MARCELO EBRARD CASAUBON MEXICO CITY’S MAYOR
Mexico City has the potential to transform, through knowledge, scientific and technological development into a powerful engine for the creation of new products and services.
their research. Biometrópolis will place Mexican medicine at the highest international levels and detonate a new economic platform for high technology research across the city.
The knowledge-based economy is spreading throughout the world. A Knowledge Economy depends on human capital and strategic thinking, as well as on the ability to create favorable conditions to assure its implementation.
These projects are feasible due to commitment of the City’s Government towards equity as a guideline of public policies. Equity generates shared values and provides the cohesion and integration that allows society to pursue common objectives and goals.
These can include identification and re-orientation of specialized knowledge, an agenda that increases connectivity, creation of innovation networks, as well as business incubators and stimuli for capital investment. All of these can be achieved through the participation and commitment of the government, the academic world and private companies, all of whom share a common goal in which everyone wins, particularly society. Mexico City’s government is committed to transform the city into a highly competitive marketplace that stands among the best in the world. This is why serious progress is being made in improving the environment, mobility, social investment -with an emphasis on education, health care, public safety-, as well as tax incentives for new investments, and support and training for small and medium-sized enterprises. We are building a balanced and friendly city that protects its environment and maintains harmony by restoring public places, increasing mobility and green areas to improve the quality of life for all of its inhabitants. A competitive city cares for the quality of the education that it provides and applies the appropriate technologies to generate advances in innovation. Campus Biometrópolis, for example, is a new concept in the creation of a Knowledge City that will revolutionize health and scientific research in Mexico City. It will create new jobs taking advantage of the city’s health and education infrastructure. An elitegroup of senior researchers will work together to guarantee top of the line knowledge in
Striving to fight inequality, the city developed Red Ángel, the most advanced social network in Mexico and Latin America. Through this investment, the city has granted an entire generation of young people an opportunity to complete high school, reducing the dropout rate from 22% to 6%, one of the lowest rates in the world. Our experience has shown that the more we invest in education and health and eliminate exclusion, the greater the possibilities of growing, fostering development and increasing employment. Mexico City has taken the lead in supporting citizen’s freedoms and rights. We protect women better, convinced that gender equality is the only road to a better society. We are the only city in the world with a Human Rights Program, designed by different organizations and institutions, reaching all areas of public actions and supervised by independent mechanisms. Through these actions, the City has taken a leading role in this matter. Mexico City is committed to build a future as rich as our past. Future lies in technological development and remarkable innovation. These, along with equity, are our main goals.
MARCELO EBRARD CASAUBON
EDUCATION JANINA MÁRQUEZ
S
cience, business and academia have common ground. To find it, one needs to really know where all the assets stand. Knowledge is the key resource that is maximized through specialized human resources and the availability of information. We’ve shifted from an industrialized world, where production of goods and services was closely tied to the physical realm, to a new paradigm where wealth is created closely tied to intangible assets. Mexico City’s research and business communities are recognizing each other as crucial partners to the development of Mexico as a whole. Through this effort and common understanding, the academic world, government, business, and civil society come together and demonstrate the city’s alignment.
The current generation of young men and women will transform today’s economy into the knowledge economy. Tools and broad access to knowledge will be achieved so that this gener tion pushes the nation forward. But gearing up for a knowledge economy requires immediate action and commitments. In this booklet we’ve carefully chosen experts in Health as this is one of the key paths where ideas from multiple sectors meet, intermingle and press forward. To the authors, there is no question that Mexico City is already the knowledge capital of Latin America.
SCIENTIKA
technology
developm SCIENTIKA is a non-profit organization of the Pitroda Group established in Mexico City. Scientika has closely focused on solving the transit towards the knowledge paradigm, and it is dedicated to promote knowledge economy related activities. It has developed several roadmaps and followed their implementation sidebyside with worldclass consulting firms. Scientika works as an honorable Think Tank, and through the guidance of their Chairman, Sam Pitroda, has been able to provide intelligent, practical and sustainable solutions to governments, private companies, and other non-profit organizations. In Scientika we believe that knowledge spread is as relevant as its creation, that is why we work whit civil society, academia, government and private sector.
JAVIER JILETA
T
he knowledge era is about creating new knowledge to form new wealth and prosperity. In the last 20 years, new knowledge generated in areas such as biotechnology, nanotechnology, communications and information has offered new hope for solving complex problems. Developing countries like Mexico need to change their economic models and move from industrial and service economies to knowledge-based economies. The question: how to change our economy when we live in a mindset of the nineteenth century, with twentieth-century processes and needs that are exclusive to the twenty-first century. Knowledge will guide this century. Cities need to be rebuilt and investments in telecommunications will remain vital. There is no way that a country can foray into this new
SAM PITRODA
knowledge era unless it is using technology to improve the quality of life for all of the people. The objective is clear: innovation is multidisciplinary. The key here is the ability to create networks and to focus global resources on local problem solving. Mexico city moved towards a knowledge paradigm long ago. Resources for the city to contnue move forward are available. I believe that Mexico can achieve a better stance toward development where all of its inhabitants can better rest assured of their future. I am a Mexico City believer.
SAM PITRODA
Mexico City is the epicenter of health care in the country and one of the most important centers of health in all of Latin America. Home to a majority of noteworthy public and private hospitals and to the most prestigious institutes offering medical attention, highly specialized scientific research and teaching, the capital city’s health infrastructure, quality of care, popularity of medical programs offered and advances in the engineering of universal health for all residents have placed the Mexican health care system among the most comprehensive in the world.
SUSTAINABILITY
HE ALTH
KNOWLEDGE EDUCATION
DEVELOPMENT
PRIVATE SECTOR
Health in
Mexico City PROGRAMS ANGEL PROGRAM
212
150
264 120 235
105
50
Is the largest social program in Mexico and Latin America. “Angel” Program is a network of health care assistance initiatives, focused on those living in areas classified as highly marginalized. Currently, More than 2.1 million people are registtered. Doctors, nurses and social workers make visits to detect sick people that for their economic resources cannot afford medical services.
* • 1,000,000 Medications to deliver
115
248
• 400 nutritional pantries for pregnancy • Comprehensive Care Program for Elderly • Attention to people with disabilities
241
126
*
Total: 1,866 * Only Research and teaching
• Hospice care
MEXICO CITY Is THE LARGEST HEALTH CLUSTER IN LATIN AMERICA. The Ministry of Health of Mexico City operates a system formed by more tan 214 health centers, that along with the National Health Institutes and the network of federal government hospitals create the most important health cluster in Latin America..
In Mexico City, there are more than 5,730 doctors, 585 dentists, 6,790 nurses and more than 2,000 health professionals including nutritionists, psychologists, among other professions, taking care of nutritional problems.
Mexico City’s Government estimates that 38,400 persons live with HIV in the city. That represents a 17% of the total in the country. Annually, the government estimates that some 2,100 get infected with HIV in Mexico.
• “Get into shape”: Seeks to promote healthy lifestyles through a proposal of daily exercises and nutritional meals. +1,500,000 participants.
• “Condesa” Specialized clinic +5,906 persons receive anti-retroviral treatment and other services for free
• “Body mass index”: Test for detecting obesity. +1,300 schools visited.
• +13,000,000 condoms distributed
• “Bariatrics clinic”: +160 operations for free.
• Free testing for HIV and other STD +25,000 annual detections
• Workshops and lectures about obesity: +150,000 participants.
• Program for the Attention of Sexual Violence Victims in the borders
• “The nutritional traffic light program”: Information box about the nutritional content of the dishes. • Specialized attention for diabetics
Mexico City’s Infraestructure
HEALTH
INTRODUCTION
P.12
INTERVIEW with Dr. Enrique Graue, P.16
Director of the Department of Medicine at the UNAM
11
NATIONAL INSTITUTES of Health P.18 BIOETHICS and the City P.20 INTERVIEW with Dr. Armando Ahued, P.23
P.
Secretary of the city’s Department of Health
Points of View Academia Government Private Sector Civil Society
UNIVERSAL HEALTH P.24 INTERVIEW with Klaus Boker, P.26
Chairman of the Board of Directors of ABC Hospitals
SMOKE-FREE PUBLIC SPACES P.28 MEDICAL TOURISM P.30 CREATING a Culture of Donation P.32 HIV AND AIDS Prevention P.33 HEALTH PROGRAMS P.34 INTERVIEW with Dr. Mercedes Juan López, P.35 President of the Mexican Health Foundation
EMERGENCY RESPONSE CAPACITY P.36 HORIZON SURPASSED Biometrópolis ESSAY: DR. MANUEL H. RUIZ DE CHÁVEZ MEXICO CITY : A Space for Knowledge, Opportunity and Certainty CONCLUSION MEXICO
CITY FACTS
P.38 P.42 P.46 P.48
14
HE ALTH
INTRODUCTION
Mexico City
is the center of the health care industry in Mexico and in Latin America as a whole. In terms of treatment, scientific research and teaching, the scope of the field is very broad. The city is home to an extensive network of public hospitals and a significant number of privately operated health care institutions. The local Department of Health runs a system of 28 hospitals (nine general, ten pediatric, eight of maternity and one of specialties). Another 20 are managed by the Mexican Social Security Institute (IMSS), along with 30 belonging to the State Employees Institute of Security and Social Services (ISSSTE), notably the 20 de Noviembre National Medical Center. Health services offered by IMSS and ISSSTE are central pillars in the social security system and attend affiliated employees and their immediate families without charge. Mexico City residents who fall outside of this coverage can now rely on the Seguro Popular, a universal insurance policy, established by the federal government, which covers health check-ups and medicine for citizens who lack other medical services. Hundred percent access to health care in the city is the goal. At the same time, some of the most important private hospital complexes in Latin America are to be found in Mexico City. Grupo ﾃ］geles facilities stand out for their geographical reach, with locations all over
15
A big health complex of world class services
Mexico City-South Medical Complex
4,0 00
16 0 Texas Medical Center, Houston
6,3 44
13
MEXICO CITY
16
3,2
4 HOUSTON
11,850 (47.95)
NY
(Manhattan)
1,000 (4.04)
00
Hospitals
Beds
Acres (km2)
Territorial extension
Source: Felipe Ochoa y Asociados Consultores 2009.
40
Mount Sinai Hospital, New York City
10.6 (0.04)
HE ALTH
INTRODUCTION
the city. Also of the highest quality is Médica Sur, a hospital founded by specialists from the National Institute of Nutrition. Another prominent provider of private medicine is Hospital ABC, with a non-profit organizational structure, and well known for providing excellent service. But dominating the city’s health care skyline are the National Institutes of Health, which efficiently treat patients, perform scientific research and train new specialists in 12 of the most challenging fields of medicine. National in scope, the location of the Institutes in the capital has influenced every aspect of medical practice in the city. The National Institutes of Health also work hand-in-hand with the country’s foremost medical schools. The vast majority of all of medical specialists in Mexico and Latin America are trained in Mexico City, in one of these institutes. The National Autonomous University of Mexico (UNAM) in Mexico City is the leading educator of specialized doctors in all Latin America. It is currently training 9,000 doctors in different areas of medicine. The Mexican capital is also at the vanguard of medical research in Latin America. The National Institutes of Health and the three principal universities located in the city - the UNAM, the Metropolitan Autonomous University (UAM) and the National Polytechnic Institute (IPN) make a significant and increasing number of contributions to specialized medical journals. In 2006, for example, Mexican research into the rotavirus won recognition after being awarded the “Article of the Year” prize by The Lancet magazine, selected from among 700,000 articles. Challenges for the upcoming decade include developing Campus Biometrópolis, a “health care city” in the south of the metropolitan area, which will also lend to the ambitious objective of positioning the city on the cutting edge of biomedical research.
