Health in Guatemala: Difference between revisions

The Regional Chimaltenango Hospital, located in Chimaltenango
Health indicators
Life expectancy	73.18 years
Infant mortality	25.57 deaths (per 1,000 live births)
Fertility rate	2.57 children
Sanitation	78.8% of population
Smoking	10.9%
Obesity in Adults	21.2%
Malnutrition (Total)	50%
Malnutrition (Rural)	70%
HIV/AIDS	0.54%

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Health in Guatemala is focused on many different systems of prevention and care. Guatemala's Constitution states that every citizen has the universal right to health care.^[4] However, this right has been hard to guarantee due to limited government resources and other problems regarding access. The health care system in place today developed out of the Civil War in Guatemala. The Civil War prevented social reforms from occurring, especially in the sector of health care.^[5]^: 6

The Human Rights Measurement Initiative^[6] finds that Guatemala is fulfilling 81.6% of what it should be fulfilling for the right to health based on its level of income.^[7] When looking at the right to health with respect to children, Guatemala achieves 94.8% of what is expected based on its current income.^[7] In regards to the right to health amongst the adult population, the country achieves only 87.3% of what is expected based on the nation's level of income.^[7] Guatemala falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 62.9% of what the nation is expected to achieve based on the resources (income) it has available.^[7]

Health care system

Today, there have been many reforms to the health care system, but the current system continues to have significant problems. The country is on its way to develop a solid health care system, and is working toward achieving many of the Millennium Development Goals in place.^[4]^: v However, the inequalities that are associated with outcomes and access have not been addressed, making it difficult for Guatemala to move forward in the field of health care.^[4]^: 1 The ratio of doctors to residents is low, at .9 doctors per 1,000 citizens.^[8] The system requires a lot of change in order to serve the whole Guatemalan community.

History

When the Civil War broke out in Guatemala, social improvements in health care were brought to a halt. The period of the 34-year Civil War (from 1954-mid 1980s) resulted in many changes within the health sector.^[9]^: 59 The focus on health care was generally abandoned throughout the period of war when the country experienced a period of "privatization through attrition,"^[9]^: 59 which generated poor service and low health care coverage for decades to follow.^[9]^: 59 As Verduga mentions, the total GDP expenditures on health was only about 1 to 2 percent during this period of war.^[9]^: 59 Therefore, it was the emergence of NGOs and other community organizations that allowed for basic health care to be provided to the general population.^[9]^: 59

Once the Guatemalan Civil War ended in 1996 with the signing of the Peace Accords,^[4] health care was placed in the hands of a new democratic government. Immediately after the war, Guatemala saw little change in the healthcare sector.^[5]^: 6 However, starting in 1999, the health care system was improved with increased government spending and aid.^[5]^: 6 Although this was a drastic improvement from the times of war, the system was still insufficient and did not come close to meeting all of the needs of the Guatemalan people.

Structure and coverage

Today, the Guatemalan health care system is split into three separate divisions: the public, private nonprofit, and private for-profit sectors.^[5]^: 7 Within the public sector, there is the Ministry of Health and Social Security (MOH), the Guatemalan Social Security Institute (IGSS), and the Military Health Service.^[8] This sector of the health care system formally covers about 88% of the population.^[8] The private sector, which accounts for about 12% of the population, includes many for-profit providers, non-profit entities, and traditional local providers.^[8]^[10] The public sector works to provide care through hospitals, health facilities, and various health centers, whereas the private sector allocates resources within private offices, clinics, and hospitals.^[8]

Very few funds are allocated to health care within Guatemala. As a share of GDP, health care spending in Guatemala is one of the lowest in Central America (2.6 percent).^[4]^: 3 The GDP expenditure shows that few funds are allocated to the health care system in Guatemala. In total, the Guatemalan government's expenditures on health were about $196 US dollars in 2010.^[4]^: 3 This amount was significantly less than the total Central American average ($350) and the average Latin American and the Caribbean (LAC) expenditures ($672).^[4]^: 3 The health care system requires more funds to improve the coverage and overall health care system in Guatemala.^[4]^: 4

The Peace Accords, which were signed in 1996, called for a change in health provision goals. In 1997, the MOH established a program called the Expansion of Coverage Program (PEC), which worked to improve the availability of health and nutrition services to young children and women in rural areas of Guatemala.^[4]^: v As Pena explains, current MOH services do not cover the poor, rural population of Guatemala, making the PEC critical to the rural population.^[4]^: v Ever since its creation, the PEC has expanded immensely, now covering about 54% of the health and nutrition needs of rural Guatemalans.^[4]^: v The coverage program works with NGOs in the area to promote good health and nutrition to populations who lack sufficient health care.^[4]^: 11 However, important accountability systems regarding transparency and progress were not installed, limiting the program's effectiveness.^[11] The services covered by the PEC include care for women and infants, illnesses and emergency care, and environmental care.^[4]^: 12

There is also an informal sector of healthcare that is often overlooked. Termed the "Maya Mobile Clinic" or the "Other Public Health", traveling salespeople (often men) are a medical resource for Guatemalans living in the highlands.^[12] These salespeople offer raw and natural ingredients to mainly indigenous populations and give talks about their health qualities.^[12] Maya Mobile Clinics act as a midpoint between the physical distance of the Guatemalan highlands and public clinic locations, and as a midpoint between the cultural gap that separates Maya medicinal norms and values from Guatemala's public health sector's medicinal norms and values.^[12]

Conditions

There are many communicable diseases and conditions that threaten the livelihood of the Guatemalan people on a day-to-day basis. Infectious diseases are still the number one cause of death for people in developing countries, whereas in the developed world, infectious diseases are no longer a significant problem.^[13] Furthermore, in Guatemala, parasites, diabetes, and malnutrition are huge health problems. Diabetes threatens development in many rural Mayan communities within Guatemala.^[14]^: 24 In order to attack this problem head-on, "health service efforts must be culturally appropriate and emphasize awareness, prevention, early detection, and universal treatment".^[14]^: 24 Also, malnutrition remains a huge problem among children and adults in Guatemala. Given the prevalence of poverty, many residents have limited access to quality nutrition, limited education, and higher rates of disease.^[15]^: 2 Even though there have been improvements, Guatemala is still characterized by high infant and maternal morbidity and mortality rates, pervasive malnutrition, and high incidences of infectious diseases.^[16] Also, in Guatemala, the prevalence of Type 2 diabetes and obesity has risen.^[14]

Communicable diseases

In Guatemala, communicable diseases for which treatment exists are still one of the major causes of death. Wealthy, more industrialized developed nations have been able to eliminate communicable diseases due to an epidemiological transition, in which death rates due to degenerative diseases have surpassed those of communicable and infectious diseases.^[13] The opposite is apparent in Guatemala. The high mortality rate for infants is a direct result of communicable and infectious diseases.^[17] Similarly, the epidemiological profile of Guatemala shows that some of the most prevalent infectious diseases, like diarrhea and acute respiratory infections, are a direct result of poverty.^[17] In Guatemala, 56 percent of the population lives below the poverty line.^[18]^: 31 Poverty levels are greatest in the indigenous communities of Guatemala, which account for about 81 percent of those living in poverty, and make up about 43 percent of Guatemala's total population.^[18]^: 32 High levels of poverty make the population more vulnerable to communicable diseases, which is why government funding of health care is necessary for the rural areas of Guatemala.^[18]^: 32

Even though Guatemala has improved its health care system substantially since the end of the Guatemalan Civil War, mortality rates for communicable diseases still show that considerable progress needs to be made to remove the burden of infectious diseases on the population. In a country like Guatemala, water is poor and frequently contaminated.^[19] In order to decrease common communicable diseases like diarrhea, tuberculosis, pneumonia, and respiratory disease, clean water and sanitation are necessary.^[20] With the health care system's provision of both clean water and food, the incidence of infectious and communicable diseases will decrease.^[13]

Parasites

Parasites present one of the biggest threats to health in Guatemala. Many of the common parasites in developing countries like Guatemala are spread through contamination of both water and food.^[18]^: 32 Some of the effects of parasites include intestinal obstructions, which can hinder the body from absorbing nutrients, lead to a loss of appetite, impair long term growth, induce vomiting, cause anemia and anorexia, and in severe cases, cause death.^[18]^: 32 Symptoms can also include intense abdominal pain, loss of appetite, nausea, diarrhea, and fever.^[18]^: 32

It has been seen that the prevalence of parasites is significantly higher among younger children and those who are malnourished.^[18]^: 35 Parasites are usually transferred through contaminated water, making them dangerous because they are able to induce malnutrition by consuming the body's nutrients, thus impeding a child's physical development.^[22]^: 97 For school children who are infected with parasites, cognitive functioning can drastically decrease, directly impacting their education.^[23] School children who have been treated for parasites immediately perform significantly better in school settings. Parasite infections can also vary based on access to clean water and whether or not sewage disposal is present.^[18]^: 38 The Millennium Development Goals discussed the importance of deworming to help meet the goals set by the United Nations.^[24] Parasites can have serious long-term consequences in that they directly affect development and health for decades after. However, inexpensive, single-dose medications exist that can fully treat these parasitic infections.^[24]

Diabetes

Diabetes is a significant problem within the Guatemalan population. As a rising public health concern, diabetes largely threatens the indigenous population of Guatemala.^[25]^[26] Because this population frequently has limited access to the Guatemalan health care system, knowledge about the emergence of diabetes is also incredibly limited.^[25] Indigenous areas are particularly under-resourced with respect to doctors and overall health care programs.^[25]^[26]

A risk factor for diabetes within the indigenous population is dietary change over time.^[14]^: 25 Changes in indigenous diets were a result of structural and economic changes, which forced the rural population to resort to energy-dense foods that are extremely high in saturated fats and simple carbohydrates.^[14]^: 25 These simple carbohydrates can be found throughout Guatemalan cuisine, especially corn, which is one of the staple foods of the Guatemalan diet. This in turn leads to the higher prevalence of Type 2 diabetes, because the entire population has added more fats and sugars into their diets.^[14]^: 25

A large issue for the indigenous population and the greater Guatemalan population in general is access to medication.^[14]^: 29^[26] Medication used to treat diabetes is very expensive and would require the Guatemalan government to devote significant resources to provide medication for every diabetic.^[14]^: 29 However, diabetes is a manageable disease, and can also be treated with frequent physical activity and a change in diet, focused on management and healthy choices.^[14]^: 29

Pesticide poisoning

Due to farming conditions and yield pressures in Guatemala, many agricultural workers are at high risk of pesticide poisoning.^[27] People often handle pesticides without protective clothing or gear, soaking it in through their skin and inhaling it into their lungs.^[27] A large black market and lack of oversight over legal pesticide use in Guatemala also contributes to its rampant and unsafe use.^[27] Pesticide poisoning most likely disproportionately affects indigenous farm workers.^[27]

Mayan health

One aspect of the Guatemalan health care system is its focus on Mayan health. Because the Mayan population is so prevalent in Guatemala, it is necessary to consider their barriers to quality health care. Taking into account the language barriers, diet, and living conditions, the Mayan population suffers enormously when it comes to proper health care. The life expectancy for Mayans can be up to 10 or 15 years lower than other Guatemalans.^[28] Since the Civil War, the Mayan population generally resides in poverty stricken areas, and therefore has limited access to the healthcare that is available to the Ladinos, or non-indigenous population.^[29]

Medical pluralism

Indigenous Guatemalan communities deal with "medical pluralism", or the intersection of beliefs and uses regarding traditional and biomedical healthcare.^[30]^{[page needed]} Traditional Maya medical care involves plant medicine and ethnomedical practitioners who learn in one-on-one or self-taught settings.^[31]^{[page needed]} Western medical systems and the Guatemalan public health system have been criticized for not considering ethnomedical practices to be legitimate, and interest among indigenous Guatemalans in taking on ethnomedical apprenticeships has been declining, resulting in tension between practices.^[30]^{[page needed]}

Language

In Guatemala, about 45% of the Ladino population lives in poverty, while about 91% of the indigenous population succumbs to extreme poverty levels.^[32] This large difference appears in other aspects of life as well, like family planning, susceptibility to disease, education level, and access to health care. Such inequalities can largely be attributed to a large language barrier between the indigenous population and the non-indigenous peoples.^[33] Generally, the indigenous people of Guatemala speak only a variety of local Mayan languages.^[33] In relation to health care, these language barriers can be significant. Most of the medical professionals that serve the indigenous communities are Ladino, and speak Spanish only.^[33] Communicating health related issues to a patient under these conditions becomes an obstacle, which in turn causes indigenous people to avoid health care centers altogether. The indigenous population is unable to communicate with the doctors directly, which is both difficult and embarrassing.^[32] Ishida et al. discovered that the combination of poverty and language barriers made indigenous women less likely to seek services from health care providers.^[33]

Diet

The Mayan diet is different from the diet of non-indigenous Guatemalans. Throughout their history, the Maya have used maize as a principal crop.^[34]^: 353 Staple foods of the Mayan diet today are corn and beans.^[35]^: 476 The better cash crops like greens, tomatoes, fruits, eggs, and poultry are mainly sold to Ladinos and are not purchased by Mayans.^[35]^: 476 Therefore, Mayan nutrition is very poor because it includes little besides starches and protein. Corn has a significant amount of carbohydrates, which in turn increases blood sugar levels. This increase in blood sugar makes diabetes a very common disease within the Mayan population.^[25] Also, with this lack of crucial nutrients, malnutrition is very prominent in the indigenous population.^[35]^: 476 The widespread consumption of corn contaminated with aflatoxins leads to serious health problems.^[36]

Living conditions

The Mayan people frequently live in rural villages of Guatemala, which are generally known to be impoverished areas. About 80% of indigenous Guatemalans live below the "international poverty line."^[37]^: 173 Very few Mayan families have the economic stability to devote money towards health care.^[29] With the high prices of medications and the poor quality of health posts, impoverished patients refuse to use or trust the westernized health care system.^[29] For centuries, the relationship between the Ladinos and the Mayans has been antagonistic. Throughout the period of the Guatemalan Civil War, Mayans were excluded from land and water resources as well as educational, health care, political, and economic resources.^[37]^: 176^[38]^: 181 Even in today's modern age, the effects of exclusion and deprivation from the war are still felt my many indigenous Mayans.^[38]^: 181 This directly affects health care because the Mayan population does trust Western medicine and hospitals. Similarly, the Ladino doctors that work in the health field make the indigenous people feel powerless and guarded instead of supported.^[38]^: 181

Many indigenous Guatemalans survive on below-subsistence agriculture.^[37]^: 174 Farms are not large enough to sustain large-scale subsistence farming, making the overall yield exceptionally low.^[37]^: 174 Because of the limited amount of farmland, its unequal distribution, and the growing population, poverty continues to ravish the Mayan civilizations.^[37]^: 174 The concrete living distance also plays a role in health care accessibility for indigenous population.^[29] More than likely, these rural villages where the Mayans reside are located close to an hour walk away from any health clinic or post.^[29] The inaccessibility of the clinics leads to fewer visits and more health complications in the indigenous population.

Government run hospitals are located in the main cities of several provinces.^[39] Indigenous peoples' highland locality - often distant from main cities - makes travel to these hospitals expensive, further limiting access.^[8] Taking advantage of the importance of midwifery in many indigenous traditional medicinal systems, the Ministry of Public Health decided to better reach indigenous populations through midwife training programs in the 1980s.^[8] However, the quality, efficacy, and cultural sensitivity of these programs has been brought into question.^[40]

Children and women's health

For women and children, the health discrepancies are very visible. In children, infant mortality and malnutrition are rampant. Severe health and nutritional deficiencies are associated with deaths of children under the age of 5.^[41]^: 147 Similarly, physical and mental development can be severely impacted by malnutrition in children.^[42]^: 1277 On the other hand, women's health focuses on preventable deaths related to pregnancy, delivery, and post-pregnancy complications. Most of the time, services that are provided for contraceptive health do not reach the at-risk population.^[41]^: 147 At-risk women and infants frequently die because of their limited access to quality health care, as well as their perilous living conditions.^[43] Many programs have been implemented to try and incorporate all levels of reproductive health in order to improve care for these populations.^[43]

Infants

In Guatemala, infant mortality continues to be a big problem. As of 2023, it is estimated that Guatemala's infant mortality rate is 25.57 for every 1,000 live births.^[44] As mentioned, rural areas of Guatemala exhibit the highest levels of morbidity and infant mortality because health care in those areas is largely inaccessible.^[41]^: 145 Generally, infant mortality rates are used as an indicator of general health levels in a particular country.

