Health and poverty in Guatemala

Unlike many other countries in Latin America, Guatemala is only at the beginning of the demographic, and epidemiological transition. The population is young, is growing rapidly, and is still primarily rural. Guatemala is among the worst performers in terms of health outcomes in Latin America, with one of the highest infant mortality rates, and one of the lowest life expectancies at birth. Major causes of death in Guatemala still include treatable, and communicable diseases, such as diarrhea, pneumonia, cholera, malnutrition, and tuberculosis. A significant share of Guatemalans lack access to health care services. A combination of both supply- and demand-side constraints limit the ability of households to seek health care services in Guatemala, with supply-side constraints playing a more dominant role in rural areas than urban. Some progress has been made in reforming the health sector. Important steps have been taken on the institutional side, with health being one of the pilot ministries to decentralize financial management under the Integrated System for Health Care (SIAS program). Public spending has shifted toward preventive care, which is essential for treating the health problems faced by the poor. Despite these efforts, spending and health outcomes has not improved significantly. In addition, public spending on health is not well targeted. Overall, public health spending benefits the highest quintiles disproportionately, By type of facility, public spending on hospitals is by far the more regressive.Health Systems Development&Reform,Health Monitoring&Evaluation,Early Child and Children's Health,Public Health Promotion,Disease Control&Prevention,Health Systems Development&Reform,Health Economics&Finance,Health Indicators,Adolescent Health,Health Monitoring&Evaluation

Nonlinear effects of altitude on child growth in Peru : a multilevel analysis

Growth at high altitude has been the object of many investigations after experimental studies on animals showed that hypoxia at high altitude slows growth. Many studies have also looked at the Andean populations and found different results. Even though a few studies find that individuals living at high altitudes are smaller than the ones living at low altitudes, a significant group of studies does not reveal such a clear relationship. This study focuses on Peru, a country characterized by a diverse territory, great altitude variations, and a population with a wide socioeconomic gradient. The analysis differs from previous studies in three ways. First, in an attempt to reconcile the main findings of the biological literature with the economic models of child health, it explores the relationship between altitude and child health within a multivariate framework. Second, it benefits from a large spectrum of altitude data and does not concentrate on one or two isolated villages. Third, it takes into account the cluster nature of the data and controls for correlation of variables in the same cluster through multilevel statistical modeling. After controlling for characteristics of the children, families, and communities, the data show a significant nonlinear relationship between altitude and child nutritional status. Peruvian children living at medium/high altitudes appear to be worse off than children living at extremely high altitudes, where the negative effect of hypoxia on growth could be compensated by other favorable health and environmental conditions.Health Monitoring&Evaluation,Street Children,Youth and Governance,Early Child and Children's Health,Adolescent Health

Malnutrition and poverty in Guatemala

The objective of this paper is to document the extent, and distribution of child, and adult malnutrition in Guatemala; to analyze the relationship between selected child, maternal, household and community characteristics, and children's nutritional status; and, to outline the implications of the most important findings for nutritional policy. The prevalence of chronic malnutrition among Guatemalan children in 2000, was the highest in Latin America, and among the highest in the world. The data show very strong socioeconomic, and geographic inequality. The econometric analysis reveals a strong impact of income, and of inter-generational effects. Education of adults in the household, and the availability of infrastructure, are other important determinants of children's growth attainment. Finally, even controlling for income, and other household and community characteristics, ethnicity remains an important determinant of child nutritional status. The study also reveals an increasing prevalence of excess weights, and obesity among children and adults. Over-nutrition tends to be higher among individuals living in urban areas, and among non-poor, and non-indigenous households.Health Monitoring&Evaluation,Early Child and Children's Health,Primary Education,Public Health Promotion,Early Childhood Development,Early Childhood Development,Youth and Governance,Nutrition,Health Monitoring&Evaluation,Early Child and Children's Health

Sustainability of healthcare financing in the Western Balkans : an overview of progress and challenges

This paper explores the major challenges to the sustainability of health sector financing in the countries of the Western Balkans - Albania, Bosnia and Herzegovina, the Former Yugoslav Republic of Macedonia, Montenegro, Serbia and the province of Kosovo. It focuses on how the incentives created by the different elements of the healthcare financing system affect the behavior of healthcare providers and individuals, and the resulting inefficiencies in revenue collection and expenditure containment. The paper analyzes patterns of healthcare expenditure, finding that there is some evidence of cost containment, but that current expenditure levels - while similar to that in EU countries as a share of GDP - are low in per capita terms and the fiscal space to increase expenditures is extremely limited. It also examines the key drivers of current healthcare expenditure and the most significant barriers to revenue generation, identifying some key health reforms that countries in the sub-region could consider in order to enhance the efficiency and sustainability of their health systems. Data are drawn from international databases, country institutions, and household surveys.Health Monitoring&Evaluation,Health Economics&Finance,Health Systems Development&Reform,Public Sector Expenditure Analysis&Management,Health Law

