Category: Health Policy

Tasa de Mortalidad

La diabetes mellitus es una enfermedad que cobró la vida de 1,777,544 mexicanos entre los años 1999 y 2020. Se trata de un número de defunciones superior al total de la población que actualmente reside en el estado de Zacatecas.  El Asesino Silencioso, como comúnmente se conoce a la enfermedad, ha más que triplicado su  número anual de víctimas mortales en las últimas dos décadas.  La pandemia diabética ha llegado al punto que en 2020 dicho padecimiento fue la causa de muerte de más de 150,000 mexicanos.

Una medida de la gravedad de la crisis de salud pública que enfrenta México con respecto a la diabetes es el hecho de que la tasa de mortalidad de la enfermedad en el país se encuentra en un nivel que supera la tasa de mortalidad combinada por sobredosis de drogas, suicidios, homicidios, accidentes de transporte y diabetes como causas de muerte en los Estados Unidos.

Además de ser una de las principales causas de muerte, la diabetes ha llevado a un número aún mayor de mexicanos a sufrir discapacidades permanentes al provocar ceguera, insuficiencia renal y daño al sistema nervioso y circulatorio que requiere amputaciones.

Es un hecho establecido y bien conocido que las bebidas con azúcares añadidos (SSBs, por sus siglas en inglés) representan una fuente importante de azúcares de rápida digestión que conducen al padecimiento de diabetes tipo 2 y enfermedades cardiovasculares.

México, con una población que bebe anualmente 176 litros per cápita de productos Coca-Cola (frente a 95 en los Estados Unidos y 22 a nivel mundial), es líder mundial en el consumo de bebidas azucaradas en la forma de refrescos carbonatados.

Se ha calculado que la mortalidad atribuible a las SSBs en el país es del orden de 40,842 muertes anuales, principalmente porque son la fuente del 70% del azúcar agregado en la dieta de los mexicanos.

Debido a que las bebidas azucaradas juegan un papel causal muy importante en el acelerado apocalipsis diabético que está destruyendo a enormes cantidades de familias mexicanas, es hora de que el gobierno tome medidas mucho más enérgicas para hacer que la industria rinda cuentas por sus externalidades negativas.

Los azúcares en las bebidas de Coca-Cola, al igual que la nicotina en los cigarrillos Marlboro y la oxicodona en las pastillas Oxycontin, son sustancias altamente adictivas que se ofrecen a millones de consumidores con la ayuda de gigantescos presupuestos de marketing y esfuerzos de cabildeo inimaginables diseñados para evitar la regulación gubernamental.

Acciones como aquellas recomendadas por la OMS (Organización Mundial de la Salud), OCDE (organización para la Cooperación y Desarrollo Económico) y la AMA (American Medical Association) —incremento en precios de al menos 20% en las bebidas con azucares añadidos por la vía a impuestos especiales, restricciones a la publicidad y eliminación de opciones de compra— están justificadas y son necesarias para frenar el consumo de SSBs en México dada la carga tan pesada que imponen al desarrollo del país y la amenaza que representan para la estabilidad de su sistema de salud pública.

Fatality Rate

Diabetes mellitus is a disease that claimed the lives of 1,777,544 Mexicans between the years of 1999 and 2020. This is a number of deaths greater than the total population currently residing in the state of Zacatecas. The Silent Killer, as the disease is commonly referred to, has more than tripled its annual gruesome toll over the past two decades. It has come to the point that in 2020, diabetes was the cause of death of more than 150,000 Mexican nationals.

A measure of how severe of a public health crisis Mexico comparatively faces with regards to diabetes is the fact that the diseases’ fatality rate in the country is at a level that exceeds the combined fatality rate of drug overdose, intentional self-harm, homicide, transport accident AND diabetes as causes of death in the United States.

In addition to being a leading cause of death, diabetes has resulted in the permanent disability of even more Mexicans due to blindness, nerve damage that requires amputations and kidney failure.

It is an established and well-known fact that sugar-sweetened beverages (SSBs) represent a major source of rapidly digestible and high-volume sugars leading to type-2 diabetes and cardiovascular disease.

Mexico is the worldwide leader in SSB consumption in the form of carbonated soft drinks, with its population annually guzzling 176 liters/capita of Coca-Cola products (vs. 95 in the US and 22 globally).

In Mexico, mortality attributable to SSBs has been calculated to be in the order of 40,842 yearly deaths, mainly because they are the source of 70% of added sugar in the country’s diet.

With SSBs playing a most important causal role in the accelerating diabetes apocalypse destroying Mexican families, it is high-time that government take further action to make industry accountable for its negative externalities.

Sugar in Coca-Cola beverages, similarly to nicotine in Marlboro cigarettes and oxycodone in Oxycontin pills, is a highly addictive substance pushed to millions of consumers with the help of gigantic marketing budgets and untold lobbying efforts designed to avoid government regulation.

Actions such as those advocated by the OECD and AMA—increased excise taxes, restrictions on advertising, and the removal of options to purchase—are warranted and necessary in order to curb SSB consumption in Mexico given the very heavy burden it imposes on the country’s development and the threat it represents to the stability of its public health care system.

