Economy and Demography
(Main references: Health and Poverty in Guatemala , Michele Gragnolati and Alessandra Marini, World Bank, World Bank Policy Research Working Paper 2966, January 2003, which is available online. Other information was obtained via the Pan American Health Organization web site and the Guatemalan Ministry of Economy.)
The population is now over 12.6 million and growing rapidly. The median age is 18 years, with nearly half the population under 15. The total fertility rate (five children per woman) is the highest in Latin America, and contraceptive use is the second lowest in Latin America .
About 65% of the people live in rural areas—the highest proportion in Central America . Agriculture generates 60% of employment.
The indigenous population makes up approximately half of the total, and is classified linguistically as Mayan, including K’iché (29%); Kaqchikel l (25%); Q’eqchi’ (14%), Mam (4%); Poqomchí’, Poqomam, and Tz’utujil (24%); and others, including the non-Mayan languages Garifuna and Xinka (4%). Roughly one third of the speakers of these indigenous languages speak no other language. (Note: many estimates using different criteria put the percent indigenous much higher.)
Compared with other countries with comparable per capita GDPs, Guatemala has a high rate of poverty. In 2000, 56% lived below the poverty line and 16% lived in extreme poverty. These figures were worse for the indigenous population: 76% in poverty and 27% in extreme poverty. There are pockets of extreme poverty in communities that are rural, remote and indigenous. For example, there are municipalities in the northern departments of El Quiché and Huehuetenango where poverty is 95% and extreme poverty 75%.
Almost two thirds of the indigenous population suffers from chronic malnutrition.
Basic Education and Literacy
In 1999, the national illiteracy rate was 32% (40% for women and 26% for men). In departments with over 75% indigenous population, the illiteracy rate was 53%, and higher still for indigenous women. Clearly the lack of spoken Spanish is a great impediment to literacy.
Inequity
There are large inequalities in health performance across geographic areas and socioeconomic groups. The poor, people who live in rural areas, and the indigenous population have worse health outcomes than do the non-poor, people who live in urban areas, and the nonindigenous population.
Health Indicators
Guatemala has the worst health indicators in Central America, and in the Amercas leads only Bolivia and Haiti . Life expectancy in Guatemala (65 years) is the lowest in Central America, 12 years less than in Costa Rica , for example. Infant mortality (45 per thousand) is the highest in Central America . Guatemala has the highest prevalence of chronically malnourished children in Latin America (44 percent).
Causes of Mortality and Morbidity
Respiratory Infections and Diarrhea
The leading causes of mortality are pneumonia and diarrhea, making up 22.3% and 6.0% of all deaths, respectively. The mortality rate in children 1-4 years old is 9 per 1,000 in the cities and 20 per 1,000 in rural areas. In 1999, acute respiratory infections accounted for 40% of all deaths in children under 1 year, acute diarrheal disease claimed 12%, and perinatal causes, 11%. In 1999, over one million cases of acute respiratory infection and nearly a quarter million cases of pneumonia were reported, with over 11,000 deaths.
Insect Borne Diseases
In 1999, over 100,000 cases of malaria (P. vivax) were reported. Although generally not fatal, malaria was, after acute respiratory infections and diarrhea, the next leading source of morbidity.
Chagas' disease affects an estimated 730 000 people in Guatemala . About one-third of those infected develop chronic symptoms after 10-20 years. Persons with chronic symptoms are seriously debilitated, have average life expectancy decreased by 9 years.
In 1999, about 3,600 cases of dengue were reported.
Other Infectious Diseases
HIV/AIDS has been concentrated in urban populations along the main transportation routes and among groups traditionally regarded as being at high risk. According to MSF, in 2003 there were 67,000 people, including 4,800 are children, living with HIV/AIDS.
In 1999, 2,820 cases of tuberculosis were reported.
Natural Disasters
Guatemala has a long history of natural disasters, including hurricanes, floods, earthquakes and volcanic eruptions. Emerguency preparedness is therefore a crucial.health consideration.