15
Point of View
Academia
DR. ENRIQUE GRAUE Director of the Faculty of Medicine at the National Autonomous University of Mexico (UNAM), Dr. Graue is an ophthalmologist who specializes in cornea treatment and in external diseases.
WITH 16,000 STUDENTS, THE UNAM’S FACULTY OF MEDICINE IS THE PREMIER SUPPLIER OF THE COUNTRY’S DOCTORS. THE UNAM ALSO TRAINS SPECIALISTS FROM ALL OVER LATIN AMERICA, PRINCIPALLY THROUGH THE NATIONAL INSTITUTES OF HEALTH. Tell us about the Faculty - the most important school of medicine in the country - and the city’s tradition of training doctors.The Department of Medicine at the
UNAM is the largest in the country if not in Latin America. We have 7,000 undergraduate students and 9,000 postgraduates. We’re the only school with many more students at postgraduate than at undergraduate level. The medical school has been training doctors for 431 years, since the period when Mexico was a Spanish viceroyalty. On October 23 1833, the grand, modern plan of studies was initiated at the behest of President Gómez Farías. This is why we still celebrate Doctors’ Day on that date. Mexico City has a great tradition of training in the medical field. The most important centers of medicine in the country are to be found here. The cities of Monterrey and Guadalajara have grown notably in this respect, as have a few other places in Mexico, but none can be compared
with the medical and scientific infrastructure of the city. Medicine in the capital remains of the highest quality to be found anywhere in the country. Very few people are not covered by either the city’s Department of Health, the Mexican Social Security Institute (IMSS) or the State Employees Institute of Security and Social Services (ISSSTE). The Federal District has close to 100% coverage.
How does Mexico City compare to other Latin American cities when it comes to medical attention? Sao Paulo and Buenos Aires are probably the only two other cities in Latin America that have considerable bearing in terms of health care. I know both of these cities well. The Brazilian system has improved the level of medical attention they’re able to offer in the last 15 years, but like us, they can be over-centralized and unbalanced.
“The Faculty of Medicine has been training doctors for
431 years” years.”
HE ALTH What percentage of medical students in Mexico City come from other countries?
It should be pointed out that a majority of Latin American doctors are trained in Mexico City. At the undergraduate level the percentage of foreign students is still low, but when you get into specialized medicine, we’re receiving students from all over the world. For every 2,000 who enroll, 300 are from abroad, about 15%. We have students from Europe, the United States, Canada, Japan, and Australia, but the greatest pre sence is from Latin America.
With such a large number of students (currently 16,000) how do you maintain quality standards in terms of academic staff and graduates?
There’s a long tradition at the undergraduate level. Every subject area is addressed by an academic team that defines the objectives and competence levels that need to be achieved for each course. Based on these, the examinations are set and applied to everyone equally. At the postgraduate level, specialized teaching is practicebased, with a single annual evaluation determined by each member of the academic team. Postgraduate teaching focuses on apprenticeships, with an average of four students per staff member.
What are the strengths of medical teaching in Mexico City?
The greatest strength of the Department of Medicine is its annual personalized evaluation which is of the highest rigor. On the other hand, the historical concentration of wealth and power in Mexico City undoubtedly translates into a better quality of academic teaching and medical care.
How do universities contribute to the improvement of the over all health care system in Mexico City?
We enable practicing doctors, who are part of the healthcare system, to remain up-to-date. We provide a solid and contemporary education at
INTERVIEW
an undergraduate level, built around three curricular axes: the first concerning the necessary medical knowledge; the second concerning professional ethics; and the third concerning the ongoing education that a doctor must engage in throughout his working life. The contribution we make within hospitals is constant, given that this is where most medical research takes place. Most hospitals in the city, in addition to attending patients, are also research centers. We have 12 National Institutes of Health, all of them but one are in the city. These are part of the Faculty of Medicine, and it’s where postgraduate teaching takes place. When someone teaches, they have to study; when someone studies, they ask questions; and when someone asks questions, they raise doubts and this leads to new knowledge. It is a virtuous circle. These are the lines followed by medical systems all around the world. They were established at the end of the 19th century, and it is a very successful model which we apply across the department.
How do you encourage modernization within the medical research community?
We have a course we call “Medicine and Information Technology” in which we teach students to use electronic media to keep upto-date with developments in medical knowledge. We also use Scientific Evidence-Based Medicine, which is a review of medical information subject to internal examination. All the articles written on a particular topic worldwide are compiled and compared. In the end perhaps five of them reveal truly scientificallyproven evidence. This tool is indispensable for keeping up-to-date in the world of medicine.
Do you meet with the boards of other Mexico City medical schools in order to share knowledge? The boards of medical schools around the country share knowledge at periodic meetings. There is a National Association of Medical Faculties and Schools (ANFEM), and although it was created several years ago it hasn’t yet managed to bring all the universities together. Once a year it holds a general meeting to share experiences.
WE’RE THE ONLY SCHOOL WITH MANY MORE STUDENTS AT THE POSTGRADUATE THAN AT UNDERGRADUATE LEVEL.
NATIONAL INSTITUTES of Health
A turning point in the teaching of medicine took place very early in the history of the subject. During the Sassanian Empire in Iran, the birthplace of the Academy of Gundishapur, the most important and innovative knowledge converged around 271 bce. A teaching technique developed there, and is still used today, whereby students learn directly under the guidance of one teacher, but also study with several specialists over the course of their training. The Academy brought together the best minds of the age, irrespective of their geographic origin, and included specialists from as far away as Greece.
20
T
HROUGHOUT HISTORY THERE HAVE BEEN ORGANIZATIONAL MODELS like the Mexican National Institutes of Health, dedicated not only to patient care but also deeply focused on scientific research and the training of specialists. This model is essentially the same as that of the Johns Hopkins Hospital in the United States, recognized as the best hospital in that country for more than twenty years. Healthcare, education and research: it’s in these areas that the National Institutes of Health have established standards of excellence in Latin America and are recognized today among the best in the world, despite their limited budget and the soaring demand for their services. Covering the vast spectrum of care, 11 of the 12 existing Institutes are located in the south of Mexico City, making the capital city a focal point in health care for the entire region. The Institutes originated with the work of doctors distinguished in each of the specializations on which they now focus. The Federico Gómez Children’s Hospital of Mexico was founded 65 years ago as a result of the efforts of the eponymous doctor whose workgroup of specialists went on to form the hospital. That was the beginning of modern public health care in the city. Another major effort resulted in the founding, in 1952, of the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery, also named after the doctor who pioneered the Institutes’ early work. The most recent is the Institute of Genomic Medicine, opened in 2004, which responds to the needs for cutting-edge scientific research. A 13th Institute is currently under construction: the National Institute of Geriatrics. The success of these Institutes is in part due to their decentralized public agency status, with legal and fiscal independence. They are regulated by the Commission of the National Institutes of Health and coordinat-
ed by the Committee of National Institutes of Health and Specialty Hospitals, overseen by the Department of Health. The autonomy with which the Institutes have historically operated has allowed them to provide the highest level in medical care in the country. They have trained world class research professionals and specialists in their respective fields. Dr. Julio Sotelo, the director of the Commission, says: “In terms of human resource training, almost all the leaders of medicine in Mexico, Central America, and the rest of Latin America were trained here at the Institutes”. Sotelo also notes that “the Institutes contain the best researchers in biomedicine in the country. In all of the areas of science that Mexico City researches, the most successful are medical sciences”. In 2006, The Lancet magazine, one of the leading publications on medical matters, selected a Mexican article as the best of the year. It was a text on the discoveries made about the rotavirus vaccine, written by one of the researchers from the National Institute of Nutrition. The selection was made from among 700,000 biomedical articles. As specialized medical complexes, patients with acute and difficult conditions are being treated at the Institutes. It’s possible to provide treatments of excellent quality thanks to the first class personnel and technology the Institutes provide. Dr. Julio Sotelo
“In all of the areas of science that the city researches, the most successful are medical sciences.”
Mexico’s 13 National Institutes of Health: • CHILDREN’S HOSPITAL OF MEXICO • NATIONAL INSTITUTE OF CANCER STUDIES • NATIONAL INSTITUTE OF CARDIOLOGY • NATIONAL INSTITUTE OF NUTRITION • NATIONAL INSTITUTE OF PEDIATRICS • NATIONAL INSTITUTE OF OBSTETRICS • NATIONAL INSTITUTE OF PSYCHIATRY • NATIONAL INSTITUTE OF PUBLIC HEALTH*• NATIONAL INSTITUTE OF REHABILITATION • NATIONAL INSTITUTE OF GENOMIC MEDICINE • NATIONAL INSTITUTE OF RESPIRATORY HEALTH • NATIONAL INSTITUTE OF NEUROLOGY • NATIONAL INSTITUTE OF GERIATRICS (CURRENTLY UNDER CONSTRUCTION.) The only one out of Mexico City, the National Institute of Public Health, is located 70 kilometers to the south, in Cuernavaca, Morelos.
*
THE NATIONAL INSTITUTE OF ONCOLOGY T
he National Institute of Oncology has a modest origin as a small clinic with a large number of oncologic patients from the gynecology department. The clinic was overrun by the demands of patients and had to be transformed into a specialized center for research and treatment of the disease. In 1946, the National Institute of Oncology was established by presidential decree. Today, led by Dr. Alejandro Mohar Betancourt, it is an obligatory starting point for information on cancer research throughout Latin America. Cancer remains one of the leading causes of death in Mexico, and one which requires a complex prognosis and treatment. The Institute coordinates the work of 25 State Cancer Centers that provide care across the nation. In a major collaboration with the National Autonomous University of Mexico’s Institute for Biomedical Research, the Institute performs original research forming a solid front in the fight against cancer through work performed at 11 medical laboratories. In 2009, the construction of a new hospital, part of the Institute, was announced. This is a vital investment in keeping with its long term mission.
A CLOSER LOOK AT SOME OF THE INSTITUTES:
THE MANUEL VELASCO SUÁREZ
NATIONAL INSTITUTE OF NEUROLOGY AND NEUROSURGERY
T
he Manuel Velasco Suarez National Institute of Neurology and Neurosurgery is considered one of the world’s leading centers for study in the neurological sciences. All three main branches of clinical neuroscience are represented with the same devotion: Neurology, Neurosurgery and Psychiatry. The integration of these disciplines allows a thorough study of brain diseases. It is also one of the few institutions in the world dedicated exclusively to research, teaching, diagnosis, and treatment of brain diseases, from their molecular basis to their extended social components. The Institute of Neurology designs programs, treatment guides and strategies to attend neurological, neurosurgical and neuropsychiatric conditions. In no small measure, the prestige of the Institute is based on the high quality medical care available. Attending more than 6,000 patients, it offers close to 100,000 medical consultations and 2,000 surgical procedures annually. Designing diagnosis and treatment protocols, the Institute generates scientific knowledge and publishes more than 100 articles in scientific journals each year. Doctors from all over the world come to Mexico City to specialize in neurology and neurosurgery at the Institute, as do patients seeking excellent treatment.
