Cognitive Abilities: Intergenerational Transmission by Socioeconomic Levels

Resumen: Un modelo switching aplicado a información de la encuesta ENNViH 2002 evidencia diferencias significativas en la formación de habilidad cognitiva infantil através de los estratos sociales mexicanos. Un pequeño conjunto de variables de política pública y de características económicas de la localidad detecta un importante gradiente y variaciones en los determinantes familiares de la habilidad cognitiva infantil. Los niños de estratos sociales bajos adquieren una menor habilidad cognitiva, y dependen de la satisfacción de necesidades más básicas, que los de niveles mas altos. En los estratos bajos los coeficientes son consistentes con la existencia de restricciones de riqueza, que impiden una inversión óptima en el desarrollo infantil.Using the ENNViH 2002 survey, a switching model shows that significant diferences exist in the formation of infant cognitive ability across Mexican social strata. Public policy variables and local economic characteristics are suficient to detect an important gradient in cognitive abilities and their family determinants in children. Children from lower strata acquire lower cognitive abilities and depend on the satisfaction of more basic needs than children in higher strata. Coeficients for the lower strata are consistent with the existence of wealth restrictions that impede optimal investment in child development.habilidades cognitivas, desigualdad, intergeneracional, politica publica, cognitive ability, inequality, intergenerational, public policy, switching

An explanatory analysis of economic and health inequality changes among Mexican indigenous people, 2000-2010

INTRODUCTION: Mexico faces important problems concerning income and health inequity. Mexico’s national public agenda prioritizes remedying current inequities between its indigenous and non-indigenous population groups. This study explores the changes in social inequalities among Mexico’s indigenous and non-indigenous populations for the time period 2000 to 2010 using routinely collected poverty, welfare and health indicator data. METHODS: We described changes in socioeconomic indicators (housing condition), poverty (Foster-Greer-Thorbecke and Sen-Shorrocks-Sen indexes), health indicators (childhood stunting and infant mortality) using diverse sources of nationally representative data. RESULTS: This analysis provides consistent evidence of disparities in the Mexican indigenous population regarding both basic and crucial developmental indicators. Although developmental indicators have improved among the indigenous population, when we compare indigenous and non-indigenous people, the gap in socio-economic and developmental indicators persists. CONCLUSIONS: Despite a decade of efforts to promote public programs, poverty persists and is a particular burden for indigenous populations within Mexican society. In light of the results, it would be advisable to review public policy and to specifically target future policy to the needs of the indigenous population

Probability and amount of medicines expenditure according to health insurance status in Kenya: A household survey in eight counties

National and county governments in Kenya have introduced various health insurance schemes to protect households against financial hardship as a result of large health expenditure. This study examines the relationship between health insurance and medicine expenditure in eight counties in Kenya.A cross-sectional study of collected primary data via household survey in eight counties was performed. Three measures of medicine expenditure were analysed: the probability of any out-of-pocket expenditure (OOPE) on medicines in the last 4 weeks; amount of OOPE on medicines; and OOPE on medicines as a proportion of total OOPE on health

Habilidades Cognitivas: Transmision Intergeneracional Por Niveles Socioeconomicos

Resumen: Un modelo switching aplicado a información de la encuesta ENNViH 2002 evidencia diferencias significativas en la formación de habilidad cognitiva infantil através de los estratos sociales mexicanos. Un pequeño conjunto de variables de política pública y de características económicas de la localidad detecta un importante gradiente y variaciones en los determinantes familiares de la habilidad cognitiva infantil. Los niños de estratos sociales bajos adquieren una menor habilidad cognitiva, y dependen de la satisfacción de necesidades más básicas, que los de niveles mas altos. En los estratos bajos los coeficientes son consistentes con la existencia de restricciones de riqueza, que impiden una inversión óptima en el desarrollo infantil. Abstract: Using the ENNViH 2002 survey, a switching model shows that significant diferences exist in the formation of infant cognitive ability across Mexican social strata. Public policy variables and local economic characteristics are suficient to detect an important gradient in cognitive abilities and their family determinants in children. Children from lower strata acquire lower cognitive abilities and depend on the satisfaction of more basic needs than children in higher strata. Coeficients for the lower strata are consistent with the existence of wealth restrictions that impede optimal investment in child development

Habilidades Cognitivas: Transmision Intergeneracional Por Niveles Socioeconomicos

