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OECD Reviews of Public Health: CHILE A healthier tomorrow Francesca Colombo, Santiago 25 October 2017
OECD Reviews of Public Health: CHILE A healthier tomorrow
Francesca Colombo, Santiago 25 October 2017
Chile: successes but significant public health challenges…
Significant improvements in Chileans’ health
Life expectancy at birth, 1970 and 2015 (or nearest year)
Source: OECD Health Statistics 2017.
83.9
83.0
83.0
82.6
82.5
82.5
82.4
82.4
82.4
82.3
82.1
82.1
81.7
81.6
81.6
81.7
81.5
81.3
81.2
81.1
81.1
81.0
80.9
80.8
80.7
80.6
79.6
79.1
78.8
78.7
78.0
77.7
77.6
76.7
75.7
75.0
74.7
74.6
74.2
40
50
60
70
80
90Years 1970 2015
Disease burden in line with OECD
Death per 100 000 population
Source: OECD Health Statistics 2017.
0
200
400
600
800
1000
1200
1400Circulatory system Cancer Respiratory system Dementia External causes Other
9 8
92
7 9
19
7 4
63
6 6
47
5 5
51
5 5
28
5 4
88
5 3
85
5 2
27
5 2
05
4 8
40
4 7
53
4 7
08
4 6
00
4 5
19
4 3
76
4 1
92
4 0
33
4 0
03
3 5
90
3 3
91
3 2
48
2 8
35
2 8
22
2 7
34
2 7
29
2 5
44
2 2
23
2 1
50
2 1
01
1 9
89
1 9
77
1 7
98
1 4
66
1 3
90
1 0
88
1 0
80
995
964
0
2 000
4 000
6 000
8 000
10 000Government/Compulsory Voluntary/Out-of-pocket
USD PPP
Low health expenditure per capita compared to OECD average
Health expenditure per capita, 2016 (or nearest year)
Source: OECD Health Statistics 2017, WHO Global Health Expenditure Database.
But significant public health challenges
Smoking rates are 60% higher than the OECD average: 33.7% of Chilean men and 26% of women smoke¹
Alcohol consumption is low but rising, running contrary to the general OECD trend
Cancer incidence is a third lower than the OECD average but mortality only 5% lower
25% of adults are obese, and 39% of children are obese or overweight (50%: primary school children)
¹Chilean data is from 2009 while OECD data is from 2015. Recent Chilean data suggest similar rates of smoking.
2.0
4.0
6.0
2.3
4.6
2.2
1.3
2.3
3.2
-0.5 -0.2 -0.1
-2
-1
0
1
2
3
4
5
6
7
Inpatient care Outpatient care Long-term care Pharmaceuticals Prevention Administration
2003-2009 2009-2015Annual growth rate in real terms (%)
Spending on prevention is low (and first thing to be cut) across OECD Growth rates of health expenditure per capita for selected services, OECD average, 2003-15
Source: OECD Health Statistics 2017, WHO Global Health Expenditure Database.
The Public Health System can
be further strengthened
4 main areas of action
Strengthen Chile’s Public
Health System
Tackle obesity, unhealthy diets and
physical activity
Better cancer screening and
prevention
Leverage genetic medicine for better
public health
Maintain the robust public health system
and leadership
1. Strengthen Chile’s public health system
Renew the good co-ordination between Ministries and levels of government
Address tobacco consumption more
robustly
Involve civil society, NG actors, and strengthen surveillance
• Plain packages for tobacco products
• A ban on menthol cigarettes
• More smoke-free public spaces
Introduce plain packaging and ??
Reduce tobacco consumption
Strengthen epidemiological surveillance
The US’ annual National Health and Nutrition Examination Survey (NHABES) records the health and nutritional status of adults and children
Mexico’s health survey (ENSANUT) takes place every 4 years and includes measures of height and weight
Each year the Health Survey for England (HSE) asks about 8 000 adults and 2 000 children about their health status
The annual Korea National health and Nutrition Examination Survey (KNHANES) asks a representative sample questions about behaviour and health
2. Addressing obesity and
overweight must be a priority
Obesity & overweight among highest in the OECD
0
10
20
30
40
50
60
70
80
% o
ve
rwe
igh
t a
nd
ob
es
ity
Overweight Obesity
Measured overweight and obesity in persons aged 15 and over, 2015 (or latest year)
Note: Data refer to the following years: 2008 (France and the Slovak Republic); 2009 (Chile); 2010 (the Czech Republic); 2011 (Finland and Turkey); 2012 (Germany); 2013 (Canada); 2014 (Australia, Belgium, Estonia, Hungary, Luxembourg and the United States); 2015 (Ireland, Japan, Korea and the United Kingdom); 2016 (Latvia, Mexico and New Zealand). Source: OECD Health Statistics 2017.
