VZCZCXYZ0015
RR RUEHWEB

DE RUEHMN #0107/01 0511656
ZNR UUUUU ZZH
R 201656Z FEB 09
FM AMEMBASSY MONTEVIDEO
TO SECSTATE WASHDC 8831

UNCLAS MONTEVIDEO 000107 
 
SIPDIS 
 
WHA/BSC FOR MDASCHBACH 
OES/IHB FOR LISA MILLER 
 
E.O. 12958: N/A 
TAGS: SOCI TBIO KPAO WHO UY
SUBJECT: CHRONIC DISEASES INCREASING IN URUGUAY 
 
REF: STATE 002172 
 
¶1. SUMMARY: In response to reftel, post prepared the following 
report to examine the impact of chronic diseases (or 
Non-Communicable Diseases, NCDs) in Uruguay and to inform the 
Department about policy related developments and the capacity of the 
local health sector to address those diseases.  Uruguay exhibits 
characteristics of a developed country, with its aging population 
and increasing percentage of deaths caused by chronic diseases, but 
its antiquated health care system impedes it from reacting to the 
changing needs of its citizens.  With over 90 percent of the 
Ministry of Public Health's budget dedicated to health care 
services, programs in prevention and health care promotion are 
severely lacking.  Still, Uruguay is a leader in cancer research, 
and is currently working to reform the system to better respond to 
the evolving needs of the population. End Summary. 
 
Background 
---------- 
 
¶2. Uruguay is a middle-income country with a population of 
approximately 3.33 million.  Throughout most of the second half of 
the 20th century, Uruguay boasted high health status indicators 
compared to other developing countries. Today, according to GOU 
data, average life expectancy at birth is 76 years, the infant 
mortality rate is 13.34 per 1,000 live births, 99 percent of births 
are delivered in a hospital or clinic, and 98 percent of the 
population has access to an potable water.  While it remains among 
the top-ranked countries of the Latin American and the Caribbean 
(LAC) region in the UNDP Human Development Report, Uruguay's 
relative position has slipped in the past few years from a ranking 
of 40 in 2000 to a ranking of 47 in 2007. 
 
Uruguay: An Aging Population with an Unhealthy Lifestyle 
------------------------- ------------------------------ 
 
¶3. Uruguay's demographic structure has changed over the last 
decades.  With 13.5 percent of the population being older than 65 
and 54 percent of the population over 31 years of age, while only 23 
percent are younger than 15, Uruguay has become the 'oldest' country 
in the Western Hemisphere.  The estimated median age was 32.8 years 
in June 2008, putting it in line with almost every developed nation 
in the world. Population growth is almost flat.  Several factors 
have contributed to the aging of Uruguay's population, including 
decreasing fertility and mortality rates, as well as a strong 
emigration flow during the last decades. 
 
¶4. Concomitantly, Uruguay's epidemiological profile has completed 
its transition from infectious diseases to NCDs. The burden of 
disease has changed mainly due to the aging of the population, 
unhealthy lifestyles, risky behavior, and changes in the social and 
economic environment.  Chronic illnesses are now the main health 
problem in Uruguay, currently claiming more deaths than infectious 
diseases. 
 
Health Sector Reform to Address NCDs 
------------------------------------ 
 
¶5. While Uruguay allocates a large portion of its income to the 
social sectors, the bulk of the social spending is concentrated in 
social security and health, largely driven by the aging of the 
Uruguayan population.  Consolidated (private and public) health 
related expenditures were estimated at 8.1 percent of the country's 
GDP for 2005, according to the WHO. The high level of health 
expenditures is due to several factors including: technological 
change, an exceedingly complex institutional structure with 
overlapping responsibilities and inadequate incentives for 
efficiency, a highly regulated physician labor market that 
undermines the ability of health organizations to control their 
personnel costs, and a delivery system that is not well matched to 
the health needs of the population. 
 
¶6. The examination of the allocation of the Ministry of Public 
Health's (MPH) budgetary resources points to the insufficient 
allocation of resources for health care prevention and promotion. 
Most resources are allocated to health care services (93.6 percent 
of the 2006 health budget).  The remaining resources are absorbed by 
administrative costs (6.2 percent) with only a negligible amount 
being assigned to health promotion and preventive care (0.2 
percent). In the medium and long term, the insufficient attention 
given to health prevention results in an increase in high-cost 
treatments for a large proportion of patients, thus generating 
additional health costs and consequences that could have otherwise 
been avoided. 
 
¶7. Until now, health reform initiatives in Uruguay had concentrated 
on financial and design problems.  Efforts were never focused on 
improving the health system's response to the areas where the 
disease burden was highest.  As a consequence, the Ministry of 
Public Health (MPH) does not have a complete set of the basic tools 
to address NCDs effectively, including appropriate information 
systems, epidemiological surveillance and monitoring systems, and a 
health promotion and prevention policy. 
 
