Latin American Region Research Articles

Cycle closure of nutrients and power generation potential by anaerobic treatment of sewage: case study in Las Juntas de Abangares, Costa Rica

[Introduction]: An adequate selection of technology in wastewater treatment plants (WWTPs) and the search for solutions to integrate these systems in the communities are necessary to promote a sustainable sanitation in the Latin American region. [Objective]: This article evaluates the recovery potential of by-products in an anaerobic-based WWTP for the community of Las Juntas de Abangares (10 000 inhabitants). [Methodology]: A mathematical model of mass and energy balance in the community was formulated to estimate the nutrient fluxes (N, P, K) and biogas generation in a proposed WWTP for the population, with an anaerobic reactor as treatment technology. The potential of use of nutrients (liquid and solid phase) to substitute chemical fertilizers in the Abangares region was evaluated and different energy uses of biogas were compared. [Results]: The results show that all the nutrients can be used in Abangares, as this supply would represent less than 1 % of the total demand of the grassland area available in this area. Additionally, the potential savings derived from the use of nutrients and biogas amounted to US $ 50 and 30 thousand dollars per year, respectively, and the use of biogas to replace firewood or cooking gas would allow a negative carbon WWTP. [Conclusions]: The study shows the potential of anaerobic reactors to promote a sustainable sanitation in the region, generating direct benefits and allowing a better integration of the treatment systems in the communities of Costa Rica and other Latin American countries.

Trade, FDI, and CO2 emissions nexus in Latin America: the spatial analysis in testing the pollution haven and the EKC hypotheses.

Americas have a mix of developing and developed economies. Thus, the pollution haven hypothesis (PHH) is expected in the developing countries of Latin America. Using the spatial Durbin model, the present study investigates the effects of foreign direct investment (FDI), exports, and imports on emissions in 18 Latin American countries from 1970 to 2019, including economic growth and the financial market development (FMD) in the model. The environmental Kuznets curve (EKC) is validated, and the region is found in the first stage of the EKC. Hence, Latin American economic growth has environmental consequences. Exports have a positive impact on home and neighboring countries' CO2 emissions and pollute the whole region, which validates the PHH. Imports could not affect the home economies but have positive environmental effects on neighboring economies and the entire Latin American region. The negative coefficient of imports is larger than the positive coefficient of exports. Therefore, the net effect of trade is environmentally pleasant in Latin America. Moreover, FDI has a statistically insignificant effect and the impact of FMD is positive on CO2 emissions. The study recommends caring the exporting, financial, and economic activities for a sustainable environment in Latin America.

Leveraging India’s Goodwill in Latin America as ‘Soft Power’

Although India commands considerable goodwill in the Latin American region, it does little to leverage this to conduct economic diplomacy. It is imperative to study the nature of India’s image and goodwill in Latin America, and subsequently, differentiate it from how the region views other countries, before examining if and how this can be leveraged as soft power. Based on interviews with select experts in Latin America, we can gather certain insights that separate India’s image from other countries in the region. Perhaps the biggest point of consensus amongst all the experts interviewed is the sheer lack of knowledge about India amongst the general population in Latin America – with the caveat that many niche segments, including businesspersons, journalists and academics have a reasonable amount of knowledge of India, including the contemporary, ‘New India.’ The Indian government can work together with stakeholders in Latin America to help increase awareness of the country, including the elements of the old and the new, be it yoga, Ayurveda and literature or the New India’s IT, pharmaceutical and manufacturing investments in the region, as well as the reach of Indian cinema and entertainment.

Development of an Application for Electronic Retrieval of Patient and Sample Information in Latin American Regions with a High Incidence of Gallbladder Cancer.

