Health and economic productivity in rural Paraguay

在整个南美洲，与邻近的农村农民社区相比，土著社区经济不那么繁荣，更容易感染许多传染病。然而，对于这些不同种族的农村社区中成年人健康状况的差异在多大程度上解释了经济繁荣的差异，人们知之甚少。拟议中的项目有三个目标：促进了解健康与经济生产力之间的关系，衡量旨在增加与健康有关的人力和社会资本存量的社区干预措施对健康和经济生产力的影响，并将社区项目的成本效益组成部分纳入巴拉圭东部的国家和私人医疗保健系统。更具体地说，本研究力求：1)检验以成人健康状况为预测变量、经济生产力和经济决策的各个方面为中间变量、家庭成员福祉为结果变量的因果路径模型的五个假设；2)检验和控制特定种族成分对路径模型因果变量的影响；3)确定健康状况的差异在多大程度上导致了位于巴拉圭东部姆巴拉卡尤保护区缓冲区的阿瓦、阿奇和农村农民社区之间的经济繁荣差异；4)设计和实施方案，并通过与社区成员的伙伴关系衡量干预措施的成本效益；5)让卫生部参与认证由项目人员培训的卫生保健工作者。在评估干预措施和现有项目时依赖于健康和经济结果措施。为了实现这些目标，巴拉圭和美国科学家、卫生保健和经济发展专业人员组成的国际合作小组将监督Mbaracayu八个社区的微观调查，包括生态比较（1-2年）、纵向干预和成本效益研究（3- 5年）。

Throughout South America, indigenous communities are less economically prosperous and more vulnerable to many infectious diseases than are neighboring rural peasant communities. However, little is known about the extent to which variation in economic prosperity is accounted for by variation in the health status of adults across these rural communities of diverse ethnicity. The three-fold objective of the proposed project is to contribute to knowledge about associations between health and economic productivity, to measure the effects on health and economic productivity of community-based interventions that are designed to increase health-related stocks of human and social capital, and to integrate cost-effective components of community-based programs into the national and private health care systems of eastern Paraguay. More specifically, the present research seeks to: 1) test five hypotheses derived from a causal path model with adult health status as the predictor variable, economic productivity and various aspects of economic decision making as intermediate variables, and the well-being of household members as the outcome variable, 2) examine and control for the effects of specific components of ethnicity on causal variables in the path model, 3) determine to what extent variation in health status accounts for differences in economic prosperity between Ava, Ache and rural peasant communities located in the buffer zone of the Mbaracayu Reserve of eastern Paraguay, 4) design and implement programs, and measure cost effectiveness of interventions through partnerships with community members, and 5) involve the Ministry of Health in certification of health care workers trained by project staff, and in evaluations of interventions and existing programs that rely on health and economic outcome measures. To meet these objectives, an international collaborative team of Paraguayan and American scientists, health care and economic development professionals will oversee microlevel investigations in eight communities of Mbaracayu that include ecologic comparison (Yrs 1-2), longitudinal intervention and cost effectiveness studies (Yrs 3- 5).