Health and wealth in Mesoamerica: findings from Salud Mesomérica 2015

BMC Medicine

Emma Iriarte⁴  Rafael Lozano²  Bernardo Hernandez²  Shelley Wilson²  Gulnoza Usmanova²  Alexandra Schaefer²  Dharani Ranganathan⁵  Jennifer Nelson⁴  Paria Naghavi²  Tasha Murphy³  Catherine W. Gillespie⁷  Sima S. Desai²  Brent W. Anderson¹  Erin B. Palmisano²  Annie Haakenstad²  Diego Ríos-Zertuche⁴  Paola Zúñiga-Brenes⁴  K. Ellicott Colson⁶  Marielle C. Gagnier²  Ali H. Mokdad² 

[1] Pardee RAND Graduate School, 1776 Main Street, Santa Monica 90401, California, USA;Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA;University of Washington School of Social Work, 4101 15th Avenue N, Seattle, WA, USA;Salud Mesoamérica 2015 / Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá;George Washington University, 950 New Hampshire Ave, NW, Washington, DC, USA;Division of Epidemiology, School of Public Health, University of California, Berkeley, California;AARP Public Policy Institute, 601 E Street NW, Washington, DC, USA

关键词: Salud Mesomérica 2015;    Central America;    Health disparities;    Poverty and health;    Maternal and child health;   

Others  :  1219800
DOI  :  10.1186/s12916-015-0393-5

 received in 2015-01-23, accepted in 2015-06-04,  发布年份 2015

【 摘 要 】

Background

Individual income and poverty are associated with poor health outcomes. The poor face unique challenges related to access, education, financial capacity, environmental effects, and other factors that threaten their health outcomes.

Methods

We examined the variation in the health outcomes and health behaviors among the poorest quintile in eight countries of Mesoamerica using data from the Salud Mesomérica 2015 baseline household surveys. We used multivariable logistic regression to measure the association between delivering a child in a health facility and select household and maternal characteristics, including education and measures of wealth.

Results

Health indicators varied greatly between geographic segments. Controlling for other demographic characteristics, women with at least secondary education were more likely to have an in-facility delivery compared to women who had not attended school (OR: 3.20, 95 % confidence interval [CI]: 2.56-3.99, respectively). Similarly, women from households with the highest expenditure were more likely to deliver in a health facility compared to those from the lowest expenditure households (OR 3.06, 95 % CI: 2.43-3.85). Household assets did not impact these associations. Moreover, we found that commonly-used definitions of poverty do not align with the disparities in health outcomes observed in these communities.

Conclusions

Although poverty measured by expenditure or wealth is associated with health disparities or health outcomes, a composite indicator of health poverty based on coverage is more likely to focus attention on health problems and solutions. Our findings call for the public health community to define poverty by health coverage measures rather than income or wealth. Such a health-poverty metric is more likely to generate attention and mobilize targeted action by the health communities than our current definition of poverty.

【 授权许可】

   
2015 Mokdad et al.

【 图 表 】

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