Rubiano García, in an interview with Colprensa, specifically referred to the need to strengthen the institute’s technical reports, which are essential for making decisions regarding public health in the country.
He also referred to the recommendations of the Panorama presented by the National Health Observatory (ONS), where the persistence of social inequality and barriers to access to health services are evident, which determine the factors that must be intervened to improve the conditions of Colombians.
Within the ONS study, maternal mortality, low birth weight, injuries from traffic accidents, obesity, COVID-19, mental health, and violence were also reported, confirming reports from other studies, but some indicates change. Account to improve interventions from a public health perspective.
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The General Director of the INS explained that they want these technical recommendations not only to reach decision makers, but that they are an important input for the management and intervention of public policy in favor of those most disadvantaged populations.
– What have you found about the development of the health system in the country since before the pandemic?
The report did not specifically analyze the health system. Some priority indicators were reviewed and, for example, issues such as mental health and maternal mortality revealed problems of access and quality of care. It also discusses how the focus on the pandemic can divert attention from other health issues that may not be addressed and will show their impact later.
– What are the biggest gaps or disparities in access to health services in the country?
When verifying specific reports of the most vulnerable populations in a country, two key aspects must be taken into account: first, that historical social inequalities persist among those most remote and vulnerable populations; Second, inadequate management of health care for these populations by various actors in the system.
Gaps are assessed as differential health outcomes in relation to socioeconomic indicators. In this sense, it has been recognized that the most vulnerable groups: the poor, the less educated, those living in rural areas, those with subsidized regime affiliations, or of certain ethnicities, have the worst outcomes.
In this report, these disparities were documented for maternal mortality, low birth weight, psychiatric disorders and homicide, although the ONS also accounts for other events such as preventable mortality and mandatory notification events, and other axes of inequality. As there is more evidence for social. class, armed conflict, access to health services.
Today there is talk of a mental health ‘epidemic’ which seems to be under-diagnosed. What have you found on this topic?
The report identifies an increase in the prevalence of the most frequent mental disorders from 2015 to 2019: depression, anxiety, bipolar affective disorder, schizophrenia. A scenario that could be worse in the context of the pandemic, despite the fact that such diagnoses were less reported during 2020, related to a lack of attention to problems other than Covid. According to patient organizations, care for depression is too limited to be used in crisis events such as suicide attempts, so diagnosis is late and time to care is insufficient.
In terms of mental health, the report also shows that only 20% of people with major depression had access to specialized counseling with their benefit plan administrator, or EAPB. This situation becomes more pronounced when there is no economic status and there are barriers to accessing services.
– Carolina Corcho, Minister of Health, talks about factors that affect health without being part of the health system, such as lack of drinking water, poor nutrition, etc. How will the sector work on these issues?
These are the so-called social determinants of health, which are understood to be causal factors, and require interdisciplinary work to improve the conditions in which people are born, live, work and die. Understanding the context in which impacts arise and bringing public policies into field application is essential.
The technical reports, which come from INS experts, have to reach the decision maker to identify the root cause of the difficulties in the area, whether due to aqueduct issues, environmental cleanliness, in short, due to various key aspects, but also the insurers. Sense of risk management by. The articulation of both the sector and health sector strategies, both at the national and departmental level, will be key to achieving results in the most disadvantaged populations in the national sector.
– What magnitude does the post-Covid situation require for the health system? Are they being looked after properly?
The pandemic points to new challenges for public health. One and a half million people who had covid presented with prolonged covid, an emerging health outcome that requires further development of evidence to understand.
The long term Covid name refers to the health consequences resulting from a Covid infection in cases reported to Sivigila and that did not result in a fatal outcome. These effects are consistent with symptoms that persist for a period of time in a significant proportion of the population and include fatigue, respiratory distress, sleep disorders, and cognitive impairment.
These can occur individually and in combination (several symptoms at the same time) and cause an impact on people’s daily functioning that translates into loss of healthy life. In the elderly, this can translate into a reduction in their life expectancy. To give you an example, 200,000 years of life lost, in other words that means the equivalent of 200,000 people lost, each one, a year of healthy life and well-being.
What has long been called COVID represents a challenge for health systems both in delivery of care and in monitoring and registering these cases.
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