Geography, Health Status, and Health Investments: An Analysis of Peru

The study examines the influence of natural geography on human health in Peru, a country that has performed rather poorly, in the Latin American context, in terms of reducing its infant and maternal mortality rates. We measured natural geography through rainfall, temperature, altitude, longitude, and latitude. We also analyzed the effect that natural geography may have on the effectiveness of government health investments. We find evidence that geography has an important and independent influence on the infant mortality rate (IMR) and the child malnutrition rate (CMNR). As latitude and longitude increase (i. e. , as one moves towards the southwest) the IMR drops. Also, higher levels of rainfall (as in the Jungle region), and higher latitudes increase the CMNR. Lower temperatures, such as those observed in the Mountain region, seem to cause higher rates of child malnutrition. Geography also appears to affect the effectiveness of government health care investments. As latitude increases towards the south, thereby reducing the IMR, health centers and posts see their effectiveness reduced. Likewise, as longitude increases towards the west, thus helping to reduce the IMR, government health centers and posts become less effective in curtailing infant mortality. These results point to a decreasing marginal productivity of government health care spending. Several variables other than geography also affect health status. For example, we find that an increase in the illiteracy rate from 10 percent to 50 percent would bring about an increase in the IMR from 40 to 75 deaths per 1,000 live births. Female illiteracy has an important influence on the IMR as well, with higher levels of illiteracy being associated with a higher IMR. A policy of increasing general and female education through public spending thus appears to be an effective way of improving infant and child health. The government of Peru has invested heavily in ambulatory facilities in areas of high IMR. These new investments may have had a positive impact on child health. However, whatever this impact, so far it appears to be mild, and not enough to overcome the low health status that led to these new investments in the first place. While endogeneity problems have kept us from measuring the effectiveness of public investments in ambulatory care infrastructure, we find that the number of doctors working in public facilities has a positive influence on child health and nutritional status. We are able to show through simulations how new public resources devoted to new facilities and doctors could be allocated among the provinces to reduce regional inequality in health status. Finally, we find that natural geography exacerbates inequality in health status, as do existing regional differences in the availability of public services, such as potable water, sewerage, electricity, and in education. Public investments aimed at reducing or eliminating such differences would help to improve equity in health status.