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*Autor para correspondencia: Mario Ricardo Calderón Pinzón. Correo electrónico: mrcalderon@aol.com
Recibido el 11 de abril de 2023. Aceptado 29 de mayo de 2023.
Rev. CMV. 2023;1(1-3):e015 e-ISSN: 2958-9533 1
Special Contribution
Corruption and health 6: a presidential vision for Guatemala based on the
social determinants of health
Corrupción y salud 6: una visión presidencial para Guatemala sustentada
en los determinantes sociales de la salud
Corruption et santé 6: une vision présidentielle pour le Guatemala basée
sur les déterminants sociaux de la santé
Author: Mario Ricardo Calderón Pinzón1
1 Doctor of Medicine and Surgery (USAC). Master of Public Health in Health Policy and Management (UCLA). Specialist in
Preventive Medicine and Epidemiological Research (USC). Futuristic Focus Leadership Specialist (CSUN). National Leadership
Specialist in Public Health (UNC). World Health Services, SA, Guatemala. Email: mrcalderon@aol.com . ORCID code:
https://orcid.org/0000-0002-7759-3647
ABSTRACT
Introduction: Over 20 presidential tickets are running in the upcoming elections in Guatemala on
June 25, 2023. Everyone is making the same promises and promoting the same solutions that every
four years the population hears and never materializes. Problem statement: the abuse of power,
inefficiencies in the executive, legislative and judicial branches, law frauds, and institutionalized
corruption, represent the prevailing and omnipresent culture of illegality and impunity in Guatemala.
If the population doesn’t realize, becomes aware, or questions and investigates to cast a vote in a
reasonable manner, but votes according to personal, party lines, employment, and economic
https://editorial.udv.edu.gt/index.php/RCMV
*Autor para correspondencia: Mario Ricardo Calderón Pinzón. Correo electrónico: mrcalderon@aol.com
Recibido el 11 de abril de 2023. Aceptado 29 de mayo de 2023.
Rev. CMV. 2023;1(1-3):e015 e-ISSN: 2958-9533 2
reasons, or by emotions or irrationality, the population will continue to contribute to the destruction
and underdevelopment of the country. Possible solution: A three-pronged strategy is
conceptualized based on a ‘Future-Focused, Shared, and Servant Leadership Approach’, to implement
a ‘Government Restructuring and Revitalization Program’, and execute a single national plan for the
public, private and non-profit sectors and international organizations founded on the concept of
‘Comprehensive Security’, comprising four types of security –-medical, education, citizen, and
economic. Discussion and conclusion: The change from a government that fails to one that
functions is possible. A ‘Comprehensive Security Approach’ is needed; one that effectively
implements a set of systems of prevention and protection against dangers and risks that negatively
impact the health, wellbeing, and prosperity of the nation, to build a better, healthier, safer, and
more inclusive, equitable, and sustainable world for the Guatemalan population.
Key Words: inefficiencies, fraud, and corruption; comprehensive security; medical, education,
citizenship, and economic security; governmental reform.
RESUMEN
Introducción: Más de 20 binomios presidenciales se han postulado para las próximas elecciones en
Guatemala el 25 de junio de 2023. Todos hacen las mismas promesas y promueven las mismas
soluciones que cada cuatro años la población escucha pero que nunca se materializan.
Planteamiento del problema: El abuso de poder, las ineficiencias en el organismo ejecutivo,
legislativo y judicial, los fraudes de ley y la corrupción institucionalizada, representan la cultura de
ilegalidad e impunidad prevalente y omnipresente en Guatemala. Si la población no se percata, toma
conciencia, o cuestiona e investiga para votar en forma razonada; sino que vota por intereses
personales, partidarios, laborales y económicos, o de manera emocional e irracional, la población
seguirá contribuyendo a la ruina y subdesarrollo del país. Posible solución: Se conceptualiza una
estrategia tripartita basada en una ‘Filosofía de Liderazgo Futurista, Compartido y de Servicio’, para
implementar un ‘Programa de Reestructuración y Revitalización Gubernamental’, y ejecutar un plan
de nación singular para los sectores público, privado, sin fines de lucro y organizaciones
internacionales fundamentado en el concepto de ‘Seguridad Integral’, consistente en cuatro tipos de
seguridad --médica, educativa, ciudadana y económica. Discusión y conclusión: El cambio de un
gobierno que falla a uno que funciona es posible. La Seguridad Integral es imprescindible; una que
implemente de manera efectiva un conjunto de sistemas de prevención y protección contra riesgos
y peligros que afectan de forma negativa la salud, el bienestar y la prosperidad de la nación, para
construir un mundo mejor y más saludable, seguro, inclusivo, equitativo y sostenible para la
población guatemalteca.