Measured overweight (including obesity) in children, 2010 (or latest year)
Note: The numbers in parentheses refer to the age of the children surveyed in each country. Source: Health at a Glance 2017 (forthcoming).
0
10
20
30
40
50
60
% o
ve
rwe
igh
t (i
nc
lud
ing
ob
es
ity)
Boys Girls Total
Especially in children
A comprehensive set of policies is needed to address obesity
0 20000 40000 60000 80000
Estimated population-level impact (Life Years) of different interventions (average effects per year)
Multiple-intervention strategy*
School-based interventions
Food advertising self-regulation
Food labelling
Worksite interventions
Physician-dietician counselling
England
0 50000 100000150000200000
Japan
0 50000 100000
Italy
* Five interventions: compulsory food labelling, self-regulation of food advertising, worksite and school-based programmes, and intensive counselling Source: OECD, Obesity and the Economics of Prevention: Fit not Fat; 2010
Good national laws on marketing,
labelling and sugar taxes
Tackle obesity and unhealthy diets
Comprehensive set of policies to tackle unhealthy behaviors associated to obesity
More Chileans could benefit from healthy
food programmes
Private insurers are disengaged from efforts to reduce obesity
Strengthen the current set of prevention policies
HIGHER sugar-sweetened beverage tax
EXPANDED food labelling system
MORE healthy meals
The City of New York has implemented mandatory menu labelling in chain restaurants, and on prepared foods sold in convenience and grocery stores
Hungary has introduced a Public Health Product Tax, which applies to a range of food products and drinks
The School Fruit and Vegetables Scheme of the European Union provides free fruit to 11.7 million children in 79 903 schools
The Vitality programme in South Africa is run by a private insurer and encourages healthy behaviours through financial incentives and rewards
Learn from other OECD countries
3. More can be done
to prevent and detect cancer
Cervical cancer screening has
contributed to falling mortality rates
3. Improve cancer screening and prevention
Breast cancer screening has increased early-stage diagnosis
Coverage outside urban areas and for
more disadvantaged groups is lower
Coverage of breast and colon
screening is weak
Chile OECD Average
35% of women screened in 2014
Mammography screening in women aged 50-69 within
the past 2 years
60.8% of women screened in 2015
75.5% 5-year survival for the period 2010-2014
Breast cancer five-year net survival
85% 5-year survival for the period 2010-2014
18.6 deaths per 100 000 population in 2014
Breast cancer mortality in women
24.9 deaths per 100 000 population in 2015
51.5% 5-year survival for the period 2010-2014
Colon cancer five-year net survival
62.8% 5-year survival for the period 2010-2014
34.0% 5-year survival for the period 2010-2014
Rectal cancer five-year net survival
61.1% 5-year survival for the period 2010-2014
19.2 deaths per 100 000 population in 2014
Colorectal cancer mortality 23.9 deaths per 100 000
population in 2015
3. Improve cancer screening and prevention
Improve uptake of cancer screening:
Target cancer screening
• Inform the population about the benefits of cancer screening
• Use data registries to target cancer screening invitations
• Send personalised and informative invitations letters to screening with a fixed screening date
• Improve access to screening through new technologies
4. Leverage the potential of
genetic medicine
Serious thought already given to the future of genetics and genomics in Chile
4. Chile understands the potential of genetic medicine
Chile has a goal of becoming a regional genetics leader
Chile has a (small) specialist genetics workforce who also give clinical genetics consultations to other medical specialists
Next steps for genetic medicine in Chile
Build a genetics-savvy health workforce: • a bigger specialist workforce • improve genetics literacy and
training amongst health professionals
Protect personal data: • Genetic data needs to be shared to
advance research, but individual privacy must be protected
KEY PRIORITIES FOR CHILE
The devil is in the detail: policies must be well-targeted; well-implemented; well-evaluated.
Expand coverage of policies: reach more Chileans, strengthen impact
Engage stakeholders : bigger role for civil society; demand more from ISAPRES; dialogue with industry players
Find out more!
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