The European–Latin American Consortium towards Eradication of Preventable Gallbladder Cancer, EULAT Eradicate GBC, is collecting high-quality data and samples in four Latin American countries with high gallbladder cancer incidence (Argentina, Bolivia, Chile, and Peru) to build a unique biorepository integrated into a tailored IT platform, to identify, validate, and functionally characterize new risk biomarkers, and to develop prediction models that integrate epidemiological and genetic–molecular risk factors. We decided to develop an application for electronic data collection to facilitate the retrieval of sociodemographic, clinical, lifestyle, dietary, and sample-related information from 15,000 Latin American study participants. The application EULAT eCollect will facilitate the work of study nurses, reduce time spent by participants, limit the use of paper and ink, minimize costs and errors associated with filling out written forms and subsequent digitisation, and support the monitoring of local recruitment rates and data quality. We describe in this article the design and implementation of the EULAT eCollect application, which started with the specification of functional and non-functional requirements, and ended with the implementation and validation of four separate application modules: Socio-Demographic Interview, Sample Information, Case Report Form, and Food-Frequency Questionnaire. We present both general and technical results, and our experience with the free and open-source software, Open Data Kit (ODK), which may be of interest for future related research projects, especially those on personalised cancer prevention carried out in low- and middle-income regions.

Network analysis of the relationships between conspiracy beliefs towards COVID-19 vaccine and symptoms of fear of COVID-19 in a sample of latin american countries.

The present study examined how conspiracy beliefs about COVID-19 vaccines specifically relate to symptoms of fear of COVID-19 in a sample of four South American countries. A total of 1785 people from Bolivia, Colombia, Ecuador, and Peru participated, responding to a sociodemographic survey, the Fear of COVID-19 scale (FCV-19 S) and the Vaccine Conspiracy Beliefs Scale-COVID-19 (VCBS-COVID-19). Network analysis identified the most important symptoms of fear and conspiracy beliefs about COVID-19 vaccines (nodes) and the associations between them (edges). In addition, the robustness of the network of these indicators of centrality and the possible differences in the structure and connectivity of the networks between the four countries were evaluated. The results suggest that the nodes with the highest centrality were items 2 and 5 of the FCV-19 S and item 2 of the VCBS-COVID-19. Likewise, item 6 is the belief that most predicts conspiracy beliefs about vaccines against COVID-19; while item 6 was the symptom that most predicts fear of COVID-19. The findings strongly support cross-cultural similarities in the networks across the four countries rather than differences. Although it was expected that a higher presence of symptoms of fear of COVID-19 may lead people to compensate for their fear by believing in conspiratorial ideas about vaccines and, consequently, rejecting the COVID-19 vaccine, the results do not clearly show this relationship. This could lead other researchers to generate evidence to explain the differences between Latin American countries and countries in other contexts in terms of vaccination rates. This evidence could be useful to develop policies favoring vaccination against COVID-19 that are more contextualized to the Latin American region, characterized by social instability and economic recession during the pandemic.

Synergies between environmental degradation and climate variation on malaria re-emergence in southern Venezuela: a spatiotemporal modelling study

Environmental degradation facilitates the emergence of vector-borne diseases, such as malaria, through changes in the ecological landscape that increase human-vector contacts and that expand vector habitats. However, the modifying effects of environmental degradation on climate-disease relationships have not been well explored. Here, we investigate the rapid re-emergence of malaria in a transmission hotspot in southern Venezuela and explore the synergistic effects of environmental degradation, specifically gold-mining activity, and climate variation. In this spatiotemporal modelling study of the 46 parishes of the state of Bolívar, southeast Venezuela, we used data from the Venezuelan Ministry of Health including population data and monthly cases of Plasmodium falciparum malaria and Plasmodium vivax malaria between 1996 and 2016. We estimated mean precipitation and temperature using the ERA5-Land dataset and used monthly anomalies in sea-surface temperature as an indicator of El Niño events between 1996 and 2016. The location of suspected mining sites in Bolívar in 2009, 2017, and 2018 were sourced from the Amazon Geo-Referenced Socio-Environmental Information Network. We estimated measures of cumulative forest loss and urban development by km2 using annual land cover maps from the European Space Agency Climate Change Initiative between 1996 and 2016. We modelled monthly cases of P falciparum and P vivax malaria using a Bayesian hierarchical mixed model framework. We quantified the variation explained by mining activity before exploring the modifying effects of environmental degradation on climate-malaria relationships. We observed a 27% reduction in the additional unexplained spatial variation in incidence of P falciparum malaria and a 23% reduction in P vivax malaria when mining was included in our models. The effect of temperature on malaria was greater in high mining areas than low mining areas, and the P falciparum malaria effect size at temperatures of 26·5°C (2·4 cases per 1000 people [95% CI 1·78-3·06]) was twice as high as the effect in low mining areas (1 case per 1000 people [0·68-1·49]). We show that mining activity in southern Venezuela is associated with hotspots of malaria transmission. Increased temperatures exacerbated malaria transmission in mining areas, highlighting the need to consider how environmental degradation modulates climate effect on disease risk, which is especially important in areas subjected to rapidly rising temperatures and land-use change globally. Our findings have implications for the progress towards malaria elimination in the Latin American region. Our findings are also important for effectively targeting timely treatment programmes and vector-control activities in mining areas with high rates of malaria transmission. Biotechnology and Biological Sciences Research Council, Royal Society, US National Institutes of Health, and Global Challenges Research Fund. For the Spanish translation of the abstract see Supplementary Materials section.

