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Integration of palliative care into health care systems is considered an ethical responsibility, yet no country in the Eastern Mediterranean Region (EaMReg) has achieved integration. Data on palliative care need and cost are crucial forEaMReg health care planners and implementers in the region. Using data from the Lancet Commission on Palliative Care and Pain Relief, we estimated the number of people in each EaMReg country who needed palliative care in 2015 and their degree of access. In three countries, we estimated the number of days during which an encounter for palliative care was needed at each level of the health care system. This enabled calculation of the number of full-time equivalents (FTEs) of clinical and non-clinical staff members needed at each level to administer the essential package of palliative care recommended by WHO. In 2015, 3.2 million people in the EaMReg needed palliative care, yet most lacked access to it. The most common types of suffering were pain, fatigue, weakness, anxiety or worry, and depressed mood. To provide safe, effective palliative care at all levels of health care systems, between 5.4 and 11.1 FTEs of trained and supervised community health workers per 100,000 population would be needed in addition to 1.0-1.9 FTEs of doctors, 2.2-4.3 FTEs of nurses, and 1.4-2.9 FTEs of social workers. Data from our study enables design of palliative care services to meet the specific needs of each EaMReg country and to calculate the cost or cost savings., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Krakauer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

2023 marks the 20-year anniversary of the creation of Mexico's System of Social Protection for Health and the Seguro Popular, a model for the global quest to achieve universal health coverage through health system reform. We analyse the success and challenges after 2012, the consequences of reform ageing, and the unique coincidence of systemic reorganisation during the COVID-19 pandemic to identify strategies for health system disaster preparedness. We document that population health and financial protection improved as the Seguro Popular aged, despite erosion of the budget and absent needed reforms. The Seguro Popular closed in January, 2020, and Mexico embarked on a complex, extensive health system reorganisation. We posit that dismantling the Seguro Popular while trying to establish a new programme in 2020-21 made the Mexican health system more vulnerable in the worst pandemic period and shows the precariousness of evidence-based policy making to political polarisation and populism. Reforms should be designed to be flexible yet insulated from political volatility and constructed and managed to be structurally permeable and adaptable to new evidence to face changing health needs. Simultaneously, health systems should be grounded to withstand systemic shocks of politics and natural disasters., Competing Interests: Declaration of interests FMK is President and Founder of Tómatelo a Pecho. FMK participated in the design, financial calculations, and implementation of the Seguro Popular, collaborating with Mexico's Ministry of Health. She is married to JF who was Minister of Health of Mexico from 2000 to 2006. FMK was employed by the Ministry of Education and the Ministry of Social Development of Mexico during the administration of President Vicente Fox. FMK received research grants from Merck and EMD Serono to the University of Miami outside the scope of the submitted work and from Merck Sharp & Dohme, Avon Cosmetics, and S de R L de C V to Tómatelo a Pecho, all outside the scope of the submitted work. FMK received research grants from the US Cancer Pain Relief Committee to the University of Miami and the Medical Research Council to the University of Miami and Funsalud (Mexican Health Foundation) for work related to palliative care. FMK has also received consulting fees from Merck and EMD Serono and Instituto Tecnológico y de Estudios Superiores de Monterrey, Mexico outside the scope of the submitted work. FMK is a member of the Board of Directors of the International Association for Hospice and Palliative Care. FMK collaborates as a Sistema Nacional de Investigadores researcher at the Mexican Health Foundation, where she has been affiliated since 2000. HA-O is a Research Professor of the Institute for Obesity Research of Tecnológico de Monterrey, is Executive Director of Tómatelo a Pecho, and participates as an Associate Researcher at Funsalud (Mexican Health Foundation). HA-O received consultancy fees from Merck through the University of Miami outside the scope of the submitted work and from Merck Sharp & Dohme, Avon Cosmetics, and S de R L de C V to Tómatelo a Pecho, AC outside the scope of the submitted work. HA-O received consultancy fees from the US Cancer Pain Relief Committee to the University of Miami and the Medical Research Council to the University of Miami and Funsalud (Mexican Health Foundation) for work related to palliative care. HA-O collaborates as a Sistema Nacional de Investigadores researcher at the Mexican Health Foundation, where he has been affiliated since 2003. TM receives consulting fees for research and writing from the University of Miami Institute for Advanced Studies of the Americas. OG-D and ES-M were partly funded by the National Institute for Health and Care Research (NIHR) Global Health Policy and Systems Research researcher-led grant (NIHR150067) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the UK Government. OG-D was Director General for Performance Evaluation at the Ministry of Health of Mexico during 2000–06, which was the initial period of implementation of the Seguro Popular. PK was Vice Minister of Health of Mexico from December, 2011, to December, 2018, under the administration of Enrique Peña Nieto. AM-V participated in the design and implementation of the Seguro Popular between 2001 and 2007. AM-V was also Director General of Planning and Evaluation at the National Coordination of the Oportunidades Program between 2009 and 2011. He also served as the Deputy Director General of the Economic Analysis Unit between 2013 and 2016, and Director General of Evaluation between 2013 and 2019, both at the Ministry of Health. JF was responsible for the design and implementation of the Seguro Popular. All other authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Overweight and obesity (OW/OB) represent a serious challenge in Mexico, with effects on health, society and economy. Demographic, epidemiological, nutritional, social and economic factors have exacerbated this problem., Objective: To analyze mortality and years of healthy life lost in Mexico due to OW/OB in the 1990-2021 period., Material and Methods: The Global Burden of Disease and Risk Factors 2021 study was used to analyze data on elevated body mass index (BMI) as a risk factor and its evolution in Mexico., Results: In 2021, 118 thousand deaths attributable to high BMI were recorded, which accounted for 10.6% of total deaths and more than 4.2 million disability-adjusted life years lost., Conclusions: The obesogenic environment, influenced by social determinants of health, has had a significant impact on mortality, burden of disease, and economic costs. Addressing OW/OB requires multisector interventions to strengthen the Mexican health system., (Copyright: © 2023 Permanyer.)

