This report is the first in a new series of reports reviewing public health policies across selected OECD countries. Health care systems across OECD are increasingly under pressure from social changes – including demographic changes and aging populations – and emerging new health challenges – from a growing burden of chronic disease, to re-emerging and new communicable diseases, or a growing burden of mental ill-health – which demand a strong public health response. The OECD Reviews of Public Health provide in-depth analysis and policy recommendations to strengthen priority areas of countries’ public health systems, highlighting best practice examples that allow learning from shared experiences, and the spreading of innovative approaches.

Chile has a well-functioning, well-organised and effectively governed health system and public health architecture. The public health challenges that Chile is facing would, however, strain any health system. Smoking rates are relatively high, alcohol consumption is low but rising, and mortality from cancer is high in comparison to cancer incidence. A quarter of Chilean adults, and nearly half of Chilean children, are obese or overweight.

Chile has a well-functioning, well-organised and effectively governed health system and public health architecture. The public health challenges that Chile is facing would, however, strain any health system. Smoking rates are relatively high, alcohol consumption is low but rising, and mortality from cancer is high in comparison to cancer incidence. Chile’s biggest challenge, though, is that in Chile 34.4% of adults are obese, and 44.5% of children are obese or overweight.

Overall Chile has a well-functioning, well-organised and effectively governed health system and public health architecture. Leadership from different levels of government is ambitious, and all government actors appear to have well-defined roles in delivering public health care. The key building blocks of the public health system are generally in place, and functioning well. However, more could be done to engage non-governmental actors in addressing Chile’s public health concerns. Equally, while ambitious efforts to tackle obesity have been undertaken in Chile, other public health risks – notably smoking and alcohol consumption – merit further policy attention. There is also scope to strengthen public health information system in Chile, notably with more regular administration of the National Health Survey, which is a rich source of epidemiological data.

Obesity is one the main causes of morbidity and mortality in Chile, and the growing prevalence is creating a major threat to the health of the country. Chile has put in place a comprehensive portfolio of interventions, from population-level fiscal policies, to school- and workplace-focused programmes, to individual interventions in primary care. There are a number of ways in which Chile could further strengthen its portfolio of interventions, including through expanding some polices so that they cover a greater share of the population, and a greater number of food products. In addition Chile’s private health insurers – the ISAPRES – have a bigger role to play, and could do more to positively influence the health of their insurees.

In Chile, cancer is the second leading cause of death and could become the first cause in the near future. In order to reduce the disease burden, Chile could do more to prevent many deaths due to cancer through cancer screening and prevention. This chapter describes the epidemiological burden of cancer in Chile, assesses the governance of Chilean cancer care system and public health policies in terms of prevention and early detection of cancer based on cross-national comparisons, and concludes with a number of policy recommendations which could help Chile strengthen cancer screening and prevention. Together with policies to promote healthy lifestyles, public health policies specific to cancer are key to reducing the burden of cancer in Chile.

A well-designed national strategy on using public health genomics to strengthen public health and preventive care could make Chile a regional leader in this emerging field. Although the global trend of increasing use of genomic testing improving diagnosis and treatments for the sick and preventive measures for the healthy, Chile lacks of a national plan for implementing precision medicine in the clinical practice or public health policies. International efforts in OECD countries can provide good examples of government-industry system structures that have been successful in the expansion of genomics services, particularly for informing public health and preventive care. Regulation, rigorous empirical evidence, development of the genetics workforce, genetics education for health professionals and the public as well as careful attention to equitable service design is necessary to achieve widespread public health and preventive care applications in Chile.