The influence of fatalistic beliefs and risk perceptions on road safety attitudes in Latin America; A two-country study

Road safety is a major challenge in the Latin American region; however, there is a significant lack of research undertaken there. To contribute to addressing this gap, this paper reports on an exploration of the antecedents of traffic safety attitudes in two Latin American contexts: Brazil and Ecuador. Building on related work undertaken in other countries, the research explored the relationships between fatalistic beliefs, traffic risk perceptions, and road safety attitudes, while accounting for age, gender, and exposure to the road environment. Data from 2432 individuals, analysed using Structural Equation Modelling, revealed differences in the extent to which different fatalistic belief constructs (including divine control, luck, helplessness, internality, and general fatalism) were related to road safety attitudes. Moreover, fatalistic beliefs were found to influence road safety attitudes both directly and indirectly through their influence on risk perceptions. Those that reported more fatalistic beliefs also reported more dangerous attitudes to road safety and a lower perception of on-road risk. Mirroring findings from work undertaken in other countries, we found males compared to females and younger compared to older respondents to report more dangerous attitudes to road safety, with inconclusive results for risk perceptions. We also found very similar patterns of results in the data from the two countries included in the research. Results are discussed with regards to informing the design of road safety interventions aimed at influencing individual road user attitudes and, ultimately, human behaviour and system performance.

Barriers of Access to Opioid Medicines within the Context of Palliative Care in Latin America: The Perception of Health Professionals.

Background: Different sets of barriers have been identified to explain the difficulties in the access and availability of opioid analgesics in palliative care, particularly in low- and middle-income countries, including Latin America. Objective: To validate a structured questionnaire for the access to opioid medicines and to investigate the perception of health professionals regarding access barriers to opioid analgesics in 17 countries of the Latin American Region. Design: Survey to identify the domains and barriers of access to opioid medicines according to health professionals, including physicians, nurses, and pharmacists affiliated to institutions that provide palliative care in Latin America between August 2019 and October 2020. Results: We analyzed responses from 426 health professionals. The median age was 44 years old (ranging from 23 to 73 years) with an average experience in palliative care of 10 years (range: 1-35), 71.8% were women, and 49.8% were affiliated to specialized health care facilities of urban areas (94.6%). The main barriers perceived to be extremely relevant by the respondents were "belief that patients can develop addiction" and "financial limitations of patients" for the patient's domain and the "appropriate education, instruction, and training of professionals" for health professional's domain. Conclusions: It is necessary to develop strategies to strengthen less-developed health systems of the region to review legal frameworks, ensure integrated palliative care systems, and deploy multidisciplinary strategies for sensitizing, training, and raising the awareness of patients, caregivers and, particularly, health professionals regarding appropriate prescription and rational use of opioid analgesics.

Challenges in the Management of Post-COVID-19 Pulmonary Fibrosis for the Latin American Population.

