BACKGROUND

Due to its geographic location, Mexico is exposed to the impact of natural phenomena that, assuming they reach a certain magnitude, can become threats to the population, productive activities, and ecosystems. The damage associated with disasters will not only depend upon the intensity of the natural phenomena that trigger them in the first place, but also on the vulnerability contexts, i.e., the social shortcomings to confront them, such as lack of preparation, marginalization, exposure, risk perception, etc.² Table 1 presents the main disasters associated with natural phenomena that occurred in Mexico between 1982 and 2018.

Tropical cyclones and earthquakes have been the disasters causing the greatest impact on Mexico, in terms of death toll, economic losses, and damage stemmed from a single natural phenomenon. In 2013, hurricanes Ingrid (in the Gulf of Mexico) and Manuel (in the Pacific Ocean) affected a large part of Mexico’s territory due to their almost simultaneous occurrence during September. Furthermore, in September 2017, the earthquake that affected the center of the country, particularly Mexico City, was the most significant geological event after the 1985 earthquake in the region, in which social networks and volunteer groups played a leading role (^{Anzaldo, Estrada, Maisterrena, Galindo, & Ramos, 2020}).

According to ^{Maskrey (2016)}, disaster risk can be defined according to three variables: hazard, exposure, and vulnerability. First, a hazard is the trigger that can cause significant damage to a society. Second, exposure relates to human societal relationships, which organize the territory. Third, vulnerability will be a function of the social, economic, political, and cultural conditions that a community develops to withstand risk (^{Maskrey, 2016}). The causes of these risk contexts must also be explained by the social, economic, and political systems, among others, which particularly affect specific sectors of society; that is to say, their degrees of vulnerability (^{Wisner, Blaikie, Cannon, & Davis, 2004}). Therefore, the effects of disasters do not have an equal impact on society. There will be communities that experience greater consequences due to their income level, access to public services, or political power, to name a few examples.

Following the contagions registered by the new coronavirus at the end of 2019 in Wuhan, China, and the spread of the virus to other countries, the World Health Organization (WHO) declared a global public health emergency on January 30, 2020, citing it constituted a risk to the public health of other states given the international spread of the disease (^{Organización Mundial de la Salud, 2016}). On March 11 of the same year, WHO Director-General declared COVID-19 a pandemic, after more than 118,000 cases had been reported in 114 countries and 4,291 people had died (^{Adhanom Ghebreyesus, 2020}).

The SARS-CoV-2 virus, associated with the COVID-19 disease, has produced a pandemic whose effects are not only limited to public health, but also have economic, political, and social consequences (^{Lazcano-Ponce and Alpuche-Aranda, 2020}). As of January 30, 2020, Mexico began executing public health emergency preparedness and response plans, implementing lessons learned during the AH1N1 influenza pandemic of 2009 (^{Alpuche-Aranda, 2020}). While the first case in the country was recorded on February 26, 2020, the first death associated with the disease occurred on March 19. Figure 1 shows the development of the COVID-19 pandemic in Mexico until November 2020.

By November 22, 2020, overall, 1,041,875 cases and 101,676 deaths associated with COVID-19 had been reported in Mexico. As of that date, the rate of cases by gender showed that 51 percent were men, and the median age was 43 years. The five states with the highest number of accumulated cases were Mexico City, State of Mexico, Nuevo León, Guanajuato, and Sonora (^{Secretaría de Salud, 2020b}). This list of infections, however, fluctuates because it can change from week to week, due to restriction strategies, lockdown measures, and the opening of productive activities implemented by each state. Graph 1 shows the downward trend, in cases and deaths, starting in August; albeit there was a peak on October 5, corresponding to a shift in methodology used for recording cases.

Source: Author’s compilation based on data from the Ministry of Health (^{Secretaría de Salud, 2020a}).

Graph 1. Evolution of COVID-19 in Mexico according to number of cases and deaths (per week) in 2020  

THE NATIONAL CIVIL PROTECTION SYSTEM

The bedrock for establishing SINAPROC and the Civil Protection Program was approved in 1986 (^{Secretaría de Gobernación, 1986}). It stated that the Mexican Ministry of the Interior would oversee joint actions together with the remaining federal agencies (^{Secretaría de Gobernación, 1986, article 3}). Similarly, this collaboration scheme is repeated locally through state and local civil protection systems. Figure 1 shows the structure of SINAPROC.

