The contribution of social participation to differences in life expectancy and healthy years among the older population : a comparison between Chile, Costa Rica and Spain

SR has received funding from the Spanish Ministry of Science, Innovation and Universities under the FPI programme (CSO-2014- 60113-R). JS has received funding from the "Ramón y Cajal" programme (RYC-2013-14851). JS and DD are financed by R&D project"Will future elderly have any relative available to care for them? A study based on a mixed micro-simulation/ABM model (CSO2017-89721-R). Financial support was also received by the European Research Council (ERC-2019-CoG-864616, HEALIN project, PI Iñaki Permanyer) and from the Catalan Government under the CERCA Program. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.We study the health trajectories of the population aged over 60, comparing between one European and two Latin American countries (Spain, Chile and Costa Rica) which have similar longevity patterns. Our focus is on functional limitation and mortality risks, considering differences by gender, education and social participation. Data come from national panel surveys (EPS, CRELES, SHARE). Multistate modelling is used to estimate transition probabilities between two health states: healthy to unhealthy, unhealthy to healthy as well as the transition to death from healthy or unhealthy states, to estimate the duration of stay in a specific state (computing healthy and unhealthy life expectancies) and the effect of the selected covariates. Results show that older Costa Ricans have the smallest gender gap in life expectancy but women have a lower healthy life expectancy compared to those in Chile and Spain. Participation in social activities leads to higher healthy life expectancy among the elderly in Costa Rica and Spain, whilst there were no relevant educational differences observed in longevity in the analysed countries. To conclude: despite the different patterns observed in health transitions and survival across the three countries, social participation is associated with greater health and longevity among people of old age, with little effect coming from educational attainment. Public policies should therefore be aimed at reducing unhealthy life years and dependency at advanced ages by promoting more engagement in social activities, especially among vulnerable groups who are more likely to experience impairment from a younger age

Disintegrated care: the Achilles heel of international health policies in low and middle-income countries

PURPOSE: To review the evidence basis of international aid and health policy. CONTEXT OF CASE: Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. DATA SOURCES: National policies, international programmes and pilot experiments are examined in both scientific and grey literature. CONCLUSIONS AND DISCUSSION: We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care

Structure preserving estimators to update socio-economic indicators in small areas

Official statistics are intended to support decision makers by providing reliable information on different population groups, identifying what their needs are and where they are located. This allows, for example, to better guide public policies and focus resources on the population most in need. Statistical information must have some characteristics to be useful for this purpose. This data must be reliable, up-to-date and also disaggregated at different domain levels, e.g., geographically or by sociodemographic groups (Eurostat, 2017). Statistical data producers (e.g., national statistical offices) face great challenges in delivering statistics with these three characteristics, mainly due to lack of resources. Population censuses collect data on demographic, economic and social aspects of all persons in a country which makes information at all domains of interest available. They quickly become outdated since they are carried out only every 10 years, especially in developing countries. Furthermore, administrative data sources in many countries have not enough quality to produce statistics that are reliable and comparable with other relevant sources. On the contrary, national surveys are conducted more frequently than censuses and offer the possibility of studying more complex topics. Due to their sample sizes, direct estimates are only published based on domains where the estimates reach a specific level of precision. These domains are called planned domains or large areas in this thesis, and the domains in which direct estimates cannot be produced due to lack of sample size or low precision will be called small areas or domains. Small area estimation (SAE) methods have been proposed as a solution to produce reliable estimates in small domains. These methods allow improving the precision of direct estimates, as well as providing reliable information in domains where the sample size is zero or where direct estimates cannot be obtained by combining data from censuses and surveys (Rao and Molina, 2015). Thereby, the variables obtained from both data sources are assumed to be highly correlated but the census actually may be outdated. In these cases, structure preservation estimation (SPREE) methods offer a solution when the target indicator is a categorical variable, with at least two categories (for example, the labor market status of an individual can be categorised as: ‘employed’, ‘unemployed’, and ‘out of labor force’). The population counts are arranged in contingency tables: by rows (domains of interest) and columns (the categories of the variable of interest) (Purcell and Kish, 1980). These types of estimators are studied in Part I of this work. In Chapter 1, SPREE methods are applied to produce postcensal population counts for the indicators that make up the ‘health’ dimension of the multidimensional poverty index (MPI) defined by Costa Rica. This case study is also used to illustrate the functionalities of the R spree package. It is a user-friendly tool designed to produce updated point and uncertainty estimates based on three different approaches: SPREE (Purcell and Kish, 1980), generalised SPREE (GSPREE) (Zhang and Chambers, 2004), and multivariate SPREE (MSPREE) (Luna-Hernández, 2016). SPREE-type estimators help to update population counts by preserving the census structure and relying on new and updated totals that are usually provided by recent survey data. However, two scenarios can jeopardise the use of standard SPREE methods: a) the indicator of interest is not available in the census data e.g., income or expenditure information to estimate monetary based poverty indicators, and b) the total margins are not reliable, for instance, when changes in the population distribution between areas are not captured correctly by the surveys or when some domains are not selected in the sample. Chapters 2 and 3 offer a solution for these cases, respectively. Chapter 2 presents a two-step procedure that allows obtaining reliable and updated estimates for small areas when the variable of interest is not available in the census. The first step is to obtain the population counts for the census year using a well-known small-area estimation approach: the empirical best prediction (EBP) (Molina and Rao, 2010) method. Then, the result of this procedure is used as input to proceed with the update for postcensal years by implementing the MSPREE (Luna-Hernández, 2016) method. This methodology is applied to the case of local areas in Costa Rica, where incidence of poverty (based on income) is estimated and updated for postcensal years (2012-2017). Chapter 3 deals with the second scenario where the population totals in local areas provided by the survey data are strengthened by including satellite imagery as an auxiliary source. These new margins are used as input in the SPREE procedure. In the case study in this paper, annual updates of the MPI for female-headed households in Senegal are produced. While the use of satellite imagery and other big data sources can improve the reliability of small-area estimates, access to survey data that can be matched with these novel sources is restricted for confidentiality reasons. Therefore, a data dissemination strategy for micro-level survey data is proposed in the paper presented in Part II. This strategy aims to help statistical data producers to improve the trade-off between privacy risk and utility of the data that they release for research purposes