This commentary aims to highlight some of the major issues (with possible solutions) that the Latin American region is currently dealing with in managing post-COVID-19 pulmonary fibrosis. Overall, there is little evidence for successful long-term COVID-19 follow-up treatment. The lack of knowledge regarding proper treatment is exacerbated in Latin America by a general lack of resources devoted to healthcare, and a lack of availability and access to multidisciplinary teams. The discussion suggests that better infrastructure (primarily multicenter cohorts of COVID-19 survivors) and well-designed studies are required to develop scientific knowledge to improve treatment for the increasing prevalence of pulmonary fibrosis in Latin America.

Income and Social Trust in Latin America

How do economic conditions affect trust? In this paper, I analyze the effect of natural resource shocks on social trust in Latin American regions. To deal with the endogeneity between income and trust, I use an identification strategy that relies on the exogeneity of the international prices of commodities. I show that income shocks have a positive effect on social trust, a result that is robust to a number of checks. I present evidence that points to two mechanisms: increases in life satisfaction and a reduction in crime victimization. I do not find that inequality is moderating this effect nor that extractive commodities are detrimental to social trust. These results are consistent with the decline in social trust on the continent during the last decade of sluggish growth and economic turmoil.

Regional implications of the tobacco value chain in Paraguay

BackgroundParaguay is a major supplier of illicit cigarettes for the Latin American region and beyond. In July 2022, Paraguay ratified the FCTC Protocol. This is an opportunity and a challenge...

Campaigning for a Global Collections Network: Improving the digital representation and visibility of natural science collections from Latin America and the Caribbean

Global conservation of biodiversity is more important than ever before. The success of the Convention on Biological Diversity’s Post-2020 Global Biodiversity Framework and monitoring strategy will depend on the availability of reliable, information-rich biodiversity data. Natural science collections throughout the world are repositories for and stewards of primary biodiversity records, which they maintain and preserve in the long-term, and can contribute to biodiversity monitoring specifically at the species and genetic diversity levels. Accurate and up-to-date information about scientific collections as data providers and mediators lie at the core of Findable, Accessible, Interoperable and Reusable (FAIR) data (Wilkinson 2016). The visibility and discoverability provided by collections’ digital representations promote an institution’s, a country’s and a region’s wealth in biodiversity records and data; highlight human efforts and social networks for maintaining and providing access to high-quality physical and digital records; and form the basis for attribution and effective transaction managment implementing the CARE principles (Collective Benefit, Authority to Control, Responsibility, and Ethics; Carroll 2021). Providing powerful functionality, the Global Biodiversity Information Facility (GBIF) Registry of Scientific Collections (GRSciColl) is evolving into the global catalog for information on collections. The Latin American and Caribbean (LAC) region is among the most biodiverse regions of the planet. Throughout the LAC region, a wealth of initiatives exists for describing, recording, protecting and managing biodiversity and biodiversity data. The region’s many collections, their scientists, staff and volunteers are crucial partners in these endeavors. A diversity of local to national and regional networks are active, fostering communication, support and capacity building. Last year, the Biodiversity Crisis Response Committee (BCRC) of the Society for the Preservation of Natural History Collections (SPNHC) in cooperation with the GRSciColl team at GBIF, developed the concept and first materials for a Global Collections Network Campaign. In cooperation with the national GBIF Node, a pilot campaign was conducted in Ecuador. In addition, close connections were formed to the task group developing Latimer Core, TDWG’s upcoming collection description standard, the MaterialSample task group of Darwin Core, as well as the community developing the next-generation data infrastructure based on the Digital Extended Specimen concept (Hardisty et al. 2022) and open FAIR digital objects (Schultes and Wittenburg 2019), e.g. defined by the openDS standard. Building on the pilot campaign and continuing the collaboration with the GRSciColl team, a partnership endorsed by GBIF’s SPNHC node and led by two members of SPNHC’s BCRC was formed that includes biodiversity scientists, collections staff and GBIF national node managers from Argentina, Ecuador and Guatemala. Supported by the GBIF Capacity Enhancement Support Programme and starting in August 2022, the partnership has the goal to increase the number, coverage and density of high quality records available through GRSciColl, thereby providing visibility and improving the recognition of natural science collections existing within the three countries and the LAC region. The CESP project contributes towards the aim of the campaign to build step by step an equitable, inclusive and engaged Global Collections Network.