Source: Author’s compilation based on data from the World Bank ^{(Banco Mundial, 2012}) and the Ministry of Security and Civil Protection (^{Secretaría de Seguridad y Protección Ciudadana, 2019}).

Figure 1. Structure of the Mexican National Civil Protection System  

The coordination of SINAPROC changed in 2018, when the Ministry of Security and Civil Protection undertook this duty, shifting its focus from being an internal policy to becoming a public safety issue (^{Secretaría de Gobernación, 2018}). The General Civil Protection Law (^{Secretaría de Gobernación, 2012}) defines SINAPROC as an organic set of structures, functional relationships, norms, instances, instruments, policies, procedures, and actions which government agencies establish jointly with public sector entities; organizations of various voluntary, social, and private groups; federal and municipal entities, and Mexico City, in order to carry out coordinated actions regarding civil protection (^{Secretaría de Gobernación, 2012, article 14}).

In SINAPROC’s structure, the President of Mexico holds the highest responsibility, which is exercised through the Ministry of Security and Civil Protection. The General Directorate of Risk Management (DGGR) coordinates the operation of financial instruments for risk management, analyzing requests for the provision of aid to federal entities, as well as submitting projects to qualify for a declaration of emergency or natural disaster. The disaster risk management model at the state and local levels is a mirror of the federal system, which is intended to implement actions and strategies in a systematic manner. The local level is the first instance of disaster prevention and response; the state and federal levels intervene, should it be necessary.

A core component for disaster response was the Natural Disaster Fund (FONDEN) trust fund.³ FONDEN was a financial instrument for disaster prevention, emergency response, and reconstruction of affected areas in municipalities, states, and Mexico City. To access FONDEN resources, a Declaration of Disaster had to be issued, then be endorsed by technical federal agencies, and later be recognized by the General Directorate of Risk Management. For the fiscal year 2020, FONDEN was allocated 3,353 million pesos, while 647 million pesos were authorized for the National Disaster Prevention Fund (FOPREDEN) (^{Secretaría de Hacienda y Crédito Público, 2019}).

Since 1986, SINAPROC has recurrently responded to disasters associated with natural phenomena. Nonetheless, the General Civil Protection Law (LGPC) itself, which legally supports SINAPROC, also defines a sanitary-ecological phenomenon as a “disturbing agent generated by the pathogenic action of biological agents that affect the population, animals, and harvests, causing death or health problems” (^{Secretaría de Gobernación, 2012, article 2}). Therefore, an epidemic is a health disaster which would fall under the purview of SINAPROC, to the extent that there are people affected by disease or mortality.

THE NATIONAL HEALTH SYSTEM

The SNS encompasses the agencies and entities of the public administration and the individuals or legal entities that provide health services, as well as the coordination mechanisms, whose purpose is to comply with the right to health protection (^{Secretaría de Salubridad y Asistencia, 1984, article 5}). The coordination of the SNS is the responsibility of the Ministry of Health, which formulates and implements national health policy, in coordination with the governments of the states, which will plan, organize, and develop state health systems in their own regions (^{Secretaría de Salubridad y Asistencia, 1984, article 9}). Figure 2 shows the structure of the national health system in Mexico.

Source: ^{Gómez, et al. (2011)}, ^{Muñoz (2012, p. 20)}, from ^{Martínez and Murayama (2016, p. 45)}.

Figure 2. Structure of the Mexican National Health System Acronyms and initialisms: Institute for Social Security and Services for State Workers (ISSSTE), Petróleos Mexicanos (PEMEX), Social Security Institute for the Mexican Armed Forces (ISSFAM), Mexican Social Security Institute (IMSS), Mexican Social Security Institute-Wellness Program (IMSS-Bienestar), Ministry of Health (SS), State Health Services (SESA), Health Institute for Well-being (INSABI).  

The SNS involves both the public and private sectors in the provision of health services. Regarding the public sector, there are two types of subsystems: social security and health protection. These complement each other to serve the population entitled to access health care under the social security subsystem, and the general population under the health protection subsystem. Funding is provided by the federal government, the employer, and the worker, in the first case; while the federal and state levels, via the State Health Services (SESA) and the Health Institute for Well-Being (Instituto de Salud para el Bienestar) provide funding in the second case. Health care users and providers are at the bottom two levels of the system (^{Martínez & Murayama, 2016}). Regarding the private sector, it is made up of insurance companies, hospital networks, and private medical services, which provide their services to people who lack public health coverage and individuals with the ability to pay (^{Martínez & Murayama, 2016}).

