The authors focus on health policy issues associated with health reform needed to meet the health needs arising from the demographic and epidemiological transitions. They illustrate these policy issues by analyzing Brazil, Colombia, and Mexico, whose populations represent about 60 percent of Latin America's population. Brazil, Colombia, and Mexico are facing an important decline in mortality and fertility rates. New health problems have arisen related to rapid urbanization and industrialization - for example, injuries, accidental intoxication and poisoning, and the occupational and noncommunicable conditions (such as hypertension and diabetes) affecting an aging population. At the same time, these countries are not free of old health problems - such as infectious and parasitic diseases - although their mortality rates are declining. That is, old and new health problems coexist while wide social disparities persist in these developing Latin American countries. The epidemiological diversity and the speed of change in disease profiles makes the health transition in many developing countries more complex than the situation developed countries faced. Most of these countries also have inadequate health infrastructure and are unlikely to be able to afford to develop them in the next decade or so. Most governments are also being pressed to adopt the therapeutic medical model to deal with noncommunicable conditions. The authors arrive at the following seven conclusions about the implications of the epidemiological transition for health policy in developing Latin American countries. The transition offers an empirical framework for strategic planning for the health system, allowing policymakers to anticipate future trends and causes of mortality and anticipate disease scenarios. Since more disease is expected among the adult and elderly populations, the health system's mission should be revised with more emphasis on disease prevention and control and less on satisfying demand. Existing inequities in the geographical distribution of health resources and in the quality of care between health institutions should be corrected to avoid greater epidemiological polarization. The health care model should be reformed to strengthen the technical capacity to provide preventive and curative services at the first level of care to control the dual burden of disease. Efficiency and quality of care need to be substantially improved to accommodate the greater demand for clinical services, especially those provided at hospitals. Criteria for setting priorities in the health sector must be defined, so resources can be allocated among competing health needs and socioeconomic groups. These countries need to strengthen their ability to analyze the health status of populations, to evaluate the health system's performance, and to design cost-effective interventions to deal with noncommunicable diseases.
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