Infants are more susceptible to infectious diseases and conditions like malaria, which can cause severe morbidity, and even death.^[23] For infants, physical growth is critical to proper and successful development. Therefore, if there are insufficient nutrients being provided to the infant during this period of growth and cell proliferation, the number of neurons will be permanently reduced.^[45]^: 220 In Guatemala, this issue is particularly prominent. Nutrition and proper health care is crucial in early infant development in order to insure that these infants will thrive and grow into strong children.^[46] Therefore, the nutritional deficiencies, infectious diseases, and parasitic diseases directly lead to higher mortality rates for children under the age of 5 in Guatemala.^[41]^: 147 These higher mortality rates are prominent in both rural and urban areas of Guatemala when diseases are present. However, these rates are significantly higher in rural areas where limited access to health care, high levels of illiteracy, poor sanitation, and nutritional deficiencies are factored into the rate.^[41]^: 145

Malnutrition in children

Malnutrition is a serious condition that threatens the health and well-being of many people in developing nations. In Guatemala, nutritional deficiencies have been shown to severely impact the growth and development of children both physically and mentally.^[42]^: 1277 Stunting and underweight are both common physical indicators for acute and chronic malnutrition in children.^[23] According to Gragnolati and Marini, in 2003, over 44 percent of the Guatemalan child population is chronically malnourished.^[15]^: 2 However, these numbers are even higher for indigenous populations of Guatemala (58 percent) in comparison to the non-indigenous population.^[15]^: 2 Although the incidence rate of stunting has decreased in Guatemala, the rate of decline is minuscule compared to other countries in the LAC region.^[22]^: 97

The high incidence of malnutrition within indigenous populations is a direct result of poor water sanitation and limited access to clean water.^[22]^: 97 According to the MOH, about 98% of the water sources in Guatemala are contaminated.^[22]^: 97 Disease and malnutrition are highly correlated with one another; both are causes and consequences of each other.^[15]^: 3 In order to improve the health system and reduce the prevalence of malnutrition, easy availability of safe drinking water, together with disease treatment and prevention, are critical for the survival of Guatemalan children.^[15]^: 3^[22]^: 98 Improvement must be implemented at the community level, by renovating infrastructures in order to provide piped water and sanitary operations for the residents.^[15]^: 3

One consequence of malnutrition and undernourishment is the degradation of cognitive performance, which can be studied and observed through schoolchildren and their performance in an educational setting.^[23]^[42] This can generally be observed in poorer settings. In poverty stricken areas of Guatemala, inadequate nutrient intake can lead to higher disease rates, which can in turn expedite the poverty cycle.^[47]^: 998 Breastfeeding is also critical for infants to obtain sufficient nutrients and antibodies.^[15]^: 3 Malnutrition severely weakens children who are already weaker to begin with, making them more vulnerable to life-threatening illnesses.^[17]^: 18 Similarly, civil conflict (from the Guatemalan Civil War period) has left the indigenous population with many barriers to combat malnutrition, which has only prevented positive outcomes of health within the population through social, political, and economic exclusion.^[17]^: 25

Reproductive health

Reproductive health focuses on the health of infants as well as mothers. Guatemala is only beginning their transition into a more health-centered nation. The overall Guatemalan population is very young, which not only affects infant mortality rates, but significantly impacts both reproductive age and fertility rates.^[17]^: 2 In Guatemala, the fertility rate is almost 5 children per mother, the highest in all of Latin America.^[17]^: 2

When the reproductive age is young, there can be many catastrophic effects. The maternal mortality rate for younger mothers is much higher.^[17]^: 23 Guatemala is the country with the highest rate of maternal death related to pregnancy and delivery.^[17]^: 23 This high rate is the result of many different factors, but mainly, it is a consequence of the scarcity of health care services, increased prevalence of illnesses, and the marginalization of women.^[43] Similarly, with a younger reproductive age, the chances of young mothers acquiring illnesses and transferring contaminants to their infants is very high.^[17]^: 23

Maternal health problems affect women throughout Guatemala, but are significantly more prevalent in poorer, more rural areas.^[43] Indigenous women frequently have unsafe living conditions, which makes them more susceptible to health related problems. This population has the highest fertility rates in Guatemala, as well as a significantly higher maternal mortality rate than the non-indigenous population.^[43] Very few births are attended by either doctors or nurses, making the indigenous population much more prone to complications related to pregnancy, delivery, or postpartum.^[43]

In Guatemala, knowledge and education about contraceptives and family planning is incredibly low, especially within the indigenous population.^[48] More education about the implications of reproduction can reduce population growth while simultaneously improving both maternal and infant health.^[17]^: 62 Since the end of the Civil War, the indigenous population of Guatemala had turned to traditional practices for maternal deliveries because this group distrusted modern health care facilities and services provided by non-indigenous personnel.^[33] There is very little knowledge about health care services related to pregnancy and abortions.^[48]^[49] Abortions are illegal in Guatemala, and are only permitted if it will save the mother's life.^[49] The Guatemalan government is working to address maternal mortality by increasing public spending on health care to gain a greater understanding of "comprehensive reproductive health."^[43]

Family planning

Typically, in Guatemala, the general population is poor and has little access to quality health care services. The indigenous population and the Ladinos generally use traditional and formal health practices respectively.^[50]^: 231 In both of these practices, family planning is very different. Differences in economic and social influences determine contraceptive use, child immunizations, prenatal care, and childbirth or delivery.^[50]^: 231

For the two populations within Guatemala, there are many large disparities between family planning actions. Family planning services are as scarce as health care services in the rural areas of Guatemala.^[51]^: 144 Indigenous people in Guatemala are more likely to have little to no education and are often living in poverty.^[51]^: 143 High poverty and illiteracy rates directly correlate with lower rates of contraceptive use.^[51]^: 144 This lower rate is both a result of limited contraceptive knowledge and also the negative social stigma behind contraceptives.^[51]^: 144 Guatemala's high fertility rate is a result of poor family planning initiatives, which result in young pregnancies, large families with many children, shorter birth intervals, and deficient growth within children.^[15]^: 3 Similarly, breastfeeding plays a huge role in family planning, both as a nutrient and antibody source for infants, as well as a way to inhibit immediate fertility (because of the absence of menstruation) and allow for greater birth spacing.^[15]^: 3

Family decisions about health care depend on many factors. Specific family dynamics, individual beliefs and decisions of the mother, and direct community influences are all aspects to take into consideration when looking at family choices.^[50]^: 233 The Guatemalan government has worked to implement family education centers within its poorer populations. A family life education class provides information pertaining to sex education, as well as reproductive health.^[23]

Education

Education is an aspect of health that is generally ignored by the Guatemalan health care system. Proper education on nutrition and contraceptives has proven to impact both education levels and survival. In children, proper nutrition has been shown to accelerate development, both mentally and physically.^[52]^: 4 Also, there is a large association between maternal education and a lower mortality rate of infants as well as healthier habits while pregnant.^[53]^: 1359 Education can also reinforce preventive measures. There is a relationship between poverty and education, but there are many possibilities within Guatemala that will allow education to prosper and serve a larger community. The lack of health education is one reason why many children and adults, through simple illnesses and pregnancies, end up dying prematurely. Health education provides mothers with resources to handle health issues and gives them access to knowledgeable sources outside their specific communities.^[53]^: 1361

Health education

Many Guatemalans do not have enough knowledge about health care to make concrete health decisions and know the results of outcomes. Education is required in order to provide both indigenous and non-indigenous Guatemalans with the understanding to make personal health choices. The education of school children and quality nutrition status have both shown to affect adult education levels.^[52]^: 31 With the implementation of nutrition interventions as children, these adults were more likely to be more educated than others in the population.^[52]^: 30 Similarly, Desai and Soumya discovered that there was a great relationship between child health and maternal education; therefore, the greater the mother's education, the healthier the child.^[54]^: 71

Within the Mayan population of Guatemala, education is not as accessible. However, it has also been observed that the indigenous population does not utilize health care services as readily.^[41]^: 161 Delgado et al. discovered that the indigenous mothers actually did have a significant affinity for health seeking behaviors.^[41]^: 163 Specifically, mothers determined which health services to frequent based on the illness of their child.^[41]^: 163 However, many mothers explained that they would "normally not attend a medical service when their children presented the symptoms," for a variety of reasons including accessibility and dissatisfaction.^[41]^: 163 Education and accessibility are required in order to expand health care into the more rural areas of Guatemala and implement health care planning techniques.^[41]^: 167

Preventive measures

Preventive measures, in the form of health care, work to improve the basic health services so that individuals can easily access them.^[17]^: 1 Guatemala has shifted its focus onto preventive care, in order to serve the poorer communities that are more disadvantaged in health care.^[17]^: 4 Especially in the field of Children and Women's Health, education on preventive measures can result in great health outcomes. In considering hygiene and sexually transmitted diseases, preventive education can alone hinder the onset of disease.^[17]^: 23 Mothers are more likely to use health services, both as a preventive and medicinal tool, when they are educated.^[53]^: 1361

In the field of education, knowledge about health outcomes is necessary, as well as poor health origins. The causes of illnesses are largely unknown or completely wrong.^[55]^: 55 In considering the effects of hygiene on health, education is very limited. The indigenous population of Guatemala knows little about the transmission of disease or easy, hygienic techniques that can reduce severe health problems.^[55]^: 56 Even with few years of education, women in the indigenous communities were more likely to understand and adopt different hygienic beliefs in order to prevent poor health outcomes.^[55]^: 59 However, because of past experiences in which Ladino communities tried to assimilate into indigenous societies, the indigenous people of Guatemala resist the idea of adopting "western" or "Ladino" health behaviors.^[55]^: 59 Therefore, the implementation of education into these communities would allow for increased preventive measures as well as overall health benefits.

Many of the deaths that occur frequently in Guatemala are a result of preventable and treatable diseases.^[56]^: 1 Different preventive measures including sanitation, hygiene, vaccines, and education work to improve the health outcomes for many people in developing countries.^[56]^: 2 There is a large discrepancy between those who are receiving preventive care and those who are not. In Guatemala, doctors only treat 24% of indigenous people, whereas they treat almost double that amount for non-indigenous Guatemalans.^[17]^: 45 This statistic shows that more money can be spent working to provide preventive care services to the indigenous population of Guatemala. Preventable diseases can be eliminated with the implementation of these services and with the influence of education.

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^ Cook, David M.; Swanson, Chad R.; Eggett, Dennis L.; Booth, Gary M. (2015). "A Retrospective Analysis of Prevalence of Gastrointestinal Parasites among School Children in the Palajunoj Valley of Guatemala". Journal of Health, Population, and Nutrition. 27 (1): 31–40. doi:10.3329/jhpn.v27i1.3321. PMC 2761809. PMID 19248646.
^ ^a ^b ^c ^d ^e Braghetta, Anne (2006). "Drawing the connection between Malnutrition and lack of safe drinking water in Guatemala". Journal (American Water Works Association). 98 (5).
^ ^a ^b ^c ^d ^e Bundy, D (2006). "58". In Jamison, DT (ed.). Disease Control Priorities in Developing Countries (2nd ed.). Washington DC. PMID 21250357. {{cite book}}: |work= ignored (help)CS1 maint: location missing publisher (link)
^ ^a ^b "The Millennium Development Goals - The evidence is in: deworming helps meet the Millennium Development Goals" (PDF). World Health Organization. WHO. 2005.
^ ^a ^b ^c ^d Chary, Anita; Greiner, Miranda; Bowers, Cody; Rohloff, Peter (2012). "Determining adult type 2 diabetes-related health care in an indigenous population from rural Guatemala: a mixed-methods preliminary study". BMC Health Services Research. 12 (1): 476. doi:10.1186/1472-6963-12-476. PMC 3546905. PMID 23260013.
^ ^a ^b ^c Nieblas-Bedolla, Edwin; Bream, Kent D. W.; Rollins, Allison; Barg, Frances K. (2019). "Ongoing challenges in access to diabetes care among the indigenous population: perspectives of individuals living in rural Guatemala". International Journal for Equity in Health. 18 (1): 180. doi:10.1186/s12939-019-1086-z. ISSN 1475-9276. PMC 6873569. PMID 31752908.
^ ^a ^b ^c ^d Barrett, Bruce (January 1995). "Commentary: Plants, pesticides and production in Guatemala; nutrition, health and nontraditional agriculture". Ecology of Food and Nutrition. 33 (4): 293–309. doi:10.1080/03670244.1995.9991437.
^ Minkowski, William L. (1988). "Mayan Indian health in Guatemala". Western Journal of Medicine. 148 (4): 474–476. PMC 1026159. PMID 3388859.
^ ^a ^b ^c ^d ^e Bhatt, Sunil (2012). "Health Care Issues Facing the Maya People of the Guatemalan Highlands: The Current State of Care and Recommendations for Improvement". Journal of Global Health Perspectives.
^ ^a ^b Randolph., Adams, Walter (2007). Health care in Maya Guatemala: confronting medical pluralism in a developing country. Hawkins, John Palmer, 1946-. Norman: University of Oklahoma Press. ISBN 9780806138596. OCLC 85622920.{{cite book}}: CS1 maint: multiple names: authors list (link)
^ Kunow, Marianna Appel (2003). Maya medicine: traditional healing in Yucatan (1st ed.). Albuquerque: University of New Mexico Press. ISBN 978-0826328649. OCLC 657141480.
^ ^a ^b Hautecoeur, Maeve; Zunzunegui, Maria Victoria; Vissandjee, Bilkis (2007). "Barrier to access to health services in the indigenous population in Rabinal, Guatemala". Salud Pública de México. 49 (2): 86–93. doi:10.1590/s0036-36342007000200003. PMID 17522734.
^ ^a ^b ^c ^d ^e Ishida, Kanako; Stupp, Paul; Turcios-Ruiz, Reina; William, Daniel B.; Espinoza, Evelyn (2012). "Ethnic Inequality in Guatemalan Women's Use of Modern Reproductive Health Care". International Perspectives on Sexual and Reproductive Health. 38 (2): 99–108. doi:10.1363/3809912. PMID 22832150.
^ White, Christine D.; Healy, Paul F.; Schawrez, Henry P. (1993). "Intensive Agriculture, Social Status, and Maya Diet at Pacbitun, Belize". Journal of Anthropological Research. 49 (4): 347–375. doi:10.1086/jar.49.4.3630154. S2CID 163419661.
^ ^a ^b ^c Minkowski, William L. (1988). "Mayan Indian health in Guatemala". Western Journal of Medicine. 38 (2).
^ "Preventing toxins threatening growth in Guatemalan children". Sustainable Development Goals Fund. 2017-05-10. Retrieved 2021-01-23.
^ ^a ^b ^c ^d ^e Taylor, Matthew J. (2005). "Electrifying rural Guatemala: central policy and rural reality". Environment and Planning C: Government and Policy. 23 (2): 173–189. doi:10.1068/c14r. S2CID 56233492.
^ ^a ^b ^c Berry, Nicole S. (2008). "Who's Judging the Quality of Care? Indigenous Maya and the Problem of "Not Being Attended"". Medical Anthropology: Cross-Cultural Studies in Health and Illness. 27 (2): 164–189. doi:10.1080/01459740802017413. PMID 18464128. S2CID 36038275.
^ Ketelhöhn, Niels; Arévalo, Rodrigo (2016). "The Guatemalan public hospital system". Journal of Business Research. 69 (9): 3900–3904. doi:10.1016/j.jbusres.2015.11.022.
^ Greenberg, Linda (1982). "Midwife training programs in highland Guatemala". Social Science & Medicine. 16 (18): 1599–1609. doi:10.1016/0277-9536(82)90290-8. PMID 7146937.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j Delgado, H.L.; Valverde, V.; Hurtado, E. (1986). "Effect of Health and Nutrition Interventions on Infant and Child Morality in Rural Guatemala". Determinants of Morality and Change and Differentials in Developing Countries.
^ ^a ^b ^c Freeman, H.E. (1980). "Nutrition and cognitive development among rural Guatemalan children". American Journal of Public Health. 70 (12): 1277–1285. doi:10.2105/ajph.70.12.1277. PMC 1619650. PMID 7435746.
^ ^a ^b ^c ^d ^e ^f ^g Franco de Mendez, Nancy (2003). "Maternal mortality in Guatemala". Population Reference Bureau.
^ "Country Comparison: Infant Mortality Rate". Central Intelligence Agency: The World Factbook. 2015. Archived from the original on June 13, 2007.
^ Lasky, Robert E.; Klein, Robert E.; Yarbrough, Charles; Engle, Patricia L.; Lechtig, Aaron; Martorell, Reynaldo (1981). "The Relationship between Physical Growth and Infant Behavioral Development in Rural Guatemala". Child Development. 52 (1): 219–26. doi:10.2307/1129234. JSTOR 1129234. PMID 7238146.
^ Donald, Rose; Martorell, Reynaldo; Rivera, Juan (1992). "Infant mortality rates before, during, and after a nutrition and health intervention in rural Guatemalan villages". Food and Nutrition Bulletin. 14 (3).
^ Immink, Maarten D.C.; Payongayong, Ellen (1999). "Risk analysis of poor health and growth failure of children in the central highlands of Guatemala". Social Science and Medicine. 48 (8): 997–1009. doi:10.1016/s0277-9536(98)00383-9. PMID 10390040.
^ ^a ^b Darabi, Leila (2006). "Guatemalan Health Care System Fails Women". Guttmacher Institute.
^ ^a ^b Singh, Susheela; Prada, Elena; Kestler, Edgar (2006). "Induced Abortion and Unintended Pregnancy in Guatemala". Guttmacher Institute. 32 (3): 136–145. doi:10.1363/3213606. PMID 17015243.
^ ^a ^b ^c Pebley, Anne R.; Goldman, Noreen; Rodriguez, German (1996). "Prenatal and delivery care and childhood immunization in Guatemala: Do family and community matter?". Demography. 33 (2): 231–47. doi:10.2307/2061874. JSTOR 2061874. PMID 8827167.
^ ^a ^b ^c ^d Terbough, Anne; Rosen, James E.; Galvez, Roberto Santiso; Terceros, Willy; Bertrand, Jane T.; Bull, Sheana E. (1995). "Family Planning Among Indigenous Populations in Latin America". International Family Planning Perspectives.
^ ^a ^b ^c Behrman, John A. (2009). "The Impact of Nutrition during Early Childhood on Education among Guatemalan Adults". PIER Working Paper. 26 (6).
^ ^a ^b ^c Cleland, John G. (1988). "Maternal education and child survival in developing countries: The search for pathways for influence". Social Science and Medicine. 27 (12): 1357–1368. doi:10.1016/0277-9536(88)90201-8. PMID 3070762.
^ Desai, Sonalde; Alva, Soumya (1998). "Maternal education and child health: Is there a strong causal relationship?". Demography. 35 (1): 71–81. doi:10.2307/3004028. JSTOR 3004028. PMID 9512911.
^ ^a ^b ^c ^d Goldman, Noreen; Pebley, Anne R.; Beckett, Megan (2001). "Diffusion of ideas about personal hygiene and contamination in poor countries: evidence from Guatemala". Social Science and Medicine. 52 (1): 53–69. CiteSeerX 10.1.1.512.73. doi:10.1016/s0277-9536(00)00122-2. PMID 11144917.
^ ^a ^b Masterson, Erin E. (2010). "Diarrheal illness and health utilization in Guatemala factors surrounding oral rehydration therapy use". OHSU Digital Commons: Scholar Archive.