Among the coordination mechanisms is the National Health Council, as a permanent body for coordination between the federal and state entities, and Mexico City. The National Health Council is constituted by the Ministry of Health and the heads of the Ministry of National Defense, Mexican Navy, Mexican Social Security Institute (IMSS), Institute for Social Security and Services for State Workers (ISSSTE), Social Security Institute for the Mexican Armed Forces (ISSFAM), Petróleos Mexicanos (PEMEX), National System for Integral Family Development, Network of Municipalities for Health, and the 32 State Health Services (SESA) heads (^{Secretaría de Salud, 2019}).

For its part, the General Health Council (CSG) declared a national health emergency due to the epidemic caused by the SARS-CoV-2 virus on March 30, 2020, with the Ministry of Health as the body that would determine all necessary emergency response actions. The CSG also issued health safety measures such as the suspension of non-essential activities, implementation of health measures, shelter-in-place orders, as well as a phased return to work and social activities, among others (^{Consejo de Salubridad General, 2020}). The National Committee for Health Safety (CNSS) is the body controlling the health safety strategies at SNS public institutions, aiming to establish a shield of care and prevention from epidemiological emergencies and disasters (^{Ministry of Health, 2003, Article 1}).

A key element for monitoring the pandemic is the Mexican National Epidemiological Surveillance System, which gathers epidemiological information from 20,005 health care units. The coordinating body of this system is the National Epidemiological Surveillance Committee, consisting of representatives from all SNS institutions at the federal level. At the state level, there are State Epidemiological Surveillance Committees, and at the local level there are Jurisdictional Committees. The information collected is entered into the Unified Information System for Epidemiological Surveillance (^{Secretaría de Salud, 2020c}). Based on these agencies’ information, the Undersecretary of Prevention and Health Promotion issues daily reports on the number of cases and deaths, incidence rate of active cases, and so forth, which are used to monitor the COVID-19 pandemic.

DISASTER RISK MANAGEMENT AND COVID-19

The disaster associated with the COVID-19 pandemic presents a challenge for risk management in Mexico and the entire world. Drawing on the public policy approach to manage COVID-19, the study of disaster risk must be based on current theoretical and methodological advances. To this end, we are required to understand the underlying causes of risk, in other words, the social construction of disaster risk.

The concept of social construction of risk “has proved to be an increasingly useful analytical tool among disaster experts and the effects disasters have had in society” (^{García, 2005, p. 12}). A couple of perspectives of analysis can be highlighted by using this concept, “a culturalist perspective, which offers the perception of social groups about risks ... and another arising from the analysis of the origin that leads to situations of vulnerability of specific groups in society” (^{García, 2005, p. 22}). Based on this, the study of vulnerability is a crucial element for risk management, whether associated with natural or sanitary-biological hazards.

According to ^{Adger (2006)}, vulnerability “is the state of susceptibility to harm from exposure to stresses associated with environmental and social change and from the absence of capacity to adapt” (^{Adger, 2006, p. 268}). But vulnerability does not appear suddenly; it obeys a process of social, environmental, political, and cultural shaping. Additionally, the “process of the construction of risk, and therefore of disasters, starts from the conflicting views on the structures of socio-cultural systems, which lead to an internal functional disorder” (^{Oliver-Smith, Alcántara-Ayala, Burton, & Lavell, 2016, p. 38}).

To face the impacts of disasters and their prevention, as well as to reduce social vulnerability, a multidimensional and participatory planning process must be developed. Disaster risk management refers to the “systematic process of using administrative directives, organizations, and operational skills and capacities to implement strategies, policies and improved coping capacities in order to lessen the adverse impacts of hazards and the possibility of disaster” (^{UNISDR, 2009, p. 19}). To reduce disaster risk, a variety of factors and situations must be considered, including economic and political factors responsible for a more complex process, such as the social construction of risk. Cultural frameworks, determined by diverse ways of interpreting risk, as well as efficient and effective frameworks for action must be developed (^{Oliver-Smith, 2020}).

The concept of risk governance “encompasses the full range of risks recognized by human societies, including health and medical, safety and security, and environmental risks, such as hazards and disasters” (^{Tierney, 2012, p. 343}). Disaster governance involves “interrelated sets of norms, organizational and institutional actors, and practices (spanning predisaster, transdisaster, and postdisaster periods) that are designed to reduce the impacts and losses associated with disasters arising from natural and technological agents...” (^{Tierney, 2012, p. 344}). Vulnerability and its risk-disaster relationship is linked to the preconditions that a society maintains to handle the impact of a hazard, such as exposure, marginalization, access to public and health services, and so on. In other words, it is associated with the contexts of fragility that are manifested when a particular hazard occurs.

