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

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

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

Cities and clusters: economy-wide and sector-specific effects in corporate location

Are the observed spatial distributions of firms decided mostly by market-mediated, economy-wide locational forces, or rather by non-pecuniary, sector-specific ones? This work finds that the latter kind of forces weight systematically more than the former in deciding firm location. The analysis uses Italian data on a variety of manufacturing and service sectors spatially disaggregated at the level of Local Labor Systems.Industrial Location, Sector-specific Agglomeration, Urbanization Economy, Maximum Likelihood Estimation

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

Rewriting Dante after Freud and the Shoah:Giorgio Pressburger’s Nel regno oscuro

Martin Heidegger and Hannah Arendt as restless and as passionately in love as the adulterous Paolo and Francesca in the ‘bufera infernal’ of Inferno V, but riding in a black cab to the (Italianized) rhythm of Goethe’s ballad Der Erlkönig; Ezra Pound, Knut Hamsun, and Louis-Ferdinand Céline as the three heads of a new Cerberus whose mixed pastiche of English, Norwegian, and French is an incomprehensible noise conveying nothing but hatred of the Jews; Primo Levi as a fallen angel taking the place of Lucifer at the very bottom of Hell: these are some of the surprises awaiting the reader of Giorgio Pressburger’s latest novel Nel regno oscuro (‘In/to the dark realm’), which is a rich and creative rewriting of Dante’s poem.Like all previous prose works by the 1937-born Hungarian Jewish author who emigrated to Italy in 1956, it is written not in his native Hungarian but in Italian. It is the first part of a planned trilogy inspired by the Divine Comedy, integrating the Middle European style of Pressburger’s previous works with the attempt to engage with the first part of Dante’s poem (of which Pressburger’s novel also seems to replicate the canonical apparatus of notes, in this case written by the author himself).Manuele Gragnolati, ‘Rewriting Dante after Freud and the Shoah: Giorgio Pressburger’s Nel regno oscuro’, in Metamorphosing Dante: Appropriations, Manipulations, and Rewritings in the Twentieth and Twenty-First Centuries, ed. by Manuele Gragnolati, Fabio Camilletti, and Fabian Lampart, Cultural Inquiry, 2 (Vienna: Turia + Kant, 2011), pp. 235–50 <https://doi.org/10.25620/ci-02_14

The Spinning Jenny and the Guillotine: Technological Diffusion at the Time of Revolutions

Why was England the cradle of the Industrial Revolution? The present work shows that scale economies and demand, combined with the conditions of the relative prices of input factors, allow to provide a purely economic answer to this question. The labor-saving innovations of the Industrial Revolution were profitable only if, after their adoption, sales expanded enough to cover the upfront cost of capital. For some time, England was the only country in which sales exceeded the minimum threshold required to make adoption profitable. This fact is illustrated here by means of a detailed case study centered on the cotton industry and on the adoption of the spinning jenny in England and in France at the dawn of the Industrial Revolution. By then, the sufficiently large and relatively well-off English middle class could guarantee to cotton spinners a level of sales that was not viable in France, where income was lower and more concentrated in the hands of the upper classes.Industrial Revolution, income distribution, economies of scale, choice of technique, spinning jenny

Analogy and Difference:Multistable Figures in Pier Paolo Pasolini’s Appunti per un’Orestiade Africana

My paper will discuss Pasolini’s preference for the figure of contradiction and his opposition to Hegelian dialectics, as he understood it, from the perspective of multistable figures or Kippbilder. A Kippbild is a figure that oscillates between distinct aspects without mediation or synthesis. My basic questions are whether it is possible to read Pasolini’s insistence on contradictions in terms of multistable figures and what might be gained from such a reading