[1] "The World Factbook: Guatemala". Central Intelligence Agency. 2015.

[2] "WHO Report on the Global Tobacco Epidemic, 2015: Country Profile - Guatemala" (PDF). World Health Organization. 2015.^{[dead link]}

[3] "WFP Guatemala | Brief" (PDF). United Nations World Food Programme. 2015.

[Pena1-4] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m Pena, Christine (2013). "Improving Access to Health Care Services through the Expansion of Coverage Program (PEC): The Case of Guatemala". UNICO Studies Series (19).

[:1-5] Dunn, Rebecca (2010). "Healthcare in Guatemala". General University Honors.

[6] "Human Rights Measurement Initiative – The first global initiative to track the human rights performance of countries". humanrightsmeasurement.org. Retrieved 2022-03-18.

[Guatemala_-_HRMI_Rights_Tracker-7] "Guatemala - HRMI Rights Tracker". rightstracker.org. Retrieved 2022-03-18.

[:2-8] ^ ^a ^b ^c ^d ^e ^f ^g Becerril-Montekio, Victor; López-Dávila, Luis (2011). "The health system of Guatemala". Salud Pública de México. 53 (2): s197–208. PMID 21877085.

[:0-9] Fort, Meredith; Verduga, Juan Carlos (2004). "The failures of neoliberalism: Health sector reform in Guatemala". Sickness and Wealth: The Corporate Assault on Global Health. Cambridge, MS: South End Press.

[10] "Guatemala" (PDF). World Health Organization. May 1, 2014. Archived from the original (PDF) on December 13, 2007.

[11] Health System Innovations in Central America: World Bank Working Papers. The World Bank. 2005. pp. 9–48. doi:10.1596/978-0-8213-6278-5. ISBN 978-0-8213-6278-5.

[mayamobile-12] Harvey, T. S. (2011-03-01). "Maya Mobile Medicine in Guatemala: The "Other" Public Health". Medical Anthropology Quarterly. 25 (1): 47–69. doi:10.1111/j.1548-1387.2010.01135.x. ISSN 1548-1387. PMID 21495494.

[:4-13] Sanders, John W.; Fuhrer, Greg S.; Johnson, Mark D.; Riddle, Mark S. (2008). "The epidemiological transition: the current status of infectious diseases in the developed world versus the developing world". Science Progress. 91 (1): 1–37. doi:10.3184/003685008X284628. PMC 10367498. PMID 18453281. S2CID 1239365.

[Little-14] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Little, Matthew (2012). "Type 2 Diabetes in Rural Guatemala: Disease Perceptions, Service-Provision Difficulties and Management Techniques". Undercurrent Journal. 9 (1).

[:11-15] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Marini, Alessandra; Gragnolati, Michele (2003). "Malnutrition and Poverty in Guatemala" (PDF). Policy Research Working Paper. Policy Research Working Papers. 2967. doi:10.1596/1813-9450-2967. S2CID 15111684.

[16] "Poverty in Guatemala: Guatemala poverty assessment. Poverty reduction and economic management unit for the Latin American and the Caribbean region." World Bank. 1995. Washington, DC: World Bank. p. 64 http://documents.worldbank.org/curated/en/1995/04/697460/guatemala-assessment-poverty

[:3-17] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ Gragnolati, Michele; Marini, Alessandra (2003). "Health and poverty in Guatemala" (PDF). World Bank Policy Research Working Paper. Policy Research Working Papers. 2966. doi:10.1596/1813-9450-2966. S2CID 70635599.

[:5-18] ^ ^a ^b ^c ^d ^e ^f ^g ^h Cook, David M.; Swanson, Chad R.; Eggett, Dennis L.; Booth, Gary M. (2015). "A Retrospective Analysis of Prevalence of Gastrointestinal Parasites among School Children in the Palajunoj Valley of Guatemala". Journal of Health, Population, and Nutrition. 27 (1): 31–40. doi:10.3329/jhpn.v27i1.3321. PMC 2761809. PMID 19248646.

[19] "Health Information for Travelers to Guatemala: Traveler View". Centers for Disease Control and Prevention. 2015.

[20] "CDC in Guatemala". Centers for Disease Control and Prevention. 2013.

[21] Cook, David M.; Swanson, Chad R.; Eggett, Dennis L.; Booth, Gary M. (2015). "A Retrospective Analysis of Prevalence of Gastrointestinal Parasites among School Children in the Palajunoj Valley of Guatemala". Journal of Health, Population, and Nutrition. 27 (1): 31–40. doi:10.3329/jhpn.v27i1.3321. PMC 2761809. PMID 19248646.

[:10-22] Braghetta, Anne (2006). "Drawing the connection between Malnutrition and lack of safe drinking water in Guatemala". Journal (American Water Works Association). 98 (5).

[:8-23] Bundy, D (2006). "58". In Jamison, DT (ed.). Disease Control Priorities in Developing Countries (2nd ed.). Washington DC. PMID 21250357. {{cite book}}: |work= ignored (help)CS1 maint: location missing publisher (link)

[:6-24] "The Millennium Development Goals - The evidence is in: deworming helps meet the Millennium Development Goals" (PDF). World Health Organization. WHO. 2005.

[:7-25] Chary, Anita; Greiner, Miranda; Bowers, Cody; Rohloff, Peter (2012). "Determining adult type 2 diabetes-related health care in an indigenous population from rural Guatemala: a mixed-methods preliminary study". BMC Health Services Research. 12 (1): 476. doi:10.1186/1472-6963-12-476. PMC 3546905. PMID 23260013.

[:23-26] Nieblas-Bedolla, Edwin; Bream, Kent D. W.; Rollins, Allison; Barg, Frances K. (2019). "Ongoing challenges in access to diabetes care among the indigenous population: perspectives of individuals living in rural Guatemala". International Journal for Equity in Health. 18 (1): 180. doi:10.1186/s12939-019-1086-z. ISSN 1475-9276. PMC 6873569. PMID 31752908.

[pesticide-27] Barrett, Bruce (January 1995). "Commentary: Plants, pesticides and production in Guatemala; nutrition, health and nontraditional agriculture". Ecology of Food and Nutrition. 33 (4): 293–309. doi:10.1080/03670244.1995.9991437.

[Minkowski-28] Minkowski, William L. (1988). "Mayan Indian health in Guatemala". Western Journal of Medicine. 148 (4): 474–476. PMC 1026159. PMID 3388859.

[Bhatt-29] Bhatt, Sunil (2012). "Health Care Issues Facing the Maya People of the Guatemalan Highlands: The Current State of Care and Recommendations for Improvement". Journal of Global Health Perspectives.

[pluralism-30] Randolph., Adams, Walter (2007). Health care in Maya Guatemala: confronting medical pluralism in a developing country. Hawkins, John Palmer, 1946-. Norman: University of Oklahoma Press. ISBN 9780806138596. OCLC 85622920.{{cite book}}: CS1 maint: multiple names: authors list (link)

[31] Kunow, Marianna Appel (2003). Maya medicine: traditional healing in Yucatan (1st ed.). Albuquerque: University of New Mexico Press. ISBN 978-0826328649. OCLC 657141480.

[:17-32] Hautecoeur, Maeve; Zunzunegui, Maria Victoria; Vissandjee, Bilkis (2007). "Barrier to access to health services in the indigenous population in Rabinal, Guatemala". Salud Pública de México. 49 (2): 86–93. doi:10.1590/s0036-36342007000200003. PMID 17522734.

[:16-33] Ishida, Kanako; Stupp, Paul; Turcios-Ruiz, Reina; William, Daniel B.; Espinoza, Evelyn (2012). "Ethnic Inequality in Guatemalan Women's Use of Modern Reproductive Health Care". International Perspectives on Sexual and Reproductive Health. 38 (2): 99–108. doi:10.1363/3809912. PMID 22832150.

[34] White, Christine D.; Healy, Paul F.; Schawrez, Henry P. (1993). "Intensive Agriculture, Social Status, and Maya Diet at Pacbitun, Belize". Journal of Anthropological Research. 49 (4): 347–375. doi:10.1086/jar.49.4.3630154. S2CID 163419661.

[:18-35] Minkowski, William L. (1988). "Mayan Indian health in Guatemala". Western Journal of Medicine. 38 (2).

[36] "Preventing toxins threatening growth in Guatemalan children". Sustainable Development Goals Fund. 2017-05-10. Retrieved 2021-01-23.

[:20-37] Taylor, Matthew J. (2005). "Electrifying rural Guatemala: central policy and rural reality". Environment and Planning C: Government and Policy. 23 (2): 173–189. doi:10.1068/c14r. S2CID 56233492.

[:19-38] Berry, Nicole S. (2008). "Who's Judging the Quality of Care? Indigenous Maya and the Problem of "Not Being Attended"". Medical Anthropology: Cross-Cultural Studies in Health and Illness. 27 (2): 164–189. doi:10.1080/01459740802017413. PMID 18464128. S2CID 36038275.

[39] Ketelhöhn, Niels; Arévalo, Rodrigo (2016). "The Guatemalan public hospital system". Journal of Business Research. 69 (9): 3900–3904. doi:10.1016/j.jbusres.2015.11.022.

[40] Greenberg, Linda (1982). "Midwife training programs in highland Guatemala". Social Science & Medicine. 16 (18): 1599–1609. doi:10.1016/0277-9536(82)90290-8. PMID 7146937.

[:9-41] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j Delgado, H.L.; Valverde, V.; Hurtado, E. (1986). "Effect of Health and Nutrition Interventions on Infant and Child Morality in Rural Guatemala". Determinants of Morality and Change and Differentials in Developing Countries.

[Freeman-42] Freeman, H.E. (1980). "Nutrition and cognitive development among rural Guatemalan children". American Journal of Public Health. 70 (12): 1277–1285. doi:10.2105/ajph.70.12.1277. PMC 1619650. PMID 7435746.

[Mendez-43] ^ ^a ^b ^c ^d ^e ^f ^g Franco de Mendez, Nancy (2003). "Maternal mortality in Guatemala". Population Reference Bureau.

[44] "Country Comparison: Infant Mortality Rate". Central Intelligence Agency: The World Factbook. 2015. Archived from the original on June 13, 2007.

[45] Lasky, Robert E.; Klein, Robert E.; Yarbrough, Charles; Engle, Patricia L.; Lechtig, Aaron; Martorell, Reynaldo (1981). "The Relationship between Physical Growth and Infant Behavioral Development in Rural Guatemala". Child Development. 52 (1): 219–26. doi:10.2307/1129234. JSTOR 1129234. PMID 7238146.

[46] Donald, Rose; Martorell, Reynaldo; Rivera, Juan (1992). "Infant mortality rates before, during, and after a nutrition and health intervention in rural Guatemalan villages". Food and Nutrition Bulletin. 14 (3).

[47] Immink, Maarten D.C.; Payongayong, Ellen (1999). "Risk analysis of poor health and growth failure of children in the central highlands of Guatemala". Social Science and Medicine. 48 (8): 997–1009. doi:10.1016/s0277-9536(98)00383-9. PMID 10390040.

[:12-48] Darabi, Leila (2006). "Guatemalan Health Care System Fails Women". Guttmacher Institute.

[:13-49] Singh, Susheela; Prada, Elena; Kestler, Edgar (2006). "Induced Abortion and Unintended Pregnancy in Guatemala". Guttmacher Institute. 32 (3): 136–145. doi:10.1363/3213606. PMID 17015243.

[:14-50] Pebley, Anne R.; Goldman, Noreen; Rodriguez, German (1996). "Prenatal and delivery care and childhood immunization in Guatemala: Do family and community matter?". Demography. 33 (2): 231–47. doi:10.2307/2061874. JSTOR 2061874. PMID 8827167.

[:15-51] Terbough, Anne; Rosen, James E.; Galvez, Roberto Santiso; Terceros, Willy; Bertrand, Jane T.; Bull, Sheana E. (1995). "Family Planning Among Indigenous Populations in Latin America". International Family Planning Perspectives.

[Behrman1-52] Behrman, John A. (2009). "The Impact of Nutrition during Early Childhood on Education among Guatemalan Adults". PIER Working Paper. 26 (6).

[Cleland-53] Cleland, John G. (1988). "Maternal education and child survival in developing countries: The search for pathways for influence". Social Science and Medicine. 27 (12): 1357–1368. doi:10.1016/0277-9536(88)90201-8. PMID 3070762.

[54] Desai, Sonalde; Alva, Soumya (1998). "Maternal education and child health: Is there a strong causal relationship?". Demography. 35 (1): 71–81. doi:10.2307/3004028. JSTOR 3004028. PMID 9512911.