Regarding the risk associated with COVID-19, vulnerability is first and foremost related to the previous medical condition of people exposed to the virus and, secondly, to the healthcare system, which includes coverage, medical equipment, and medication. The COVID-19 disease does not affect all people equally—it affects the most vulnerable. According to a statement from the Undersecretary of Prevention and Health Promotion, Lopez-Gatell, more than 80 percent of the people who have died from COVID-19 had pre-existing chronic conditions such as diabetes, heart disease, and vascular issues. In other words, these problems related to poor nutrition had a significant bearing on their susceptibility to die from COVID-19, besides their advanced age (^{Lopez-Gatell, 2020, min. 29:08 to 30:08}).

This statement points out that people’s pre-existing conditions play a vital role in the progression of the pandemic. Vulnerability, exposure, and hazard combine in a way that shows an increase in the number of cases and deaths from COVID-19. As a matter of fact, the disaster risk approach has developed different methodologies to define scenarios of vulnerability to floods, earthquakes, and tropical cyclones, among others; an illustration of this is the National Risk Atlas of Mexico, coordinated by the National Disaster Prevention Center.

In the context of COVID-19, the experience from the disaster risk approach should be used to define the “new contexts of vulnerability” to health risks, which entails rethinking schemes to identify the most vulnerable populations facing new diseases. At the same time, collaboration schemes among SNS institutions should be reinforced to identify and solve problems of coverage, medical equipment, and medication needed to cope with a health disaster.

This analysis found no formal evidence of collaboration or coordination between SINAPROC and the SNS in responding to the COVID-19 pandemic, except for the implementation of the DN-III-E Plan, by means of the hospital reconversion of some military facilities and the support offered in specific surveillance activities. These two models have specific goals and objectives for health and disaster risk response and reduction, but there are no cross-sectional communication mechanisms between both systems, which may limit action framework. Since the early days of SINAPROC, mechanisms have been developed for coordination, monitoring of intense natural phenomena, response protocols, the creation of volunteer networks to assist those affected by emergencies or disasters and, above all, civil protection systems at the local level. These resources may well be implemented under national and state coordination to shoulder the effects of COVID-19 Nevertheless, some areas of local government have collaborated with the health sector to curtail COVID-19 cases, such as closing of public areas and monitoring business compliance with public health measures.

The two public health decision-making and coordination bodies, the General Health Council and the National Committee for Health Safety, are made up of representatives from the health sector. This integration is justified given that this is a public health issue. The COVID-19 pandemic put the SNS to the test and poses challenges that must be addressed from other fields, ranging from public safety to the economic and social spheres. The WHO serves as a reference for international coordination, which recommends strategies for national healthcare systems around the world. This could explain why Mexico opted for a merely health-related response to COVID-19, by having an international point of reference that offers mechanisms, protocols, and methodologies to control a pandemic, while leaving aside the expertise of civil protection and not offering a perspective of a health disaster that affects other aspects of daily life.

Therefore, this paper proposes that the context of the ongoing COVID-19 in Mexico be seen as an opportunity to consolidate a national policy for disaster risk reduction for any hazard. The SNS’s health perspective should be enhanced with the progress made by SINAPROC in recent years. The health disaster unfolding in the country must be addressed from a comprehensive perspective of disaster risk management, given that public health problems also become economic and social crises, as has occurred with the impact of intense hurricanes such as Ingrid and Manuel in 2013 or the earthquake on September 19, 2017 (See Table 1). To this end, modifications are required in the legislation that sustains both SINAPROC and the SNS.

SINAPROC needs to step up its actions against health risks, as contemplated in the LGPC, considering how it frequently deals with hydro-meteorological and geological hazards. For its part, the SNS should continue to address the issue of health risk as provided by law, but it can be supported based on the civil protection model by involving the organization and structure of SINAPROC, which is more relevant at the local level, a scale where the consequences of disasters associated with natural phenomena as well as those associated with the pandemic could be better observed.

In the same fashion, “the social study of the construction and accumulation of risks implies that disasters associated with the COVID-19 virus and disease represent the materiality of pre-existing and underlying risk conditions” (^{Lavell, Mansilla, Maskrey, & Ramirez, 2020, p. 3}). In this sense, disaster risk is associated with a hazard of biological origin (SARS-CoV-2), as well as with the conditions of exposure and vulnerability of people, which in turn creates unsafe physical, social, and economic conditions.