Children's growth and poverty in rural Guatemala

The author investigates the extent and determinants of poor child health and nutrition in rural Guatemala, as reflected in attained height. Exploiting a rich data set on relevant social, economic, ethnic, and geographic characteristics, he estimates the role played by exogeneous individual, household, and community covariates in shaping differentials in children's height. Then he addresses empirical questions ignored in previous anthropometric research, such as the distribution of child stunting across communities and the magnitude of intra-family correlation of height-for-age outcomes, before and after controlling for observed covariates. The author estimates are guided by the economic model of the family and the proximate determinants framework. The author fits multilevel models to hierarchically clustered data to control for family and community heterogeneity. His results confirm findings from previous research, suggesting that poor child growth outcomes in Guatemala are the result of widespread poverty. He finds that height-for-age differentials between children of latino mothers and children of indigenous mothers who do not speak Spanish are larger among children living in communities with better health care facilities. Estimates derived from multilevel models reveal much clustering of child height-for-age outcomes within families and communities. The models account for most of the community-level variation in child growth patterns, but explain only half of the overall intra-family correlation.Education and Society,Public Health Promotion,Population&Development,Health Monitoring&Evaluation,Early Child and Children's Health,Education and Society,Population&Development,Health Monitoring&Evaluation,Youth and Governance,Adolescent Health

The Impoverishing Effect of Ill Health: Evidence from the Western Balkans

This paper investigates the extent to which the health systems of the Western Balkans (Albania, Bosnia and Herzegovina, Montenegro, Serbia and Kosovo) have succeeded in providing financial protection against adverse health events. We examine disparities in health status, health care utilization and out-of-pocket payments for health care (including informal payments), and explore the impact of health care expenditures on household economic status and poverty. Data are drawn from LSMS surveys and methodologies include ‘catastrophic-health’ analysis, poverty incidence analysis adjusted for health payments, and multivariate regression analysis. On balance, we find that economic status is significantly associated with health care-seeking behavior in all transition economies and the cost of illness can increase the incidence and depth of poverty. The impoverishing effect of health expenditures is most severe in Albania and Kosovo, followed by Serbia, Bosnia and Herzegovina and Montenegro. Moreover, health care costs seem to place a heavier burden on the weakest strata of the population, such as children and people with chronic illness, with serious consequences for the breaking out of the illness-poverty vicious circle.Health system, Health care expenditure, Poverty, Western Balkans

The impoverishing effect of adverse health events : evidence from the western Balkans

This paper investigates the extent to which the health systems of the Western Balkans (Albania, Bosnia and Herzegovina, Montenegro, Serbia, and Kosovo) have succeeded in providing financial protection against adverse health events. The authors examine disparities in health status, healthcare utilization, and out-of-pocket payments for healthcare (including informal payments), and explore the impact of healthcare expenditures on household economic status and poverty. Methodologies include (i) generating a descriptive assessment of health and healthcare disparities across socioeconomic groups, (ii) measuring the incidence and intensity of catastrophic healthcare payments, (iii) examining the effect of out-of-pocket payments on poverty headcount and poverty gap measures, and (iv) running sets of country-specific probit regressions to model the relationship between health status, healthcare utilization, and poverty. On balance, the findings show that the impact of health expenditures on household economic wellbeing and poverty is most severe in Albania and Kosovo, while Montenegro is striking for the financial protection that the health system seems to provide. Data are drawn from Living Standards and Measurement Surveys.Health Monitoring&Evaluation,Health Systems Development&Reform,Health Economics&Finance,Population Policies,Rural Poverty Reduction

Improving child nutrition outcomes in India : can the integrated child development services be more effective?

Levels of child malnutrition in India fell only slowly during the 1990s, despite significant economic growth and large public spending on the Integrated Child Development Services (ICDS) program, of which the major component is supplementary feeding for malnourished children. To unravel this puzzle, the authors assess the program's placement and its outcomes using National Family Health Survey data from 1992 and 1998. They find that program placement is clearly regressive across states. The states with the greatest need for the program - the poor northern states with high levels of child malnutrition and nearly half of India's population - have the lowest program coverage and the lowest budgetary allocations from the central government. Program placement within a state is more progressive: poorer and larger villages have a higher probability of having an ICDS center, as do those with other development programs or community associations. The authors also find little evidence of program impact on child nutrition status in villages with ICDS centers.Health Monitoring&Evaluation,Early Child and Children's Health,Youth and Governance,Primary Education,Adolescent Health

New Insights into the Far Eastern Pattern of Mortality

The Far Eastern pattern of mortality, first identified in 1980, is characterized by some of the largest sex differentials at adult ages to be found anywhere in the world. These atypically high levels of excess male mortality were present in several Far Eastern populations during the 1960s and 1970s and have progressively disappeared since that time. This study uses cause of death data to determine the diseases responsible for the existence and attenuation of these sex differences in Hong Kong, Singapore and Taiwan. The analysis focuses primarily on two hypotheses – regarding the roles of respiratory tuberculosis and liver diseases associated with hepatitis B infection – which were proposed to explain the Far Eastern pattern but were never tested. The results of our analysis indicate that respiratory tuberculosis is the single most important cause underlying the existence and attenuation of the Far Eastern pattern, that the role of liver diseases is far from clear cut, and that other causes (such as cardiovascular diseases) are important as well. Some of the risk factors which may underlie these exceptional mortality patterns are identified

Population, development, and policy

The extensive literature on population and development yielded few policy-relevant results before the discovery of the demographic dividend. This dividend refers to a rise in per capita income that results from an increase in workers per capita as a population’s fertility declines. This paper describes the role of the demographic dividend in economic development in developing countries and summarizes policy options for strengthening the dividend. The first section reviews the demographic transition with an emphasis on its later phases when declining fertility and a changing population age structure produce the dividend. Next, the demographic drivers of the dividend and its potential impact on economic growth are examined. The last sections discuss policy options. Special attention is given to the role of voluntary family planning programs to meet rising demand for contraception thus accelerating the fertility decline and increasing the dividend when demand for smaller families is growing. The focus throughout is on sub-Saharan Africa (SSA), the region that has experienced little demographic dividend but where the potential for a future dividend is greatest