Health and wealth in Mesoamerica: findings from Salud Mesomérica 2015

Abstract

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.

Fig. 1

Composite coverage by household expenditure quintile. ANC4 Antenatal care (four visits). SBA Skilled birth attendance. EBF: exclusive breastfeeding, ORS oral rehydration solution for diarrhea treatment

Fig. 2

Heatmaps of key indicators of health behavior across segments. EXP monthly household expenditure, ANC4 antenatal care (four visits), BF early initiation of breastfeeding, ORS oral rehydration solution for diarrhea treatment (White cells for ORS indicate that there were no children exhibiting symptoms of diarrhea in the past two weeks in that segment.), SBA skilled birth attendance, STUNT percent of children not stunted, VAC complete vaccination for age. Correlation is reported for each indicator with household expenditure at the segment level

Fig. 3

Continuum of care for mother-child pairs, most recent birth in the past two years, by household expenditure quintile or attained maternal education level. PNC postnatal care, ANC1 1 visit of antenatal care, ANC4 4 visits of antenatal care