THE IGNACIO CHÁVEZ
NATIONAL INSTITUTE OF CARDIOLOGY
T THE SALVADOR ZUBIRÁN
NATIONAL INSTITUTE OF MEDICAL SCIENCES AND NUTRITION T
he Salvador Zubirán National Institute of Medical Sciences and Nutrition is a hub of the greatest scientific activity in Mexico City. Inaugurated on October 12, 1946, the Institute gradually extended its functions to medical fields beyond nutrition and today it encompasses 40 medical specialties. Its current Director is Dr. Fernando Gabilondo Navarro. The National Institute of Nutrition provides outpatient services to 135,000 patients and an average of 215,000 consultations annually. Patients are referred to the Institute for an enormous range of conditions and so the laboratory is equipped like few others in the world. Patients are attended by a medical staff of 176 specialists, all with multiple years of training in Mexico or abroad. In the words of Dr. Gabilondo, the Institute’s key strength lies in the nature of the attention given to patients. “We have excellent doctors
he Ignacio Chávez National Institute of Cardiology was founded in 1944. The first institute of its kind in the world, it provides highly specialized cardiovascular care. The Institute pursues cutting-edge scientific research and in collaboration with the National Autonomous University, it also offers highly specialized courses in General Cardiology, Cardiothoracic Surgery, Pediatric Cardiology, Nephrology and Rheumatology. Home to the Mexican Society of Cardiology and the General Secretariat of the Interamerican Society of Cardiology, under its current director, Dr. Marco Antonio Martínez Ríos, the Institute is “the best in the country in the field, among both public and private sectors.” The Institute is also a hotbed of specialists. “We’ve graduated cardiologists from almost everywhere in the world and we are the great trainer of cardiologists in Latin America.” The Institute recently inaugurated a fourth global scanner, the first of its kind in Latin America. Throughout its history, the Institute has made major contributions to the field of cardiology and electrocardiography. The research which began in the late 1940s, led eventually to the development of artificial heart valves, and there still is a department dedicated exclusively to their manufacture at the Institute.
The National Institute of Nutrition provides
215,000 CONSULTATIONS
ANNUALLY.
who work in a multidisciplinary manner, and who are able to look at pathology from a variety of different angles.” The Institute offers 20 postgraduate courses endorsed by the UNAM and specializations in many fields of medicine and surgery. The quality of teaching is so high that most of the specializations imparted are given first place nationally in the departmental examinations. Graduates of the Institute are practicing throughout the country and are leaders in academic medicine and in other educational hospitals.
19
BIOETHICS and the City
Bioethics is a relatively new field in the landscape of medical thinking. Dealing with the concerns that are as old as humankind, technological developments and medical advances have made it more necessary than ever to closely examine the ethical issues surrounding medicine and medical practice.
T
HE TERM “BIOETHICS” WAS coined by German theologian and philosopher Fritz Jahr in 1927. But international attention only focused on these issues when the Nuremberg trials first shed light onto the horrific medical experiments conducted by the Nazi doctor, Josef Mengele. Bioethics deals with issues as far ranging as abortion, decisions to suspend the treatment of terminally ill patients, cloning, and stem cell research, among many others. Today, bioethics is a rapidly evolving discipline. Public health legislation in this field has placed Mexico City at the forefront in Latin America. Medical advances such as the passage of the laws on abortion (2007) and on advance directive (2008) have positioned the city on the world stage. The exact figure for deaths as a result of un-regulated abortions are unknown, but an estimated four million illegal procedures take place each year worldwide, of which at least 4,000 result in fatalities. Avoidable deaths like these make illegal abortions a grave public health matter. In most of Latin America there is still resistance to opening the issue to debate. At this moment, the surgical termination of pregnancy is still a crime in most of Latin America, though in Europe the procedure is far more common. In Peru, on average, two pregnancies are interrupted for every woman of reproductive age, and in Colombia the average is one for every woman. Abortion is essentially illegal in both countries. Mexico City is the only major city in the region to have considerably reduced the number of deaths from botched and un-regulated procedures. This improvement in the numbers has been generated over the last three years since the approval of the legal interruption of pregnancy law. There have been 39,117 procedures performed, 22,343 by pharmaceutically induced miscarriage, 13,853 by surgical vacuum and 2,920 by surgical intervention. Rates in Mexico City are approaching those in countries like the UK, where in 2008, 195,296 procedures were performed, 91% of them within the National Health System. Authorities at all levels of the city recognize without hesitation that the real challenge is to reduce the number of unwanted pregnancies through timely and accurate sex education and advances in availability of healthcare to women at all stages of life. Of the 39,117 women mentioned above, 33,249 reported using a safe contraception method after the procedure. The same authorities, and the majority of residents in the city, understand that women’s chances for economic, societal and psychological independence relates to the availability of the procedure. Another bioethical issue confronted in Mexico City was the advanced directive or living will act passed in early 2008. The law gives citizens the right to refuse medical treatment for the prolongation of life when there is no possible cure to the disease that afflicts them, nor reasonable hope for a good quality of life. Even in Germany, in 2010, the court had to intervene to determine whether it is a crime to suspend the medical treatment to patients who no longer wish to pursue it.
Though few people have come forward to express their wishes in advance, with the endorsement of a notary, it is now possible and legal. To date, 361 terminally ill patients have benefited from the law and 18 of these have since passed away. Most suffer from chronic degenerative diseases such as cancer, diabetes and cardiovascular disease that eventually severely diminish their quality of life. Mexico City is thus at the forefront of the discussion on bioethics, on par with cities like Quebec, which has implemented similar measures to ensure “death with dignity” to citizens suffering from chronic illnesses. Providing residents with options and information for full decision-making capability has not been least among those efforts. These new legislative acts, and intense consultation with the World Health Organization, put Mexico City among the most advanced societies in the world in bioethics.
Three years after abortion became legal there have been:
66,000 REQUESTS FOR INFORMATION
40,000 PROCEDURES UNDERTAKEN, OF WHICH 2,194 WERE FOR MINORS (UNDER THE AGE OF 18)
“The fundamental point is an opening on the part of the authorities to listen to
public opinion.” HE ALTH
INTERVIEW
DR. ARNOLDO KRAUS Arnoldo Kraus is a doctor who teaches medical ethics at the Graduate School of Medicine at the National Autonomous University of Mexico (UNAM). A member of the Mexican Association of Bioethics, Kraus is a columnist and author of several articles essential to the national debate on bioethics.
PUBLIC HEALTH LEGISLATION IN THE FIELD OF BIOETHICS HAS PLACED MEXICO CITY AT THE FOREFRONT OF THE DABATE IN LATIN AMERICA. THE CITY NOW RIGHTFULLY PARTICIPATES IN THE DISCUSSION OF RELATED ISSUES THAT HAVE GAINED MOMENTUM INTERNATIONALLY. What is the significance of Mexico City being one of the first cities in the world to pass these laws? It’s a major step forward in the field of public health. The fundamental point is an opening on the part of the authorities to listen to public opinion and to replicate what is occurring in more advanced countries. Assisted dying, or euthanasia, is an issue that has been under discussion for a long time in Europe. Holland was the first country to legalize it in 2002. In places such as Switzerland and the United States, first in Oregon and now in Washington, what is known as “assisted suicide” has also recently been approved. Only a few countries are talking about the issue.
How does the Advance Directive Law work?
A document – which used to be called a
needs to be drawn up and formalized, witnessed by a notary, one or two doctors and a family member. While you are healthy, you prepare it to indicate that in the event of a terminal or degenerative illness, or an accident that leaves you in a vegetative state, you do not wish to be kept alive by artificial means. We haven’t spoken about euthanasia in the Federal District yet. What we’re talking about is a patient choosing not to begin or not to continue a course of treatment.
What are the concrete benefits in terms of public health? Does this make it easier to transplant organs in good condition?It is true that in the case of patients
who are in a vegetative state the law represents a good opportunity to promote the use of their organs to save or prolong the lives of others.
“living will” but which in the Federal District has been given the name of “advance directive” -
With regards to the law on abortion, what are the concrete benefits in terms of public health? Almost 40,000 abortions have been carried out in the past three years and there has only been one death as a result of the procedure. For those of us who believe that health is a right for everyone, and that women should be the ones who make decisions about their own bodies, it is a major step forward.
How was the process of civil society, experts in bioethics such as yourself, and the local city government being able to bring this law into effect? There were several factors. Firstly the involvement of the mayor Marcelo Ebrard, with the strength of will to see it through, and the Department of Health, Armando Ahued, who supported the mayor. The struggle has lasted 20 or 30 years, led by non-governmental health organizations such as Martha Lamas’s GIRE, or MEXFAM, which for a long time have been trying to give a voice to women.
4.5% W ERE AG ED BETWEEN 15 AND 17 47.4% WERE AGED BETWEEN 18 AND 24 21.8% W E R E AG ED BETWEE N 25 AND 29 13.9% WERE AGED BETWEEN 30 AND 34
78%
WERE FEDERAL DISTRICT RESIDENTS
83% OF THE PROCEDURES WERE NON-INVASIVE
41.9% TOOK UP USE OF THE IUD FOLLOWING THE PROCEDURE
MEDICAL TOURISM
24
Medical Tourism may very well be the first kind of tourism, so it should come as no surprise to us that, even today, people are willing and even pleased to travel far and wide to seek relief from illness or malady. Ancient Greeks, in fact, made pilgrimages to Epidaurus, near the modern Greek city of Epidavros, in search of cures to their ailments, more than 2,000 years ago.
been certified by the Joint Comission International (JCI), the most important organisation to certify hospitals in the United States. The network of hospitals and institutions in Mexico City is the most complete and comprehensive in all of Latin America. The Medical Tourism Association, a non-profit trade association, recently ranked Mexico City as an “excellent” health care destination. Mexico City is the third most popular medical tourism spot in Latin America, behind only Costa Rica and Brazil.
M
The virtues of Mexico City as a medical care destination are:
EDICAL TOURISM IS SIMPLY the act of traveling to another country for the primary purpose of undergoing a medical, surgical or therapeutic procedure that is not urgent. It’s not uncommon for the same trip to include rehabilitation, recovery and leisure activities, hence the additional component of “tourism.” Several forces drive today’s medical tourism industry. Significantly lower costs of travel and equally significant increases in the quality standards of medical services in many host countries have combined to make the idea of traveling in search of care that much more attractive. Consumers in countries with nationalized health systems sometimes may have to wait months or even years to undergo an elective procedure. In contrast, some destinations can conveniently schedule and perform certain procedures in a more timely manner and at considerable cost savings to the consumer. Heart bypass surgery, for example, costs about US$130,000 in the United States, while the same procedure in Mexico is around US$33,000. Cost differentials tend to be the most important factor in the medical tourist’s decision-making process. Even after airfare, lodging and tourism, the basic treatment in another country can cost as little as one fifth of what the same treatment costs in a developed economy. Angioplasty, which involves dilation of an occluded artery is one of the most common surgeries sought by medical travelers. In the United States, the procedure typically costs about US$57,000. In Mexico, angioplasty can be performed in a high quality private hospital for about US$11,000. The idea of medical tourism in Mexico City has recently moved increasingly toward being solidly realized in more visitors. The Mexican capital has the human talent and the advanced technology needed to provide patients from all over the world with excellent care at markedly lower costs when compared to many other countries. In addition, access to the city is extensive and allows patients to reach the capital from all major cities around the world without connecting flights. The idea of economically developing this niche started with examples set by countries like India, Brazil and Costa Rica, each of which has made medical tourism an increasingly important aspect in the development of their own economies. The Mexico City newspaper Milenio Diario reports that the worldwide medical tourism market represents US$60 billion annually, and it is growing. The flow of American travelers to border towns who come seeking more affordable medical services is today a reality. Mexicans living in the United States, who otherwise lack health insurance also look to Mexico for a more cost-effective option. Each year, between 250,000 and 300,000 people travel from the United States looking for quality care at a more affordable cost than is available at home. Already, Mexico City boasts more than 40 private hospitals capable of offering high quality medical services, eight of these have already
Excellent medical specialists with national and international experience. The vast majority speak English and hold international degrees.
