Page 61 - Genomic Medicine in Emerging Economies

50 CHAPTER 4: Le v er aging Int ernational Collabor ations

restrictions; an insufficient number of trained health professionals; and
inadequate data on the true magnitude and economic burden of congenital
disorders” (WHO, 2010).

In general, all these limitations are present in most countries in Latin Amer-
ica. In Colombia there was a delay in introducing genomic medicine in stan-
dard clinical care, compared with countries such as Argentina, Mexico, and
Brazil. One of the main reasons for this is limited health care resources, but
also policy makers, health care providers, and health insurances lack a general
knowledge of the importance of genetics in medical care. In general, there is
poor health planning, insufficient training in genetics for health care profes-
sionals, a lack of adequate laboratories and infrastructure, and the molecu-
lar diagnostic tests available in the country are very expensive. In Colombia
one of the most advanced medical fields in genomic medicine is oncology, in
which genetic and genomic tests are starting to be more widely used for cancer
patients. To overcome the obstacles mentioned above, a strategy involving dif-
ferent health care actors and international collaborators was developed at the
Instituto de Cancerología SA (IDC) in Medellin, Colombia.

COLOMBIAN POPULATION

Colombia is a country located in the northwestern part of South America.
The Spanish explored the Colombian territory for the first time in 1499. In
the first half of the 16th century, the Spanish initiated a period of coloniza-
tion, creating the New Kingdom of Granada, with the capital, Santa Fe de
Bogotá. In 1717 the Viceroyalty of New Granada was created and gained
its independence from Spain in 1819. After many transitions in its govern-
ment and territories, it finally became the Republic of Colombia in 1886
(BHEC, 2015).
Colombia has a total land area of 1,138,910 square kilometers, which makes it
slightly less than twice the size of Texas. Its gross domestic product (GDP) was
292.08 billion USD in 2015, according to the World Bank (World Bank, 2016).
Even though Colombia has an upper-middle income, as defined by the World
Bank, it has very high socioeconomic inequalities, similar to other countries
in Latin America, reflected by a high Gini index (a measure of income inequal-
ity) (Davies et al., 2007; de Andrade et al., 2015). In 2004, the average income
Gini index reached 52.5 in Latin America, which was 8 points higher than in
Asia, 18 points higher than in Eastern Europe and Central Asia, and 20 points
higher than in high-income countries (Gasparini and Lustig, 2011). After 2005,
Gini indexes in Latin America started improving (de Andrade et al., 2015).
Close to half of the Latin American population lives in poverty and 27.6%
earns less than $2 per day, according to the World Bank (World Bank, 2014).