Mortality in Mexico by Age, Gender and Health Condition

As Mexico enters the darkest days of the COVID-19 pandemic, it is only appropriate that a debate take place regarding the public health preconditions that have fueled a crisis bringing death and suffering to the country’s population.

Mexico’s federal authorities publish daily detailed data on the health conditions of persons tested for COVID-19. As of last week, the dataset included records for over 4.3 million individuals. Out of this population sample, 35% were reported as having much higher mortality rates in connection with at least one of the following morbitidies: hypertension, obesity, diabetes, smoking, asthma, cardiovascular disease, kidney failure and immunosuppression.

With obesity diminishing life expectancy in the country by an average of 4.2 years and reducing economic output to the tune of 5.3% per year, it is imperative that Mexico take urgent measures—as recommended by the OECD—to improve the diet of a population sickened by ultra-processed and unhealthy products.

In this most important battle for public health, Mexico—where the population gulps Coca-Cola products at a world-record rate of 225 liters/capita/year—must confront the extremely powerful interests of the sugary beverage industry. As a measure of the industry’s economic power, consider that the market capitalization of two of the world’s largest Coca-Cola’s bottlers—Mexican-controlled Coca-Cola FEMSA and Arca Continental— is equivalent to 1.59% of Mexico’s GDP whereas The Coca-Cola Company’s own market capitalization stands at only 1.00% of US GDP.

A variety of efforts have been made on behalf of the ultra-processed and soda industry’s interests. These include non-stop lobbying of the executive and legislative branches, massive advertising campaigns and even the deployment of the Mexican government’s surveillance capabilities against public health researchers and activists working in support of a tax on sugary beverages.

In spite of the industry’s efforts to counter measures to improve public health via a better diet, there are reasons for hope. One such reason is Mexico’s recent implementation of one of the world’s most advanced front-of-the-package labeling laws.

Mortality by Health Condition Among Population Tested for COVID-19 in Mexico

As Dr. Guillermo Torre Amione—the cardiologist who heads TecSalud—has pointed out, Mexico’s government has published detailed data on over one million individuals tested for COVID-19.

The dataset, which includes each individual’s age and sex along with geographic and morbidity information is of interest since it provides input for an analysis of public health in Mexico.

The most striking statistics among the tested population are:

• the high prevalence of preexisting morbidity (40% are reported as having hypertension, obesity, diabetes, smoking, asthma, cardiovascular disease, kidney failure and/or immunosuppression) and
• the significantly higher death rate among those with preexisting morbidities than those free of them (11.0% vs 3.0%)

The toll exacted by multimorbidity associated with malnutrition in Mexico was too high to ignore even before the COVID-19 pandemic. The OECD, for example, has estimated that obesity diminishes average life expectancy in the country by 4.2 years and reduces Mexico’s GDP by 5.3%.

2020 has brought most Mexicans to the realization that, after decades of neglect and mismangement, urgent and significant changes are needed in the public health policy, regulatory and enforcement arenas.

Morbidity and Mortality Among Population Tested for COVID-19 in Nuevo León

The state of Nuevo León in Northeastern Mexico has a population currently estimated to be 5.6 million. The metropolitan area of Monterrey, where the state capital is located, houses 4.7 million residents and is the country’s third largest city.

Dr. Simón Barquera and other health and nutrition researchers in Mexico have long warned that public health in the country was deteriorating rapidly and would some day become a national security threat. No other place in the Mexico illustrates public health failure best than Monterrey, which is where Manuel Uribe—the world’s heaviest person (560 kg)—made his home until his death in 2014 at age 48.

With a population rid with comorbidities it is no surprise that COVID-19 is taking a heavy death toll in Mexico. The numbers published by federal health authorities for Nuevo León are dramatic. 36% of those tested for COVID-19 have at least one preexisting condition (hypertension, obesity, diabetes, smoking, asthma, cardiovascular disease, kidney failure and/or immunosuppression) and their death rate is 5 times that of individuals without comorbidities (7.1% vs 1.4%).

It is therefore very concerning that the Rio Grande Valley in Texas, just 137 miles away from Monterrey, has become the hottest of all COVID-19 hot spots in North America.

This week 2,750 tons of ammonium nitrate blew up the port of Beirut killing at least 157 in city which houses 2.2 million residents. The agricultural fertilizer had been unsafely stored in a warehouse at the port since 2013 when a ship in transit to Mozambique was abandoned and its cargo seized by Lebanese authorities. The unheeded public safety risk posed by having tons of fertilizer in close proximity to a warehouse storing fireworks has belatedly led to the arrest of 16 port officials.

Will the public health risk posed by rampant comorbidities in Monterrey, Nuevo León and Mexico together with a COVID-19 disaster in South Texas lead to a humanitarian catastrophe south of the border?

Will those responsible for decades of bad health policy in Mexico and terrible social outcomes (i.e.: blindness, kidney failures, heart attacks, strokes and lower limb amputations caused by diabetes) ever be called to account?