¶8. The Vazquez Administration, with financial assistance from the 
World Bank (a USD 25.2 million Specific Investment Loan), is 
currently implementing a major health care system reform, the pillar 
of which has been the creation of an Integrated National Health 
System (INHS).  Such a system was designed to identify a basic 
package of comprehensive health services to be provided by public 
and private health care providers alike.  An important component of 
the health reform focuses on strengthening the MPH's ability to 
carry out the essential public health functions: regulation and 
stewardship, health promotion and prevention, and epidemiological 
surveillance and monitoring. 
 
The Prevalence of NCDs in Uruguay 
--------------------------------- 
 
¶9. In Uruguay, 100 percent of deaths are recorded, and all death 
certificates are completed by a physician.  According to the latest 
(2004) GOU figures, almost 32,000 people died in the country in 
¶2002.  NCDs were responsible for an estimated 80 percent of those 
deaths.  The major NCDs affecting the Uruguayans were cardiovascular 
diseases (32.8 percent of all deaths), cancer (24.4 percent), 
chronic respiratory diseases (3.5 percent), and diabetes mellitus 
(2.1 percent).  In fact, Uruguay has already reached the level of 
NCDs projected by the WHO for Latin America in 2020. 
 
¶10. In 2006, Uruguay's MPH conducted a national survey aimed at 
identifying the main risk factors that lead to NCDs in Uruguay. The 
study focused on four behavioral risk factors (tobacco consumption, 
over consumption of alcohol, unhealthy diet habits, and lack of 
physical activity) as well as four biological risk factors 
(overweight, high blood pressure, high blood sugar level, and 
abnormal blood lipids level). 
 
¶11. The survey found that many Uruguayan smoke regularly, are 
relatively inactive, are overweight, have high blood pressure and 
high cholesterol, and most do not eat as many fruits and vegetables 
as they should.  Only 1% of Uruguayans were found to have low risk 
of NCDs.  Thirty eight percent of the adults 25-44 years old present 
an elevated risk (at least three risk factors). Adults 45-64 years 
old present an elevated risk also (63 percent). In other words, 
while any Uruguayan strategy to combat NCDs should have as its 
immediate, highest priority the middle-aged segment of the 
population, the young adults segment also demands urgent attention. 
 
Addressing the Impact of NCDs 
----------------------------- 
 
¶12.  The Government has already begun to implement several outreach 
and health care programs to improve coverage of NCDs in public 
hospitals, including programs for: diabetes, hypertension, and 
cervical and breast cancer prevention. 
 
¶13.  New initiatives are also being implemented as a result of 
international cooperation.  For example, Uruguay had no chronic 
disease surveillance capacity in the past.  In 2002 Uruguay sent a 
team of physicians to be trained at the CDC in Atlanta.  Upon their 
return, an Epidemiology Surveillance Unit was established. The Unit 
is in the process of designing a national chronic disease 
surveillance system for Uruguay. 
 
¶14.  Also, Uruguay has been selected to take part in NCI's Office of 
Latin American Cancer Program Development's pilot initiative to 
advance relevant cancer research and training programs.  Uruguay's 
selection to participate is notable given the size of the other 
participation countries: Brazil, Argentina, Mexico, and Chile.  Its 
participation will elevate Uruguay's visibility as a country capable 
of cutting edge technology. 
 
¶15.  The GOU has also taken regulatory measures to prevent harm from 
tobacco through the legislative approval and implementation of "The 
Framework Convention on Tobacco Control (FCTC)."  Uruguay became the 
first country in Latin America to pass anti-smoking legislation, 
perhaps an unsurprising step considering that President Vazquez is a 
practicing oncologist.  Prior to the law's implementation, GOU data 
indicated that smoking was causing 5,500 tobacco-related deaths a 
year. "Passive smoking is also linked to chronic disease and 
premature deaths. Since there's not a secure level of exposure, the 
best thing to do is to ban cigarettes in enclosed places," argued 
Vazquez. To help promote his smoke-free plan, the president launched 
a campaign called "A Million Thanks," which is a reference to the 
number of Uruguayan smokers (31 percent of the population). 
 
A Long Road Ahead 
----------------- 
 
¶16.  Despite the changes in its epidemiological profile and the 
higher prevalence of NCDs, Uruguay's health system has made only a 
few adaptative changes.  The health care system is still organized 
to attend acute illnesses rather than chronic illness.  The World 
Bank estimates that 22 percent of all deaths and 32 percent of the 
deaths among those younger than 65 years old are avoidable. 
 
¶17.  As a result of limited health promotion activities, general 
knowledge about NCDs is relatively low, particularly among 
low-income population groups.  The intensive use of basic public 
health tools to address NCDs could render rapid improvements in 
health status.  Massive public health campaigns aimed at promoting 
healthy lifestyles and the early detection of high-risk diseases 
such as diabetes, hypertension and high cholesterol could have a 
considerable impact on reducing health care costs and increasing the 
quality of life of many Uruguayans.  Support for prevention measures 
is likely to be broad, as the population views an increased focus on 
promotion and prevention as positive. 
 
MATTHEWMAN