The case of the municipality of San Borja and precision public health

It was argued that – in the same way that modern analyzes make it possible to find out the genetic mutations of cancer in order to choose medications that are more personalized to the type of tumor that the patient has – it was possible for municipalities to obtain a much finer and more detailed knowledge of the characteristics of their neighborhoods. , to offer much more specific and personalized health services. The recent experience of the Municipality of San Borja illustrates the application of this concept.

precision medicine

This medicine is the one that bases the prevention and treatment strategies of a disease on the genetic variability of the individual.

For example, some BRCA2 gene mutations predispose to more aggressive breast and prostate cancers, so certain molecularly targeted treatments -such as PARP inhibitors for prostate cancer or olaparib for breast cancer- have improved the treatment of those patients.

In this context, in the early years of this century the sophisticated concept of precision public health has been proposed that, using genomics, studies large populations to identify small groups of individuals with a higher genetic risk of developing a disease.

In the same way that precision medicine focuses on the genetics of an individual to identify a person at risk, it was suggested that public health is also precision, and is based on the application of genetics in the study of large groups. of individuals to identify smaller groups of individuals with a higher genetic risk of developing a disease.

“Precision medicine focuses on an individual’s genetics to identify a person at risk.”

As the use of large-scale genetic studies is beyond the reach of poor countries, it has been suggested that the concept of precision public health focus on the identification of the social determinants that condition disease (poverty, education, housing, social inequalities). , etc.) in the different neighborhoods of a municipality, to design specific health services and centered on their own data.

Let us remember that public health is concerned with the health of the community on a large scale and focuses its efforts on organizing society to maximize the health and well-being of a population, designing and executing long-term educational programs, and supervising the role of institutions. and governments to ensure good health in communities.

The experience of San Borja

The Organic Law of Municipalities (27972) authorizes provincial and district municipalities to manage primary health care, building and equipping medical posts, first-aid kits, and health posts, and carrying out local campaigns on preventive medicine, first aid, health education, and prophylaxis.

With this idea, and during the pandemic, the municipality carried out the first Census of Health and Health Determinants, and collected more than 56,000 data from the 12 sectors of the district. Thus, the exact distribution of anemia in children under 5 years of age and chronic diseases such as high blood pressure and diabetes in adults were known.

With such granular data, the municipality used traveling brigades to offer more personalized care programs and weekly health fairs, and managed to cover the health needs –including vaccination– of 83% of the residents of the 12 sectors of the district during the pandemic. , with which it managed to be the municipality with the lowest mortality from COVID-19.

Meanwhile, the Munisalud Family Clinic, instead of being commercially outsourced, signed agreements with Essalud and the Ministry of Health for its sustainability. Thus, it provided general medicine services and 20 specialties, giving mental health consultations through the community mental health center (which has completed more than 58,000 consultations), and physical medicine and rehabilitation (which has provided more than 22,000 cares in 1,700 patients).

The Family Clinic serves residents and non-residents of the district. It is free for members of Essalud and SIS, and costs S/30 per consultation and S/20 for physical medicine for uninsured people. The financing of the project comes from the resources it generates through its agreements and the municipal budget.

An important element of the initiative is the creation of the District Health Committee, made up of 22 grassroots organizations from the district, which recently made the historic decision to allocate one million soles from the municipal budget to the health program. First time that the health of the neighbors is prioritized over cement works in streets or parks.

Corollary

There is a consensus that one of the explanations for the high number of deaths from the pandemic was the precariousness of the primary health system in Peru. In this regard, the strategy for its strengthening has not been clearly outlined by the Ministry of Health.

We believe that – if repeated in other municipalities – the award-winning project developed by the Municipality of San Borja would be capable of contributing to the strengthening of the primary health system in Peru. It would be ideal for the next administration in San Borja to refine the concept of precision community medicine, building small community health centers in strategically selected neighborhoods of the district.