Advances and Challenges in COVID-19 Vaccination in Latin American: A public health perspective

The vaccination against SARS-CoV-2 has been recognized as a priority strategy to safeguard public health. However, disparities in productive, acquisitive and distributional capacity have led to delays in immunization, particularly in low- and middle-income countries. Consequently, global coverage is expected to achieve herd immunity against COVID-19 by 2023 or 2024, although with highly variable coverage percentages among countries. In Latin America, immunization against COVID-19 faces different challenges to achieve herd immunity. To date (February 6, 2022), the countries that had several doses needed to immunize their populations with at least two doses (number of doses between population) were Peru (520.7%), Chile (458.4%), Argentina (298.0%), Brazil (236.6%), Bolivia (206.0%) and Uruguay (unconfirmed doses). On the other hand, Uruguay (210.7%) and Chile (238.3%) have applied twice as many doses as their populations. Argentina (194.3%), Brazil (173.6%), Ecuador (170.3%), Peru (170.3%), Costa Rica (161.1%), and Panama (153.5%) are on the way to achieving this goal. In addition, Latin American countries also showed an insufficient distribution of vaccines and a storage capacity limited to only a few cities and multiple frequencies of vaccine hesitancy. Due to these scenarios, the production of more vaccine doses and equitable distribution to the rest of the population within the Latin American region should remain a public health priority to achieve collective immunity in the shortest time possible

Psychosocial response to the COVID-19 pandemic in Panama.

BackgroundThe impact of the COVID-19 pandemic and the associated restrictions on mental health is being studied.ObjectiveTo analyze the psychosocial response to the COVID-19 pandemic in adults residing in Panama.MethodsA community sample of 480 adult residents of Panama completed a survey that included sociodemographic questions, COVID-19 related questions (e.g., health concerns regarding the virus, knowledge and behaviors in biosafety) and scales of stress, anxiety, depression, prosocial behavior, resilience, perceived social support, and insomnia.ResultsMost of the participants (>60%) reported being negatively affected by the pandemic. Women experienced greater depression, anxiety, and stress symptoms than men, and age was negatively associated with depression, anxiety, and stress symptoms. Self-perceived health status and self-perceived social support were negatively associated with depression, anxiety, and stress symptoms. Self-perceived social isolation was positively associated with depression, anxiety, and stress symptoms. Psychiatric illness and insomnia were positively associated with depression, anxiety, and stress symptoms, whereas psychological resilience was negatively associated with depression, anxiety, and stress symptoms.DiscussionThese results corroborate other studies regarding COVID-19 and mental health. This study highlights the need for specific prevention and intervention mechanisms related to the COVID-19 pandemic in different population groups. This is the first report of the psychological impact of COVID-19 in the general Panamanian population and one of the only studies in the Latin American region and, therefore, contributes to research in the Latino population and lower-middle income countries.

Capital mobility in Latin American and Caribbean countries: alternative view on the “Feldstein-Horioka” coefficient

