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EF: What is the health problem as you see it?
EH: The health problem is overwhelmingly a lack of prevention and early detection. In my own company about 3 years ago we changed the whole concept of how our cafeteria works, starting with the design of the kitchen, putting in a different high tech oven which uses about 10% of the grease usually used for cooking. This is not an important investment for a company, some 500 thousand pesos for a high tech oven which allows for a healthier cooking system compared to 50 thousand peso oven. It is not enough to have a healthy salad bar laid out—we also have to have talked about health issues in the company, a nutritionist comes in for all our employees in Aguascalientes, the program is voluntary. Of the 600 people who work there, 100 on average have participated every year losing on average 5 kilograms per person per year. We can say we have lost a ton and a half over 3 years!
EF: What impact has that had on absenteeism and productivity?
EH: I have interviewed a few employees that have lost 30 kilos; changing their cooking and eating habits have been life-changing for them, the food is there in the cafeteria but they now choose the correct proportions, they don’t go hungry or even eat different food, just one well-proportioned meal and of course much less sugar in the liquids they drink and smaller portions of deserts with less sugar. This has made a difference for some of our employees, one case of a lady who couldn’t play with 1-year-old child because she became exhausted as she was overweight, she lost 30 kilos and now she can play with her child, she comes in the office and is not tired so is more productive as well according to her own words. I will try and promote this initiative for all the large companies that have cafeterias. The Consejo Mexicano de Negocios has already adopted it; we are working now with the human resources departments on what they should do which is basically down to two things, exercise and a change in the cafeteria menus which in our experience it costs about 30% more but the results are amazing. We have to convince the directors and owners not to provide the cheapest food possible, to provide instead a well-balanced menu and make sure there is access to a nutritionist. Without that communication and the management directives being convinced of its benefits, there won’t be any results health-wise or productivity-wise. We know from a study AMIIF made that 2% of the total amount of hours worked are lost because of absenteeism, but 7% is lost when people go to work but aren’t productive—and 7% is a very high number. We also did diabetes detection and sure enough, there were people who didn’t know they had diabetes and now can search for treatment. There was a social security experiment done in Monterey where they would go to the companies to check employees looking for early detection and taking certain measures instead of the employees having to go to the social security when sick.
EF: In diabetes, there is a 20 to 1 ratio of prevention versus cure and it cost 20 times more to cure than to prevent, and it is a similar ratio in other therapeutic areas.
EH: In Mexico, there is also a big problem with compliance, even in those who have had the disease detected, there is a significant drop in the taking of medicines after 6 months. What is very evident and the new administration is very aware of this, is that we have to change the mentality of the doctors; we had this problem and had to change the doctor here because he was not interested in doing prevention, monitoring and taking blood samples. Doctors are trained to cure not to prevent and this is a huge problem in Mexico as the Undersecretary of Health Cristina Laurel has detected. She has put the focus and interest on prevention and having what she calls a "community doctor" responsible for the health of the surrounding area. How she will manage it I don’t know because doctors are not used to doing this nor is the general public used to it from a mental and social standpoint. The risk, however, is they will put all the resources in the new idea and stop Seguro Popular, which has been very successful taking care of the catastrophic diseases which have stopped a lot of people falling into poverty by covering things like infant mortality, leukaemia, cancer for women and men in their 30s and 40s which is a very important period of their lives as its when they are the sustenance of the families. This is something that has worked so I hope it won’t be destroyed or diminished but prevention must be done because it is so much cheaper than the cure and its consequences, amputated legs for example, which is ending up on the wrong side of health.
EF: There’s an old project-management adage known as the Iron Triangle: “Fast, good, or cheap. Pick two.” In other words, you can have it fast and good, but it’ll be expensive; you can have it fast and cheap, but it’ll be low quality; you can have it good and cheap, but it’ll take forever. If you had to pick two for this healthcare transformation, which would they be?
EH: I think we have to avoid the discussion of a triangle for traditional medicine because this is not about traditional medicine, it is about a change of mentality, of how we look at health and how we deal with it. Vaccination, for example, is on the cheap massive approach and it is very hard to change behaviours. There have been case study demonstrations in Australia, Canada and different countries of bringing ideas to the business community and the case studies will be used to make the point as there is an overwhelming amount of knowledge but most importantly a political will is needed to achieve real change.
EF: But what are the levers that you can use not only as the head of a private company but as the head of FunSalud, to make sure companies and business leaders adopt these changes so the behaviour of the people in organisations changes?