Air connectivity with all major cities worldwide. Medical services are an estimated 40% less costly than in the US. Important private hospitals, certified internationally. Mexico City offers a broad cultural experience, comparable to any other major world capital.
MEDICAL TOURISM COST DIFFERENTIALS (in US dollars) TREATMENT HEART BYPASS HEART VALVE REPLACEMENT ANGIOPLASTY HYSTERECTOMY KNEE REPLACEMENT HIP REPLACEMENT SPINAL FUSION
US/UK
MEXICO
$130,000 $160,000 $57, 000 $20,000 $40,000 $43,000 $62,000
$33,000 $34,000 $11, 000 $5,500 $11,000 $12,500 $16,000
Source: Woodman, Patients Beyond Borders and Companion Global Healthcare, Inc.
PROJECTIONS FROM
THE SECRETARY OF TOURISM ESTIMATE THAT MEDICAL TOURISM
IN 2010 WILL BE WORTH
US$304 MILLION.
The Mexican government
PREDICTS THAT IN 2015,
450,000 MEDICAL TOURISTS, PRIMARILY FROM THE UNITED STATES, WILL VISIT MEXICO FOR MEDICAL TREATMENT. THE ESTIMATED VALUE TO MEXICO’S ECONOMY WILL BE
US$350 MILLION.
MEDICAL TOURISM, BY 2020, COULD BE WORTH US$4.5 BILLION AND ATTRACT 650,000 MEDICAL TOURISTS EACH YEAR.
Point of View
Government HE ALTH
INTERVIEW
DR. ARMANDO AHUED Armando Ahued is surgeon by the Autonomous Metropolitan University (UAM). He was Subsecretary of the Department of Medical Services and Supplies until he was made Secretary of the city’s Department of Health, charge which he currently holds.
WITH THE AIM OF OFFERING COMPREHENSIVE MEDICAL SERVICES TO CITIZENS, THE DEPARTMENT OF HEALTH PROVIDES MEXICO CITY AND ITS SUBURBS WITH FREE HEALTH CARE SERVICES AND HEALTH EDUCATION IN ORDER TO CHANGE THE HABITS OF FUTURE GENERATIONS. How does the Department of Health go What is the situation regarding health about promoting comprehensive health research in the capital? Mexico City is where most research into in Mexico City? The Department of Health works at two levels. The first of these is based on the Health Centers: primary care, visits to the doctor and treatment. The second level is hospitalization. There are almost 50 Health Centers in the city, as well as specialized clinics, such as Pascua Dermatology, the HIV-AIDS clinic, and those attending to prisons (covering 42,000 adult prisoners and 3,000 juveniles). We currently have a total of 28 hospitals, plus three near completion. Soon there will be 31 hospitals in the Federal District Department of Health Hospitals Network.
How does the capital city’s government care for citizens who don’t have social security? In Mexico City, there is a pro bono law which ensures that anyone living here who doesn’t receive social security benefits can get free medical check-ups, medicines, analysis, scans, hospitalization and surgery, all without any cost. Every year we attend to between six and seven million people. However, the backbone of the city government’s health program is preventive action. Healthy people stay healthy and sick people are detected rapidly.
What measures are being taken to resolve the huge obesity problem in the city?
Obesity is the foremost health problem in Mexico City. It leads to diabetes, hypertension and the so-called metabolic syndrome. If we don’t take systematic action now, health services risk collapse. Chronic degenerative illnesses are a world-wide phenomenon. The key to prevention is education, and this is the arena we have been fighting in. We will become the first body in the federation to make health education obligatory from kindergarten to upper secondary school.
health care and medicine takes place in the country. Home to the National Institutes of Health, and the research centers at the National Autonomous University of Mexico (UNAM), the National Polytechnic Institute (IPN) and the Metropolitan Autonomous University (UAM), the most important education institutions are found in the city, and they are carrying out intensive scientific work. Now, there is also the Federal District Science and Technology Institute (ICyTDF), set up by the current city government. The ICyTDF is undertaking excellent work. With the A-H1N1 epidemic a lot of research was done and two further laboratories have been established, one at the Reasearch and Advanced Studies Center (CINVESTAV) and one at the Autonomous University of Mexico City, while a third is to be set up by the Federal District Department of Health in the Ajusco Medio General Hospital.
Since you mention the influenza, how well are you equipped to deal with a public health emergency?
The epidemic put our health systems to the test, and the Department of Health prevailed. We are continually improving our tools, preventive programs, and the strategic actions we utilize in the case of a crisis.
MEXICO CITY IS WHERE MOST RESEARCH INTO HEALTH TAKES PLACE IN THE COUNTRY.
“Every year we attend to between six and seven
million people.” What policies in the field of health care allow Mexico City to be compared with other noteworthy cities worldwide? Our progressive laws, for one. Legal termination of pregnancy, for example, is not allowed in any other city in the country. We’re also at the forefront in questions such as gender equality and the protection of women. Federal law does not allow euthanasia, but local government has managed to pass a law in Mexico City for those in the terminal phase of an illness. Then there is the 100% smoke-free law, which won us the Bloomberg Prize in recognition of the most important strategy of protection for the health of non-smokers in the world. Recently we were also awarded the National Prize for Innovation in Health Quality for the Angel Program, which has seen around 20,000 capital city residents receive free medical attention and medicines at the 276 consultation points set up in the poorest areas. Finally, we are the only place to offer bariatric surgery to people suffering from morbid obesity, with weights in excess of 130 kilos (287 pounds). Fifty people have undergone this surgical operation, which normally costs US$15,000, but which we are offering for free at the Rubén Leñero Hospital.
25
UNIVERSAL HEALTH After the Second World War, state-sponsored insurance began to appear in more and more countries in response to the urgent needs of the post-war world. Since then insurance and medical coverage has continued to develop and evolve and the Constitution of the World Health Organization states that one of the fundamental human rights is access to the highest standards of health care.
26 C
OMPREHENSIVE HEALTH CARE IS INCREASINGLY a possibility in Mexico’s capital where initiatives have brought care to more segments of the population. The 1948 Universal Declaration of Human Rights guarantees the right to a standard of living, health and welfare for all people and includes rights to security in the event of unemployment, sickness, disability, death of a spouse, and old age. Mexico City’s government has renewed its commitment to realizing that guarantee and has seen very positive results with several projects aimed at the population who did not previously have access to private health or social security. The history of the health system in Mexico has been marked by the development of the institutions aimed toward providing for these needs. During the post-Revolutionary period the Department of Health and the Ministry of Welfare both came into being. These were later merged into the existing Federal Department of Health and Welfare. In 1943, the Mexican Social Security Institute (IMSS) was established to better protect workers and their families. At about the same time, the first National Institutes of Health, the Children’s Hospital of Mexico and the National Institute of Nutrition, were also established. In 1960, the State Employees Institute of Security and Social Services (ISSSTE) first offered services to 487,742 beneficiaries and the institute’s role has continued to evolve and grow since then. Still an important segment of the population was left unprotected. Those lacking steady jobs or relying on very scarce financial resources were forced to pay out of pocket for medical services. As a result, this segment of the population suffered from poorer health in general. To bridge the gap, the Seguro Popular, a universal coverage policy, was established in 2003 to focus on the treatment of all citizens. Promoting awareness of the rights of all beneficiaries is among the key aims of the program as is the delivery of preventive health care to more than 10 million people. Internationally, one of the challenges for all health systems according to the World Health Organization is to continue ensuring that people with fewer economic resources can receive quality medical care irrespective of their ability to pay. Worldwide more than 100 million people lose their livelihoods
each year as a result of the expense of medical or health services. In Mexico City the health system of the government of the Federal District aims to recognize the right to health protection and to maintain a gratuitous, universal and integral spirit in the delivery of health care. Part of meeting that challenge involved implementing the Health Care and Medications Delivery Program as part of the Ángel program (a network of health care assistance initiatives). It focuses on those living in areas classified as highly marginalized. Currently 2.6 million people are registered with the program. The 2009 budget was US$415 million. Ángel also includes 13 other programs like school lunch assistance, services to people with disabilities and treatment for alcohol and drug addictions. The network aims to provide access to education and health services for low-income people, including the Federal District’s numerous indigenous communities. To deliver the service to those who truly need it, the city government provided 8 mobile medical units that, last year, delivered 57,781 consultations, and 5,934 specialty consultations. One of the most important trends in the global discussion of health care delivery is in the better quality of and access to health coverage for women. The World Health Organization notes that special attention needs to be payed in this area, and Mexico City has far exceeded its own goals in this respect. Since 2009 the city has performed more than 391,000 mammograms, well above the 300,000 estimated for the same period. In cases where breast cancer was positively diagnosed (129 cases), patients were referred for treatment coordinated by Inmujeres, the Women’s Health Institute operated by the Mexico City Department of Health. The Comprehensive Care Program for Older Adults offers care to another of Mexico City’s growing population: the elderly. The program extends a variety of health related services to people both inside and outside of long-term residential care and it’s open to anyone over 60 years of age who is not covered by the federally administered social security program. The 2008 World Health Report issued by the World Health Organization announced that the population of the world is now living longer and healthier than it was thirty years ago. The health economy, having grown by leaps and bounds, increased its contribution to global GDP from 8% to almost 9% between 2000 and 2005. This growth in overall investment signals an international trend towards greater private sector financial participation in the health sector, as is now the case in both the US and Canada. Mexico City is home to most of the major research centers in the country. Dr. Enrique Ruelas Baraja, current Secretary of the General Health Council of the Department of Health of the federal government says: “In academic fields there is a natural inclination to share, discuss issues, and to present papers. The doctor is an academic by definition.” The constant flow of information between public and private hospitals is due to the fact that most doctors work in both sectors. This generates a highly dynamic
“Since 2009, the city has performed more than 391,000 mammograms, well above the 300,000 estimated for the same period.”
25
THE HEALTH CARE AND MEDICATIONS DELIVERY PROGRAM FOCUSES ON THOSE LIVING IN AREAS CLASSIFIED AS INDIGENOUS FAMILY- Portales Community Center
environment, further cooperation and a rich exchange of research results, the development and proliferation of new treatments and, above all, the possibility of strengthening initiatives that can lead to better public policy. Access to high-level medical care, specialized clinics and free or reduced cost medications fill out a culture of increasing availability of high quality care. Improving the quality of life for all the people of the capital remains the singular purpose of the city health care system.
