OECD Development Pathways Multi-dimensional Review of Paraguay Volume 3. From Analysis to Action: Volume 3. From Analysis to Action

Foreword
Acknowledgements
Acronyms and abbreviations
Executive summary
Assessment and recommendations
	Chile’s public health system
		Chile has a robust public health system
		The public health system should give due attention to all public health risks
		Engagement of civil society and the private sector is weak
		There is scope to strengthen epidemiological surveillance and monitoring
	Tackling obesity and unhealthy diets in Chile
		Chile has implemented a comprehensive set of prevention policies to tackle unhealthy behaviours associated to obesity
		Population-based primary prevention actions should be further reinforced  and extended to target a larger share of the population
		Private insurance should play a more active role in promoting healthy behaviours and preventing the complications of chronic diseases
		Chile should better assess the effectiveness of the policies and measure achievements in reducing obesity
	Cancer screening and prevention in Chile
		Chile has developed its cancer care system incrementally to tackle the increasing burden of cancer
		The cervical cancer screening programme has contributed to substantial reduction in mortality rates but screening coverage could be increased
		Chile needs to develop and implement more effective strategies for breast cancer screening programme
		For other cancers Chile should improve health literacy and promote access to screening and diagnostic tests
		Chile should develop more systematic monitoring for cancer control
	Developing public health genomics to strengthen preventive care in Chile
		Chile is already giving serious thought to the future development of precision medicine at national level
		Regulation and health care coverage have not kept up with clinical advances  in precision medicine in Chile
		A national strategy for precision medicine in Chile should be developed
		Appropriate regulation should underpin analysis and sharing of individuals’ genetic data
		The range of clinical genetic services covered by health insurers should be incrementally expanded
		Ambitious goals to increase “genetic literacy” amongst both professionals  and the public should be pursued
Chapter 1.  The Public Health System in Chile
	1.1. Introduction
		1.1.1. The health status of the Chilean population presents substantial cause for concern
		1.1.2. High rates of smoking and obesity in Chile represent significant risks to population health
		1.1.3. Like Chile’s OECD peers, the burden of disease is dominated by non-communicable diseases, though infectious diseases are more prevalent
		1.1.4. Earthquakes are a recurring public health hazard in Chile
	1.2. Organisational Structure
		1.2.1. The Chilean Health System
		1.2.2. Delivery of essential public health operations in Chile
		1.2.3. Primary, secondary and tertiary prevention
			Primary prevention efforts in Chile
			Preventive health checks – Examen de Medicina Preventiva
			Tertiary programmes
		1.2.4. Emergency response mechanisms
	1.3. Leadership and governance
		1.3.1. Key actors in the public health system
		1.3.1. Engagement across government is effective
		1.3.2. Regional and local public health leadership
		1.3.3. Leadership from Chilean civil society
	1.4. Partnerships and collaborations
		1.4.1. Engagement with patient groups
		1.4.2. Partnerships with the private sector could be strengthened
		1.4.3. Chile’s private insurance sector is disengaged from public health issues
	1.5. Financial resources
		1.5.1. Spending on health is low compared to the OECD average, but has been increasing
		1.5.2. When it comes to expenditure on public health, it is hard to identify, and difficult to ring fence
		1.5.3. Some payment mechanisms exist to incentivise public health functions amongst key providers
	1.6. Knowledge development
		1.6.1. Strengthening key data sources
		1.6.2. Promoting health literacy around public health
	1.7. Workforce
		1.7.1. Human resource shortages are affecting public health care, but the Ministry is addressing the problem head-on
		1.7.2. To ensure that the public health workforce is able to deliver public health services, Chile could advance its public health and prevention training
	1.8. Conclusion
	References
Chapter 2.  Tackling obesity, unhealthy diet and physical inactivity
	2.1. Introduction
	2.2. Obesity and associated unhealthy behaviours are a top public health priority in Chile
		2.2.1. Nearly two-thirds of the Chilean population, and a third of children, is overweight or obese
		2.2.2. Obesity and associated factors contribute significantly to the overall burden of disease in Chile
		2.2.3. A number of factors are driving the high rate of obesity
	2.3. Chile has put in place a comprehensive policy package to tackle obesity
		2.3.1. Mass media campaigns have played a part in Chile’s prevention strategy
		2.3.2. Chile’s threshold values for food warning labels are among the strictest in the world
		2.3.3. Chile has implemented comprehensive regulations to restrict the marketing of unhealthy foods to children
		2.3.4. The implementation of a sugar-sweetened beverage tax shifted consumption towards low-sugar products
		2.3.5. Municipalities play an important role in delivering cross-sectoral population health programmes
		2.3.6. Chile is taking steps to transform public spaces to encourage physical activity and healthy diets
		2.3.7. A comprehensive portfolio of school-based interventions has been developed to improve diet and exercise in students