EH: We have just started working on this, having the numbers of case studies in Mexico that show the economic benefits helps seeing it not as an expense but as an investment because normally the cafeteria is considered an expense when in reality it is an investment. Having healthy people goes in hand with having early detection and simple tests (blood pressure and sugar). My theory is that the expense pays for itself in the medium to long term. We are now covering major health expenses for all our non-syndicated workers, that is all our sales force, managers, etc., even though they have social security. As social security is such a mess that we are buying private insurance policies for the non-unionized workers and we think this will important in attracting young blood into the company as it something they expect when entering a company and we think it is important to retain and attract young talent.
EF: Can you speak to your unique approach to HR?
EH: Last year we increased our sales representatives by 50%—we had 200 and we wanted to hire another 100—and we received 1500 applications! That means we are a place where people want to work. Our starting age for reps is now 45 years old. It used to be 60, and before that 65 years old. We have such a good track record that we don’t even need to go out and find them, they find us. Older reps have experience and many times have been discarded by the multinational companies. However, they know that with us there is no age limit on retirement. Some of our reps have worked till they are 80 years old. Before 1985, we used to hire young kids and train them, but we found that the good ones were always taken from us by multinational companies. So we dropped that strategy and took the opposite course.
EF: You are a renowned botanist with a special affinity for orchids; what was your most recent discovery?
EH: I am actually leaving tomorrow for Peru, where I will be spending a week in a mountain range parallel to the The Andes on the border in-between Amazonas and San Martin. In northern South America, some areas have a basalt base with a 2 km mass depth of sand which became sandstone and that’s what there is today in what we call the Guyana Shield, mountains that look like cakes straight at the sides. That’s where Salto del Angel is located, which is the highest free-falling cascade in the world, at about one km in height. There is another area in between the borders of Guyana, Brazil and Venezuela about 13 km long by 3 km wide and 1500m above the savannahs. I was there last year, I flew from a helicopter from Venezuela and I found an orchid I had only seen in a photograph 40 years ago! The genus I am working with has about 2,400 species, of which I probably published half, some 600 of the 1200 of the genus Epidendrum. If you look at Ecuador’s orchids, half of them have been described by me, the same for Colombia. Peru is an open group, all collections have been done of the centre of Peru, but not the south and not the north. They look alike but they are not the same. I have my own theories of how this speciation occurred, due to the 3 rivers that run in a north/south direction in Peru and each one has been in the ice age, each isolated from the others, so they evolved into different species. The mountain ranges on the east of the Andes share several affinities with the Guyana shield even though they run east/west. This time I am going to the Roraima mountain range, which is about 1700 million years, some of the genes are 400 million years old but I am working on genes that are 20 million years old, so they are relatively recent.
EF: What would be your message to our readers about how to implement the changes that you were talking about earlier?
EH: There are already a number of ideas going around on how it should be done, but we have to have a practical guide to give the CEOs to implement with the help of their NGOs and in some cases, people from outside the company will be needed. On the one hand, we are working with the government to analyze how the whole system, which has very real problems, in the sense that previous governments from a long time back have done things like taking the equipment inaugurated to a clinic with it and the next day everything is taken to the next clinic. Another problem occurring during the last administration was the Ministry of Finance not authorising new doctors or new nurses or new personnel for the health system in general so about 30% of the personnel of the public institutions are on a 3-month temporary basis contract. The new government has gotten rid of all these people so now there is 30% less personnel in these institutions and the timelines for cancer treatments have been affected and gone from 30 to 120 days wait. Unfortunately, the government is completely disorganised in hiring new people and even in positions that have been in existence for a long time like directors for the health institutes. There is a person in the Ministry of Health and the Ministry of Finance who has to authorise the actual contract. They are checking if all these people that are being hired have corresponding lifestyles and incomes and this will take a few months for sure but in the meantime, these directors that have been elected by the governing body of each institute cannot take over due to the lack of authorisation. With all these new people in the government, there are about 9 thousand people who were occupying the top three echelons of all government institutions which have either left the government because of lower salaries or because they had to hand in their resignation due to the change of administration. The director of COFEPRIS has to spend 3 hours a day including the weekends authorising all the imports, raw materials and renovations because the person in the Ministry of Finance has not approved his team. This is a huge problem, but I hope it is temporary. The real challenge is how to do preventive medicine and early detection, and change the mentality and mindset of the patients and people.