HIGHLY MARGINALIZED.
CURRENTLY 2.6 MILLION PEOPLE ARE REGISTERED WITH THE PROGRAM. THE 2009 BUDGET WAS
US$415 MILLION.
Point of View
Private Sector
KLAUS BOKER Klaus Boker studied at the University of Hamburg and is the owner of Boker, SA de CV, the oldest hardware store in Mexico. A businessman active in numerous trusts and foundations, Boker is currently Chairman of the Board of Directors of ABC Hospital.
AS A PRIVATE ASSISTANCE INSTITUTION, THE ABC HOSPITAL REINVESTS PROFITS INTO THE IMPROVEMENT OF ITS FACILITIES AND EQUIPMENT. INSPIRED BY THE AMERICAN SYSTEM IN WHICH HOSPITALS ARE ALSO EDUCATIONAL INSTITUTIONS, IT IS ADMINISTERED BY A BOARD OF 18 MEMBERS.
“Southwards from the United States, Mexico is in in terms of health care.”
first place What are the benefits to the ABC Hospital in not having an owner and being administered by a board of directors? ABC Hospital is a private assistance institution. The board performs the role of
a board of directors as in a corporation, this means that the General Direction has all of the control functions.
The hospital was founded by the American and British communities in 1941. Today there is a body of between 250 and 300 associated members, and a board of 18 directors is elected: five Americans, or American descendents, five British, five Mexicans and three more of international origin. The terms for which the board members serve are staggered such that
not all the members are changed, begin or end simultaneously.
How does this administrative scheme result in a better service?
In the absence of profit sharing, nobody gets a penny. The directors are paid and hired, but the associated members do not receive any
HE ALTH remuneration and everything is reinvested into the enlargement of the facilities and new equipment. A large percentage goes toward welfare work and education.
How has the ABC been able to develop social services within the healthcare field?
The hospital has its own clinics that offer these services. They benefit more than 7,500 patients, provide nearly 18,000 consultations and perform over 400 surgeries annually. The clinic was founded following the 1985 earthquake with a grant from the British Government, hence its name, BRIMEX. The ABC Hospital also has a mobile clinic that visits the poor communities and municipalities around Santa Fe where people still live in poverty. At the same time, low-income neighborhoods are surveyed, house by house, to diagnose patterns of illness that have to be treated. If it’s not possible to serve them directly, patients are channeled to state institutions such as the General Hospital and the Social Security system.
In what ways is the ABC growing? The ABC Hospital doesn’t have access to capital markets, nor can it issue shares, which is how economic growth is achieved. But ABC is not interested in building hospitals throughout the country. We have campuses at Observatorio and Santa Fe, and we are adding to these two highly specialized clinical campuses. Next to the General Hospital of Santa Fe, for example, is the Center of Obstetrics, Gynecology and Pediatrics. And a Center for Neurosciences, Orthopedics and Rehabilitation is also being built. In Observatorio, we opened a Cancer Center just one year ago.
INTERVIEW
As for private health care, how does How do you ensure the quality of Mexico City compare with other large service and stay on top of personnel cities in Latin America? development and new technology? Southwards from the United States, it’s in first ABC Hospital has been a model of healthcare excellence over many decades. Many doctors are attracted to practicing medicine with us; young doctors find it incredibly encouraging to be part of a nonprofit institution that’s adhering to the highest medical standards. On the other hand, our administrative model allows us to reinvest a large percentage of the profits into new projects, equipment and training.
What are the specific strengths of the ABC? The ABC is a nonprofit teaching hospital whose ultimate goal is not economic. The ABC is the first hospital in Mexico City that is certified internationally by the Joint International Commission. This implies that administrative transparency is absolute, and that patient protocols are excellent.
Are there any systems for sharing information between hospitals?
ABC Hospital has an affiliation with the Methodist Hospital in Houston and with them there is an intensive exchange. There’s also the National Association of Private Hospitals in which information is exchanged among members.
Is there an institutional framework in Mexico City that ensures the quality of health care? There is the National Council of Health (Consejo de Salubridad Nacional) which certifies hospitals, but not all are certified. The ABC, of course, is.
place in terms of health care. Mexico is an attractive health destination to Latin American patients, for language, proximity and quality, and to other foreign patients also for its cost differentials. If you go to Social Security’s Siglo XXI Medical Center, they can offer care as fine as that which you’ll find in the private hospitals. The problem in both cases is one of access.
OUR ADMINISTRATIVE MODEL ALLOWS US TO REINVEST A LARGE PERCENTAGE OF THE PROFITS INTO NEW PROJECTS, EQUIPMENT AND TRAINING.
SMOKE-FREE PUBLIC SPACES Tobacco addiction is nothing new. Native Americans were using the plant as a powerful hallucinogen well before the arrival of Europeans to the Americas. Tobacco was even a valuable medium of exchange before eventually becoming a daily consumer good in the form of cigars and cigarettes. The 1990s, in Mexico City, were characterized by a cloud of smoke covering offices, bars, restaurants and night clubs.
30
T
HE HEALTH RISK CAUSED BY CIGARETTE SMOKE had reached alarming levels. In 2006, lung cancer killed more people, 6,000 deaths per year, than any other type of cancer in Mexico. A radical change began to seem increasingly necessary. For good. The impact of addictions on life in public spaces came to the center of attention in 2007 when the city government implemented a series of legislative projects aimed at reducing and preventing the consequences of tobacco consumption, alcohol and other drugs. The Mexico City measures paralleled those in other cities around the world. In England, for example, a 2007 law mandated that all indoor spaces be smoke-free. Similarly, by decree of the Mexico City government, in September 2008, all restaurants and bars became smoke-free places. The same decree has secured the air in all enclosed public spaces like office and school buildings. This has dramatically reduced exposure to cigarette smoke. Legislation, enthusiasm, research and patience converged to see this healthy measure enforced throughout the city. Mexico City opted also to provide residents the most basic tool: information. In 2008, the city began a massive campaign to educate the public about the harmful effects of cigarette consumption. Financing for the project came from the National Council Against Addictions, the InterAmerican Heart Foundation, CAEDRO and the World Lung Foundation, in addition to Mexico City’s government. The campaign included advertisments in the Public Transit System and began with promotion of the new law for the protection of the health of non-smokers. To make quick and substantial progress in implementing the new law in bars and restaurants of the city, brigades of healthcare workers from the 16 health jurisdictions aided in enforcement of the new measure. Strong objections that the measure would adversely affect bar and restaurant owners were disputed by experiences in countries such as Australia, where after implementing smoke-free laws, attendance in bars and restaurants actually increased by 5%. Non-smokers who had previously been discouraged by cigarette smoke actually began to show up more. The Bloomberg Philanthropies Foundation awarded the city government special recognition for having developed the techniques, programs and regulations to combat the risks of cigarette smoking to smokers and to non-smokers. In 2009, Mexico City’s contribution to the experience of the governments of the world was documented by the International Union Against Tuberculosis and Lung Disease. Currently, the Pan American Health Organization and the World Health Organization are documenting the implementation of the 100% smoke-free public spaces program and its corresponding regulations.
A TEAM OF EXPERTS HAVE DELIVERED MORE THAN 2,753 TALKS ABOUT THE CONSUMPTION OF TOBACCO AND THE BENEFITS OF QUITTING TO MORE THAN 54,784 PEOPLE.
16 Since 2008,
CAPRI RESTAURANT-
NICOTINE ADDICTION CLINICS
have offered about 6,000 smoking cessation consultations.
Mariana, 22, student: “It’s an excellent regulation because I’m not a smoker. It was really annoying whether you were hanging out in a club or at a restaurant. It was always unpleasant to have your clothes smell of cigarette smoke. I, myself, became a passive smoker, which I found unfair because it’s my personal decision not to smoke. I’ve noticed that the regulation has encouraged people who do smoke a lot, to somehow smoke less.”
ALCOHOL-FREE
DRIVING
nother substantial change occured in the A city’s streets and highways through a program aimed at preventing traffic accidents related to excessive alcohol consumption, the leading cause of death for people between 14 and 29 years of age, and the fourth leading cause of death in the country. Through the program, checkpoints to randomly monitor drivers for alcohol consumption were introduced. Those who have consumed alcohol are tested with a “breathalyzer.” Drivers with levels over the 0.40 milligrams per liter permitted by law are taken to a civil judge, who will impose a detention sentence of between 20 and 36 hours as well as a fine. The regulations also apply to drivers in the public transit system and to the police. The alcohol-free driving project has helped to reduce fatalities significantly. Between 2003 and 2004 deaths from car crashes decreased substantially, And while in 2004 deaths due to drunk driving were numbered at 1,371, by 2005 that number was reduced to 651.
The alcohol-free driving program in numbers: Between September 8, 2003 and February 7, 2010:
WORKING DAYS:
OFFENDERS CHARGED:
1,047 55,418 DRIVERS INTERVIEWED:
1,404,563 Between February and October of 2008 the program “Smoke-Free Buildings” was implemented. The City Department of Health established that, during this period, 260 public buildings would become 100% free of tobacco smoke.
BREATHALYZER TESTS
ADMINISTERED:
160 Under-age offenders:
CARS IMPOUNDED:
198,238 32,833
29
CREATING a Culture of Donation
In human organ transplantation, Mexico City is at the forefront in Latin America. A rising rate in donations.
In Mexico, unlike many other countries, it is normal for people to donate a kidney to an ill relative.
1,000
986
Yearly successful donations
800
678 600
2006
2007
2008
2009
There are two kinds of donors: (Percentage of donations in Mexico)
Living: An unusually high percentage of the national total, living donors translate into more succesful transplants.
75
25
In 2009, however,
In Mexico City,
of 4924 transplants performed, an important increase was seen in donations from deceased donors (%).
Living: 2,072
the percentage of people who agree to donate in the event of their death is very high. Accepted
Deceased: 42
58
Deceased: From donnors who suffered a traumatic injury or heart attack resulting in brain death.
Did not accept 20
2,852
80
The evolution of kidney transplant in Mexico City from 1963-2009 2,000 Living
1,805
Deceased
1,513
1,500 1,273
Transplants performed in Mexico's Social Security Hospitals (%)
590 500
40
All Others 0 3
490
280 35
87
250
19 63 19 65 19 67 19 69 19 71 19 73 19 75 19 77 19 79 19 81 19 83 19 85 19 87 19 89 19 91 19 93 19 95 19 97 19 99 20 01 20 03 20 05 20 07 20 09
60
1,000
Source: National Transplants Center 2009 (CENATRA).
HIV AND AIDS Prevention
Nowadays, there is some 26 millions latin americans living abroad. The migration corridor between mexico and the united states is the most important in the world (10 million people annually). This event causes the transit of many diseases, such as hiv and aids not only in migrants but in locals too. These diseases have become potentially dangerous, and that is the reason why mexico city’s government is working on their attention and treatment..
