Consultative Meeting on Social Insurance and Health Promotion

1. Consultative Meeting on Social Insurance and Health Promotion Health Promotion in the Mexican Social Security Institute Dr. Victor H. Borja Helsinki, May 27-28

2. Background • IMSS is a decentralized public agency created in 1943 • Financed by employers, employees and the government • Covers 50% of Mexico’s population (50 million) • Scheme covers insured workers employed in the private formal sector and dependents • Social Security benefits: • Occupational accidents and diseases • Sickness and maternity insurance • Disability and death • Retirement, unemployment at in advanced age, and old age • Child-day care centers and social benefits

3. IMSS was created as an institution for people's welfare, since its foundation in 1943 it was involved in public health and preventive activities, seeing initially as social benefits and not as part of health care activities (sports was an important component) Health services: Occupational safety and health focus on vaccines application, family planning and safe pregnancy. Secondary prevention (detection of chronic diseases) More recently PREVENIMSS changed the approach of preventing specific risks and diseases to an integrated approach to protect the heath of demographic groups

4. Occupational accidents in Mexico/ 100 workers

5. CURRENT SCOPE SISTEMATIC OFFER OF HEALTH PROMOTION AND HEALTH PROTECTION SERVICES, GROUPED BY AGE AND GENDER: • - Children (under 10 years old) • - Adolescents ( 10 to 19 years old) • - Women ( 20 to 59 years old) • - Men ( 20 to 59 years old) • - Elderly ( > 60 years old)

6. 1981 2003 > 60 yrs 6.6 13.0 22.9 Women % P O P % P O P 28.5 22.2 Men 24.8 21.4 Adolescents 13.9 Children 26.9 19.7 81 83 85 87 89 91 93 95 97 99 00 02 03 Year PREVENIMSS PROGRAMATIC GROUPS DEMOGRAPHIC TRANSITION

7. OBJECTIVES To increase the coverage of health programs To provide to each insurer a group of interventions on disease prevention and health promotion according to age and gender To stimulate insurers to participate in their health improvement To easy the provision of services in family care units To easy the multiple preventive tasks of the health teams

8. Intervention settings • Family health units • Schools • Industry

9. WOMEN’S HEALTH HEALTH PROMOTION DISEASE DETECTION Cervical cancer Breast cancer Diabetes Hypertension Health education Formation of groups • Overweight and obesity • Diabetes – Hypertension • Family violence • Drug abuse NUTRITION REPRODUCTIVE HEALTH Surveillance of weight, height and abdominal circumference Family planning Safe pregnancy Menopause DISEASE PREVENTION HIV/ AIDS STDS Tuberculosis Principal components *

10. I. INFORMATION TO THE POPULATION Institutional health cards Guidelines for health care Mass media program

16. Practical and technical guidelines Instruction of Family care units personnel Start with IMSS personnel II. EDUCATION OF HEALTH CARE PROVIDERS

17. Major partners • Ministry of Health • Ministry of Education • Ministry of Labor

18. III. INFORMATION SYSTEM UPDATE TO EVALUATE IMPACTS Information system for the integrated health care (SIAIS) * Automated nominal system Preventive and medical interventions Systematic analysis of information Surveys

19. INCORPORATED INSURERS * PROGRAM NUMBER COVERAGE (%) CHILDREN ADOLESCENTS WOMEN MEN ELDERLY T O T A L 3 523 275 2 370 618 5 043 147 3 737 219 2 559 469 17 233 728 53.2 50.9 54.6 45.6 62.0 52.5 ** * Informed provision of Cartilla de Salud and guidelines for health care. ** August 2002 – December 2003.

21. Non insured IMSS insured * Per 100,000 women 20-a 59 yeasr old Cervical cancer mortality Insured and noninsured population 1991 - 2003

22. FUTURE PLANS To incorporate preventive services in new facilities to match curative services Evaluate interventions Specific plan for obesity, hypertension and diabetes