Burden of disease assessment and health system reform: Results of a study in Mexico

This paper describes in broad terms the first national assessment of the burden of disease using Disability Adjusted Life Years, which formed part of an overall study of health system reform in Mexico. The overall project, ‘Health and the Economy: proposals for improving the Health System in Mexico’, is one of the first experiences of applying the analytical tools featured in the World Development Report 1993: Investing in Health. The Mexican National Burden of Disease (NBD) study was a critical component of the analysis of health system reform in Mexico. It provided a strong analytical basis for the identification of epidemiological priorities. The results of the study document the heterogeneous nature of the epidemiological transition in different parts of Mexico, and included both premature mortality and disability in the analysis. The results of this study were employed along with information on the cost‐effectiveness of major health interventions in Mexico to design a package of essential health services for all Mexicans. Not only was the NBD study useful in identifying health needs and interventions that may have a major health impact, but the exercise itself had a number of other benefits. Through the careful review of all available sources of information on the incidence, prevalence, duration and severity of disability and mortality by age, sex and cause, the strengths and gaps in the current information system were identified. The process by which a large number of Mexican experts were involved in the estimation of the burden of each disease encouraged broad participation of health experts in the discussions about health reform in Mexico.