Releasing survey microdata with exact cluster locations and additional privacy safeguards

Household survey programs around the world publish fine-granular georeferenced microdata to support research on the interdependence of human livelihoods and their surrounding environment. To safeguard the respondents’ privacy, micro-level survey data is usually (pseudo)-anonymized through deletion or perturbation procedures such as obfuscating the true location of data collection. This, however, poses a challenge to emerging approaches that augment survey data with auxiliary information on a local level. Here, we propose an alternative microdata dissemination strategy that leverages the utility of the original microdata with additional privacy safeguards through synthetically generated data using generative models. We back our proposal with experiments using data from the 2011 Costa Rican census and satellite-derived auxiliary information. Our strategy reduces the respondents’ re-identification risk for any number of disclosed attributes by 60–80% even under re-identification attempts

Critical Care Tower: Improving the Healthcare of Children for the Future

The Children\u27s Hospital Costa Rica Foundation (CHCRF), the organization for which we worked, is raising more than $22 million to fund the construction and equipment for the new Critical Care Tower in the Hospital Nacional de Ninos in Costa Rica. A Critical Care Tower is necessary because currently, the Hospital Nacional de Ninos is overcrowded and lacks crucial equipment. The goal of this project was to assist the CHCRF in improving the quality and quantity of healthcare provided to children. Our objectives were to prepare a list of potential funders; write a business case, which will serve as a blueprint for brochures; make recommendations for the brochure, which included devising methods of breaking down the Tower\u27s total cost; and defining the social implications of improved health care as a result of the new Critical Care Tower

Review of Methodologies for Land Degradation Neutrality Baselines: Sub-National case studies from Costa Rica and Namibia

The objective of this report is to identify entry points and challenges for subnational LDN baselines in order to inform subnational planning processes as potential vehicle for the implementation of LDN targets on the ground. For this purpose two focus regions were chosen within two of the countries – namely Namibia and Costa Rica – that participated in the first LDN pilot phase. The focus areas in Namibia and Costa Rica are the regions of Otjozondjupa and Rio Jesus Maria watershed respectively. Both Namibia and Costa Rica provide interesting case studies given the differences in types of land degradation, national capacities, and land resources

Integration of remote-sensing based metrics and econometric models to assess the socio-economic contributions of carbon sequestration in unmanaged tropical dry forests

Carbon sequestration by forests is one of the vital ecosystem services regulating the global climate. Equally important are the socio-economic co-benefits of carbon sequestration, given their implications for designing policies focused on conservation or restoration of tropical forests. Much debate has been around how to account for, and maximize, the co-benefits of carbon sequestration. Prior research suggests that a better understanding of the spatial relationship between carbon sequestration potential and forest types and dynamics - as a function of geographical context and time - is needed to better estimate their socio-economic benefits. Hence, this paper uses the Tropical Dry Forests of Central and South America to propose a new approach to quantify carbon sequestration of this biome, and its efficiency, using time series of the Terra-MODIS satellite. Our estimations of carbon sequestration are then coupled with a benefit transfer approach to infer carbon sequestration's monetary cost. Results reveal that these tropical forests sequester an annual average of 22.3 ​± ​3.3 tCO2 ha-1 yr-1 or in total, 1.16 GtCO2. The associated social cost of carbon, calculated using three econometric models, ranges from USD 489 ​ha-1 ​yr-1 to USD 2828 ​ha-1 ​yr-1. These results can open new perspectives regarding the benefits of carbon sequestration against the costs of the negative impacts of climate change for national welfare accounts, their relevance for environmental policy-making, and the implementation or monitoring of carbon-based incentive programs (e.g., WAVES)

Regional Disparities in Cognitive Functioning of Rural and Urban Older Adults in Costa Rica

