Person:
Gragnolati, Michele

Health, Nutrition and Population
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Demography, Health economics, Population studies, Aging, Development economics
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Health, Nutrition and Population
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Last updated: January 31, 2023
Biography
Michele Gragnolati currently serves as the Manager for Strategy, Operations and Global Engagement in the Health, Nutrition and Population Global Practice. He joined the World Bank as a Young Professional in 1998 and since 2000, he served first as an economist with the health sector in Latin America and South Asia, and later as program leader for Human Development for the Western Balkans, Brazil, and Argentina, Paraguay and Uruguay. His last position was as Global Lead for Population and Development and he worked mostly on issues related to high fertility and rapid population growth in Sub-Saharan Africa. Before coming back to HQ in Washington, DC, Michele was based in Sarajevo, Brasilia and Buenos Aires. Michele has published on different topics, including methodological and statistical demography, poverty during the East Asia financial crisis, malnutrition in Central America and India, the impact of health expenditures on poverty in former Yugoslavia, the economics of demographic change in Africa and the socioeconomic implications of population aging in Argentina, Brazil and Uruguay. Economist graduated from Luigi Bocconi Commercial University (Italy), Gragnolati has also a Master’s Degree in Population and Development from the London School of Economics (Great Britain) and a Ph.D. in Demography from the University of Princeton (USA). Michele speaks Italian, English, Spanish, French and Portuguese.
Citations 72 Scopus

Publication Search Results

Now showing 1 - 5 of 5
  • Publication
    Twenty Years of Health System Reform in Brazil : An Assessment of the Sistema Único de Saúde
    (Washington, DC: World Bank, 2013-06-13) Gragnolati, Michele; Lindelow, Magnus
    It has been more than 20 years since Brazil's 1988 Constitution formally established the Unified Health System (Sistema Unico de Saude, SUS). Building on reforms that started in the 1980s, the SUS represented a significant break with the past, establishing health care as a fundamental right and duty of the state and initiating a process of fundamentally transforming Brazil's health system to achieve this goal. This report aims to answer two main questions. First is have the SUS reforms transformed the health system as envisaged 20 years ago? Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions, there are many gaps and caveats in the story. A secondary aim of the report is to consider how some of these gaps can be filled through improved monitoring of health system performance and future research. The introduction presents a short review of the history of the SUS, describes the core principles that underpinned the reform, and offers a brief description of the evaluation framework used in the report. Chapter two presents findings on the extent to which the SUS reforms have transformed the health system, focusing on delivery, financing, and governance. Chapter three asks whether the reforms have resulted in improved outcomes with regard to access to services, financial protection, quality, health outcomes, and efficiency. The concluding chapter presents the main findings of the study, discusses some policy directions for addressing the current shortcomings, and identifies areas for further research.
  • Publication
    Malnutrition and Poverty in Guatemala
    (World Bank, Washington, DC, 2003-01) Marini, Alessandra; Gragnolati, Michele
    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.
  • Publication
    Health and Poverty in Guatemala
    (World Bank, Washington, DC, 2003-01) Gragnolati, Michele
    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.
  • Publication
    Nonlinear Effects of Altitude on Child Growth in Peru – A Multilevel Analysis
    (World Bank, Washington, DC, 2006-01) Marini, Alessandra; Gragnolati, Michele
    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.
  • Publication
    Growing Old in an Older Brazil : Implications of Population Ageing on Growth, Poverty, Public Finance, and Service Delivery
    (World Bank, 2011-09-07) Gragnolati, Michele; Rocha, Romero; Fruttero, Anna
    This chapter introduces the main issues associated with population aging, many of which will be investigated in detail throughout the volume. The next section describes the demographic transformation that Brazil has been experiencing and highlights its specific features, including a very rapid population aging process in the next few decades. Then the main economic framework behind this work, the life cycle theory according to which individuals' economic behavior varies according to their age, is discussed. The section after that introduces the first and second demographic dividends associated with the changing population age structure that accompanies the demographic transition of any country. Next covered is how poverty is linked to the life cycle in Brazil and the role of public transfers in reducing poverty among different age groups, followed by an investigation of how public expenditures vary across age groups and generations and what makes Brazil distinct from comparable OECD (Organization for Economic Co-operation and Development) and Latin American countries. Concluding the chapter are the main findings of the report.