Health, Nutrition and Population
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Demography, Health economics, Population studies, Aging, Development economics
Health, Nutrition and Population
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Last updated January 31, 2023
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.
Publication Search Results
Now showing 1 - 9 of 9
Publication(Washington, DC: World Bank, 2013-06-13) Gragnolati, Michele ; Lindelow, Magnus ; Couttolenc, BernardIt 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(World Bank, Washington, DC, 2005-08) Gragnolati, Michele ; Shekar, Meera ; Das Gupta, Monica ; Bredenkamp, Caryn ; Lee, Yi-KyoungThis paper explores the dimensions of child undernutrition in India, and examines the effectiveness of the Integrated Child Development Services (ICDS) program in addressing it. The paper finds that although levels of undernutrition in India declined modestly during the 1990s, the reductions lagged far behind that achieved by other countries with similar economic growth rates. Nutritional inequalities across different states, socioeconomic and demographic groups are large - and, in general, are increasing. The study also finds that the ICDS program appears to be well-designed and well-placed to address the multidimensional causes of malnutrition in India. However, there are several mismatches between the program's design and its actual implementation that prevent it from reaching its potential. The paper concludes with a discussion of a number of concrete actions that can be taken to bridge the gap between the policy intentions of ICDS and its actual implementation.
Improving Child Nutrition Outcomes in India : Can the Integrated Child Development Services Program Be More Effective?(World Bank, Washington, DC, 2005-06) Das Gupta, Monica ; Lokshin, Michael ; Gragnolati, Michele ; Ivaschenko, OleksiyLevels of child malnutrition in India fell only slowly during the 1990s, despite significant economic growth and large public spending on the Integrated Child Development Services (ICDS) program, of which the major component is supplementary feeding for malnourished children. To unravel this puzzle, the authors assess the program's placement and its outcomes using National Family Health Survey data from 1992 and 1998. They find that program placement is clearly regressive across states. The states with the greatest need for the program - the poor northern states with high levels of child malnutrition and nearly half of India's population - have the lowest program coverage and the lowest budgetary allocations from the central government. Program placement within a state is more progressive: poorer and larger villages have a higher probability of having an ICDS center, as do those with other development programs or community associations. The authors also find little evidence of program impact on child nutrition status in villages with ICDS centers.
Publication(World Bank, Washington, DC, 2003-01) Gragnolati, Michele ; Marini, AlessandraUnlike 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(Washington, DC: World Bank, 2006) Gragnolati, Michele ; Bredenkamp, Caryn ; Shekar, Meera ; Das Gupta, Monica ; Lee, Yi-KyoungThe prevalence of child undernutrition in India is among the highest in the world; nearly double that of Sub-Saharan Africa, with dire consequences for morbidity, mortality, productivity and economic growth. Drawing on qualitative studies and quantitative evidence from large household surveys, this book explores the dimensions of child undernutrition in India and examines the effectiveness of the Integrated Child Development Services (ICDS) program, India's main early child development intervention, in addressing it. Although levels of undernutrition in India declined modestly during the 1990s, the reductions lagged behind those achieved by other countries with similar economic growth. Nutritional inequalities across different states and socioeconomic and demographic groups remain large. Although the ICDS program appears to be well-designed and well-placed to address the multi-dimensional causes of malnutrition in India, several problems exist that prevent it from reaching its potential. The book concludes with a discussion of a number of concrete actions that can be taken to bridge the gap between the policy intentions of ICDS and its actual implementation.
Publication(World Bank, Washington, DC, 2006-01) Marini, Alessandra ; Gragnolati, MicheleGrowth 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.
Sustainability of Healthcare Financing in the Western Balkans : An Overview of Progress and Challenges(World Bank, Washington, DC, 2007-10) Bredenkamp, Caryn ; Gragnolati, MicheleThis paper explores the major challenges to the sustainability of health sector financing in the countries of the Western Balkans - Albania, Bosnia and Herzegovina, the Former Yugoslav Republic of Macedonia, Montenegro, Serbia and the province of Kosovo. It focuses on how the incentives created by the different elements of the healthcare financing system affect the behavior of healthcare providers and individuals, and the resulting inefficiencies in revenue collection and expenditure containment. The paper analyzes patterns of healthcare expenditure, finding that there is some evidence of cost containment, but that current expenditure levels - while similar to that in EU countries as a share of GDP - are low in per capita terms and the fiscal space to increase expenditures is extremely limited. It also examines the key drivers of current healthcare expenditure and the most significant barriers to revenue generation, identifying some key health reforms that countries in the sub-region could consider in order to enhance the efficiency and sustainability of their health systems. Data are drawn from international databases, country institutions, and household surveys.
Publication(World Bank, Washington, DC, 2007-12) Mendola, Mariapia ; Bredenkamp, Caryn ; Gragnolati, MicheleThis paper investigates the extent to which the health systems of the Western Balkans (Albania, Bosnia and Herzegovina, Montenegro, Serbia, and Kosovo) have succeeded in providing financial protection against adverse health events. The authors examine disparities in health status, healthcare utilization, and out-of-pocket payments for healthcare (including informal payments), and explore the impact of healthcare expenditures on household economic status and poverty. Methodologies include (i) generating a descriptive assessment of health and healthcare disparities across socioeconomic groups, (ii) measuring the incidence and intensity of catastrophic healthcare payments, (iii) examining the effect of out-of-pocket payments on poverty headcount and poverty gap measures, and (iv) running sets of country-specific probit regressions to model the relationship between health status, healthcare utilization, and poverty. On balance, the findings show that the impact of health expenditures on household economic wellbeing and poverty is most severe in Albania and Kosovo, while Montenegro is striking for the financial protection that the health system seems to provide. Data are drawn from Living Standards and Measurement Surveys.
Publication(World Bank, Washington, DC, 2003-01) Marini, Alessandra ; Gragnolati, MicheleThe 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.