devdata.worldbank.org/hnpstats/HnpAtaGlance.asp?sCtry=MEX,Mexico
HEALTH CARE FINANCE
YEAR MEXICO YEAR U.S.
Total Health Expenditures (% of GDP)
2001 5 2001 13.9
Public health expenditures as % of total expenditures
2001 44.3 2001 44.4
Private health expenditures as % of total expenditures
2001 55.7 2001 55.6
Social Security Expenditures as % of health expenditures
2001 66.5 2001 32.9
Physicians per 1,000 people
2000 1.8 2000 2.8
Hospital Beds per 1,000 population
200 1.1 2000 4
2000 $4,499 Health Care Expenditures per capita ($US)
2000 $311
http://www.who.int/country/mex/en/
Health Care Aid
• OECD – Aid from U.S.– 1990-92 US$60M– 1993-95 US$103.3M– 1996-98 US$241.7M
• Inter-American Development Bank– Summary of IDB Financing ($US)
• 2002 Lending $1B• 1961-2002 Lending $16B• 2002 Disbursements $993B• 1961-2002 Disbursements $13.2B
http://www.oecd.org/dataoecd/22/31/25503059.pdf
http://www.iadb.org/exr/country/eng/mexico/index.cfm
Telecommunications
• Telephones: main lines in use: 12.32M (2000)
• Mobile cellular: 2.3M (1998)
• Radio broadcast stations: 1465 (2000)
• Television broadcast stations: 236 (1997)
• Internet Service Providers (ISPs): 51 (2000)
• Internet users: 3.5M (2002)
http://www.odci.gov/cia/publications/factbook/geos/mx.html
Military ForcesArmed Forces
Personnel Strength
World
Ranking
Army 130,000 #18
Air Force 8,000 #33
Navy 37,000 #15
http://www.nationmaster.com/country/mx/Military
Military Spending Mexico United States Military Expenditures per % GDP
(FY99, Mexico & US) 1% 3.2%
Military Expenditures Dollar Figure (FY99, Mexico & US)
$4B $276.7 B
Military Health Care
• Secretariats of National Defense and Navy operate separate health care services– Mexico City
• The Central Military Hospital• Naval Medical Center
– Physicians are well trained and well regarded by civilian authorities
– Training of nursing and paramedical personnel is substandard compared to the U.S.
• Blood supply is safe
https://mic.afmic.detrick.army.mil/osis/search/sitesearch/filetest.php?query=mexico
Implications for Military Planners
• Viral or bacterial diarrhea could occur among personnel consuming local food, water, or ice
• Water Resources
• Disease Prevalence
• Field conditions (including lack of hand washing and primitive sanitation) may facilitate person-to-person spread of epidemics