		2.3.8. Voluntary workplace interventions are incentivised through accreditation
		2.3.9. Primary care plays a key role in delivering counselling and physical activity classes
	2.4. Further policies can be implemented or expanded to enhance Chile’s current obesity strategy
		2.4.1. Nutritional labelling policies could be strengthened and expanded to include other products and settings
		2.4.2. The ISAPREs could play a more active role in the prevention and management of obesity
		2.4.3. The successful school-based programme could be expanded to include more measures, cover more schools, and extend to other sectors
		2.4.4. Physical activity interventions could be expanded and better coordinated to complement the policies on diet
		2.4.5. Monitoring and evaluation are key to ensure Chile’s strategy is effective
	2.5. Conclusion
	References
Chapter 3.  Cancer screening and prevention in Chile
	3.1. Introduction
	3.2. Burden of cancer is high in Chile
		3.2.1. In Chile, cancer incidence is low but cancer could become the first cause of mortality in the near future
		3.2.2. Many people in Chile develop and die from preventable cancers
		3.2.3. Lung, prostate and colorectal cancer mortality rates in Chile have not declined as they have in many OECD countries
		3.2.4. In Chile, the burden of cancer varies by regions, ethnicity and socio-economic group
		3.2.5. Chile has developed its cancer care system incrementally to tackle the increasing burden of cancer
		3.2.6. Key governance structure and policy tools already exist in Chile for cancer control
		3.2.7. Cancer care in Chile is better organised for some cancers than for others
		3.2.8. Chile still faces many challenges in cancer control
	3.3. Prevention and cancer screening have been introduced in Chile but cancer outcomes remain relatively poor
		3.3.1. Cervical cancer screening has improved early detection but its coverage could still be increased
		3.3.2. The introduction of HPV vaccination could help reduce the burden of cervical cancer in the near future
		3.3.3. An increase in mammography coverage would likely reduce the burden of breast cancer
		3.3.4. For other cancers, preventive vaccinations and screening tests are also available but access to screening and diagnostic tests vary
		3.3.5. Some efforts to build public awareness of cancer screening and prevention have been made
	3.4.  Chile needs to further strengthen its effort in cancer prevention and screening
		3.4.1. Systematic involvement of key stakeholders needs to be encouraged to further develop strategies for cancer prevention and screening
		3.4.2. More systematic personalised invitations could improve cancer screening coverage
		3.4.3. Better communication and information-sharing strategies could improve public awareness and health literacy
		3.4.4. Chile should explore ways to improve access to cancer screening and diagnostic tests across regions and population groups
		3.4.5. Comprehensive information systems can help manage screening programmes more effectively
		3.4.6. Effective detection of cancer at an early stage requires strong primary care and standardised and high quality diagnosis
	3.5. Conclusion
	References
Chapter 4.  Developing public health genomics to strengthen preventive care in Chile
	4.1. Introduction
	4.2. The potential for clinical genetics and genomics to improve public health and preventive health care in Chile
		4.2.1. Precision medicine and public health genomics
		4.2.2. Precision medicine can be used as a powerful diagnostic tool
		4.2.3. Newer genomic technologies may advance preventive health care and public health more broadly
		4.2.4. Applied genomics could bring benefits to a number of Chilean public health priorities
		4.2.5. Combining genetic information with environmental and behavioural risks
	4.3. Current clinical genetics and genomics services in Chile
		4.3.1. Chile benefits from a specialist clinical genetics workforce, although it is small by international standards
		4.3.2. Genetic services offered in Chile
		4.3.3. Very few precision medicine services are covered by the public insurance system, leading to access inequalities
		4.3.4. There are limited efforts to build professional and public knowledge about the role of precision medicine in health care
		4.3.5. Regulation has not kept up with clinical advances in the clinical genetics field
	4.4. Current plans to develop precision medicine and genomics services
		4.4.1. Chile is already giving serious thought to the future development of genetics and genomics at national level
		4.4.2. Countries where clinical genetics is more robustly embedded within the health system may offer an example for Chile to follow
		4.4.3. Chile has an active research community in the field of genetics
	4.5. Accelerating the provision of clinical genetics and genomics services in a sustainable, equitable way in Chile
		4.5.1. A Ministerial working party should develop a national strategy for clinical genetics and genomic services in Chile
		4.5.2. Appropriate regulation should underpin analysis and sharing of individuals’ genetic data
		4.5.3. The range of clinical genetic services covered by health insurers should be incrementally expanded
		4.5.4. Ambitious goals to increase “genetic literacy” amongst both professionals and the public should be pursued
		4.5.5. Core public health goals of bringing about social, environmental and behavioural change should not be overshadowed by new genetic technologies
	4.6. Conclusion
	References
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