PurposeThe purpose of this study is to examine two issues, namely the degree of current account deficit (CAD) sustainability and the degree of capital mobility.Design/methodology/approachThe sample for this study comprises 24 Latin American and Caribbean countries, including three regional agreements: Andean Community, MERCOSUR (Mercado Común del Sur), and SICA (Central American Integration System). This study employs the dynamic common correlated effects mean group (DCCEMG) estimator in a panel data set to investigate the long-run relationship between savings and investment along with short-run dynamics.FindingsThe findings indicate that CAD is weakly sustainable in the Latin American and Caribbean region, MERCOSUR, and SICA, while CAD is strongly unsustainable in the Andean Community. The sub-period analysis reveals that CAD has been adversely affected by the 2008 crisis. However, in the post-crisis period, CAD has been slowly decreasing in the Latin American and Caribbean region and Andean Community, whereas CAD has continued increasing in MERCOSUR and SICA. Further, the estimates of error-correction terms and short-run coefficients indicate that the Andean Community and MERCOSUR observe a higher degree of long-run and short-run capital mobility than SICA.Practical implicationsThe results carry fundamental implications for policy-making processes aimed at maintaining sustainable CADs.Originality/valueThis study gives an alternative interpretation of the “Feldstein-Horioka” coefficient in terms of CAD sustainability and analyses the saving–investment relationship in light of Chudik and Pesaran (2015).

STIpolicy conventions in Uruguay. An analysis of political party platforms 2004–2019

AbstractScience, Technology, and Innovation (STI) have been considered as critical tools in development processes, gaining growing importance in the public policy agenda. We assert that an intersubjective agreement about STI policy has emerged in Latin America from the beginning of the twenty‐first century. This operates as a developmental convention which is based on a hybrid theoretical rationale from neoclassical economics and the innovation systems approach. This process has been analyzed from different perspectives of innovation and political economy studies. However, as far as we know, the role of political parties in the construction and reproduction of STI conventions has not been studied. After illustrating the general assertion with stylized facts from the whole Latin American region, we study the platforms that Uruguayan political parties presented in the national elections between 2004 and 2019. Text analysis techniques show that platforms of both left‐ and right‐wing political parties were embedded in the current STI policy convention. However, critical discrepancies emerge in relation to policy implementation—the positive and negative agendas—which show that there has been political competition regarding the role of the state and of markets. This leads us to conclude that even though one can observe a shared set of building blocks on STI policy and development, there is competition within the current convention, suggesting that any agreement is illusory.

A wind power comparison between Costa Rica and the rest of the world

Wind turbine installations continue to grow throughout the world and play an important role in the way the world is powered. This study analyses the growth of wind energy in the most important regions of the world and make a comparison with Costa Rica. The regions of the study include Europe, United States, China and Latin America. This article is also intended to show Costa Rica’s investments in terms of building and maintenance of wind farms. There is a relationship between the costs of installing and maintaining wind farms and the development of installed wind capacity. For the sake of clarity, a real example from Tejona’s Costa Rica wind farm is provided. This analysis shows that Costa Rica is a leader in wind energy in Central America and also stands out in the Latin American region and the Caribbean, but needs to overcome some challenges in the economy and costs related to wind energy to achieve higher goals in wind power production.

Distribution of human papillomavirus genotypes by severity of cervical lesions in HPV screened positive women from the ESTAMPA study in Latin America.

The proportion of HPV16 and 18-associated cervical cancer (CC) appears rather constant worldwide (≥70%), but the relative importance of the other HR-HPV differs slightly by geographical region. Here, we studied the HPV genotype distribution of HPV positive Latin American (LA) women by histological grade, in a sub-cohort from the ESTAMPA study; we also explored the association of age-specific HPV genotypes in severe lesions. Cervical samples from 1,252 participants (854 ≤CIN1, 121 CIN2, 194 CIN3 and 83 CC) were genotyped by two PCRs-Reverse Blotting Hybridization strategies: i) Broad-Spectrum General Primers 5+/6+ and ii) PGMY9/11 PCRs. HPV16 was the most frequently found genotype in all histological grades, and increased with the severity of lesions from 14.5% in ≤ CIN1, 19.8% in CIN2, 51.5% in CIN3 to 65.1% in CC (p < 0.001). For the remaining HR-HPVs their frequency in CC did not increase when compared to less severe categories. The nonavalent vaccine HR-types ranked at the top in CC, the dominant ones being HPV16 and HPV45. HR-HPV single infection occurs, respectively, in 57.1% and 57.0% of ≤CIN1 and CIN2, increasing to 72.2% and 91.6% in CIN3 and CC (p<0.001). No association between age and HPV type was observed in CC, although the risk of HPV16 infection in CIN3 cases increased with age. Results confirm the relevance of HPV16 in the whole clinical spectrum, with a strong rise of its proportion in CIN3 and cancer. This information will be relevant in evaluating the impact of HPV vaccination, as a baseline against which to compare genotype changes in HPV type-specific distribution as vaccinated women participate in screening in LA region. Likewise, these data may help select the best HPV testing system for HPV-based efficient, affordable, and sustainable screening programmes.

