Changing paradigms and challenges: evidence on the epidemiological and economic burden of diabetes in Latin America

Arredondo, Armando

doi:10.1111/dme.13311

Cited by 8 publications

(6 citation statements)

References 6 publications

(7 reference statements)

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“… The challenges of the health system and model of care. In spite of several generations of health reforms implemented in the last 20 years, in Mexico as in the majority of MICs, we have a health system that originated in the 1940’s and that is still in place as of 2018 with the original organic and functional structure [ 45 , 46 ]. In addition to a policy of efficiency in the search and allocation of financial resources, it is also necessary to develop policies to strengthen financing of promotion, prevention and control of health damages, mainly for non-communicable diseases such as diabetes and hypertension.…”

Section: Discussionmentioning

confidence: 99%

Challenges and dilemmas on universal coverage for non-communicable diseases in middle-income countries: evidence and lessons from Mexico

2018

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BackgroundDespite more than 20 years of reform projects in health systems, the universal coverage strategy has not reached the expected results in most middle-income countries (MICs). Using evidence from the Mexican case on diabetes and hypertension as tracers of non-communicable diseases, the effective coverage rate barely surpasses half of the expected goals necessary to meet the challenges that these two diseases represent at the population level. Prevalence and incidence rates do not diminish either; they even grow. In terms of the economic burden, this means that lack of financial protection and catastrophic expense rates have increased, contrary to what could have been expected.DiscussionAs any complex system, health systems present challenges and dilemmas that are difficult to solve. In terms of universal coverage, when contrasting normative coverage versus effective coverage, the epidemiological, cultural, organizational and economic challenges and barriers become evident. Such challenges have not allowed a greater effectiveness of the contributions of state of the art medicine in the resolution of health problems, particularly in relation to diabetes and hypertension.ConclusionsDespite of the existence of many universal coverage projects, strategies and programs implemented in MICs, challenges remain and, far from disappearing, unresolved problems are still present, even with increasing trends. The model of care based on a curative biomedical approach was enough to respond to the health needs of the last century, but is no longer adapted to the needs of the present century. The dilemmas of continuity vs. rupture require to review and discuss the background and structure of health systems and their underlying models of care. These two elements have not allowed the different coverage schemes to guarantee greater effectiveness in the application of state of the art medicine, nor a greater health care financial protection for patients and their families. We thus can either accept the fragmented health systems and bio-medical-curative models of care approach or, instead, we can move towards integrated health systems that would be based on a socio-medical-preventive approach to health care.

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Section: Discussionmentioning

confidence: 99%

Challenges and dilemmas on universal coverage for non-communicable diseases in middle-income countries: evidence and lessons from Mexico

2018

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“…Latin America is undergoing an epidemiologic transition, going from a region with a high burden of infectious disease to one of increasing burden of chronic disease (Arredondo, 2016). Diabetes is one of the chronic conditions most affecting the region.…”

Section: Introductionmentioning

confidence: 99%

Types and sources of social support among adults living with type 2 diabetes in rural communities in the Dominican Republic

Wallace

Rodríguez

Walker

et al. 2018

Global Public Health

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Type 2 diabetes management hinges on various determinants, including the role of interpersonal relationships in self-management behaviours. The aim of this study was to explore the types and sources of social support received by adults in the diabetes diagnosis and self-management processes. We conducted qualitative interviews with 28 men and women at two rural clinics in the Dominican Republic and used a combination of narrative and thematic analytic techniques to identify key sources and types of social support in their diabetes experiences. Participants described three stages in their diabetes experience: diagnosis, programme-enrolment, and long-term management. During diabetes diagnosis, most participants described receiving no support. At the programme-enrolment stage, friends and neighbours frequently provided informational or instrumental support to get to the clinic. In long-term management, cohabiting partners provided the most support, which was often assistance with their diet. Our findings highlight he need to assess and leverage distinct types and sources of social support at different stages of the diabetes experience.

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“…El acceso limitado a cuidados de salud adecuados ocasiona que los costos indirectos (causados por las afectaciones productivas debidas a discapacidad y mortalidad prematura) excedan a los costos directos por cuidados de salud 76 . Se estima que el 55% de los costos de la DM en AL-C son atribuibles a mortalidad prematura y discapacidad temporal y permanente 77 .…”

Section: Algunos Resultados Del Global Burden Of Disease Study 2015 Para La Diabetes Mellitusunclassified

La carga de la diabetes en América Latina y el Caribe: análisis a partir de los resultados del Estudio Global de Carga de Enfermedad del año 2015

Alonso¹

2018

ALAD

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Changing paradigms and challenges: evidence on the epidemiological and economic burden of diabetes in Latin America

Cited by 8 publications

References 6 publications

Challenges and dilemmas on universal coverage for non-communicable diseases in middle-income countries: evidence and lessons from Mexico

Challenges and dilemmas on universal coverage for non-communicable diseases in middle-income countries: evidence and lessons from Mexico

Types and sources of social support among adults living with type 2 diabetes in rural communities in the Dominican Republic

La carga de la diabetes en América Latina y el Caribe: análisis a partir de los resultados del Estudio Global de Carga de Enfermedad del año 2015

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