The present and future of Mexican health promotion.

Mexico, with a 92 percent literacy, 62 native languages and 12.7 million indigenous people, has entered a new era of macroeconomic stability. Nevertheless 40 percent of the population live below the poverty line. The burden of disease includes malnutrition, infectious diseases, reproductive health problems, as well as chronic diseases. Addressing the social determinants of health has been a priority. This can be seen in two of the most successful Mexican programs. The National Healthy Communities Program that uses a setting approach to establish a link between socioeconomic development and health levels and the Opportunities Program that has become an international model and which is a comprehensive, poverty alleviation program that uses education, fiscal measures and health education to improve population health. Both have been implemented throughout all the states in an intersectorial manner, since 1997 and 2000 respectively. Health promotion in Mexico has evolved in many positive ways during the past 20 years. Development of healthy environments and community actions are the strongest components. Evidence and evaluation, health services reorientation, and building personal skills and empowerment are the weakest. The paradox between low empowerment and high community action results in a superficial community participation that lacks a real commitment towards health. The newest Mexican health promotion policy is named National Alliance for Health and it aims to involve all members of society. Its value is to be independent of any international recommendation; its weakness is that it lacks a deep analysis of the health issues that it is supposed to solve. Consequently valid evaluations are not feasible, and without real evidence the impact of these kinds of policies will remain unknown.