[:21-55] Goldman, Noreen; Pebley, Anne R.; Beckett, Megan (2001). "Diffusion of ideas about personal hygiene and contamination in poor countries: evidence from Guatemala". Social Science and Medicine. 52 (1): 53–69. CiteSeerX 10.1.1.512.73. doi:10.1016/s0277-9536(00)00122-2. PMID 11144917.

[:22-56] Masterson, Erin E. (2010). "Diarrheal illness and health utilization in Guatemala factors surrounding oral rehydration therapy use". OHSU Digital Commons: Scholar Archive.

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@@ Line 1: / Line 1: @@
+{{Short description|none}}
 {| class="infobox" style="font-size: 90%; border: 1px solid #999; float: right; margin-left: 1em;"
 |- style="background:#f5f5f5;"
-! colspan="2" |[[File:Mobile Clinic on Lake Atitlán.JPG|thumb|center|360x480px|A mobile clinic setup in [[San Pedro La Laguna|San Pedro la Laguna]], Guatemala]]
+! colspan="2" |[[File:Inicio de operaciones del Hospital Regional de Chimaltenango 20220220.jpg|center|thumb|360x360px|The Regional Chimaltenango Hospital, located in [[Chimaltenango]]]]
 |-
 |- style="background:#f5f5f5;"
 ! colspan="2" | Health indicators<ref>{{Cite web|url = https://www.cia.gov/the-world-factbook/countries/guatemala/|title = The World Factbook: Guatemala|date = 2015|website = Central Intelligence Agency}}</ref><ref>{{Cite web|url = http://who.int/tobacco/surveillance/policy/country_profile/gtm.pdf?ua=1|title = WHO Report on the Global Tobacco Epidemic, 2015: Country Profile - Guatemala|date = 2015|website = World Health Organization}}{{dead link|date=December 2021|bot=medic}}{{cbignore|bot=medic}}</ref><ref>{{Cite web|url = http://documents.wfp.org/stellent/groups/public/documents/ep/wfp272220.pdf|title = WFP Guatemala {{!}} Brief|date = 2015|website = United Nations World Food Programme}}</ref>
 |-
-| [[Life expectancy]] || style="text-align: right;" |72.02 years
+| [[Life expectancy]] || style="text-align: right;" |73.18 years
 |-
-| [[Infant mortality]] || style="text-align: right;" |22.73 deaths (per 1,000 live births)
+| [[Infant mortality]] || style="text-align: right;" |25.57 deaths (per 1,000 live births)
 |-
-| [[Total fertility rate|Fertility rate]] || style="text-align: right;" |2.9 children
+| [[Total fertility rate|Fertility rate]] || style="text-align: right;" |2.57 children
 |-
-| [[Sanitation]] || style="text-align: right;" |63.9% of population
+| [[Sanitation]] || style="text-align: right;" |78.8% of population
 |-
-| [[Smoking]] || style="text-align: right;" |11.4%
+| [[Smoking]] || style="text-align: right;" |10.9%
 |-
-| [[Obesity|Obesity in Adults]] || style="text-align: right;" |16.4%
+| [[Obesity|Obesity in Adults]] || style="text-align: right;" |21.2%
 |-
 | [[Malnutrition]] (Total) || style="text-align: right;" |50%
@@ Line 25: / Line 26: @@
 |}
-Health in [[Guatemala]] is focused on many different systems of prevention and care. Guatemala's Constitution states that every citizen has the universal right to health care.<ref name="Pena1" />{{rp|v}} However, this right has been hard to guarantee due to limited government resources and other problems regarding access. The health care system in place today developed out of the Civil War in Guatemala. The Civil War prevented social reforms from occurring, especially in the sector of health care.<ref name=":1" />{{rp|6}}
+Health in [[Guatemala]] is focused on many different systems of prevention and care. Guatemala's Constitution states that every citizen has the universal [[right to health care]].<ref name="Pena1" /> However, this right has been hard to guarantee due to limited government resources and other problems regarding access. The health care system in place today developed out of the Civil War in Guatemala. The Civil War prevented social reforms from occurring, especially in the sector of health care.<ref name=":1" />{{rp|6}}
+The Human Rights Measurement Initiative<ref>{{Cite web |title=Human Rights Measurement Initiative – The first global initiative to track the human rights performance of countries |url=https://humanrightsmeasurement.org/ |access-date=2022-03-18 |website=humanrightsmeasurement.org}}</ref> finds that Guatemala is fulfilling 81.6% of what it should be fulfilling for the right to health based on its level of income.<ref name="Guatemala - HRMI Rights Tracker">{{Cite web |title=Guatemala - HRMI Rights Tracker |url=https://rightstracker.org/ |access-date=2022-03-18 |website=rightstracker.org |language=en}}</ref> When looking at the right to health with respect to children, Guatemala achieves 94.8% of what is expected based on its current income.<ref name="Guatemala - HRMI Rights Tracker"/> In regards to the right to health amongst the adult population, the country achieves only 87.3% of what is expected based on the nation's level of income.<ref name="Guatemala - HRMI Rights Tracker"/> Guatemala falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 62.9% of what the nation is expected to achieve based on the resources (income) it has available.<ref name="Guatemala - HRMI Rights Tracker"/>
-== Health Care System ==
+== Health care system ==
 Today, there have been many reforms to the health care system, but the current system continues to have significant problems.  The country is on its way to develop a solid health care system, and is working toward achieving many of the [[Millennium Development Goals]] in place.<ref name="Pena1">{{cite journal|last1 = Pena|first1 = Christine|title = Improving Access to Health Care Services through the Expansion of Coverage Program (PEC): The Case of Guatemala|journal = UNICO Studies Series|date = 2013|issue = 19}}</ref>{{rp|v}} However, the inequalities that are associated with outcomes and access have not been addressed, making it difficult for Guatemala to move forward in the field of health care.<ref name="Pena1" />{{rp|1}}  The ratio of doctors to residents is low, at .9 doctors per 1,000 citizens.<ref name=":2" /> The system requires a lot of change in order to serve the whole Guatemalan community.
 === History ===
+[[File:Life expectancy by WBG -Guatemala.png|thumb|[[Life expectancy]] in Guatemala]]
-When the Civil War broke out in Guatemala, social improvements in health care were brought to a halt. The period of the 34-year Civil War (from 1954-mid 1980s) resulted in many changes within the health sector.<ref name=":0">{{Cite book|title = Sickness and Wealth: The Corporate Assault on Global Health|last = Fort|first = Meredith|publisher = South End Press|year = 2004|location = Cambridge, MS|chapter = The failures of neoliberalism: Health sector reform in Guatemala|last2 = Verduga|first2 = Juan Carlos}}</ref>{{rp|59}} The focus on health care was generally abandoned throughout the period of war when the country experienced a period of "privatization through attrition,"<ref name=":0" />{{rp|59}} which generated poor service and low health care coverage for decades to follow.<ref name=":0" />{{rp|59}} As Verduga mentions, the total [[GDP]] expenditures on health was only about 1 to 2 percent during this period of war.<ref name=":0" />{{rp|59}} Therefore, it was the emergence of [[NGOs]] and other community organizations that allowed for basic health care to be provided to the general population.<ref name=":0" />{{rp|59}}
+When the Civil War broke out in Guatemala, social improvements in health care were brought to a halt. The period of the 34-year Civil War (from 1954-mid 1980s) resulted in many changes within the health sector.<ref name=":0">{{Cite book|title = Sickness and Wealth: The Corporate Assault on Global Health|last1 = Fort|first1 = Meredith|publisher = South End Press|year = 2004|location = Cambridge, MS|chapter = The failures of neoliberalism: Health sector reform in Guatemala|last2 = Verduga|first2 = Juan Carlos}}</ref>{{rp|59}} The focus on health care was generally abandoned throughout the period of war when the country experienced a period of "privatization through attrition,"<ref name=":0" />{{rp|59}} which generated poor service and low health care coverage for decades to follow.<ref name=":0" />{{rp|59}} As Verduga mentions, the total [[GDP]] expenditures on health was only about 1 to 2 percent during this period of war.<ref name=":0" />{{rp|59}} Therefore, it was the emergence of [[NGOs]] and other community organizations that allowed for basic health care to be provided to the general population.<ref name=":0" />{{rp|59}}
 Once the [[Guatemalan Civil War]] ended in 1996 with the signing of the Peace Accords,<ref name="Pena1" /> health care was placed in the hands of a new democratic government. Immediately after the war, Guatemala saw little change in the healthcare sector.<ref name=":1">{{Cite journal|title = Healthcare in Guatemala|last = Dunn|first = Rebecca|date = 2010|journal = General University Honors}}</ref>{{rp|6}} However, starting in 1999, the health care system was improved with increased government spending and aid.<ref name=":1" />{{rp|6}} Although this was a drastic improvement from the times of war, the system was still insufficient and did not come close to meeting all of the needs of the Guatemalan people.
-=== Structure and Coverage ===
+=== Structure and coverage ===
-Today, the Guatemalan health care system is split into three separate divisions: the public, private nonprofit, and private for-profit sectors.<ref name=":1" />{{rp|7}} Within the public sector, there is the [http://www.mspas.gob.gt/ Ministry of Health and Social Security (MOH)], the [http://www.igssgt.org/ Guatemalan Social Security Institute (IGSS)], and the Military Health Service.<ref name=":2">{{Cite journal|title = The health system of Guatemala|last = Becerril-Montekio|first = Victor|date = 2011|journal = Salud Pública de México|pmid = 21877085|last2 = López-Dávila|first2 = Luis|issue = 2|volume = 53 |pages=s197–208}}</ref> This sector of the health care system formally covers about 88% of the population.<ref name=":2" /> The private sector, which accounts for about 12% of the population, includes many for-profit providers, non-profit entities, and traditional local providers.<ref name=":2" /><ref>{{Cite web|url =https://www.who.int/countryfocus/cooperation_strategy/ccsbrief_gtm_en.pdf|archive-url =https://web.archive.org/web/20071213130805/http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_gtm_en.pdf|url-status =dead|archive-date =December 13, 2007|title = Guatemala|date = May 1, 2014|website = World Health Organization}}</ref> The public sector works to provide care through hospitals, health facilities, and various health centers, whereas the private sector allocates resources within private offices, clinics, and hospitals.<ref name=":2" />
+Today, the Guatemalan health care system is split into three separate divisions: the public, private nonprofit, and private for-profit sectors.<ref name=":1" />{{rp|7}} Within the public sector, there is the [http://www.mspas.gob.gt/ Ministry of Health and Social Security (MOH)], the [http://www.igssgt.org/ Guatemalan Social Security Institute (IGSS)], and the Military Health Service.<ref name=":2">{{Cite journal|title = The health system of Guatemala|last1 = Becerril-Montekio|first1 = Victor|date = 2011|journal = Salud Pública de México|pmid = 21877085|last2 = López-Dávila|first2 = Luis|issue = 2|volume = 53 |pages=s197–208}}</ref> This sector of the health care system formally covers about 88% of the population.<ref name=":2" /> The private sector, which accounts for about 12% of the population, includes many for-profit providers, non-profit entities, and traditional local providers.<ref name=":2" /><ref>{{Cite web|url =https://www.who.int/countryfocus/cooperation_strategy/ccsbrief_gtm_en.pdf|archive-url =https://web.archive.org/web/20071213130805/http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_gtm_en.pdf|url-status =dead|archive-date =December 13, 2007|title = Guatemala|date = May 1, 2014|website = World Health Organization}}</ref> The public sector works to provide care through hospitals, health facilities, and various health centers, whereas the private sector allocates resources within private offices, clinics, and hospitals.<ref name=":2" />
 Very few funds are allocated to health care within Guatemala. As a share of GDP, health care spending in Guatemala is one of the lowest in [[Central America]] (2.6 percent).<ref name="Pena1" />{{rp|3}} The GDP expenditure shows that few funds are allocated to the health care system in Guatemala. In total, the Guatemalan government's expenditures on health were about $196 US dollars in 2010.<ref name="Pena1" />{{rp|3}} This amount was significantly less than the total Central American average ($350) and the average [[Latin America]]n and the [[List of Caribbean islands|Caribbean]] (LAC) expenditures ($672).<ref name="Pena1" />{{rp|3}} The health care system requires more funds to improve the coverage and overall health care system in Guatemala.<ref name="Pena1" />{{rp|4}}
-The Peace Accords, which were signed in 1996, called for a change in health provision goals. In 1997, the MOH established a program called the Expansion of Coverage Program (PEC), which worked to improve the availability of health and [[nutrition]] services to young children and women in rural areas of Guatemala.<ref name="Pena1" />{{rp|v}} As Pena explains, current MOH services do not cover the poor, rural population of Guatemala, making the PEC critical to the rural population.<ref name="Pena1" />{{rp|v}} Ever since its creation, the PEC has expanded immensely, now covering about 54% of the health and nutrition needs of rural Guatemalans.<ref name="Pena1" />{{rp|v}} The coverage program works with NGOs in the area to promote good health and nutrition to populations who lack sufficient health care.<ref name="Pena1" />{{rp|11}} However, important accountability systems regarding transparency and progress were not installed, limiting the program's effectiveness.<ref>{{Cite book|title=Health System Innovations in Central America: World Bank Working Papers|year=2005|isbn=978-0-8213-6278-5|pages=9–48|language=en|doi=10.1596/978-0-8213-6278-5|series = World Bank Working Papers}}</ref> The services covered by the PEC include care for women and infants, illnesses and emergency care, and environmental care.<ref name="Pena1" />{{rp|12}}
+The Peace Accords, which were signed in 1996, called for a change in health provision goals. In 1997, the MOH established a program called the Expansion of Coverage Program (PEC), which worked to improve the availability of health and [[nutrition]] services to young children and women in rural areas of Guatemala.<ref name="Pena1" />{{rp|v}} As Pena explains, current MOH services do not cover the poor, rural population of Guatemala, making the PEC critical to the rural population.<ref name="Pena1" />{{rp|v}} Ever since its creation, the PEC has expanded immensely, now covering about 54% of the health and nutrition needs of rural Guatemalans.<ref name="Pena1" />{{rp|v}} The coverage program works with NGOs in the area to promote good health and nutrition to populations who lack sufficient health care.<ref name="Pena1" />{{rp|11}} However, important accountability systems regarding transparency and progress were not installed, limiting the program's effectiveness.<ref>{{Cite book|title=Health System Innovations in Central America: World Bank Working Papers|year=2005|isbn=978-0-8213-6278-5|pages=9–48|publisher=The World Bank |language=en|doi=10.1596/978-0-8213-6278-5}}</ref> The services covered by the PEC include care for women and infants, illnesses and emergency care, and environmental care.<ref name="Pena1" />{{rp|12}}
 There is also an informal sector of healthcare that is often overlooked. Termed the "Maya Mobile Clinic" or the "Other Public Health", traveling salespeople (often men) are a medical resource for Guatemalans living in [[Guatemalan Highlands|the highlands]].<ref name="mayamobile">{{Cite journal|last=Harvey|first=T. S.|date=2011-03-01|title=Maya Mobile Medicine in Guatemala: The "Other" Public Health|journal=Medical Anthropology Quarterly|language=en|volume=25|issue=1|pages=47–69|doi=10.1111/j.1548-1387.2010.01135.x|pmid=21495494|issn=1548-1387}}</ref> These salespeople offer raw and natural ingredients to mainly indigenous populations and give talks about their health qualities.<ref name="mayamobile" /> Maya Mobile Clinics act as a midpoint between the physical distance of the Guatemalan highlands and public clinic locations, and as a midpoint between the cultural gap that separates Maya medicinal norms and values from Guatemala's public health sector's medicinal norms and values.<ref name="mayamobile" />
@@ Line 49: / Line 53: @@
 [[File:Rural Village of Guatemala.JPG|thumb|320x240px|An image of a rural village in the highlands of Guatemala]]
-=== Communicable Diseases ===
+=== Communicable diseases ===
