Chronic diseases in Chile

I first became interested in non-communicable diseases and their intersection with poverty when I was a CGPH fellow during my master’s. I spent 3 months in Rio de Janeiro studying diabetes and hypertension. I was very interested in why, with free and available medications, and an active community health worker system the majority of patients still didn’t have their diseases under control.
 
Now, as a health policy PhD student I am especially interested in non-communicable disease policy. This summer (actually, winter!) I spent several months in Santiago, Chile researching reasons for continued non-control of non-communicable diseases like hypertension and diabetes.

About three quarters of the Chilean population uses the public healthcare system, FONASA, funded primarily by a 7% tax on wages (for those above a certain income threshold. Not only does FONASA provide medications for non-communicable diseases totally free to its users, the system is also home to several innovative health policies: in 2016 the Nutritional Composition of Food and Food Advertising act was passed, requiring among other things the labelling of all processed foods that are high in sodium, sugars, saturated fats, and/or calories (per 100g), and restrictions on advertising these foods to children. See below for the labels on a jar of Nutella and a can of soda.

The Food Act was the government’s responses to rapidly worsening health statistics: Chileans have the highest per capita soft drink consumption in the world, and 60% of the population is overweight or obese. Whether they cause substitution away from these foods is yet to be seen – as far as I know several academics in addition to the ministry of health are currently evaluating the policy.
A second innovative health policy – and one I worked on evaluating this summer while in Santiago – is the PSCV appointment reminder program. This program, which was phased in to primary care clinics over the past three years, signs up patients with non-communicable diseases for text message reminders. Patients receive a reminder before their scheduled appointment. They can respond to confirm the appointment, or reply that they wish to reschedule. The text message also serves as a reminder to take their medications. Not only does this text message serve as a nudge to keep NCD patients in care, it also allows the primary care center to reallocate appointment slots if the patient texts back that they wish to reschedule the appointment. Our hypothesis is that this program will not only improve health, but cause positive spillovers to patients not directly enrolled in the program who are now able to get same-day primary care appointments.
My summer (winter) spent in Santiago working in collaboration with researchers at the Universidad Catolia de Chile was an enriching experience, and left me with more questions than I began – good news for a graduate student! I will be continuing to work with the mentors and peers I met this summer, and am grateful for the continued support from the Center for Global Public Health. 
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