Prior research examining health disparities by region (urban vs. rural) on dementia and cognition have been studied using screening tools mostly, with conflicting results. Some studies support a rural health disadvantage, while other consider that urban dwellers are at greater risk of dementia and cognitive impairment. Latin American (LA) countries are underrepresented in these studies. Full neuropsychological assessment batteries have been administered in a limited number of studies, without addressing measurement equivalence of the tests across regions. The present study situates within a larger research project called EDAD (Epidemiology and Development of Alzheimer’s Disease) with Costa Rican older adults. The EDAD included a group of 16 neuropsychological tests among other health-related measurement tools. The purpose of the present study was to (a) identify the cognitive dimensions of the EDAD neuropsychological battery, (b) examine the comparability of the measures and cognitive constructs across the urban and rural sample of EDAD participants from Costa Rica, (c) determine whether group differences exists in the cognitive constructs, and (d) evaluate the contribution of age and education in the group differences. An exploratory/confirmatory factor analytic approach was implemented to identify the baseline model for the EDAD neuropsychological measures. Then, based on multiple-group confirmatory factor analysis, measurement invariance was examined. Once measurement invariance was established, group comparisons of the latent cognitive factors were conducted to explore regional disparities. Three cognitive constructs were identified in the factor model: Verbal Memory, Spatial Reasoning and Cognitive Flexibility. The findings showed that most of the neuropsychological tests in EDAD can be directly compared across the groups, allowing for latent mean comparisons. The rural sample of Costa Rican older adults had a disadvantage in the Spatial Reasoning and Cognitive Flexibility abilities. When age and education were included in the models, no differences between the regions were found. The results of the present study suggested that norms for Costa Rican older adults should consider age and education adjustments. This study contributes to the growing are of measurement invariance in neuropsychological assessment as it highlights the importance of examining the comparability of assessment measures across different cultural groups

Hunger in America 2006 Local Report Prepared for The Food Bank of Contra Costa and Solano Counties

This report presents information on the clients and agencies served by the Food Bank of Contra Costa and Solano Counties. The information is drawn from a national study, Hunger in America 2006, conducted for America's Second Harvest (A2H), the nation's largest organization of emergency food providers. The national study is based on completed in person interviews with more than 52,000 clients served by the A2H food bank network, as well as on completed questionnaires from more than 30,000 A2H agencies. The study summarized below focuses mainly on emergency food providers and their clients who are supplied with food by food banks in the A2H network.Key Findings: The A2H system served by the Food Bank of Contra Costa and Solano Counties provides food for an estimated 75,400 different people annually.33% of the members of households served by The Food Bank of Contra Costa & Solano are children under 18 years old (Table 5.3.2).43% of client households include at least one employed adult (Table 5.7.1).Among client households with children, 73% are food insecure and 48% are food insecure with very low food security (Table 6.1.1.1).43% of clients served by The Food Bank of Contra Costa & Solano report having to choose between paying for food and paying for utilities or heating fuel (Table 6.5.1).29% had to choose between paying for food and paying for medicine or medical care (Table 6.5.1).24% of households served by The Food Bank of Contra Costa & Solano report having at least one household member in poor health (Table 8.1.1)The Food Bank of Contra Costa & Solano included approximately 176 agencies at the administration of this survey, of which 108 have responded to the agency survey. Of the responding agencies, 85 had at least one food pantry, soup kitchen, or shelter.60% of pantries, 50% of kitchens, and 12% of shelters are run by faith-based agencies affiliated with churches, mosques, synagogues, and other religious organizations (Table 10.6.1).61% of pantries, 80% of kitchens, and 12% of shelters of the Food Bank of Contra Costa and Solano Counties reported that there had been an increase since 2001 in the number of clients who come to their emergency food program sites (Table 10.8.1).Food banks are by far the single most important source of food for agencies with emergency food providers, accounting for 70% of the food distributed by pantries, 48% of the food distributed by kitchens, and 49% of the food distributed by shelters (Table 13.1.1).For the Food Bank of Contra Costa and Solano Counties, 89% of pantries, 84% of kitchens, and 56% of shelters use volunteers (Table 13.2.1)

Review: groundwater management and groundwater/surface-water interaction in the context of South African water policy

Groundwater/surface-water interaction is receiv¬ing increasing focus in Africa due to its importance to ecologic systems and sustainability. In South Africa's 1998 National Water Act (NWA), water-use licenses, including groundwater, are granted only after defining the Reserve, the amount of water needed to supply basic human needs and preserve some ecological integrity. Accurate quantification of groundwater con¬tributions to ecosystems for successful implementation of the NWA proves challenging; many of South Africa's aquifers are in heterogeneous and anisotropic fractured-rock settings. This paper reviews the current conceptualizations and investigative approaches regard¬ing groundwater/surface-water interactions in the con¬text of South African policies. Some selected pitfall experiences are emphasized. The most common approach in South Africa is estimation of average annual fluxes at the scale of fourth-order catchments (~500 km2) with base flow separation techniques and then subtracting the groundwater discharge rate from the recharge rate. This approach might be a good start, but it ignores spatial and temporal variability, potentially missing local impacts associated with production-well placement. As South Africa's NWA has already been emulated in many countries including Zambia, Zimbabwe and Kenya, the successes and failures of the South African experience dealing with the groundwater/surface-water interaction will be analyzed to guide future policy directions.Web of Scienc