-In Guatemala, communicable diseases for which treatment exists are still one of the major causes of death. Wealthy, more industrialized developed nations have been able to eliminate communicable diseases due to an [[epidemiological transition]], in which death rates due to degenerative diseases have surpassed those of communicable and infectious diseases.<ref name=":4">{{Cite journal|title = The epidemiological transition: the current status of infectious diseases in the developed world versus the developing world|last = Sanders|first = John W.|date = 2008|journal = Science Progress|last2 = Fuhrer|first2 = Greg S.|issue = 1|volume = 91|last3 = Johnson|first3 = Mark D.|last4 = Riddle|first4 = Mark S.}}</ref> The opposite is apparent in Guatemala. The high mortality rate for infants is a direct result of communicable and infectious diseases.<ref name=":3">{{Cite journal|title = Health and poverty in Guatemala|last = Gragnolati|first = Michele|date = 2003|journal = World Bank Policy Research Working Paper|last2 = Marini|first2 = Alessandra|volume = 2966}}</ref> Similarly, the epidemiological profile of Guatemala shows that some of the most prevalent infectious diseases, like [[diarrhea]] and [[Acute respiratory failure|acute respiratory infections]], are a direct result of poverty.<ref name=":3" /> In Guatemala, 56 percent of the population lives below the poverty line.<ref name=":5" />{{rp|31}} Poverty levels are greatest in the indigenous communities of Guatemala, which account for about 81 percent of those living in poverty, and make up about 43 percent of Guatemala's total population.<ref name=":5" />{{rp|32}} High levels of poverty make the population more vulnerable to communicable diseases, which is why government funding of health care is necessary for the rural areas of Guatemala.<ref name=":5" />{{rp|32}}
+In Guatemala, communicable diseases for which treatment exists are still one of the major causes of death. Wealthy, more industrialized developed nations have been able to eliminate communicable diseases due to an [[epidemiological transition]], in which death rates due to degenerative diseases have surpassed those of communicable and infectious diseases.<ref name=":4">{{Cite journal|title = The epidemiological transition: the current status of infectious diseases in the developed world versus the developing world|last1 = Sanders|first1 = John W.|date = 2008|journal = Science Progress|last2 = Fuhrer|first2 = Greg S.|issue = 1|volume = 91|last3 = Johnson|first3 = Mark D.|last4 = Riddle|first4 = Mark S.| pages=1–37 | doi=10.3184/003685008X284628 | pmid=18453281 | pmc=10367498 | s2cid=1239365 }}</ref> The opposite is apparent in Guatemala. The high mortality rate for infants is a direct result of communicable and infectious diseases.<ref name=":3">{{Cite journal|title = Health and poverty in Guatemala|last1 = Gragnolati|first1 = Michele|date = 2003|journal = World Bank Policy Research Working Paper|last2 = Marini|first2 = Alessandra| series=Policy Research Working Papers |volume = 2966| doi=10.1596/1813-9450-2966 | s2cid=70635599 | url=http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/02/22/000094946_0302070416252/Rendered/PDF/multi0page.pdf }}</ref> Similarly, the epidemiological profile of Guatemala shows that some of the most prevalent infectious diseases, like [[diarrhea]] and [[Acute respiratory failure|acute respiratory infections]], are a direct result of poverty.<ref name=":3" /> In Guatemala, 56 percent of the population lives below the poverty line.<ref name=":5" />{{rp|31}} Poverty levels are greatest in the indigenous communities of Guatemala, which account for about 81 percent of those living in poverty, and make up about 43 percent of Guatemala's total population.<ref name=":5" />{{rp|32}} High levels of poverty make the population more vulnerable to communicable diseases, which is why government funding of health care is necessary for the rural areas of Guatemala.<ref name=":5" />{{rp|32}}
 Even though Guatemala has improved its health care system substantially since the end of the Guatemalan Civil War, mortality rates for communicable diseases still show that considerable progress needs to be made  to remove the burden of infectious diseases on the population. In a country like Guatemala, water is poor and frequently contaminated.<ref>{{Cite web|url = http://wwwnc.cdc.gov/travel/destinations/traveler/none/guatemala|title = Health Information for Travelers to Guatemala: Traveler View|date = 2015|website = Centers for Disease Control and Prevention}}</ref> In order to decrease common communicable diseases like diarrhea, [[tuberculosis]], [[pneumonia]], and respiratory disease, clean water and sanitation are necessary.<ref>{{Cite web|url = https://www.cdc.gov/globalhealth/countries/guatemala/|title = CDC in Guatemala|date = 2013|website = Centers for Disease Control and Prevention}}</ref> With the health care system's provision of both clean water and food, the incidence of infectious and communicable diseases will decrease.<ref name=":4" />
 === Parasites ===
-[[Human parasite|Parasites]] present one of the biggest threats to health in Guatemala. Many of the common parasites in developing countries like Guatemala are spread through contamination of both water and food.<ref name=":5">{{Cite journal|title = A Retrospective Analysis of Prevalence of Gastrointestinal Parasites among School Children in the Palajunoj Valley of Guatemala|last = Cook|first = David M.|date = 2015|journal = Journal of Health, Population, and Nutrition|doi = 10.3329/jhpn.v27i1.3321|pmid = 19248646|last2 = Swanson|first2 = Chad R.|issue = 1|volume = 27|last3 = Eggett|first3 = Dennis L.|last4 = Booth|first4 = Gary M. |pages=31–40 |pmc=2761809}}</ref>{{rp|32}} Some of the effects of parasites include intestinal obstructions, which can hinder the body from absorbing nutrients, lead to a loss of appetite, impair long term growth, induce [[Vomiting reflex|vomiting]], cause [[anemia]] and [[Anorexia (symptom)|anorexia]], and in severe cases, cause death.<ref name=":5" />{{rp|32}} Symptoms can also include intense abdominal pain, loss of appetite, [[nausea]], diarrhea, and fever.<ref name=":5" />{{rp|32}}
+[[Human parasite|Parasites]] present one of the biggest threats to health in Guatemala. Many of the common parasites in developing countries like Guatemala are spread through contamination of both water and food.<ref name=":5">{{Cite journal|title = A Retrospective Analysis of Prevalence of Gastrointestinal Parasites among School Children in the Palajunoj Valley of Guatemala|last1 = Cook|first1 = David M.|date = 2015|journal = Journal of Health, Population, and Nutrition|doi = 10.3329/jhpn.v27i1.3321|pmid = 19248646|last2 = Swanson|first2 = Chad R.|issue = 1|volume = 27|last3 = Eggett|first3 = Dennis L.|last4 = Booth|first4 = Gary M. |pages=31–40 |pmc=2761809}}</ref>{{rp|32}} Some of the effects of parasites include intestinal obstructions, which can hinder the body from absorbing nutrients, lead to a loss of appetite, impair long term growth, induce [[Vomiting reflex|vomiting]], cause [[anemia]] and [[Anorexia (symptom)|anorexia]], and in severe cases, cause death.<ref name=":5" />{{rp|32}} Symptoms can also include intense abdominal pain, loss of appetite, [[nausea]], diarrhea, and fever.<ref name=":5" />{{rp|32}}
-[[File:Entamoeba histolytica.jpg|thumb|''[[Entamoeba histolytica|E. histolytica]]'', a parasite that is very common among children in Guatemala<ref>{{Cite journal|title = A Retrospective Analysis of Prevalence of Gastrointestinal Parasites among School Children in the Palajunoj Valley of Guatemala|last = Cook|first = David M.|date = 2015|journal = Journal of Health, Population, and Nutrition|doi = 10.3329/jhpn.v27i1.3321|pmid = 19248646|last2 = Swanson|first2 = Chad R.|issue = 1|volume = 27|last4 = Booth|first3 = Dennis L.|last3 = Eggett|first4 = Gary M. |pages=31–40 |pmc=2761809}}</ref>]]
+[[File:Entamoeba histolytica.jpg|thumb|''[[Entamoeba histolytica]]'', a parasite that is very common among children in Guatemala<ref>{{Cite journal|title = A Retrospective Analysis of Prevalence of Gastrointestinal Parasites among School Children in the Palajunoj Valley of Guatemala|last1 = Cook|first1 = David M.|date = 2015|journal = Journal of Health, Population, and Nutrition|doi = 10.3329/jhpn.v27i1.3321|pmid = 19248646|last2 = Swanson|first2 = Chad R.|issue = 1|volume = 27|last4 = Booth|first3 = Dennis L.|last3 = Eggett|first4 = Gary M. |pages=31–40 |pmc=2761809}}</ref>]]
 It has been seen that the prevalence of parasites is significantly higher among younger children and those who are [[Malnutrition|malnourished]].<ref name=":5" />{{rp|35}} Parasites are usually transferred through contaminated water, making them dangerous because they are able to induce malnutrition by consuming the body's nutrients, thus impeding a child's physical development.<ref name=":10">{{Cite journal|title = Drawing the connection between Malnutrition and lack of safe drinking water in Guatemala|last = Braghetta|first = Anne|date = 2006|journal = Journal (American Water Works Association)|issue = 5|volume = 98}}</ref>{{rp|97}} For school children who are infected with parasites, cognitive functioning can drastically decrease, directly impacting their education.<ref name=":8">{{Cite book|title = Disease Control Priorities in Developing Countries|last = Bundy|first = D|year = 2006|location = Washington DC|chapter = 58|work = School-based Health and Nutrition Programs|editor-last = Jamison|editor-first = DT|edition=2nd|pmid = 21250357}}</ref> School children who have been treated for parasites immediately perform significantly better in school settings. Parasite infections can also vary based on access to clean water and whether or not sewage disposal is present.<ref name=":5" />{{rp|38}} The Millennium Development Goals discussed the importance of deworming to help meet the goals set by the [[United Nations]].<ref name=":6">{{Cite web|url = http://apps.who.int/iris/bitstream/10665/68876/1/WHO_CDS_CPE_PVC_2005.12.pdf|title = The Millennium Development Goals - The evidence is in: deworming helps meet the Millennium Development Goals|date = 2005|website = World Health Organization|publisher = WHO}}</ref>  Parasites can have serious long-term consequences in that they directly affect development and health for decades after. However, inexpensive, single-dose medications exist that can fully treat these parasitic infections.<ref name=":6" />
 === Diabetes ===
-Diabetes is a significant problem within the Guatemalan population. As a rising public health concern, diabetes largely threatens the indigenous population of Guatemala.<ref name=":7">{{Cite journal|title = Determining adult type 2 diabetes-related health care in an indigenous population from rural Guatemala: a mixed-methods preliminary study|last = Chary|first = Anita|date = 2012|journal = BMC Health Services Research|doi = 10.1186/1472-6963-12-476|pmid = 23260013|pmc = 3546905|last2 = Greiner|first2 = Miranda|last3 = Bowers|first4 = Peter|first3 = Cody|last4 = Rohloff|issue = 1|volume = 12 |pages=476}}</ref><ref name=":23">{{Cite journal|last=Nieblas-Bedolla|first=Edwin|last2=Bream|first2=Kent D. W.|last3=Rollins|first3=Allison|last4=Barg|first4=Frances K.|date=2019|title=Ongoing challenges in access to diabetes care among the indigenous population: perspectives of individuals living in rural Guatemala|url= |journal=International Journal for Equity in Health|language=en|volume=18|issue=1|pages=180|doi=10.1186/s12939-019-1086-z|issn=1475-9276|pmc=6873569|pmid=31752908}}</ref>  Because this population frequently has limited access to the Guatemalan health care system, knowledge about the emergence of diabetes is also incredibly limited.<ref name=":7" /> Indigenous areas are particularly under-resourced with respect to doctors and overall health care programs.<ref name=":7" /><ref name=":23" />
+Diabetes is a significant problem within the Guatemalan population. As a rising public health concern, diabetes largely threatens the indigenous population of Guatemala.<ref name=":7">{{Cite journal|title = Determining adult type 2 diabetes-related health care in an indigenous population from rural Guatemala: a mixed-methods preliminary study|last1 = Chary|first1 = Anita|date = 2012|journal = BMC Health Services Research|doi = 10.1186/1472-6963-12-476|pmid = 23260013|pmc = 3546905|last2 = Greiner|first2 = Miranda|last3 = Bowers|first4 = Peter|first3 = Cody|last4 = Rohloff|issue = 1|volume = 12 |pages=476 | doi-access=free }}</ref><ref name=":23">{{Cite journal|last1=Nieblas-Bedolla|first1=Edwin|last2=Bream|first2=Kent D. W.|last3=Rollins|first3=Allison|last4=Barg|first4=Frances K.|date=2019|title=Ongoing challenges in access to diabetes care among the indigenous population: perspectives of individuals living in rural Guatemala|url= |journal=International Journal for Equity in Health|language=en|volume=18|issue=1|pages=180|doi=10.1186/s12939-019-1086-z|issn=1475-9276|pmc=6873569|pmid=31752908 |doi-access=free }}</ref>  Because this population frequently has limited access to the Guatemalan health care system, knowledge about the emergence of diabetes is also incredibly limited.<ref name=":7" /> Indigenous areas are particularly under-resourced with respect to doctors and overall health care programs.<ref name=":7" /><ref name=":23" />
 A risk factor for diabetes within the indigenous population is dietary change over time.<ref name="Little" />{{rp|25}} Changes in indigenous diets were a result of structural and economic changes, which forced the rural population to resort to energy-dense foods that are extremely high in saturated fats and simple carbohydrates.<ref name="Little" />{{rp|25}} These simple carbohydrates can be found throughout Guatemalan cuisine, especially corn, which is one of the staple foods of the Guatemalan diet. This in turn leads to the higher prevalence of [[Diabetes mellitus type 2|Type 2 diabetes]], because the entire population has added more fats and sugars into their diets.<ref name="Little" />{{rp|25}}
@@ Line 68: / Line 72: @@
 A large issue for the indigenous population and the greater Guatemalan population in general is access to medication.<ref name="Little" />{{rp|29}}<ref name=":23" /> Medication used to treat diabetes is very expensive and would require the Guatemalan government to devote significant resources to provide medication for every diabetic.<ref name="Little" />{{rp|29}} However, diabetes is a manageable disease, and can also be treated with frequent physical activity and a change in diet, focused on management and healthy choices.<ref name="Little" />{{rp|29}}
-=== Pesticide Poisoning ===
+=== Pesticide poisoning ===
-Due to farming conditions and yield pressures in Guatemala, many agricultural workers are at high risk of [[pesticide poisoning]].<ref name="pesticide">{{Cite journal|last=Barrett|first=Bruce|date=January 1995|title=COMMENTARY: PLANTS, PESTICIDES AND PRODUCTION IN GUATEMALA; NUTRITION, HEALTH AND NONTRADITIONAL AGRICULTURE|journal=Ecology of Food and Nutrition|volume=33|issue=4|pages=293–309|doi=10.1080/03670244.1995.9991437}}</ref> People often handle pesticides without protective clothing or gear, soaking it in through their skin and inhaling it into their lungs.<ref name="pesticide" /> A large [[black market]] and lack of oversight over legal pesticide use in Guatemala also contributes to its rampant and unsafe use.<ref name="pesticide" /> Pesticide poisoning most likely disproportionately affects indigenous farm workers.<ref name="pesticide" />
+Due to farming conditions and yield pressures in Guatemala, many agricultural workers are at high risk of [[pesticide poisoning]].<ref name="pesticide">{{Cite journal|last=Barrett|first=Bruce|title=Commentary: Plants, pesticides and production in Guatemala; nutrition, health and nontraditional agriculture |date=January 1995|journal=Ecology of Food and Nutrition|volume=33|issue=4|pages=293–309|doi=10.1080/03670244.1995.9991437}}</ref> People often handle pesticides without protective clothing or gear, soaking it in through their skin and inhaling it into their lungs.<ref name="pesticide" /> A large [[black market]] and lack of oversight over legal pesticide use in Guatemala also contributes to its rampant and unsafe use.<ref name="pesticide" /> Pesticide poisoning most likely disproportionately affects indigenous farm workers.<ref name="pesticide" />
-== Mayan Health ==
+== Mayan health ==
-One aspect of the Guatemalan health care system is its focus on Mayan health. Because the Mayan population is so prevalent in  Guatemala, it is necessary to consider their barriers to quality health care. Taking into account the language barriers, diet, and living conditions, the Mayan population suffers enormously when it comes to proper health care. The life expectancy for Mayans can be up to 10 or 15 years lower than other Guatemalans.<ref name="Minkowski">{{cite journal|last1=Minkowski|first1=William L.|title=Mayan Indian health in Guatemala|journal=Western Journal of Medicine|date=1988|volume=148|issue=4|page=474|pmid=3388859}}</ref> Since the Civil War, the Mayan population generally resides in poverty stricken areas, and therefore has limited access to the healthcare that is available to the Ladinos, or non-indigenous population.<ref name="Bhatt">{{cite journal|last1=Bhatt|first1=Sunil|title=Health Care Issues Facing the Maya People of the Guatemalan Highlands: The Current State of Care and Recommendations for Improvement|journal=Journal of Global Health Perspectives|date=2012}}</ref>