I
N MEXICO, THE FIRST CASES OF AIDS APPEARED IN 1983 More than 20 years ago, the number of infected people rises up to 38,400 persons only in Mexico City. This number represents the 17% of the total number of people infected in the country. The Department of Health of the Mexico City’s Government (SSDF) estimates that annually some 2,100 people are infected with HIV. HIV and AIDS are two main diseases that have taken lots of victims in the world. Because of that, governments have implemented policies in order to decrease the number of infected people in the cities. Mexico City’s Government has also worked on this issue and has created the “La Condesa” Clinic, a place specialized in the attention of HIV and AIDS infected people. This clinic attends the biggest number of HIV patients in the country, with more than 5,906 people, who receive medical treatment and other services for free. Whit these actions, Mexico City’s government can elevate the life expectancy up to 90%. In order to prevent HIV and AIDS, the clinic makes face to face approach, lectures, workshops and ludic activities to inform the community about the health and social consequences of HIV. Some of the actions are: basic information about STD and HIV, the correct use of condom, how to deal with stigma and discrimination, management of perception and risk, free condom distribution and promotion of early HIV diagnosis through quick testing. In 2010, Mexico City’s prevention program distributed more than 13 million condoms. Furthermore, Mexico City’s Health Department makes an estimated of 25,000 annual detections, the biggest number of tests in all the country. Also worried for the transmission of these diseases in prisons, the SSDF has a program, authorized by the Mexico City’s Human Rights Commission (CDHDF), for testing the convicts. So far, 85% have accepted the test. There is also a program for the protection of victims of sexual violence, where testing, prophylaxis treatment (syphilis, hepatitis b, c), and legal abortion services are provided. Recently, Mexico City’s Health Department, the Public Health’s National Institute and other institutions and NGO’s have implemented the Program for the Attention of Sexual Violence Victims in the México-Central America and Colombia-Ecuador borders in order to attend and prevent the transmission of diseases such as HIV and AIDS among migrants.
HEALTH PROGRAMS ď‚›AMANECE
In
pursuit of the Millennium Development Goals - signed by all countries in the world - the Carlos Slim Health Institute and the Mexico City Department of Health are joining forces to provide timely care to pregnant women and their newborn children. Amanece was created to meet this purpose and to provide attention throughout maternity, during childbirth and infancy, for children and mothers. The Carlos Slim Health Institute works to advance more equitable health conditions for women, families, and children. The Amanece program works with the Mexico City Department of Health towards meeting the millennium goals to reduce child mortality by two thirds and maternal mortality by 75% by 2015, from their 1990 levels. The program provides timely and comprehensive care and a preventive approach to pregnant women and their children from birth until they reach five years of age. Amanece also places special emphasis on the early detection of serious disabilities, such as blindness in newborns. Reinforcement strategies such as community participation and the training of professionals in areas like human development support local health systems at the same time placing care for the mother and the child in the hands of the community as a whole. In the Federal District, health authorities targeted the Iztapalapa borough, for its tremendous needs and young population, to embark on this ambitious program. Computers and medical equipment for eight hospitals in the city were donated by Telmex Foundation, to make 30,000 services available. These included ultrasounds, heart monitors, incubators, ventilators, table delivery care, operating room lighting, to mention only a few. As of the first semester of 2010, Amanece has trained 45 directors and health professionals in the local government to strengthen leadership and management in maternal and child issues. In addition, the Carlos Slim Health Institute awarded 51 scholarships for health care workers in contact with women and newborns to study for the Maternity and Child Health Virtual Diploma accredited by the National Politechnic Institute and other renowned institutions. Amanece is working for a solution to the problems of infant and maternal mortality in Mexico, offering mothers and children the opportunity of a better tomorrow.
ď‚›THE HEALTH OBSERVATORY PROGRAM OF THE CARLOS SLIM HEALTH INSTITUTE
T
he Health Observatory, developed by the Carlos Slim Health Institute in collaboration with the Mexican Health Foundation (Funsalud), is a network that generates and disseminates comparative data and statistics for Mexico and other countries in Latin America and the Caribbean. Health conditions and the performance of the public health systems are both carefully examined. The Observatory regularly gathers experts from countries across the region to identify and address public health issues for each nation. Though the numbers will vary from year to year, as of 2010, the Observatory network consists of 244 researchers from 67 institutions in 21 countries. This international network is very helpful to identify trends and pursue common solutions. National maps have been developed to provide significant information on priority health problems and the compiled information is available through the Atlas Health Systems, through which the Observatory has also developed six regional reports. These enable theoretical analysis and recommendations to national decision makers in the health sector. Beyond analysis of the region as a whole, the Observatory also allows researchers to examine conditions in specific countries. There are four national chapters: Colombia, Costa Rica, Dominican Republic and Mexico, so far. Researchers are being trained in the design of tools and methods for measuring health conditions, and the response capacity of the organized society to meet their medical needs. Technical reports describing the magnitude and distribution of risks and health damage in the region are also among the systems strengths. In Mexico City, 38 researchers and academics have been trained through the program.
HE ALTH
Point of View
INTERVIEW
Civil Society
DR. MERCEDES JUAN LÓPEZ Dr. Mercedes Juan López is former Undersecretary of Health and former Federal Deputy Commissioner of the Health Operation for the Federal Commission for Protection Against Health Risks (Cofepris). She currently heads the Mexican Health Foundation.
THE MEXICAN HEALTH FOUNDATION HAS SET ITSELF THE PRIORITY OF ENSURING THAT BY THE END OF 2010 THERE BE MEDICAL COVERAGE FOR ALL RESIDENTS OF THE CAPITAL. What philosophy guides the Mexican Health Foundation? The Foundation has been a private institution in community service for the past 25 years. We’re a civil society organization with a scientific and technological profile, composed of business people who are interested in health and are able to provide financial resources for research, especially for the development of public health policies. An example of someone possessing all of these attributes is Dr. Guillermo Soberón, First Executive President of the Foundation, and former Secretary of Health, who’s made major achievements in public health policies. Our central task is to generate information and to form critical, purposeful and independent opinions about health problems facing the Mexican people.
AN ACHIEVEMENT OF THE FOUNDATION HAS BEEN THE PROMOTION OF RESEARCH IN GENOMIC MEDICINE.
working
“We’re with the Department of Health to achieve universal coverage in health services.” What have been The Foundation’s main contributions to the Mexican health system?
Among the most important is the Seguro Popular, a governement sponsored universal insurance program. It was devised by a group of researchers who worked for years in the economics and health care fields. They created a system of health protection for people in Mexico City who can not rely on the federally administered Social Security system. One of the most important figures in that group was Dr. Julio Frenk, who was appointed Secretary of Health by the then President Vicente Fox. Prior to Seguro Popular, only people with salaried jobs had access to public insurance. Today any citizen is qualified. Since implementing the Seguro Popular, the health budget has increased fivefold and that has translated into better facilities, equipment and infrastructure. Another achievement of the Foundation has been the promotion of research in genomic medicine. In 2004, a consortium composed of the Foundation, the National Autonomous University of Mexico (UNAM), the Department of Health and the National Council of Science and Technology (CONACyT) was formed specifically to address the issue. Only recently the National Institute of Genomic Medicine was opened as a result of the consortium’s
work. Also in conjunction with CONACyT, the Foundation is working to create a network on Obesity and Metabolic Syndrome to strengthen communication and the work being done by the scientific and technological community in this area of growing concern.
Is Mexico City privileged in the Latin American region for its health care coverage and systems?
You could say so. It is true that health systems are overcrowded because the demand is very high. Inhabitants of the city have the advantage that in addition to the services of their own Federal Department of Health are the rest of the federal facilities and hospitals, also those of the Social Security system.
What are the main challenges facing the Foundation?
In response to a call from the President of the Republic, today we’re working with the Department of Health to achieve universal coverage in health services. There are still people without it, making it a priority for us and the government that by the end of this year there is universal coverage. We’re also engaged in the issue of improving the competitiveness of the Mexican health system.
EMERGENCY RESPONSE CAPACIT Y Responding to emergency is one of the preeminent responsibilities of the modern city. they are called upon in times of natural or man-made disaster to protect citizens and their property, and to minimize the impact of the disaster itself. a city’s capacity to respond to emergencies is continually being challenged.
T 36
HIS CONCERN TO RESPOND TO UNEXPECTED EVENTS goes back to the very origins of the city itself, the first of which were established to protect inhabitants from the continual threat of invasion among other very good reasons for cohabitating. Crowding into a confined protective space, though, immediately increased the risk of uncontrollable fires that demanded a coordinated response lest the entire city be consumed. Records of private for-profit fire-fighting companies include written testimony of one of the earliest emergency services, the Vigiles Urbani, a police and fire-fighting force in the Roman Empire, inspired itself in the legendary fire brigade of Alexandria in Egypt. Security concerns run by private and public police forces are as varied as the entire history of cities, but the first ambulance service is not recorded until a Spanish variant was established in 1487. Today, of course, in many countries one may simply pick up the phone and dial a number to call for help, but this type of service was only originated in 1937 in London.
“Epidemics and natural disasters are the two clear threats Mexico City faces.” -DR. ARMANDO AHUED,
Secretary of Health of Mexico City.
Responding to emergencies in a prompt and effective manner represents the difference between saving thousands of lives or losing them. Mexico City, like any large metropolis, must be prepared at all times for a number of emergency situations. Specialized agencies have developed throughout the history of the city and exist today as a result of the citizens having learned from each subsequent situation how to better prepare themselves for the inevitable next emergency. The Federal District Red Cross and The Heroic Federal District Fire Corp were both founded in the late nineteenth century. The International Red Cross and Red Crescent is often confused with a single corporation, but it is actually made up of several organizations, each legally independent of the others but united by a set of basic principles and
goals. Three governing bodies administer their activities in Mexico: the International Committee of the Red Cross, the International Federation Societies of the Red Cross and Red Crescent. The original movement was organized by Swiss businessman and activist Henry Durant in 1863. The Mexican Red Cross was officially recognized in 1910 after it was founded by Ma. Luz González Cosío de López, though presidential decree soon made it officially part of the Mexican Army. The first brigade with the emblem of the red cross on white background left from Mexico City bound for Monterrey in response to a flood, and soon after the newly created ambulance services were called upon for relief during the years of the Mexican Revolution. In 1919, the Mexican Red Cross was recognized by the International Red Cross, and its 1923 charter gave it full independence from both the army and the Mexican government. Today, under the emblems of the Cross, the Crescent and the newly established Red Diamond, 97 million people volunteer worldwide. In Mexico City, the Red Cross operates with 225 doctors, nurses and health specialists, 188 support staff, 85 emergency medical technicians, and 121 youth volunteers. It has grown consistently since its initial charter, and in 1968 opened its first hospital in the capital city. Today, for prompt response to emergencies, rescue services have been specialized in urban, water, and mountain rescue units. In Mexico City, the organization works with the government and many NGOs to provide rapid response to all emergency situations.
THE FEDERAL DISTRICT
HEROIC FIRE DEPARTMENT T
he Federal District Heroic Fire Department has 16 stations corresponding to the boroughs of the district and is among the best organized fire departments in Latin America. In 2007, Mexico City devoted a budget of US$5.5 million to the fire department and an additional US$12.1 million to the Civil Protection department. “Epidemics and natural disasters are the two clear threats Mexico City faces,” says Dr. Armando Ahued, Secretary of Health of Mexico City. He continues, “The epidemic of H1N1 influenza tested our reactions and we overcame it. We actually waited nine years for the avian influenza to arrive. No country can be fully prepared for an epidemic of this scale. We do have the best preventive measures in place, but there will be cases where we need to offer a continuity plan. We’re also aware that at any moment an earthquake can occur. It’s a seismic zone and we need to be prepared. There’s an established culture of civil protection, but it is important to strengthen it, and it’s important that everyone knows what to do if the earth trembles. People need to have safe places to go, documents, battery powered lamps and radios, water reserves, and such things ready.”
