Executive summary
Chile has a well-functioning, well-organised and effectively governed health system and public health architecture. The public health challenges that Chile is facing would, however, strain any health system. Smoking rates are relatively high, alcohol consumption is low but rising, and mortality from cancer is high in comparison to cancer incidence. A quarter of Chilean adults, and nearly half of Chilean children, are obese or overweight.
In the face of such considerable public health issues, Chile has introduced a comprehensive package of policies designed to improve Chileans’ health status. Leadership from different levels of government, and in particular central government, has been ambitious. In particular, the response to the obesity epidemic has been significant. Chile has introduced a food labelling scheme on packaged food, has made efforts to ensure that food consumed in schools is healthier, and has put in place comprehensive diet counselling services led by primary care. Focus on the effective implementation of these programmes should be maintained, and there is also space for fine tuning and expansion. For example healthy food programmes in schools could be expanded to canteens in all public institutions, and physical activity could be promoted more strongly. Careful monitoring of these schemes is also advisable – for example monitoring the nutritional labelling scheme should be monitored for adherence – as is evaluation to assess effectiveness, so that both Chile and other countries could learn from successes as well as, potentially, ongoing challenges.
Careful attention to detail in policy implementation and monitoring will be critical in other areas, too. When it comes to cancer, Chile has established extensive governance structures for cervical and breast cancers, but screening for these and other cancers do not appear to be reaching all populations. Furthermore, mortality from cancer remains disproportionately high relative to incidence, giving a clear indication that more could be done in terms of prevention, early detection, and rapid treatment at early stages. Chile should look to take a dual approach to strengthening cancer prevention: some strategies should target cancer specifically, for example strengthening screening programmes and ensuring sufficient availability of diagnostic tools, while other approaches with a broader reach – improving health literacy, and improving data systems – ought to also support stronger cancer prevention and screening.
Public health genomics is at an early stage in Chile, but its potential to transform the health care landscape should not be underestimated, and in Chile ambition to be at the cutting edge of research, policy, and clinical implementation around precision medicine appears high. This early stage is the right moment to fully engage with the necessary steps to maximise the contribution of precision medicine to public health goals, balancing potentially rapid advances with the need to preserve privacy, equal access to care, and sustainable use of resources. In particular, alongside a strategic plan for the development of public health genomics, Chile should take steps to ensure that quality assurance of genetic testing, use of genetic data, appropriate training of health care workers and health care entitlement are covered by appropriate regulation.
Across all areas, there is scope to strengthen engagement across Chilean society. Faced with significant public health challenges, change is needed, which must happen at scale and at pace. Leadership from the government and the Ministry of Health has been commendable in many areas, but other key stakeholders – including patient groups, civil society actors, the food and beverage industry and private health insurers – have been left behind. In other OECD countries government and industry have collaborated, for example on healthy eating campaigns. The private health insurers (ISAPREs) have not become public health innovators of their own accord, and may need to be better incentivised or required to take a more proactive approach to preventive health. Perhaps most vitally, the Chilean population could be more systematically included in public health strategies. Gaps in population health literacy, for example, appear to be holding back early detection of cancer.