+One aspect of the Guatemalan health care system is its focus on Mayan health. Because the Mayan population is so prevalent in  Guatemala, it is necessary to consider their barriers to quality health care. Taking into account the language barriers, diet, and living conditions, the Mayan population suffers enormously when it comes to proper health care. The life expectancy for Mayans can be up to 10 or 15 years lower than other Guatemalans.<ref name="Minkowski">{{cite journal|last1=Minkowski|first1=William L.|title=Mayan Indian health in Guatemala|journal=Western Journal of Medicine|date=1988|volume=148|issue=4|pages=474–476 |pmid=3388859|pmc=1026159 }}</ref> Since the Civil War, the Mayan population generally resides in poverty stricken areas, and therefore has limited access to the healthcare that is available to the Ladinos, or non-indigenous population.<ref name="Bhatt">{{cite journal|last1=Bhatt|first1=Sunil|title=Health Care Issues Facing the Maya People of the Guatemalan Highlands: The Current State of Care and Recommendations for Improvement|journal=Journal of Global Health Perspectives|date=2012}}</ref>
 [[File:Indian Corn Maize Zea mays 3008px.jpg|thumb|320x213px|Variations of maize that are a staple food in the Mayan diet]]
-=== Medical Pluralism ===
+=== Medical pluralism ===
-Indigenous Guatemalan communities deal with [[Medical Pluralism|medical pluralism]], or the intersection of beliefs and uses regarding traditional and biomedical healthcare.<ref name="pluralism">{{Cite book|title=Health care in Maya Guatemala: confronting medical pluralism in a developing country|last=Randolph.|first=Adams, Walter|date=2007|publisher=University of Oklahoma Press|others=Hawkins, John Palmer, 1946-|isbn=9780806138596|location=Norman|oclc=85622920}}</ref>{{page needed|date=April 2018}} Traditional Maya medical care involves plant medicine and ethnomedical practitioners who learn in one-on-one or self-taught settings.<ref>{{Cite book|title=Maya medicine: traditional healing in Yucatan|last=1958-|first=Kunow, Marianna Appel|date=2003|publisher=University of New Mexico Press|isbn=978-0826328649|edition=1st|location=Albuquerque|oclc=657141480|url-access=registration|url=https://archive.org/details/mayamedicinetrad0000kuno}}</ref>{{page needed|date=April 2018}} Western medical systems and the Guatemalan public health system have been criticized for not considering ethnomedical practices to be legitimate, and interest among indigenous Guatemalans in taking on ethnomedical apprenticeships has been declining, resulting in tension between practices.<ref name="pluralism"/>{{page needed|date=April 2018}}
+Indigenous Guatemalan communities deal with "[[Medical Pluralism|medical pluralism]]", or the intersection of beliefs and uses regarding traditional and biomedical healthcare.<ref name="pluralism">{{Cite book|title=Health care in Maya Guatemala: confronting medical pluralism in a developing country|last=Randolph.|first=Adams, Walter|date=2007|publisher=University of Oklahoma Press|others=Hawkins, John Palmer, 1946-|isbn=9780806138596|location=Norman|oclc=85622920}}</ref>{{page needed|date=April 2018}} Traditional Maya medical care involves plant medicine and ethnomedical practitioners who learn in one-on-one or self-taught settings.<ref>{{Cite book|title=Maya medicine: traditional healing in Yucatan|author=Kunow, Marianna Appel|date=2003|publisher=University of New Mexico Press|isbn=978-0826328649|edition=1st|location=Albuquerque|oclc=657141480|url-access=registration|url=https://archive.org/details/mayamedicinetrad0000kuno}}</ref>{{page needed|date=April 2018}} Western medical systems and the Guatemalan public health system have been criticized for not considering ethnomedical practices to be legitimate, and interest among indigenous Guatemalans in taking on ethnomedical apprenticeships has been declining, resulting in tension between practices.<ref name="pluralism"/>{{page needed|date=April 2018}}
-=== Language and Diet ===
+=== Language ===
-In Guatemala, about 45% of the Ladino population lives in poverty, while about 91% of the indigenous population succumbs to extreme poverty levels.<ref name=":17">{{Cite journal|title = Barrier to access to health services in the indigenous population in Rabinal, Guatemala|last = Hautecoeur|first = Maeve|date = 2007|journal = Salud Pública de México|doi = 10.1590/s0036-36342007000200003|pmid = 17522734|last2 = Zunzunegui|first2 = Maria Victoria|issue = 2|volume = 49|last3 = Vissandjee|first3 = Bilkis |pages=86–93|doi-access = free}}</ref> This large difference appears in other aspects of life as well, like family planning, susceptibility to disease, education level, and access to health care. Such inequalities can largely be attributed to a large language barrier between the indigenous population and the non-indigenous peoples.<ref name=":16" /> Generally, the indigenous people of Guatemala speak only a variety of local Mayan languages.<ref name=":16" /> In relation to health care, these language barriers can be significant. Most of the medical professionals that serve the indigenous communities are Ladino, and speak Spanish only.<ref name=":16" /> Communicating health related issues to a patient under these conditions becomes an obstacle, which in turn causes indigenous people to avoid health care centers altogether. The indigenous population is unable to communicate with the doctors directly, which is both difficult and embarrassing.<ref name=":17" /> Ishida et al. discovered that the combination of poverty and language barriers made indigenous women less likely to seek services from health care providers.<ref name=":16" />
+In Guatemala, about 45% of the Ladino population lives in poverty, while about 91% of the indigenous population succumbs to extreme poverty levels.<ref name=":17">{{Cite journal|title = Barrier to access to health services in the indigenous population in Rabinal, Guatemala|last1 = Hautecoeur|first1 = Maeve|date = 2007|journal = Salud Pública de México|doi = 10.1590/s0036-36342007000200003|pmid = 17522734|last2 = Zunzunegui|first2 = Maria Victoria|issue = 2|volume = 49|last3 = Vissandjee|first3 = Bilkis |pages=86–93|doi-access = free}}</ref> This large difference appears in other aspects of life as well, like family planning, susceptibility to disease, education level, and access to health care. Such inequalities can largely be attributed to a large language barrier between the indigenous population and the non-indigenous peoples.<ref name=":16" /> Generally, the indigenous people of Guatemala speak only a variety of local Mayan languages.<ref name=":16" /> In relation to health care, these language barriers can be significant. Most of the medical professionals that serve the indigenous communities are Ladino, and speak Spanish only.<ref name=":16" /> Communicating health related issues to a patient under these conditions becomes an obstacle, which in turn causes indigenous people to avoid health care centers altogether. The indigenous population is unable to communicate with the doctors directly, which is both difficult and embarrassing.<ref name=":17" /> Ishida et al. discovered that the combination of poverty and language barriers made indigenous women less likely to seek services from health care providers.<ref name=":16" />
+=== Diet ===
-The Mayan diet is different from the diet of non-indigenous Guatemalans. Throughout their history, the Maya have used [[maize]] as a principal crop.<ref>{{Cite journal|title = Intensive Agriculture, Social Status, and Maya Diet at Pacbitun, Belize|last = White|first = Christine D.|date = 1993|journal = Journal of Anthropological Research|last2 = Healy|first2 = Paul F.|issue = 4|volume = 49|last3 = Schawrez|first3 = Henry P.}}</ref>{{rp|353}} Staple foods of the Mayan diet today are corn and [[bean]]s.<ref name=":18">{{Cite journal|title = Mayan Indian health in Guatemala|last = Minkowski|first = William L.|date = 1988|journal = Western Journal of Medicine|issue = 2|volume = 38}}</ref>{{rp|476}} The better [[cash crop]]s like greens, tomatoes, fruits, eggs, and poultry are mainly sold to Ladinos and are not purchased by Mayans.<ref name=":18" />{{rp|476}} Therefore, Mayan nutrition is very poor because it includes little besides [[starch]]es and protein. Corn has a significant amount of [[carbohydrate]]s, which in turn increases blood sugar levels. This increase in blood sugar makes diabetes a very common disease within the Mayan population.<ref name=":7" /> Also, with this lack of crucial nutrients, malnutrition is very prominent in the indigenous population.<ref name=":18" />{{rp|476}} The widespread consumption of corn contaminated with [[Aflatoxin B1|aflatoxins]] leads to serious health problems.<ref>{{Cite web|date=2017-05-10|title=Preventing toxins threatening growth in Guatemalan children|url=https://www.sdgfund.org/preventing-toxins-threatening-growth-guatemalan-children|access-date=2021-01-23|website=Sustainable Development Goals Fund|language=en}}</ref>
+The Mayan diet is different from the diet of non-indigenous Guatemalans. Throughout their history, the Maya have used [[maize]] as a principal crop.<ref>{{Cite journal|title = Intensive Agriculture, Social Status, and Maya Diet at Pacbitun, Belize|last1 = White|first1 = Christine D.|date = 1993|journal = Journal of Anthropological Research|last2 = Healy|first2 = Paul F.|issue = 4|volume = 49|last3 = Schawrez|first3 = Henry P.| pages=347–375 | doi=10.1086/jar.49.4.3630154 | s2cid=163419661 }}</ref>{{rp|353}} Staple foods of the Mayan diet today are corn and [[bean]]s.<ref name=":18">{{Cite journal|title = Mayan Indian health in Guatemala|last = Minkowski|first = William L.|date = 1988|journal = Western Journal of Medicine|issue = 2|volume = 38}}</ref>{{rp|476}} The better [[cash crop]]s like greens, tomatoes, fruits, eggs, and poultry are mainly sold to Ladinos and are not purchased by Mayans.<ref name=":18" />{{rp|476}} Therefore, Mayan nutrition is very poor because it includes little besides [[starch]]es and protein. Corn has a significant amount of [[carbohydrate]]s, which in turn increases blood sugar levels. This increase in blood sugar makes diabetes a very common disease within the Mayan population.<ref name=":7" /> Also, with this lack of crucial nutrients, malnutrition is very prominent in the indigenous population.<ref name=":18" />{{rp|476}} The widespread consumption of corn contaminated with [[Aflatoxin B1|aflatoxins]] leads to serious health problems.<ref>{{Cite web|date=2017-05-10|title=Preventing toxins threatening growth in Guatemalan children|url=https://www.sdgfund.org/preventing-toxins-threatening-growth-guatemalan-children|access-date=2021-01-23|website=Sustainable Development Goals Fund|language=en}}</ref>
-=== Living Conditions ===
+=== Living conditions ===
-The Mayan people frequently live in rural villages of Guatemala, which are generally known to be impoverished areas. About 80% of indigenous Guatemalans live below the "international poverty line."<ref name=":20">{{Cite journal|title = Electrifying rural Guatemala: central policy and rural reality|last = Taylor|first = Matthew J.|date = 2005|journal = Environment and Planning C: Government and Policy|doi = 10.1068/c14r|volume = 23 |issue = 2|pages=173–189}}</ref>{{rp|173}} Very few Mayan families have the economic stability to devote money towards health care.<ref name="Bhatt" /> With the high prices of medications and the poor quality of health posts, impoverished patients refuse to use or trust the westernized health care system.<ref name="Bhatt" /> For centuries, the relationship between the Ladinos and the Mayans has been antagonistic. Throughout the period of the Guatemalan Civil War, Mayans were excluded from land and water resources as well as educational, health care, political, and economic resources.<ref name=":20" />{{rp|176}}<ref name=":19">{{Cite journal|title = Who's Judging the Quality of Care? Indigenous Maya and the Problem of "Not Being Attended"|last = Berry|first = Nicole S.|date = 2008|journal = Medical Anthropology: Cross-Cultural Studies in Health and Illness|doi = 10.1080/01459740802017413|pmid = 18464128|issue = 2|volume = 27 |pages=164–189}}</ref>{{rp|181}} Even in today's modern age, the effects of exclusion and deprivation from the war are still felt my many indigenous Mayans.<ref name=":19" />{{rp|181}} This directly affects health care because the Mayan population does trust Western medicine and hospitals. Similarly, the Ladino doctors that work in the health field make the indigenous people feel powerless and guarded instead of supported.<ref name=":19" />{{rp|181}}
+The Mayan people frequently live in rural villages of Guatemala, which are generally known to be impoverished areas. About 80% of indigenous Guatemalans live below the "international poverty line."<ref name=":20">{{Cite journal|title = Electrifying rural Guatemala: central policy and rural reality|last = Taylor|first = Matthew J.|date = 2005|journal = Environment and Planning C: Government and Policy|doi = 10.1068/c14r|volume = 23 |issue = 2|pages=173–189| s2cid=56233492 }}</ref>{{rp|173}} Very few Mayan families have the economic stability to devote money towards health care.<ref name="Bhatt" /> With the high prices of medications and the poor quality of health posts, impoverished patients refuse to use or trust the westernized health care system.<ref name="Bhatt" /> For centuries, the relationship between the Ladinos and the Mayans has been antagonistic. Throughout the period of the Guatemalan Civil War, Mayans were excluded from land and water resources as well as educational, health care, political, and economic resources.<ref name=":20" />{{rp|176}}<ref name=":19">{{Cite journal|title = Who's Judging the Quality of Care? Indigenous Maya and the Problem of "Not Being Attended"|last = Berry|first = Nicole S.|date = 2008|journal = Medical Anthropology: Cross-Cultural Studies in Health and Illness|doi = 10.1080/01459740802017413|pmid = 18464128|issue = 2|volume = 27 |pages=164–189| s2cid=36038275 }}</ref>{{rp|181}} Even in today's modern age, the effects of exclusion and deprivation from the war are still felt my many indigenous Mayans.<ref name=":19" />{{rp|181}} This directly affects health care because the Mayan population does trust Western medicine and hospitals. Similarly, the Ladino doctors that work in the health field make the indigenous people feel powerless and guarded instead of supported.<ref name=":19" />{{rp|181}}
 Many indigenous Guatemalans survive on below-subsistence agriculture.<ref name=":20" />{{rp|174}} Farms are not large enough to sustain large-scale [[Subsistence agriculture|subsistence farming]], making the overall yield exceptionally low.<ref name=":20" />{{rp|174}} Because of the limited amount of farmland, its unequal distribution, and the growing population, poverty continues to ravish the Mayan civilizations.<ref name=":20" />{{rp|174}} The concrete living distance also plays a role in health care accessibility for indigenous population.<ref name="Bhatt" /> More than likely, these rural villages where the Mayans reside are located close to an hour walk away from any health clinic or post.<ref name="Bhatt" /> The inaccessibility of the clinics leads to fewer visits and more health complications in the indigenous population.
-Government run hospitals are located in the main cities of several provinces.<ref>{{Cite journal|last=Ketelhöhn|first=Niels|last2=Arévalo|first2=Rodrigo|title=The Guatemalan public hospital system|journal=Journal of Business Research|volume=69|issue=9|pages=3900–3904|doi=10.1016/j.jbusres.2015.11.022|year=2016}}</ref> Indigenous peoples' [[Guatemalan Highlands|highland]] locality - often distant from main cities - makes travel to these hospitals expensive, further limiting access.<ref name=":2" /> Taking advantage of the importance of [[Midwifery in Maya society|midwifery]] in many indigenous traditional medicinal systems, the Ministry of Public Health decided to better reach indigenous populations through midwife training programs in the 1980s.<ref name=":2" /> However, the quality, efficacy, and cultural sensitivity of these programs has been brought into question.<ref>{{Cite journal|last=Greenberg|first=Linda|title=Midwife training programs in highland Guatemala|journal=Social Science & Medicine|volume=16|issue=18|pages=1599–1609|doi=10.1016/0277-9536(82)90290-8|year=1982}}</ref>
+Government run hospitals are located in the main cities of several provinces.<ref>{{Cite journal|last1=Ketelhöhn|first1=Niels|last2=Arévalo|first2=Rodrigo|title=The Guatemalan public hospital system|journal=Journal of Business Research|volume=69|issue=9|pages=3900–3904|doi=10.1016/j.jbusres.2015.11.022|year=2016}}</ref> Indigenous peoples' [[Guatemalan Highlands|highland]] locality - often distant from main cities - makes travel to these hospitals expensive, further limiting access.<ref name=":2" /> Taking advantage of the importance of [[Midwifery in Maya society|midwifery]] in many indigenous traditional medicinal systems, the Ministry of Public Health decided to better reach indigenous populations through midwife training programs in the 1980s.<ref name=":2" /> However, the quality, efficacy, and cultural sensitivity of these programs has been brought into question.<ref>{{Cite journal|last=Greenberg|first=Linda|title=Midwife training programs in highland Guatemala|journal=Social Science & Medicine|volume=16|issue=18|pages=1599–1609|doi=10.1016/0277-9536(82)90290-8|year=1982|pmid=7146937 }}</ref>
