When the current federal public administration arrived, and even since the campaign and the transition teams created in 2018, the approach to health from the perspective of Primary Health Care, or PHC, was discussed. A concept of care based on a comprehensive approach to health care from prevention, diagnosis and early care, and the integration of the person, their family and social circle, as well as the health professionals available in their sociodemographic environment.
The concept is not new, although it has existed in the vocabulary of the Pan American Health Organization since the late 1970s, in Mexico we have the first records of these concepts in 1998, in the document entitled: “The new public health: A vision from Mexico”, which addressed the importance of social, economic and political factors in the health of the population. This report stated that social factors, such as poverty, social exclusion, lack of education and discrimination are determinant factors of the health status of the Mexican population.In addition, he argued that efforts to improve health should go beyond medical care services and consider many other aspects, which I will detail later.
Subsequently, in 2006, the Federal Ministry of Health published the book “Social determinants of health in Mexico”, which delved into the factors that influence the health of the population and presented strategies to address them. Since then, the notion of the social determinants of health has become a key issue in public health policy in Mexico and efforts have been made to address these factors in the planning and development of health policies.
The SABI model of the Federal Government in Mexico; The model that was intended to be the backbone of the Institute of Health for Well-being (INSABI), now under the OPD IMSS-Bienestar, aims to address the complexity of health and well-being problems in the country, integrating an intersectoral perspective and of human rights. The SABI model focuses on disease prevention and health promotion, and recognizes the importance of the social determinants of health in the construction of public policies and action programs. In this sense, the SABI model integrates the concept of social determinants of health as one of its main pillars. It is recognized that health is not only determined by medical care, but is influenced by a number of factors that go beyond health services, such as access to education, housing, employment, food security, gender equality, among others.
What is fair will be to recognize that this health model is ambitious and although on paper it may be seen as a very laudable and theoretically viable effort, it is necessary to understand that the objective of this Comprehensive Primary Health Care (APS-I) approach is focused on health promotion and prevention through health education and the development of disease prevention strategies; To this must be added the consideration of the time necessary for these strategies to permeate the social conscience of the country, which can take from two to three generations; In addition, this type of strategy must consider that preventive medicine does not replace the need for a sustainable model of curative medicine by its mere implementation, at least not significantly during the first two generations.
In the understanding of whoever writes this, INSABI, with its SABI model; or now, the MAS-Well-being model that will support the recently created OPD IMSS-Bienestar are medium-long-term models that should not replace, or neglect, curative health care strategies. INSABI should have been a model that turned the so-called Seguro Popular into an entity with a greater scope in the following 12 to 18 years after its creation. The “Seguro Popular” itself, more than 12 years after it was created, was still in the process of development and, although it required an intervention (not a minor one), it still had a lot to be exploited and improved.
Today I close with a phrase that I heard from my elders, even though there are those who attribute it to Benito Juárez: “Slowly, I’m in a hurry.”
*Oscar Flores has 25 years of experience in the health sector in Mexico and Latin America, he is currently the managing partner of a consultancy focused on the analysis of public policies, digital health and sustainability.