Payment for ecosystem services in Peru: Assessing the socio-ecological dimension of water services in the upper Santa River basin

Increasing pressures on ecosystems in the Latin American region, as well as the adoption of multilateral conservation commitments, have led to the implementation of instruments that are economic in nature but oriented towards the recovery, conservation, and functioning of ecosystems such as Payment for Ecosystem Services (PES). In the Peruvian Andes, hydro-climatic factors and land-use changes are affecting the capacity of the ecosystems of the glaciated Cordillera Blanca to provide water services, in terms of both quality and quantity, to the main users of the Santa River basin. Thus, this study analyses how the socio-ecological interactions affect, and are affected by, the planned introduction of water-related PES in the Quillcay sub-basin, the most populated sub-basins along the Santa River basin. We use a conceptual model based on the current evolution of the water metabolism approach to integrate into a common language of analysis the multiple dimensions of water: water as an ecological fund, as a service, and as a political asset. To explore the interface of these three domains of analysis we rely on a mixed-method data collection: primary data collection through a stakeholder survey and interviews and a review of information from secondary sources. The result of our case study shows that both the ecological dimension and the social dimension affect on the PES project and vice versa. These complex interactions could result in the design of a mechanism in which not all stakeholders benefit equally. This raises the need to recognise the multidimensional nature of water in the design and implementation of policies, and the importance of identifying processes and barriers which affect the success of these policies without making invisible the direct effect they also have on social-ecological systems.

A comparative analysis of health status of international migrants and local population in Chile: a population-based, cross-sectional analysis from a social determinants of health perspective

BackgroundDuring recent decades intraregional migration has increased in Latin America. Chile became one of the main receiving countries and hosted diverse international migrant groups. Evidence have suggested a healthy migrant effect (HME) on health status, but it remains scarce, controversial and needs to be updated. This study performed a comprehensive analysis verifying the existence of HME and its association with social determinants of health (SDH).MethodsWe analyzed data from the Chilean National Socioeconomic Characterization Survey (CASEN, version 2017). Unadjusted prevalence of health status indicators such as negative self-perceived health, chronic morbidity, disability, and activity limitations were described in both international migrants and local population. Adjusted associations between these outcomes and sets of demographics, socioeconomic, access to healthcare, psychosocial and migration-related SDH were tested using multivariate logistic regression in each population. The HME for each health outcome was also tested using multivariate logistic regression and sequentially adjusting for each set of SDH (ref = Chilean).ResultsInternational migrants had lower unadjusted prevalence of all health indicators compared to Chileans. That is, unadjusted analysis revealed an apparent HME in all health outcomes. Age, unemployment, and health care system affiliation were associated with health outcomes in both populations. Psychosocial determinants were both risk and protective for the analysed health outcomes. After adjustment for each set of SDH, the immigrant health advantage was only significant for chronic morbidity. Being migrant was associated with 39% lower odds of having chronic diseases compared to locals (OR: 0.61; 95% CI: 0.44–0.84; P = 0.0003). For all other outcomes, HME disappeared after adjusting by SDH, particularly unemployment, type of health system and psychosocial factors.ConclusionsTesting the HME in Chile revealed an advantage for chronic morbidities that remained significant after adjustment for SDH. This analysis shed light on health disparities between international migrants and local population in the Latin American region, with special relevance of unemployment, type of health system and psychosocial SDH. It also informed about differential exposures faced during migration process that could dissolve the HME over time. Evidence from this analytical approach is useful for informing health planning and intersectoral solutions from a SDH perspective.