 == Children and women's health ==
@@ Line 96: / Line 101: @@
 === Infants ===
-In Guatemala, [[infant mortality]] continues to be a big problem. As of 2015, it is estimated that Guatemala's infant mortality rate is 22.73 for every 1,000 live births.<ref>{{Cite web|url = https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html|title = Country Comparison: Infant Mortality Rate|date = 2015|website = Central Intelligence Agency: The World Factbook}}</ref> As mentioned, rural areas of Guatemala exhibit the highest levels of morbidity and infant mortality because health care in those areas is largely inaccessible.<ref name=":9">{{Cite journal|title = Effect of Health and Nutrition Interventions on Infant and Child Morality in Rural Guatemala|last = Delgado|first = H.L.|date = 1986|journal = Determinants of Morality and Change and Differentials in Developing Countries|last2 = Valverde|first2 = V.|last3 = Hurtado|first3 = E.}}</ref>{{rp|145}} Generally, infant mortality rates are used as an indicator of general health levels in a particular country.
+In Guatemala, [[infant mortality]] continues to be a big problem. As of 2023, it is estimated that Guatemala's infant mortality rate is 25.57 for every 1,000 live births.<ref>{{Cite web|url = https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html|archive-url = https://web.archive.org/web/20070613003931/https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html|url-status = dead|archive-date = June 13, 2007|title = Country Comparison: Infant Mortality Rate|date = 2015|website = Central Intelligence Agency: The World Factbook}}</ref> As mentioned, rural areas of Guatemala exhibit the highest levels of morbidity and infant mortality because health care in those areas is largely inaccessible.<ref name=":9">{{Cite journal|title = Effect of Health and Nutrition Interventions on Infant and Child Morality in Rural Guatemala|last1 = Delgado|first1 = H.L.|date = 1986|journal = Determinants of Morality and Change and Differentials in Developing Countries|last2 = Valverde|first2 = V.|last3 = Hurtado|first3 = E.}}</ref>{{rp|145}} Generally, infant mortality rates are used as an indicator of general health levels in a particular country.
-Infants are more susceptible to infectious diseases and conditions like [[malaria]], which can cause severe morbidity, and even death.<ref name=":8" /> For infants, physical growth is critical to proper and successful development. Therefore, if there are insufficient nutrients being provided to the infant during this period of growth and [[Cell growth|cell proliferation]], the number of neurons will be permanently reduced.<ref>{{Cite journal|url = http://digitalcommons.calpoly.edu/cgi/viewcontent.cgi?article=1014&context=psycd_fac|title = The Relationship between Physical Growth and Infant Behavioral Development in Rural Guatemala|last = Lasky|first = Robert E.|date = 1981|journal = Child Development|doi = 10.2307/1129234|pmid = 7238146|last2 = Klein|first2 = Robert E.|issue = 1|volume = 52|last3 = Yarbrough|first3 = Charles|last4 = Engle|first4 = Patricia L.|last5 = Lechtig|first5 = Aaron|last6 = Martorell|first6 = Reynaldo |pages=219–26|jstor = 1129234}}</ref>{{rp|220}} In Guatemala, this issue is particularly prominent. Nutrition and proper health care is crucial in early infant development in order to insure that these infants will thrive and grow into strong children.<ref>{{Cite journal|title = Infant mortality rates before, during, and after a nutrition and health intervention in rural Guatemalan villages|last = Donald|first = Rose|date = 1992|journal = Food and Nutrition Bulletin|last2 = Martorell|first2 = Reynaldo|issue = 3|volume = 14|last3 = Rivera|first3 = Juan}}</ref> Therefore, the nutritional deficiencies, infectious diseases, and parasitic diseases directly lead to higher mortality rates for children under the age of 5 in Guatemala.<ref name=":9" />{{rp|147}} These higher mortality rates are prominent in both rural and urban areas of Guatemala when diseases are present. However, these rates are significantly higher in rural areas where limited access to health care, high levels of [[illiteracy]], poor sanitation, and nutritional deficiencies are factored into the rate.<ref name=":9" />{{rp|145}}
+Infants are more susceptible to infectious diseases and conditions like [[malaria]], which can cause severe morbidity, and even death.<ref name=":8" /> For infants, physical growth is critical to proper and successful development. Therefore, if there are insufficient nutrients being provided to the infant during this period of growth and [[Cell growth|cell proliferation]], the number of neurons will be permanently reduced.<ref>{{Cite journal|url = http://digitalcommons.calpoly.edu/cgi/viewcontent.cgi?article=1014&context=psycd_fac|title = The Relationship between Physical Growth and Infant Behavioral Development in Rural Guatemala|last1 = Lasky|first1 = Robert E.|date = 1981|journal = Child Development|doi = 10.2307/1129234|pmid = 7238146|last2 = Klein|first2 = Robert E.|issue = 1|volume = 52|last3 = Yarbrough|first3 = Charles|last4 = Engle|first4 = Patricia L.|last5 = Lechtig|first5 = Aaron|last6 = Martorell|first6 = Reynaldo |pages=219–26|jstor = 1129234}}</ref>{{rp|220}} In Guatemala, this issue is particularly prominent. Nutrition and proper health care is crucial in early infant development in order to insure that these infants will thrive and grow into strong children.<ref>{{Cite journal|title = Infant mortality rates before, during, and after a nutrition and health intervention in rural Guatemalan villages|last1 = Donald|first1 = Rose|date = 1992|journal = Food and Nutrition Bulletin|last2 = Martorell|first2 = Reynaldo|issue = 3|volume = 14|last3 = Rivera|first3 = Juan}}</ref> Therefore, the nutritional deficiencies, infectious diseases, and parasitic diseases directly lead to higher mortality rates for children under the age of 5 in Guatemala.<ref name=":9" />{{rp|147}} These higher mortality rates are prominent in both rural and urban areas of Guatemala when diseases are present. However, these rates are significantly higher in rural areas where limited access to health care, high levels of [[illiteracy]], poor sanitation, and nutritional deficiencies are factored into the rate.<ref name=":9" />{{rp|145}}
-=== Malnutrition in Children ===
+=== Malnutrition in children ===
-[[Malnutrition]] is a serious condition that threatens the health and [[well-being]] of many people in developing nations. In Guatemala, nutritional deficiencies have been shown to severely impact the growth and development of children both physically and mentally.<ref name="Freeman" />{{rp|1277}} [[Stunted growth|Stunting]] and [[underweight]] are both common physical indicators for acute and chronic malnutrition in children.<ref name=":8" /> According to Gragnolati and Marini, over 44 percent of the Guatemalan child population is chronically malnourished.<ref name=":11">{{Cite journal|title = Malnutrition and Poverty in Guatemala|last = Marini|first = Alessandra|date = 2003|journal = Policy Research Working Paper|last2 = Gragnolati|first2 = Michele|volume = 2967}}</ref>{{rp|2}} However, these numbers are even higher for indigenous populations of Guatemala (58 percent) in comparison to the non-indigenous population.<ref name=":11" />{{rp|2}} Although the incidence rate of stunting has decreased in Guatemala, the rate of decline is minuscule compared to other countries in the LAC region.<ref name=":10" />{{rp|97}}
+[[Malnutrition]] is a serious condition that threatens the health and [[well-being]] of many people in developing nations. In Guatemala, nutritional deficiencies have been shown to severely impact the growth and development of children both physically and mentally.<ref name="Freeman" />{{rp|1277}} [[Stunted growth|Stunting]] and [[underweight]] are both common physical indicators for acute and chronic malnutrition in children.<ref name=":8" /> According to Gragnolati and Marini, in 2003, over 44 percent of the Guatemalan child population is chronically malnourished.<ref name=":11">{{Cite journal|title = Malnutrition and Poverty in Guatemala|last1 = Marini|first1 = Alessandra|date = 2003|journal = Policy Research Working Paper|last2 = Gragnolati|first2 = Michele| series=Policy Research Working Papers |volume = 2967| doi=10.1596/1813-9450-2967 | s2cid=15111684 | url=http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2003/02/22/000094946_03020804020125/Rendered/PDF/multi0page.pdf }}</ref>{{rp|2}} However, these numbers are even higher for indigenous populations of Guatemala (58 percent) in comparison to the non-indigenous population.<ref name=":11" />{{rp|2}} Although the incidence rate of stunting has decreased in Guatemala, the rate of decline is minuscule compared to other countries in the LAC region.<ref name=":10" />{{rp|97}}
 The high incidence of malnutrition within indigenous populations is a direct result of poor water sanitation and limited access to clean water.<ref name=":10" />{{rp|97}} According to the MOH, about 98% of the water sources in Guatemala are contaminated.<ref name=":10" />{{rp|97}} Disease and malnutrition are highly correlated with one another; both are causes and consequences of each other.<ref name=":11" />{{rp|3}}  In order to improve the health system and reduce the prevalence of malnutrition, easy availability of safe drinking water, together with disease treatment and prevention, are critical for the survival of Guatemalan children.<ref name=":11" />{{rp|3}}<ref name=":10" />{{rp|98}} Improvement must be implemented at the community level, by renovating infrastructures in order to provide piped water and sanitary operations for the residents.<ref name=":11" />{{rp|3}}
-One consequence of malnutrition and undernourishment is the degradation of cognitive performance, which can be studied and observed through schoolchildren and their performance in an educational setting.<ref name=":8" /><ref name="Freeman" /> This can generally be observed in poorer settings. In poverty stricken areas of Guatemala, inadequate nutrient intake can lead to higher disease rates, which can in turn expedite the [[Cycle of poverty|poverty cycle]].<ref>{{Cite journal|title = Risk analysis of poor health and growth failure of children in the central highlands of Guatemala|last = Immink|first = Maarten D.C.|date = 1999|journal = Social Science and Medicine|doi = 10.1016/s0277-9536(98)00383-9|pmid = 10390040|last2 = Payongayong|first2 = Ellen|issue = 8|volume = 48 |pages=997–1009}}</ref>{{rp|998}} [[Breastfeeding]] is also critical for infants to obtain sufficient nutrients and antibodies.<ref name=":11" />{{rp|3}} Malnutrition severely weakens children who are already weaker to begin with, making them more vulnerable to life-threatening illnesses.<ref name=":3" />{{rp|18}} Similarly, civil conflict (from the Guatemalan Civil War period) has left the indigenous population with many barriers to combat malnutrition, which has only prevented positive outcomes of health within the population through social, political, and economic exclusion.<ref name=":3" />{{rp|25}}
+One consequence of malnutrition and undernourishment is the degradation of cognitive performance, which can be studied and observed through schoolchildren and their performance in an educational setting.<ref name=":8" /><ref name="Freeman" /> This can generally be observed in poorer settings. In poverty stricken areas of Guatemala, inadequate nutrient intake can lead to higher disease rates, which can in turn expedite the [[Cycle of poverty|poverty cycle]].<ref>{{Cite journal|title = Risk analysis of poor health and growth failure of children in the central highlands of Guatemala|last1 = Immink|first1 = Maarten D.C.|date = 1999|journal = Social Science and Medicine|doi = 10.1016/s0277-9536(98)00383-9|pmid = 10390040|last2 = Payongayong|first2 = Ellen|issue = 8|volume = 48 |pages=997–1009}}</ref>{{rp|998}} [[Breastfeeding]] is also critical for infants to obtain sufficient nutrients and antibodies.<ref name=":11" />{{rp|3}} Malnutrition severely weakens children who are already weaker to begin with, making them more vulnerable to life-threatening illnesses.<ref name=":3" />{{rp|18}} Similarly, civil conflict (from the Guatemalan Civil War period) has left the indigenous population with many barriers to combat malnutrition, which has only prevented positive outcomes of health within the population through social, political, and economic exclusion.<ref name=":3" />{{rp|25}}
 [[File:Lake Atitlán is one of the major sources of water in Guatemala.JPG|thumb|center|800x217px|An image of [[Lake Atitlán]], which is a major water source in Guatemala]]
-=== Reproductive Health ===
+=== Reproductive health ===
 Reproductive health focuses on the health of infants as well as mothers. Guatemala is only beginning their transition into a more health-centered nation. The overall Guatemalan population is very young, which not only affects infant mortality rates, but significantly impacts both reproductive age and fertility rates.<ref name=":3" />{{rp|2}} In Guatemala, the fertility rate is almost 5 children per mother, the highest in all of Latin America.<ref name=":3" />{{rp|2}}
@@ Line 116: / Line 121: @@
 [[Maternal health]] problems affect women throughout Guatemala, but are significantly more prevalent in poorer, more rural areas.<ref name="Mendez" /> Indigenous women frequently have unsafe living conditions, which makes them more susceptible to health related problems. This population has the highest fertility rates in Guatemala, as well as a significantly higher maternal mortality rate than the non-indigenous population.<ref name="Mendez" /> Very few births are attended by either doctors or nurses, making the indigenous population much more prone to complications related to pregnancy, delivery, or postpartum.<ref name="Mendez" />
-In Guatemala, knowledge and education about [[Birth control|contraceptives]] and family planning is incredibly low, especially within the indigenous population.<ref name=":12">{{Cite journal|title = Guatemalan Health Care System Fails Women|last = Darabi|first = Leila|date = 2006|journal = Guttmacher Institute}}</ref> More education about the implications of reproduction can reduce population growth while simultaneously improving both maternal and infant health.<ref name=":3" />{{rp|62}} Since the end of the Civil War, the indigenous population of Guatemala had turned to  traditional practices for maternal deliveries because this group distrusted modern health care facilities and services provided by non-indigenous personnel.<ref name=":16">{{Cite journal|title = Ethnic Inequality in Guatemalan Women's Use of Modern Reproductive Health Care|last = Ishida|first = Kanako|date = 2012|journal = International Perspectives on Sexual and Reproductive Health|doi = 10.1363/3809912|pmid = 22832150|last2 = Stupp|first2 = Paul|issue = 2|volume = 38|first5 = Evelyn|first3 = Reina|last3 = Turcios-Ruiz|last4 = William|first4 = Daniel B.|last5 = Espinoza|pages=99–108|doi-access = free}}</ref>  There is very little knowledge about health care services related to pregnancy and abortions.<ref name=":12" /><ref name=":13">{{Cite journal|title = Induced Abortion and Unintended Pregnancy in Guatemala|last = Singh|first = Susheela|date = 2006|journal = Guttmacher Institute|last2 = Prada|first2 = Elena|last3 = Kestler|first3 = Edgar|issue = 3|volume = 32}}</ref> [[Abortion]]s are illegal in Guatemala, and are only permitted if it will save the mother's life.<ref name=":13" /> The Guatemalan government is working to address maternal mortality by increasing public spending on health care to gain a greater understanding of "comprehensive reproductive health."<ref name="Mendez" />
+In Guatemala, knowledge and education about [[Birth control|contraceptives]] and family planning is incredibly low, especially within the indigenous population.<ref name=":12">{{Cite journal|title = Guatemalan Health Care System Fails Women|last = Darabi|first = Leila|date = 2006|journal = Guttmacher Institute}}</ref> More education about the implications of reproduction can reduce population growth while simultaneously improving both maternal and infant health.<ref name=":3" />{{rp|62}} Since the end of the Civil War, the indigenous population of Guatemala had turned to  traditional practices for maternal deliveries because this group distrusted modern health care facilities and services provided by non-indigenous personnel.<ref name=":16">{{Cite journal|title = Ethnic Inequality in Guatemalan Women's Use of Modern Reproductive Health Care|last1 = Ishida|first1 = Kanako|date = 2012|journal = International Perspectives on Sexual and Reproductive Health|doi = 10.1363/3809912|pmid = 22832150|last2 = Stupp|first2 = Paul|issue = 2|volume = 38|first5 = Evelyn|first3 = Reina|last3 = Turcios-Ruiz|last4 = William|first4 = Daniel B.|last5 = Espinoza|pages=99–108|doi-access = free}}</ref>  There is very little knowledge about health care services related to pregnancy and abortions.<ref name=":12" /><ref name=":13">{{Cite journal|title = Induced Abortion and Unintended Pregnancy in Guatemala|last1 = Singh|first1 = Susheela|date = 2006|journal = Guttmacher Institute|last2 = Prada|first2 = Elena|last3 = Kestler|first3 = Edgar|issue = 3|volume = 32| pages=136–145 | doi=10.1363/3213606 | pmid=17015243 |doi-access = free}}</ref> [[Abortion]]s are illegal in Guatemala, and are only permitted if it will save the mother's life.<ref name=":13" /> The Guatemalan government is working to address maternal mortality by increasing public spending on health care to gain a greater understanding of "comprehensive reproductive health."<ref name="Mendez" />