CIVIL PROTECTION
I
nformation is one of the most important tools when it comes to being prepared to respond to emergencies. The General Coordinator of the Office of Government, Public Safety and Civil Protection of Mexico City, Carlos Sainz Luna, stresses the importance of citizen participation. “Programs and plans should be made jointly. No government of any size and even with unlimited resources can put all of its citizens out of danger from every calamity. It’s simply not possible.” This is why citizen participation is crucial. The Department of Civil Protection of the Federal District defines itself as the manager of emergency services and all of the individual organizations responsible for protecting residents from disasters, of natural or human origin. The department acts to identify, analyze and manage risks that may result in harm to the population. They also plan and operate in high-risk areas, implement environmental measures to preserve natural areas, verify the enforcement of construction standards, and monitor public and private buildings that have internal programs for civil protection. When people know what steps to take in the event of a disaster, the cost in human lives is dramatically reduced. In order to keep the public well informed, the Department of Civil Protection maintains a website to provide continual advice and news. After the health warning was issued in the Mexican capital with the outbreak of H1N1 influenza, all the information needed was posted there for any citizen to consult. According to Luna, the country has made significant strides in the field of Civil Protection. In particular the operation of an early warning earthquake alarm system, a Mexican invention with international certification that has operated in Mexico City since 1991. The system issues a public alarm when an earthquake of a magnitude greater than 6.6 degrees is approaching. The alarm allows the public about 60 seconds to reach safety before the quake impacts the city. This system works based on information from the Seismic Registry and Instrumentation center which operates 12 sensors always on alert along the coast of the state of Guerrero. A radio sends continual information to the Federal District to allow for early action. The department’s website also allows citizens to access the permanent monitoring of the Popocatépetl volcano with images from three stations: Altzomoni, Tlamacas, and Tianguismanalco. And a directory provides easy access to emergency services phone numbers in the city. The work of the Department of Civil Protection is constant and its mission is to continually reduce the number of emergencies based on preventive action. In 2009, the budget for Civil Protection was US$10.5 million. Important progress has been achieved in just one year. During 2008, 1,628 fires were reported, while in 2009 the number actually dropped to 993. Incidents of flooding declined by almost 50%, from 1,131 in 2008 to 519 in 2009.
IN ORDER TO KEEP THE PUBLIC INFORMED, THE DEPARTMENT OF CIVIL PROTECTION MAINTAINS A WEBSITE TO PROVIDE CONTINUAL ADVICE AND NEWS.
To ensure that adequate information and citizen involvement continues to inform and improve the department, the city also maintains a Civil Protection Council in which private enterprise plays an active role. In a disaster, the loss of human lives and the paralysis of the city creates a political and economic catastrophe at the very center of the country. This can quickly result in economic stagnation with national implications. To address this important issue, Mexico City is prepared to react in worst case scenarios. The 1985 earthquake and the outbreak of the H1N1 virus both showed very positive results in spite of overwhelming circumstances. Emergency services always strive to achieve efficiency sufficient to better respond and overcome any incapacities they may confront in difficult situations.
“Society has progressed, becoming more attentive and participating, not only in cases of emergency, but also in terms of conscience. Better behavior leads to lower risks for everyone.” THE TOPOS DE TLATELOLCO
RESCUE SQUAD I
n 1985, the Federal District was hit by an earthquake of 8.1 degrees on the Richter scale which in just over two minutes killed approximately 10,000 people. Immediately following the quake, an informal rescue team was formed. Today it is known as the Topos de Tlatelolco Rescue Squad. Specializing in major catastrophes, the team’s international reputation has grown to the extent that, today, it is a world leader when it comes to natural disasters, collapses from human error or any other situation where the rescue of people in confined, dangerous spaces is necessary. “Los topos,” as they are known in Mexico City, are at the vanguard in providing these services in even the remotest parts of the world. Recently, they have participated in rescue operations after the Pacific tsunami in 2004 and the recent disaster in Haiti.
35
HORIZON S U R PA S S ED
Biometrópolis
Mexico City’s government
is highly committed to transforming the city into a knowledge-based economy, and Campus Biometrópolis is one of the projects most representative of that commitment. Through cutting-edge design, and close ties to the Mexico City-South Health Complex, the campus will provide best-in-class health services for all of Latin America.
T
38
he commission for the masterplan for Campus Biometrópolis was awarded to the internationally prestigious architecture firm Foster+Partners. Well known for sustainable developments built to LEED (Leadership in Energy & Environmental Design) standards, Foster+Partners designed this campus to be Latin America’s most environmentally and ecologically sustainable development. Among the experts being relied upon to realize the project is no less than Sam Pitroda, former President of the Knowledge Commission of India, and Elis Rubinstein, President of the New York Academy of Sciences. Betting on high tech knowledge-based projects, the government of the city, through Biometrópolis, is encouraging cooperation between the pub-
HEALTH
lic, private and academic sectors. The project merges technology and research, to create an innovation-based micro-economy that includes residential, cultural and commercial areas along with those for health and research fields. Biometrópolis will offer world-class service facilities for medical development along with engineering and biotechnology. The campus will attract national and international pharmaceutical laboratories, hospitals, medical and educational institutions, among others. It seeks to create a lively and diverse community with the participation of residents, those who come to the campus to work and visitors. Its extensive mixed uses facilities will contribute to this goal.
INTERVIEW
RICARDO MATEU Partner of Foster + Partners
CAMPUS BIOMETRÓPOLIS IS THE FIRST PROJECT THAT RENOWNED ARCHITECTURE FIRM FOSTER + PARTNERS HAS DEVELOPED IN MEXICO. BIOMETRÓPOLIS IS TO BE A CENTER OF MEDICAL EXCELLENCE, BUT ALSO A COLLABORATIVE COMMUNITY, WHERE SPACES FOR LIVING, WORKING AND PLAYING WILL BE IN BALANCE.
“Our design for Campus Biometrópolis draws from Mexican architecture. It re-interpretates the patio, and integrates a thriving street life with open courtyards and public plazas.”
inspiration
How was Biometrópolis conceived architecturally? The project was conceived as an environmentally sensitive response to the site, which would preserve the local ecology and the area’s geological features. At the same time, the developed part of the site will have the character of a thriving academic campus, with direct links to the adjacent academic institutions and the wider medical cluster to the south of the metropolitan area of Mexico City. The project’s primary aim is to create a center of medical excellence, focused on a new hospital. The design approach draws inspiration from Mexican architecture and urban planning: the re-interpretation of the patio and the integration of a thriving street life with open courtyards and public plazas is a key aspect of the project.
What kind of challenges does Foster + Partners face with a project of this nature?
The arrangement of buildings navigates the Pedregal lava fields, with the network of subterranean lava tubes and caves, sections of which will be accessible to encourage scientific investigation. This presented a specific challenge, as the tough volcanic rock on the site makes excavation difficult. At the same time, it provides a much firmer base and has much more favorable seismic conditions than other parts of the city, such as Paseo de la Reforma or the Historic Center.
39
What are the values that guide the project, aesthetically, functionally and conceptually? If Biometrópolis is to be a temple of knowledge, how has that shaped the architectural concept? The principal values are openness and flexibility. There must be a balance between the spaces for living, working and playing. Public space is an important part of creating a community, along with spaces that promote co-operation, integration and communication. The design features internal, semi-covered and external courtyard spaces and plazas, which promote the level of collaboration needed to address some of the most complex scientific research and medical problems.
What will Biometrópolis come to represent for the city? What will it do for the city? As well as establishing a center of medical excellence, the campus will function as a highly collaborative space, bringing significant employment opportunities for young Mexican healthcare professionals, as well as those working in auxiliary services. The project also heralds new thinking about transport:
it continues and expands initiatives such as Mexico City’s cycle share scheme, as well as encouraging people to adopt public transport with a Pumabus (internal free bus network) or Metrobus link to the nearby UNAM metro station.
The place where Biometrópolis is to be built is one of the few remaining green areas within the city. How will this be dealt with? At least half of the site will be maintained as green space - more than half of this will be made up of a nature reserve. The scarcity of water is a major issue within the metropolitan area. The net result of the development should be to augment the recharging of the aquifer, by assisting natural collection in green areas with water harvested from all landscaped and built areas, including the run-off from adjacent sites. Rainwater will be stored on site and re-injected into the aquifer. In addition, most built structures will have ‘green roofs’ for use as gardens, nurseries for the cultivation of medicinal plants, scientific study and water collection. We have worked closely with the Department of the Environment and the Department of Urban Development, and with local experts such as landscape architects Grupo de Diseño Urbano
to help achieve a balance between protecting a vital wilderness and enabling the protection of that environment through inward investment.
How has the experience of working in Mexico City been so far?
It’s an exciting place to be working. As well as being very welcoming, the culture and architectural traditions are fascinating. With every new project there are things to learn and this is an exciting process. We pride ourselves in understanding the genius loci of every location where we work and that knowledge is used to create a building or master plan that is unique to the place.
How has the city influenced the project?
The initial stages of the master plan involved an in-depth study of the culture and typology of Mexico City and the wider region. Working with local experts, this analysis was expanded to look at the detailed nature of existing street and building typology. The character of the city’s historic buildings and public spaces certainly influenced our approach, in particular the many examples of patios as well as the street life of the ‘mercado,’ which are highly prevalent in Mexican architecture.
HORIZON S U R PA S S ED
Biometrópolis
WHAT PURPOSES DOES BIOMETRÓPOLIS SERVE?
BRINGING TOGETHER ALL ASPECTS OF HEALTH,
it will be supported by academical members from UNAM, medical experts from the National Institutes of Health and the participation of the pharmaceutical and bio-tech industries.
153,600 offices
Community Health Sciences, Research 49% 51% + Development
120,000 hospitals
Area, in square meters
20,520 illness control & prevention 27,600 scientific research
46,800 education
36,000 clinical studies
36,000 post-clinical studies
Strategic Water Use on Campus Green roofs
Reflecting pool
100% of water is recycled
Water Treatment Plant*
Controlled re-introduction of rain water to groundwater 24 hour storage tank for used water system
*For toilets watering the lawn
60,000 bio-tech companies
Normal soil filtration is unaffected by the development
The project aims for infiltration into the subsoil of 75% more than a traditional building of the same scope.
A TRUE MIXED-USE
COMMUNITY: CAMPUS BIOMETRÓPOLIS
WILL CREATE MORE THAN
GREEN AREAS 87 tons of CO2 HAVE THE CAPACITY TO ELIMINATE
EMISSIONS, AND TO GENERATE 185 TONS OF CLEAN OXYGEN EACH YEAR.
15,000 HIGHLY SPECIALIZED JOBS.