Resumen: Un modelo switching aplicado a información de la encuesta ENNViH 2002 evidencia diferencias significativas en la formación de habilidad cognitiva infantil através de los estratos sociales mexicanos. Un pequeño conjunto de variables de política pública y de características económicas de la localidad detecta un importante gradiente y variaciones en los determinantes familiares de la habilidad cognitiva infantil. Los niños de estratos sociales bajos adquieren una menor habilidad cognitiva, y dependen de la satisfacción de necesidades más básicas, que los de niveles mas altos. En los estratos bajos los coeficientes son consistentes con la existencia de restricciones de riqueza, que impiden una inversión óptima en el desarrollo infantil. Abstract: Using the ENNViH 2002 survey, a switching model shows that significant diferences exist in the formation of infant cognitive ability across Mexican social strata. Public policy variables and local economic characteristics are suficient to detect an important gradient in cognitive abilities and their family determinants in children. Children from lower strata acquire lower cognitive abilities and depend on the satisfaction of more basic needs than children in higher strata. Coeficients for the lower strata are consistent with the existence of wealth restrictions that impede optimal investment in child development

The relationship of age and place of delivery with postpartum contraception prior to discharge in Mexico: A retrospective cohort study

AbstractObjectivesTo test the association of age (adolescents vs. older women) and place of delivery with receipt of immediate postpartum contraception in Mexico.Study designRetrospective cohort study, Mexico, nationally representative sample of women 12–39years old at last delivery. We used multivariable logistic regression to test the association of self-reported receipt of postpartum contraception prior to discharge with age and place of delivery (public, employment based, private, or out of facility). We included individual and household-level confounders and calculated relative and absolute multivariable estimates of association.ResultsOur analytic sample included 7022 women (population, N=9,881,470). Twenty percent of the population was 12–19years old at last birth, 55% aged 20–29 and 25% 30–39years old. Overall, 43% of women reported no postpartum contraceptive method. Age was not significantly associated with receipt of a method, controlling for covariates. Women delivering in public facilities had lower odds of receipt of a method (Odds Ratio=0.52; 95% Confidence Interval (CI)=0.40–0.68) compared with employment-based insurance facilities. We estimated 76% (95% CI=74–78%) of adolescents (12–19years) who deliver in employment-based insurance facilities leave with a method compared with 59% (95% CI=56–62%) who deliver in public facilities.ConclusionBoth adolescents and women ages 20–39 receive postpartum contraception, but nearly half of all women receive no method. Place of delivery is correlated with receipt of postpartum contraception, with lower rates in the public sector. Lessons learned from Mexico are relevant to other countries seeking to improve adolescent health through reducing unintended pregnancy.ImplicationsAdolescents receive postpartum contraception as often as older women in Mexico, but half of all women receive no method

A Cross-Sectional Study of Prisoners in Mexico City Comparing Prevalence of Transmissible Infections and Chronic Diseases with That in the General Population.

ObjectivesTo describe patterns of transmissible infections, chronic illnesses, socio-demographic characteristics and risk behaviors in Mexico City prisons, including in comparison to the general population, to identify those currently needing healthcare and inform policy.Materials and methodsA cross-sectional study among 17,000 prisoners at 4 Mexico City prisons (June to December 2010). Participation was voluntary, confidential and based on informed consent. Participants were tested for HIV, Hepatitis B & C, syphilis, hypertension, obesity, and, if at risk, glucose and cholesterol. A subset completed a questionnaire on socio-demographic characteristics and risk behaviors. Positive results were delivered with counseling and treatment or referral.Results76.8% (15,517/20,196) of men and 92.9% (1,779/1,914) of women participated. Complete data sets were available for 98.8%. The following prevalence data were established for transmissible infections: HIV 0.7%; syphilis: Anti-TP+/VDRL+ 2.0%; Hepatitis B: HBcAb 2.8%, HBsAg 0.15%; Anti-HCV 3.2%. Obesity: 9.5% men, 33.8% women. Compared with national age- and sex-matched data, the relative prevalence was greater for HIV and syphilis among women, HIV and Hepatitis C in men, and all infections in younger participants. Obesity prevalence was similar for women and lower among male participants. The prevalence of previously diagnosed diabetes and hypertension was lower. Questionnaire data (1,934 men, 520 women) demonstrated lower educational levels, increased smoking and substance use compared to national data. High levels of non-sterile tattooing, physical abuse and histories of sexual violence were found.ConclusionThe study identified that health screening is acceptable to Mexico City prisoners and feasible on a large-scale. It demonstrated higher prevalence of HIV and other infections compared to national data, though low rates compared to international data. Individual participants benefited from earlier diagnosis, treatment and support. The data collected will also enable the formulation of improved policy for this vulnerable group

Understanding the heterogeneous nature of the demand for soft drinks in Mexico: why social determinants also matter.

