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Unhealthy politics

3 March 2007

Comparing the low estimate of the number of HIV/AIDS infections in the United State given by the CDC (1,039,000 cases) against the Mexican estimate (40,000), and then multiplying the Mexican number by 4 because “some estimates” — with no documentation that I can find — estimate a number four times higher:  160,000.  The Mexican population is slightly less than a third of that in the U.S., so I multiplied 160,000 by three:  480,000.  That means for every one Mexican who MIGHT be HIV+, there are at least 2.16 people in the U.S. with the same disease. 

That shouldn’t make sense, given that the Mexicans are younger and poorer than the people in the U.S. And HIV is primarily a disease of the young and poor.  Or maybe it the low numbers do make sense.

The real “star” of the Fox administration was a guy almost no one’s heard about — Dr. Julio Frenk Mora — Fox’s Secretary of Health.  The author of the Wikipedia article on Frenk, besides listing his many accomplishments and publications in the field of public health, mostly writes Frenk’s push to get the “morning after pill” on the market, despite his PANista (conservative) credentials.  What impressed me about him was the way he stayed “above politics” and stuck to his guns when it came to public health. 

The Wikipedia article suggests that Frenk’s decision to allow tobacco companies to make a sizable donation to the Mexican health system rather than face a tax increase on cigarettes cost him the top job at the World Health Organization.  It probably played an important part, but Frenk had to withdraw from actively seeking the job when a Chiapas premature baby nusery was infected, and created a national scandal.  There was a “rush to judgement” (the hospital administrator was briefly jailed for murder) but Frenk survived the scandal.  This scandal arose just as the U.S. began attacking Bagdad, by the way.  My students were struck by the cost of replacing the maternity hospital (about a million U.S. dollars) versus the cost of one rocket launched against Bagdad (also about a million bucks). 

Good pre- and post-natal care has been a Mexican success story.  As has birth control and comprehensive sex education.  Arguing that prejudice leads to violence (and violence is a public health issue) and — more importantly for preventive medicine — that discrimination discourges people for using health facilities, or getting tested for things like HIV, Frenk also brought his considerable influence to bear on combatting homophobia. 

One hold-over from the days when the government indirectly controlled the media through their advertising budget was that Cabinet Secretaries have huge ad budgets.  Most put out lame commercials trying to convince you they’re relevent (it’s hard to make the Department of Public Accounting sexy, or sell the Treasury as friendly, but the ad agencies do their best).  Arguing that getting people tested for AIDS and preventing violence were both public health issues, Frenk approved commercials designed to combat discrimination against minorities, including gays and lesbians.  The anti-discrimination ads were expanded to include indigenous peoples, the handicapped and women.  “Yo no discrimina” is a pretty good sales pitch.  Naturally, the right-wingers went apeshit, but the Doctor stuck to his guns. 

I’d hoped he’d stay on, or that he’d established a precedent for keeping the Department of Public Health out of politics.  Nooooo.  Calderón’s Secretary of Health, José Cordova Villalobos voted against distributing “morning after pill” when he was a Deputy, and sees neither condoms nor HIV testing as priorities.  He has some decidedly strange ideas about public health:

He said that this government should not promote condom use so much, since in his view it promotes high-risk sexual practices, but instead should encourage sex education by the family itself, to be imparted on the basis of parents’ beliefs and values. He also declared that campaigns against homophobia foment homosexuality.

As his ministry’s director of legal affairs, Córdova appointed a former lawyer for the Catholic Archdiocese of Mexico, Bernardo Fernández, who defended Cardinal Norberto Ribera against charges of alleged complicity in cases of pederasty involving a priest.

Fernández, who has also spoken out against the sex education campaigns, is now responsible for ruling on the legality of any public health strategy or law that is proposed by the Health Ministry.

Another change that has made activists wary was the dismissal of Jorge Saavedra as director of the state National Centre for the Prevention and Control of HIV/AIDS and his replacement by a person with no experience whatsoever in the field.

More of José Cordova’s opinions can be found here (en español).

Mexico had a fairly decent public health system.  Like in other Latin American countries, there is the problem that the rich set up their parallel services (like hospitals and medical delivery systems) and are reluctant to pay taxes for extending those services to the rest of society.  Even so, Mexico did — and continues to do — an amazing job.  There aren’t enough public health facilities, but they do a good job, and the system has always stressed preventative health care.

Fred Reed, who doesn’t go in for pretentious bullshit (unpretentious bullshit, yeah, but that’s Fred) noticed (column #319) that even the poor have good teeth… meaning people are getting enough to eat and are farily healthy.  At least Cordoba has some training in nutrition, and, although a surgeon and medical school lecturer, has more political than public health experience. 



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