41
Mexico City, June 2010
DR . MANUEL H. R UIZ D E C H Ă V EZ President of the National Academy of Medicine of Mexico
MEXICO CITY : A Space for Knowledge, Opportunity and Certainty 42
M
exico City is a universe inhabited by many other universes. As is the case with other large cities in the world, Mexico City responds primarily to demands that are inherent in pretty much any contemporary society: the search for alternatives and the un-ending drive for access to better living conditions. The phenomenon of migration is entwined with the history of this city, which has always had its door open to receiving people from other cultures. Economical factors, of course, play a crucial role in understanding this dinamic social mobility, but it is also attributable to the fact that this city is the most important political, social and cultural center of the country. I have experienced this metropolis, since I was a teenager, with all of its intense activity, growth and changes, its incessant transformation and, at times, its permanence. I have seen it from one pole to the other, in the changing of schools, in the pursuit of friendships, new discoveries, wonders and in the vibrancy of its people. Since I decided to study medicine and to devote myself to the task of pursuing the welfare of others, I followed good advice and I presumed -not without some timidity- to seek
HE ALTH
ESSAY
the adventure of guidance from those who know much more than one alone could. I had the good fortune, one which I still celebrate, to meet a major figure in medicine, Dr. Ignacio Chávez: “The Founder of Institutions,” as he was rightly addressed by Nobel Laureate and Poet, Octavio Paz. He will remain a landmark in the history of modern Mexico. Under his direction, but with fresh eyes, I realized the enormous wealth housed in our city, the nation’s capital. I discovered an inexhaustible center of knowledege in the fields of medicine and the health sciences. Over time, the contributions of other great instructors have grown and become stronger, inspiring and mentoring restless and adventurous young people. Today, Mexico City is home to the most important National Institutes of Health, centers of specialized medicine and research. A majority of all prestigious centers for research in the country are here, among them the National Polytechnic Institute (IPN) and the National Autonomous University of Mexico (UNAM), recently awarded the Prince of Asturias Prize in recognition of its contributions to sciences in the country. Likewise, private associations, corporations, schools DR. MANUEL H. RUIZ DE CHÁVEZ IS A PHYSICIAN WHO GRADUATED FROM THE and cultural centers have a home in the NATIONAL AUTONOMOUS UNIVERSITY OF city. Without detriment to the many othMEXICO. HE RECEIVED HIS MASTERS DEGREE FROM THE UNIVERSITY OF LONDON. ers not mentioned, the National Academy HAVING HELD NUMEROUS POSITIONS IN PUBLIC SERVICE AND THE ACADEMIC of Medicine of Mexico, with nearly a cenWORLD, INCLUDING THE CHAIRMANSHIP OF BOTH THE MEXICAN HEALTH FOUNtury of uninterrupted academic achieveDATION AND THE MEXICAN FOUNDATION FOR INNOVATION AND TRANSFER OF ment, the National Academy of Sciences, TECHNOLOGY, RUIZ DE CHÁVEZ IS CURRENTLY PRESIDENT OF THE MEXICAN the National College, and the College of ACADEMY OF MEDICINE. Mexico, can also be found in the capital.
41
44
We boast the biggest decision-making capacity and the most modern infrastructure in terms of research and health care in the country. The city has the largest number of hospitals, clinics and social security centers. The Department of Health, which is the highest federal health authority in Mexico, is also to be found here. The private health sector, constituted by important players like Grupo Ángeles and Médica Sur, and important national and international insurance companies, are based in the capital. Being a unique center for knowledge and development, investing in the city is a phenomenal opportunity, it offers confidence and certainty. The most renowned scholars and researchers in the basic sciences, clinical professionals like surgeons and professors are present both in the context of institutional and public services, as they are in the private sphere. Still, Mexico City is much more: a milenary receptacle of history. In its neighborhoods and boroughs, in its colonial buildings, museums, and public spaces for assembly and recreation, we can experience that special energy that distinguishes and incites those who inhabit the city and those who visit. Just to mention a few of the most beautiful places, the old town of Tlalpan with its precious plaza and its cultural inheritance, its cafes and restaurants, combines unparalleled colonial splendour with the canons of modern urbanism, as do Coyoacán and San Ángel. In the north of the city we can look out on traditional neighborhoods that have retained their own particular atmosphere such as those in Azcapozalco, Clavería or Lindavista. It is impossible, then, to omit the park at Chapultepec with its castle, the Paseo de la Reforma, or the newer developments in Santa Fe or Interlomas. But beyond all of the above, it is the Historic Center that takes the first
HE ALTH
“ For the years to come, drawing on the traditions of our native people and our cultural greatness will present the biggest of all opportunities.�
ESSAY
prize. Seat of our native settlers, whose secrets present unfathomable marvels and where new archaeological discoveries are presented to us even today. This city has a surprising ability to grow spectacularly, to extend and renew itself everyday, and yet to always be the same. Within this megalopolis, inspiration is germinated. For those who want to live near knowledge, seize opportunities in a growing economy and an ever increasing modernization, and witness the rapid changes offered by medical science innovations and advances in health care, the city offers everything. The windows to generate ideas are opened widely, but they also require considerable investments. There is indeed human talent with sufficient preparation, vision, ability and creativity to advance the sciences, arts and culture. Likewise, in the areas of services, there are important niches of opportunity to provide health care, to enhance the development of telecommunications and transportation, to create new businesses with a long term sustainable vision and to discover new competitive markets. For the years to come, drawing on the traditions of our native people and our cultural greatness, recreating it and making it known to the world will present the biggest of all opportunities. Mexico City is a living space, a generator of life.
43
free Seguro Popular,
Medical services of the IMSS and ISSSTE are to workers of affiliated companies and their immediate families. Those who fall outside this coverage may now apply for a government-sponsored insurance program.
431 years WITH
7,000
UNDERGRADUATE STUDENTS AND
9,000
GRADUATE STUDENTS,
THE UNAM IS THE ONLY SCHOOL WITH MORE MEDICAL GRADUATE STUDENTS THAN UNDERGRADS . DR. ENRIQUE GRAUE, Director of the Faculty of Medicine, UNAM.
THE FACULTY OF MEDICINE AT THE UNAM IS 431 YEARS OLD AND IS THE LARGEST MEDICAL SCHOOL IN LATIN AMERICA .
“
Southwards from the United States, Mexico is in first place in terms of health care.
”
Mexico is an attractive medical tourism destination for its excellent human resources, outstanding care and cost differentials. KLAUS BOKER, President of the Board of the ABC Medical Group.
HE ALTH
CONCLUSION
The National Institutes of Health offer medical care, scientific research and advanced training for medical specialists - a model of Mexican medical excellence.
MEXICO CITY IS ONE OF THE MOST ADVANCED IN THE WORLD IN THE FIELD OF BIOETHICS. IN 2007, THE CITY PASSED THE LEGAL INTERRUPTION OF PREGNANCY LAW AND IN 2008 THE
advance directive law.
HEALTH CARE COVERAGE IS ALMOST
100% IN MEXICO CITY.
best researchers
Young doctors
FROM ALL OVER THE WORLD, ESPECIALLY THOSE FROM CENTRAL AND SOUTH AMERICA , COME TO MEXICO CITY TO STUDY SPECIALIZED MEDICINE.
All public spaces in Mexico City are
smoke-free. According to the National Consortium of Science and Technology (CONACyT), Mexico’s National Institutes of Health have the best researchers in biomedicine in the country, if not in the entire region. In all of the areas of science where Mexico conducts research, medical science is the most successful.
City
A representation of the prophesied sight that led to the founding of Tenochtitlán based, on the Mendocino Codex.
FACTS
The ancient Mexica people believed that the shape of the lakes of the ancient Valley of Mexico corresponded to patterns on the moon.
After wandering for many generations,
the Aztecs
encountered a Tenuchtli, a prickly pear cactus, and recognized it as the fulfillment of an ancient prophesy that here they were to found their city. One hypothesis, among many, suggests that the word “Mexico” means “Spring of Origination,” for the city of the Mexica people, was founded atop a lake, one of many that, with the surrounding mountains, dominated the landscape of the Valley of Mexico. After the conquest of the Spanish, the city was to serve for 300 years as the capital of New Spain. In 1824, just a few years after the struggle for independence from Spain, the city was designated as the official headquarters of the new Federation of Mexican States and the Federal District surrounding the city was demarcated.
16 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.
BOROUGHS
MAKE UP THE FEDERAL DISTRICT
Álvaro Obregón Azcapotzalco Benito Juárez Coyoacán Cuajimalpa Cuauhtémoc Gustavo A. Madero Iztacalco Iztapalapa Magdalena Contreras Miguel Hidalgo Milpa Alta Tláhuac Tlalpan Venustiano Carranza Xochimilco
Historic Center
30,371
Otomí
12,460
Mixteca
12,337
Zapoteca
9,944
Meztli: Moon Xictli: Navel or center Co: Place
THE BOROUGH CUAUHTÉMOC IS THE SITE OF THE COLONIAL AND HISTORIC CENTER OF THE CITY. THE MOST IMPORTANT REMNANTS OF THE PRE-HISPANIC CIVILIZATION TENOCHTITLÁN THAT WAS ESTABLISHED IN
ARE HERE.
IN THE FEDERAL DISTRICT
Number of inhabitants who speak indigenous languages
Miguel Hidalgo
ANOTHER HYPOTHETICAL EXPLANATION OF THE ORIGIN FOR THE WORD “MEXICO” IS THAT THE WORD DERIVES FROM THE FOLLOWING:
1325
The Most widely spoken INDIGENOUS LANGUAGES Náhuatl
The navel of the moon
Cuajimalpa
1,485
SQUARE KILOMETERS At 0.1% of the total Mexican territory, the Federal District is the smallest federal entity in the Republic.
584 PUBLIC MEDICAL
UNITS
Álvaro Obregó
Magdalena Contreras
8
th
MEXICO CITY’S BENITO JUARÉZ
INTERNATIONAL AIRPORT
1 is the
st
IN LATIN AMERICA Azcapotzalco
Gustavo A. Madero
IN THE NUMBER OF FLIGHTS AND PASSENGERS. IT OFFERS CONNECTIONS TO EVERY MAJOR CITY WORLDWIDE.
In 2009, more than
348,000 FLIGHTS
ORIGINATED FROM OR ARRIVED AT MEXICO CITY’S AIRPORT. Venustiano Carranza
1
place in the
GLOBAL CITIES Index ranked by
GDP
st Place in
Latin America
MEXICO CITY ALSO RANKED IN THE FOLLOWING CATEGORIES:
9
th EXPERIENCE IN CULTURAL
11
th ENGAGEMENT IN POLITICAL
Cuauhtémoc
RELIGION OF THE CAPITAL’S INHABITANTS
91%
Iztacalco Benito Juárez
o ón
ROMAN
CATHOLIC
Iztapalapa
POPULATION DISTRIBUTION in the Federal District
Coyoacán
Tlalpan
Xochimilco
Tláhuac
0.3 % Rural
99.7% URBAN
Milpa Alta SOURCE: INEGI • Population and Housing Census of 2005. • Federal District Statistical Yearbook. Mexico. • Statistical Perspectives, Federal District. Mexico. • Municipal Geostatistical Framework. • 2nd Counting of Population and Housing, 2005. • Foreign Policy, AF Kearney and The Chicago Council on Global Affairs: The Global Cities Index 2010.
10,154
Schools in the Federal District
MEXICO CITY A KNOWLEDGE ECONOMY,
was printed in May 2011. Fonts used were the ITC Conduit Std and Emona and their entire families. The book was printed on matte art paper 150 g/m2 in its interior and lining and includes matte coated guards at 250 g/m2
CONTACT:
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