Purpose The incidence of infection-associated cancers and lethality of cancers amenable to treatment are closely correlated with the income of countries. We analyzed a core part of this global cancer divide-the distribution of premature mortality across country income groups and cancers-applying novel approaches to measure avoidable mortality and identify priorities for public policy. Methods We analyzed avoidable cancer mortality using set lower- and upper-bound age limits of 65 and 75 years (empirical approach), applying cancer-specific and country income group-specific ages of death (feasibility approach), and applying cancer-specific ages of death of high-income countries to all low- and middle-income countries (LMICs; social justice approach). We applied these methods to 2015 mortality data on 16 cancers for which prevention is possible and/or treatment is likely to result in cure or significant increase in life expectancy. Results At least 30% and as much as 50% of cancer deaths are premature, corresponding to between 2.6 and 4.3 million deaths each year, and 70% to 80% are concentrated in LMICs. Using the feasibility approach, 36% of cancer deaths are avoidable; with the social justice approach, 45% of cancer deaths are avoidable. Five cancer types-breast, colorectal, lung, liver, and stomach-account for almost 75% of avoidable cancer deaths in LMICs and worldwide. Conclusion Each year, millions of premature cancer deaths could be avoided with interventions focused on four priority areas: infection-associated cancers, lifestyle and risk factors, women's cancers, and children's cancers. Our analysis of the global burden and the specific cancer types associated with avoidable cancer mortality suggests significant opportunities for health systems to redress the inequity of the global cancer divide.

Objective: To determine the impact of Seguro Popular (SPS) on catastrophic and impoverishing household expenditures and on the financial protection of the Mexican health system., Material and Methods: The propensity score matching (PSM) method was applied to the population affiliated to SPS to determine the program's attributable effect on health expenditure. This analysis uses the National Household Income and Expenditure Survey (ENIGH) during 2004-2012, conducted by Mexico's National Institute of Statistics andGeography (INEGI)., Results: It was found that SPS has a significant effect on reducing the likelihood that households will incur impoverishing expenditures. A negative effect on catastrophic expenditures was also found, but it was not statistically significant., Conclusions: This paper shows the effect that SPS, in particular health insurance, has as an instrument of financial protection. Future studies using longer periods of ENIGH data should analyze the persistence of high out-of-pocket expenditure., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Unlabelled: Objetive: Document financial protection in health in Mexico up to 2014., Materials and Methods: We up date the measures of impoverishing and catastrophic health expenditure to 2014, to analyse shifts since the implementation of the System for Social Protection in Health and the Seguro Popular using time series data from the Household Income and Expenditure Survey., Results: Between 2004 and 2014 there has been a continued improvement in levels of financial protection. Excessive expenditure reached its lowest point: -2.0% in 2012 and 2.1% in 2014. Impoverishing expenditure dropped to 1.3% in 2004, compared to 0.5% in 2014, and catastrophic expenditures from 2.7% to 2.1%., Conclusions: The time series of data on financial protection show a clear pattern of improvement between 2000 and 2014 and level off and low levels in 2012 and 2014. Still, levels continue to be relatively high for households in the poorest quintile, in rural areas and with an elderly person.

Absence of financial protection in health is a recently diagnosed "disease" of health systems. The most obvious symptom is that families face economic ruin and poverty as a consequence of financing their health care. Mexico was one of the first countries to diagnose the problem, attribute it to lack of financial protection, and propose systemic therapy through health reform. In this article we assess how Mexico turned evidence on catastrophic and impoverishing health spending into a catalyst for institutional renovation through the reform that created Seguro Popular de Salud (Popular Health Insurance). We present 15-year trends on the evolution of catastrophic and impoverishing health spending, including evidence on how the situation is improving. The results of the Mexican experience suggest an important role for the organisation and financing of the health system in reducing impoverishment and protecting households during periods of individual and collective financial crisis.

Absence of financial protection in health is a recently diagnosed "disease" of health systems. The most obvious symptom is that families face economic ruin and poverty as a consequence of financing their health care. Mexico was one of the first countries to diagnose the problem, attribute it to lack of financial protection, and propose systemic therapy through health reform. In this article we assess how Mexico turned evidence on catastrophic and impoverishing health spending into a catalyst for institutional renovation through the reform that created Seguro Popular (Popular Health Insurance). We present 15-year trends on the evolution of catastrophic and impoverishing health spending, including evidence on how the situation is improving. The results of the Mexican experience suggest an important role for the organisation and financing of the health system in reducing impoverishment and protecting households during periods of individual and collective financial crisis.