According to ^{Lavell and Lavell (2020)}, there are common elements that can be transferred from the practice of disaster risk management to the current management of the COVID-19 pandemic. Prominent among these practices are:

These are not the only forms of collaboration between the disaster risk management model and the pandemic response. They could, however, become the turning point in shifting the focus of attention from the disease at this time, and above all, in implementing new risk management mechanisms in the future. Similarly, there is a clear idea of the effects of disasters associated with natural phenomena, particularly regarding the degree and scale of impact in each area, but the COVID-19 pandemic presents complex challenges, especially seeing how its area of impact has global and multisectoral influence, and its temporal scale has not ended. Even so, the experience acquired should be used to minimize the effects of natural phenomena, including biological agents.

CONCLUSIONS

Disasters associated with natural phenomena frequently impact Mexico’s territory. On the one hand, tropical cyclones are frequent during hurricane season, which in contexts of vulnerability have triggered disasters with consequences on people's lives, infrastructure, and the development of regions. On the other, earthquakes are unpredictable natural events; even one single occurrence can cause severe damage. Knowing the causes of risk is an essential element to diminish the impact of disasters.

By registering an increasing number of cases and deaths, the COVID-19 pandemic is a public health problem, but it has also brought consequences that translate into economic losses and moving online for work (home office), education, and social spaces, among others. Fortunately, COVID-19 cases and deaths are being controlled by actions taken by the health sector institutions and the participation of civil society, which has changed its daily life routine, although this may vary as the pandemic progresses over time. Even national and international health experts find it difficult to determine when the pandemic will end. In the meantime, there are lessons to be learned in the health sector, as well as in the economic and social fields, or in other areas.

The model adopted by SINAPROC aims to move from a reactive to a preventive model. For instance, it is necessary to overcome the welfare-oriented approach at times of a hazard and move on to risk reduction as a national policy issue, which implies reducing the exposure and vulnerability of communities. Yet, this has not been easy. SINAPROC’s structure specializes in emergency response, which should be set up as a cross-sectional issue in the country's territorial development.

Social, economic, and territorial policies should include a disaster risk reduction approach, aiming to reduce future risk when developing new projects, starting from a long-term vision, and contributing to the reduction of current risk. At this point, the intervention of local governments is relevant since it is at this level where the contexts of vulnerability and risk crystallization can be observed when a disaster occurs.

The SNS model embodies the national effort to address public health problems. It is a disjointed model that involves public and private sector institutions, whose objectives may be oriented towards different goals. On the one hand, the government's welfare approach and, on the other, a private service in which only people with sufficient financial resources to pay for healthcare have access to it. Thus far, the COVID-19 pandemic has been the greatest challenge for the SNS, after which it would be expected to consolidate its approach to health risk. Comparatively to how SINAPROC was created because of the social, economic, and cultural consequences associated with the 1985 earthquake, perhaps the COVID-19 pandemic is the moment of juncture that will propel us forward to engage in substantive and comprehensive risk management and to work more on the reduction of risk, exposure, and vulnerability of local communities.

The COVID-19 pandemic is still active, and it is necessary to wait for new results on its consequences and, above all, on the way in which government agencies respond to the emergency and damage control, regarding epidemiological, social, and economic matters. Therefore, here are some specific recommendations for coordinating both models:

This is not by any means a complete or exhaustive list. These points simply reflect the experience acquired in recent years in terms of prevention and response to the effects of disasters. Likewise, they propose to break down the barrier between the two general legislations by viewing disasters as specific problems: on the one hand, those associated with natural phenomena and, on the other, with biological or health phenomena.

The contributions of this research seek to cover two aspects in the way disasters are dealt with in Mexico. The first is aimed at comparing two models of risk response that are currently separate, but that in the context of the COVID-19 pandemic can be restructured to complement each other, particularly the National Health System now that it has been overwhelmed by these recurring struggles. This restructuring should be based on the concepts used by the disaster risk approach, such as hazard, exposure, and vulnerability, hence being able to identify the nature of the SARS-CoV-2 virus; the previous health, social, and environmental conditions that can affect a community from contracting the disease, as well as the conditions of fragility that certain sectors of the population have developed before the disease. Lastly, this paper proposes that to face the current pandemic as well as new health disasters, the social construction of risk approach should be included, which can explain how people contend with health risk, their attitudes, or their perception of risk, as well as their strategies for recovering from disease.