 === Family planning ===
-Typically, in Guatemala, the general population is poor and has little access to quality health care services. The indigenous population and the Ladinos generally use traditional and formal health practices respectively.<ref name=":14">{{Cite journal|title = Prenatal and delivery care and childhood immunization in Guatemala: Do family and community matter?|last = Pebley|first = Anne R.|date = 1996|journal = Demography|doi = 10.2307/2061874|pmid = 8827167|last2 = Goldman|first2 = Noreen|issue = 2|volume = 33|last3 = Rodriguez|first3 = German |pages=231–47|jstor = 2061874|doi-access = free}}</ref>{{rp|231}} In both of these practices, [[family planning]] is very different. Differences in economic and social influences determine contraceptive use, child immunizations, prenatal care, and childbirth or delivery.<ref name=":14" />{{rp|231}}
+Typically, in Guatemala, the general population is poor and has little access to quality health care services. The indigenous population and the Ladinos generally use traditional and formal health practices respectively.<ref name=":14">{{Cite journal |last1=Pebley |first1=Anne R. |last2=Goldman |first2=Noreen |author-link2=Noreen Goldman |last3=Rodriguez |first3=German |date=1996 |title=Prenatal and delivery care and childhood immunization in Guatemala: Do family and community matter? |journal=Demography |volume=33 |issue=2 |pages=231–47 |doi=10.2307/2061874 |jstor=2061874 |pmid=8827167 |doi-access=free}}</ref>{{rp|231}} In both of these practices, [[family planning]] is very different. Differences in economic and social influences determine contraceptive use, child immunizations, prenatal care, and childbirth or delivery.<ref name=":14" />{{rp|231}}
-For the two populations within Guatemala, there are many large disparities between family planning actions. Family planning services are as scarce as health care services in the rural areas of Guatemala.<ref name=":15" />{{rp|144}} Indigenous people in Guatemala are more likely to have little to no education and are often living in poverty.<ref name=":15">{{Cite journal|title = Family Planning Among Indigenous Populations in Latin America|last = Terbough|first = Anne|date = 1995|journal = International Family Planning Perspectives|last2 = Rosen|first2 = James E.|last3 = Galvez|last5 = Bertrand|first3 = Roberto Santiso|last4 = Terceros|first4 = Willy|first5 = Jane T.|last6 = Bull|first6 = Sheana E.}}</ref>{{rp|143}} High poverty and illiteracy rates directly correlate with lower rates of contraceptive use.<ref name=":15" />{{rp|144}} This lower rate is both a result of limited contraceptive knowledge and also the negative social stigma behind contraceptives.<ref name=":15" />{{rp|144}} Guatemala's high fertility rate is a result of poor family planning initiatives, which result in young pregnancies, large families with many children, shorter birth intervals, and deficient growth within children.<ref name=":11" />{{rp|3}} Similarly, breastfeeding plays a huge role in family planning, both as a nutrient and antibody source for infants, as well as a way to inhibit immediate fertility (because of the absence of menstruation) and allow for greater birth spacing.<ref name=":11" />{{rp|3}}
+For the two populations within Guatemala, there are many large disparities between family planning actions. Family planning services are as scarce as health care services in the rural areas of Guatemala.<ref name=":15" />{{rp|144}} Indigenous people in Guatemala are more likely to have little to no education and are often living in poverty.<ref name=":15">{{Cite journal|title = Family Planning Among Indigenous Populations in Latin America|last1 = Terbough|first1 = Anne|date = 1995|journal = International Family Planning Perspectives|last2 = Rosen|first2 = James E.|last3 = Galvez|last5 = Bertrand|first3 = Roberto Santiso|last4 = Terceros|first4 = Willy|first5 = Jane T.|last6 = Bull|first6 = Sheana E.}}</ref>{{rp|143}} High poverty and illiteracy rates directly correlate with lower rates of contraceptive use.<ref name=":15" />{{rp|144}} This lower rate is both a result of limited contraceptive knowledge and also the negative social stigma behind contraceptives.<ref name=":15" />{{rp|144}} Guatemala's high fertility rate is a result of poor family planning initiatives, which result in young pregnancies, large families with many children, shorter birth intervals, and deficient growth within children.<ref name=":11" />{{rp|3}} Similarly, breastfeeding plays a huge role in family planning, both as a nutrient and antibody source for infants, as well as a way to inhibit immediate fertility (because of the absence of menstruation) and allow for greater birth spacing.<ref name=":11" />{{rp|3}}
 Family decisions about health care depend on many factors. Specific family dynamics, individual beliefs and decisions of the mother, and direct community influences are all aspects to take into consideration when looking at family choices.<ref name=":14" />{{rp|233}} The Guatemalan government has worked to implement family education centers within its poorer populations. A family life education class provides information pertaining to [[sex education]], as well as reproductive health.<ref name=":8" />
@@ Line 129: / Line 134: @@
 {{main|Education in Guatemala}}
-[[Education]] is an aspect of health that is generally ignored by the Guatemalan health care system. Proper education on nutrition and contraceptives has proven to impact both education levels and survival. In children, proper nutrition has been shown to accelerate development, both mentally and physically.<ref name="Behrman1">{{cite journal|last1 = Behrman|first1 = John A.|title = The Impact of Nutrition during Early Childhood on Education among Guatemalan Adults|journal = PIER Working Paper|date = 2009|volume = 26|issue = 6}}</ref>{{rp|4}} Also, there is a large association between maternal education and a lower mortality rate of infants as well as healthier habits while pregnant.<ref name="Cleland">{{cite journal|last1 = Cleland|first1 = John G.|title = Maternal education and child survival in developing countries: The search for pathways for influence|journal = Social Science and Medicine|date = 1988|volume = 27|issue = 12|pages =1357–1368|doi=10.1016/0277-9536(88)90201-8}}</ref>{{rp|1359}} Education can also reinforce preventive measures. There is a relationship between poverty and education, but there are many possibilities within Guatemala that will allow education to prosper and serve a larger community. The lack of [[health education]] is one reason why many children and adults, through simple illnesses and pregnancies, end up dying prematurely. Health education provides mothers with resources to handle health issues and gives them access to knowledgeable sources outside their specific communities.<ref name="Cleland" />{{rp|1361}}
+[[Education]] is an aspect of health that is generally ignored by the Guatemalan health care system. Proper education on nutrition and contraceptives has proven to impact both education levels and survival. In children, proper nutrition has been shown to accelerate development, both mentally and physically.<ref name="Behrman1">{{cite journal|last1 = Behrman|first1 = John A.|title = The Impact of Nutrition during Early Childhood on Education among Guatemalan Adults|journal = PIER Working Paper|date = 2009|volume = 26|issue = 6}}</ref>{{rp|4}} Also, there is a large association between maternal education and a lower mortality rate of infants as well as healthier habits while pregnant.<ref name="Cleland">{{cite journal|last1 = Cleland|first1 = John G.|title = Maternal education and child survival in developing countries: The search for pathways for influence|journal = Social Science and Medicine|date = 1988|volume = 27|issue = 12|pages =1357–1368|doi=10.1016/0277-9536(88)90201-8| pmid=3070762 }}</ref>{{rp|1359}} Education can also reinforce preventive measures. There is a relationship between poverty and education, but there are many possibilities within Guatemala that will allow education to prosper and serve a larger community. The lack of [[health education]] is one reason why many children and adults, through simple illnesses and pregnancies, end up dying prematurely. Health education provides mothers with resources to handle health issues and gives them access to knowledgeable sources outside their specific communities.<ref name="Cleland" />{{rp|1361}}
+[[File:Presidente supervisa Hospital Regional de Chimaltenango 20220222.jpg|thumb|220x220px|Medical students from [[Galileo University]]]]
-[[File:Education of Children in Guatemala.JPG|thumb|360x480px|An image of public health education, focused on hygiene, being implemented in an elementary school in rural Guatemala]]
-=== Health Education ===
+=== Health education ===
-Many Guatemalans do not have enough knowledge about health care to make concrete health decisions and know the results of outcomes. Education is required in order to provide both indigenous and non-indigenous Guatemalans with the understanding to make personal health choices. The education of school children and quality nutrition status have both shown to affect adult education levels.<ref name="Behrman1" />{{rp|31}} With the implementation of nutrition interventions as children, these adults were more likely to be more educated than others in the population.<ref name="Behrman1" />{{rp|30}} Similarly, Desai and Soumya discovered that there was a great relationship between child health and maternal education; therefore, the greater the mother's education, the healthier the child.<ref>{{Cite journal|title = Maternal education and child health: Is there a strong causal relationship?|last = Desai|first = Sonalde|date = 1998|journal = Demography|doi = 10.2307/3004028|pmid = 9512911|first2 = Soumya|last2 = Alva|issue = 1|volume = 35 |pages=71–81|jstor = 3004028|doi-access = free}}</ref>{{rp|71}}
+Many Guatemalans do not have enough knowledge about health care to make concrete health decisions and know the results of outcomes. Education is required in order to provide both indigenous and non-indigenous Guatemalans with the understanding to make personal health choices. The education of school children and quality nutrition status have both shown to affect adult education levels.<ref name="Behrman1" />{{rp|31}} With the implementation of nutrition interventions as children, these adults were more likely to be more educated than others in the population.<ref name="Behrman1" />{{rp|30}} Similarly, Desai and Soumya discovered that there was a great relationship between child health and maternal education; therefore, the greater the mother's education, the healthier the child.<ref>{{Cite journal|title = Maternal education and child health: Is there a strong causal relationship?|last1 = Desai|first1 = Sonalde|date = 1998|journal = Demography|doi = 10.2307/3004028|pmid = 9512911|first2 = Soumya|last2 = Alva|issue = 1|volume = 35 |pages=71–81|jstor = 3004028|doi-access = free}}</ref>{{rp|71}}
 Within the Mayan population of Guatemala, education is not as accessible. However, it has also been observed that the indigenous population does not utilize health care services as readily.<ref name=":9" />{{rp|161}} Delgado et al. discovered that the indigenous mothers actually did have a significant affinity for health seeking behaviors.<ref name=":9" />{{rp|163}} Specifically, mothers determined which health services to frequent based on the illness of their child.<ref name=":9" />{{rp|163}} However, many mothers explained that they would "normally not attend a medical service when their children presented the symptoms," for a variety of reasons including accessibility and dissatisfaction.<ref name=":9" />{{rp|163}} Education and accessibility are required in order to expand health care into the more rural areas of Guatemala and implement health care planning techniques.<ref name=":9" />{{rp|167}}
-=== Preventive Measures ===
+=== Preventive measures ===
 Preventive measures, in the form of health care, work to improve the basic health services so that individuals can easily access them.<ref name=":3" />{{rp|1}} Guatemala has shifted its focus onto preventive care, in order to serve the poorer communities that are more disadvantaged in health care.<ref name=":3" />{{rp|4}} Especially in the field of Children and Women's Health, education on preventive measures can result in great health outcomes. In considering [[hygiene]] and [[Sexually transmitted infection|sexually transmitted diseases]], preventive education can alone hinder the onset of disease.<ref name=":3" />{{rp|23}} Mothers are more likely to use health services, both as a preventive and medicinal tool, when they are educated.<ref name="Cleland" />{{rp|1361}}
-In the field of education, knowledge about health outcomes is necessary, as well as poor health origins. The causes of illnesses are largely unknown or completely wrong.<ref name=":21">{{Cite journal|title = Diffusion of ideas about personal hygiene and contamination in poor countries: evidence from Guatemala|last = Goldman|first = Noreen|date = 2001|journal = Social Science and Medicine|doi = 10.1016/s0277-9536(00)00122-2|pmid = 11144917|last2 = Pebley|first2 = Anne R.|last3 = Beckett|first3 = Megan|volume = 52 |issue = 1|pages=53–69|citeseerx = 10.1.1.512.73}}</ref>{{rp|55}} In considering the effects of hygiene on health, education is very limited. The indigenous population of Guatemala knows little about the transmission of disease or easy, hygienic techniques that can reduce severe health problems.<ref name=":21" />{{rp|56}} Even with few years of education, women in the indigenous communities were more likely to understand and adopt different hygienic beliefs in order to prevent poor health outcomes.<ref name=":21" />{{rp|59}} However, because of past experiences in which Ladino communities tried to assimilate into indigenous societies, the indigenous people of Guatemala resist the idea of adopting "western" or "Ladino" health behaviors.<ref name=":21" />{{rp|59}} Therefore, the implementation of education into these communities would allow for increased preventive measures as well as overall health benefits.
+In the field of education, knowledge about health outcomes is necessary, as well as poor health origins. The causes of illnesses are largely unknown or completely wrong.<ref name=":21">{{Cite journal |last1=Goldman |first1=Noreen |author-link=Noreen Goldman |last2=Pebley |first2=Anne R. |last3=Beckett |first3=Megan |date=2001 |title=Diffusion of ideas about personal hygiene and contamination in poor countries: evidence from Guatemala |journal=Social Science and Medicine |volume=52 |issue=1 |pages=53–69 |citeseerx=10.1.1.512.73 |doi=10.1016/s0277-9536(00)00122-2 |pmid=11144917}}</ref>{{rp|55}} In considering the effects of hygiene on health, education is very limited. The indigenous population of Guatemala knows little about the transmission of disease or easy, hygienic techniques that can reduce severe health problems.<ref name=":21" />{{rp|56}} Even with few years of education, women in the indigenous communities were more likely to understand and adopt different hygienic beliefs in order to prevent poor health outcomes.<ref name=":21" />{{rp|59}} However, because of past experiences in which Ladino communities tried to assimilate into indigenous societies, the indigenous people of Guatemala resist the idea of adopting "western" or "Ladino" health behaviors.<ref name=":21" />{{rp|59}} Therefore, the implementation of education into these communities would allow for increased preventive measures as well as overall health benefits.
 Many of the deaths that occur frequently in Guatemala are a result of preventable and treatable diseases.<ref name=":22">{{Cite journal|title = Diarrheal illness and health utilization in Guatemala factors surrounding oral rehydration therapy use|last = Masterson|first = Erin E.|date = 2010|journal = OHSU Digital Commons: Scholar Archive}}</ref>{{rp|1}} Different preventive measures including sanitation, hygiene, [[vaccine]]s, and education work to improve the health outcomes for many people in developing countries.<ref name=":22" />{{rp|2}} There is a large discrepancy between those who are receiving preventive care and those who are not. In Guatemala, doctors only treat 24% of indigenous people, whereas they treat almost double that amount for non-indigenous Guatemalans.<ref name=":3" />{{rp|45}} This statistic shows that more money can be spent working to provide preventive care services to the indigenous population of Guatemala. Preventable diseases can be eliminated with the implementation of these services and with the influence of education.
@@ Line 151: / Line 155: @@
 == References ==
 {{Reflist}}
+{{Guatemala topics}}
 [[Category:Health in Guatemala| ]]