Changing the Delivery of Healthcare in Mexico-Time for Advanced Practice Nursing

Abstract

Mexico has a population of 131 million, and it has observed a dramatic rise in obesity over the past three decades, with only 23.5% of the adult population having a healthy body mass index (Barquera and Rivera 2020). The prevalence of obesity is 70%, and diabetes rates are at 40%, and the two most common causes of death are cardiovascular disease (20%) and diabetes (15%) accounting for 315,000 deaths in 2022 (Mendoza 2024). This shift, seen as a rapid epidemiological transition, reflects changes in behaviour, resulting in obesity. Lifestyle-related risk factors include a poor diet (high in saturated fat, salt and sugar), lack of physical activity, and increased alcohol consumption, which results in long-term health conditions such as hypercholesterolaemia, hypertension and diabetes. One study reported that, in the Mexican population, sugary drinks represent 10% of total daily energy intake and 70% of total daily sugar (Sánchez-Pimienta et al. 2016). A recent study noted increased BMI in children examining nonessential energy-dense food consumption, highlighting the need for health-related monitoring and education (Illescas-Zárate et al. 2024). Despite the knowledge of the growing issue with obesity and the continuing increase in diabetes and obesity in adults and children, policies have focused on food labelling and tax on sugary drinks, and some believe it is much too late, and the obesity rates support this (Barquera and White 2018). An expansion of the policy scope is needed.

Mexico has enshrined the right to health care within the constitution; however, the lack of funding and the way health care provision is organised has resulted in the need for focusing on treating lifestyle-related diseases instead of preventing their development in the first place. Solutions offered to address obesity and related health issues have not, to date, considered nurses. There is now significant evidence demonstrating the benefits of advanced practice nurses (APNs) across the globe (Htay and Whitehead 2021). APNs can undertake clinical assessments, order and interpret diagnostic tests, treat conditions (including prescribing medications where appropriate), provide patient education and advice, and undertake regular monitoring and follow-up. Given the incidence of chronic long-term conditions in Mexico, APNs are one viable solution to address healthcare needs.

The recently elected Mexican Government has stated its willingness to improve healthcare through a focus on primary care, prevention, integration of the healthcare system, and improved training for practitioners. This is partly driven by people arriving late to health services, where early detection and prevention may have improved outcomes. Their 10-point plan is aimed at the very young and the very old, with an increase in care delivered in people's homes, with incentives for families who care for their family member at home and vaccination programmes. The ‘Republica Sana’ will have a culture of prevention and promotion of healthy lifestyles, which is essential if behavioural lifestyle risk factors are to be addressed and managed. Although point 9 refers to the role of nurses in the provision of services at the primary care level, so far, no specific steps have been given to accomplish this goal.

Given the burden of obesity and related conditions on the population, the huge financial cost of long term chronic conditions, it would seem appropriate to seriously consider nurses and APNs to address the demands. Development and implementation of APNs across Mexico could detect and manage chronic conditions such as hypertension, raised lipids, obesity, diabetes and smoking. We would recommend that the APN role be developed and widely implemented as a matter of urgency with a regulatory and legislative framework drafted as soon as possible. Our previous work showed a keen appetite for APN development in Mexico (Nigenda et al. 2021; Lee et al. 2022). APNs are well placed to undertake this in primary care and within the Mexican context, there is an urgent need to address the obesity epidemic and related long-term health issues.