Background. Soft drink consumption is a risk factor for obesity and non-communicable chronic diseases, and policies to reduce it have been proposed around the world, including taxation. Little is known about the role of other social and economic factors on the demand of such goods. In addition, heterogeneity of the demand due to different levels of consumption has been rarely explored. The aim of this study is to analyse the heterogeneous nature of the demand for soft drinks to understand the role of economic and social factors (provision of safe water /local food market conditions) and draw recommendations for the design of obesity prevention. Methods. Population, cross-sectional analysis of household data from the Mexican Family Life Survey, grouped into three consumption groups (low/medium/high consumers, defined by the proportion of total household expenditure devoted to soft drink purchases) and three economic poverty groups (defined by extreme and moderate income poverty lines). Multivariate probit regressions were applied to explore factors associated to the probability to be a consumer, and simultaneous multivariate quantile regressions were used to model the quantity purchased of soft drinks. Heckman’s procedure was used to control for identification bias. Results. The adjusted probability that a household becomes a consumer is significantly higher with male, educated heads of households and higher household income. Living in localities where access to safe water for drinking and cooking needs is not universal significantly increases the probability to consume soft drinks while living in localities with convenience stores and supermarkets (local food market condition) significantly decreases it, especially in households facing extreme poverty. Demand from low-consumption households is price-inelastic (-0.97) compared with high-consumers (-1.2). Yet when the population is grouped by poverty, households in extreme poverty have a higher significant price-elasticity (-1.5) than those above moderate poverty line (-1.3). Conclusions. In order to design policies that adequately affect the demand for soft drinks on high consumers and benefit the poor, social factors should be considered. A comprehensive obesity prevention strategy should complement taxes with policies that affect social determinants such as the local provision of safe water and local food market conditions

Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Human resources for health (HRH) include a range of occupations that aim to promote or improve human health. The UN Sustainable Development Goals (SDGs) and the WHO Health Workforce 2030 strategy have drawn attention to the importance of HRH for achieving policy priorities such as universal health coverage (UHC). Although previous research has found substantial global disparities in HRH, the absence of comparable cross-national estimates of existing workforces has hindered efforts to quantify workforce requirements to meet health system goals. We aimed to use comparable and standardised data sources to estimate HRH densities globally, and to examine the relationship between a subset of HRH cadres and UHC effective coverage performance. Methods: Through the International Labour Organization and Global Health Data Exchange databases, we identified 1404 country-years of data from labour force surveys and 69 country-years of census data, with detailed microdata on health-related employment. From the WHO National Health Workforce Accounts, we identified 2950 country-years of data. We mapped data from all occupational coding systems to the International Standard Classification of Occupations 1988 (ISCO-88), allowing for standardised estimation of densities for 16 categories of health workers across the full time series. Using data from 1990 to 2019 for 196 of 204 countries and territories, covering seven Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) super-regions and 21 regions, we applied spatiotemporal Gaussian process regression (ST-GPR) to model HRH densities from 1990 to 2019 for all countries and territories. We used stochastic frontier meta-regression to model the relationship between the UHC effective coverage index and densities for the four categories of health workers enumerated in SDG indicator 3.c.1 pertaining to HRH: physicians, nurses and midwives, dentistry personnel, and pharmaceutical personnel. We identified minimum workforce density thresholds required to meet a specified target of 80 out of 100 on the UHC effective coverage index, and quantified national shortages with respect to those minimum thresholds. Findings: We estimated that, in 2019, the world had 104·0 million (95% uncertainty interval 83·5–128·0) health workers, including 12·8 million (9·7–16·6) physicians, 29·8 million (23·3–37·7) nurses and midwives, 4·6 million (3·6–6·0) dentistry personnel, and 5·2 million (4·0–6·7) pharmaceutical personnel. We calculated a global physician density of 16·7 (12·6–21·6) per 10 000 population, and a nurse and midwife density of 38·6 (30·1–48·8) per 10 000 population. We found the GBD super-regions of sub-Saharan Africa, south Asia, and north Africa and the Middle East had the lowest HRH densities. To reach 80 out of 100 on the UHC effective coverage index, we estimated that, per 10 000 population, at least 20·7 physicians, 70·6 nurses and midwives, 8·2 dentistry personnel, and 9·4 pharmaceutical personnel would be needed. In total, the 2019 national health workforces fell short of these minimum thresholds by 6·4 million physicians, 30·6 million nurses and midwives, 3·3 million dentistry personnel, and 2·9 million pharmaceutical personnel. Interpretation: Considerable expansion of the world's health workforce is needed to achieve high levels of UHC effective coverage. The largest shortages are in low-income settings, highlighting the need for increased financing and coordination to train, employ, and retain human resources in the health sector. Actual HRH shortages might be larger than estimated because minimum thresholds for each cadre of health workers are benchmarked on health systems that most efficiently translate human resources into UHC attainment

Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING: Bill & Melinda Gates Foundation