February 11, 2016 | Fernando Iñarra Talboy, MD
International

As cardiologists we have a huge responsibility with the general population, since the leading causes of death worldwide are of cardiovascular nature. We must focus not only in direct patient care and primary care physician education, but also we should be deeply involved with legislators and policymakers to ensure that the health care systems evolve in order to address this global epidemic. Cardiovascular diseases represent an enormous burden to government budgets around the world, enough to collapse the system itself, so the people involved in making health care policies need to be advised by the cardiovascular community. In this manner, the policies will not be made just to regulate or restrict actions, but to join efforts to improve cardiovascular care.

Since I became a FIT, I am amazed at the involvement the College has with the U.S. Congress. Members of the ACC learn how the legislative process works and how it can be shaped by working with their representatives in Congress to have an impact on cardiovascular disease.

In Mexico we are far behind from that. Academic and medical societies and the Congress of the Union live and work in two different worlds, coming together occasionally, when health policies are revised and updated. What the Mexican medical societies and government officials have to understand is that health care is a dynamic process, in which there are epidemiological and demographic transitions that modify the impact of various diseases. More importantly, medical science is evolving, new treatments, drugs, devices and surgical procedures are developed every year in every branch of medicine, especially in cardiology. Our policies need to be updated and must keep up with these advances. We must emphasize cost-effectiveness and encourage the switch from treating diseases to preventing them.

The Mexican Society of Cardiology and the National Cardiology Association of Mexico, the two main societies for cardiovascular clinicians in Mexico, need to encourage cardiovascular clinicians to work more closely with primary care physicians. In a country with 110 million inhabitants, and around 2,000 cardiovascular clinicians – most of them concentrated in third-level specialty centers in the main cities – we cannot solely rely on cardiovascular clinicians to prevent, diagnose and treat cardiovascular diseases. Most of the work has to be done out there, in rural communities and small towns, with general practitioners or family physicians receiving some cardiovascular training.

Even more so, the general population needs to be taken into account. Efforts must be made to educate patients, so they can have healthier lifestyles. Mexico is facing a dark future if actions are not taken immediately. It is one of the most obese countries in the world. It has the most obese children in the world. An estimated 15 to 25 million Mexicans will be diagnosed with diabetes by the year 2050. Neither physicians nor the government can face this problem alone. Paraphrasing John F. Kennedy’s inaugural speech, “ask not what your [doctor] can do for [your health], ask what you can do for your [own health]”, and we must take these problems in our hands, reaching out to patients, primary care physicians and policymakers.

This article was authored by Fernando Iñarra Talboy, MD, a fellow in training (FIT) at the Instituto Nacional de Cardiología Ignacio Chávez, in México City, México.