Palabras Clave: ineficiencias, fraude y corrupción; seguridad integral; seguridad médica, educativa,
ciudadana y económica; reforma gubernamental.
https://editorial.udv.edu.gt/index.php/RCMV
*Autor para correspondencia: Mario Ricardo Calderón Pinzón. Correo electrónico: mrcalderon@aol.com
Recibido el 11 de abril de 2023. Aceptado 29 de mayo de 2023.
Rev. CMV. 2023;1(1-3):e015 e-ISSN: 2958-9533 3
RÉSUMÉ
Introduction: Plus de 20 couples présidentiels se sont présentés aux prochaines élections au
Guatemala le 25 juin 2023. Ils font tous les mêmes promesses et promeuvent les mêmes solutions
dont la population entend parler tous les quatre ans mais qui ne se concrétisent jamais. Exposé du
problème: L'abus de pouvoir, l'inefficacité des organes exécutifs, législatifs et judiciaires, la fraude
judiciaire et la corruption institutionnalisée représentent la culture prédominante et omniprésente de
l'illégalité et de l'impunité au Guatemala. Si la population n'est pas au courant, prendre conscience,
ou questionner et enquêter pour voter de manière raisonnée; mais plutôt voter pour des intérêts
personnels, partisans, ouvriers et économiques, ou de manière émotionnelle et irrationnelle, la
population continuera à contribuer à la ruine et au sous-développement du pays. Solution possible:
une stratégie tripartite basée sur une «philosophie de leadership futuriste, partagé et de service» est
conceptualisée, pour mettre en œuvre un «programme de restructuration et de revitalisation du
gouvernement» et exécuter un plan national unique pour les secteurs public, privé et non public. A
but lucratif et des organisations internationales basées sur le concept de «Sécurité Globale»,
consistant en quatre types de sécurité: médicale, éducative, citoyenne et économique. Discussion
et conclusion: Le passage d'un gouvernement qui échoue à un gouvernement qui fonctionne est
possible. Une sécurité complète est essentielle; celui qui met en œuvre efficacement un ensemble
de systèmes de prévention et de protection contre les risques et les dangers qui affectent
négativement la santé, le bien-être et la prospérité de la nation, pour construire un monde meilleur
et plus sain, plus sûr, inclusif, équitable et durable pour la population guatémaltèque.
Mots clés: les inefficacités, la fraude et la corruption; sécurité complète; la sécurité médicale,
éducative, citoyenne et économique; réforme du gouvernement.
EXHIBITION OF THE COMMENT
I. INTRODUCTION: THE REALITY: all people have the government they deserve
Guatemala is once again faced with a critical and historical dilemma that can lead to success or
failure, change or the status quo, innovation or tradition, significant changes or continuity, and
efficiency and effectiveness or inefficiency. in government administration and corruption in public
management. More than 20 pairs have run for the Presidency and Vice Presidency of the Republic.
Almost all of them make the same promises and promote the same solutions that the population
hears about every four years but that never materialize.
Albert Einstein, the most influential physicist of the 20th century, who was awarded the Nobel Prize
in 1921, aptly coined the phrase “Insanity is doing the same thing over and over again and expecting
different results”. 1 If the population votes for the same political parties, the same characters who
move or change parties, the same people who have governed on different occasions and
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*Autor para correspondencia: Mario Ricardo Calderón Pinzón. Correo electrónico: mrcalderon@aol.com
Recibido el 11 de abril de 2023. Aceptado 29 de mayo de 2023.
Rev. CMV. 2023;1(1-3):e015 e-ISSN: 2958-9533 4
governments or in their spouses or relatives, or for people with a known corrupt history, they can´t
then expect different results.
If the population is not aware, becomes aware, or questions and investigates to vote in a reasoned
manner, but instead votes for personal, partisan, labor, and economic interests, or in an emotional
and irrational manner, the population will continue to contribute to the ruin and underdevelopment
of the country. Since the Guatemalan population is eminently Catholic and Evangelical Christian, it
must understand the exhortation of King Solomon, considered in Judaic and Islamic literature as the
wisest of the wise that have ever existed, “every people has the government it deserves. When the
king is ignorant, the people end up in ruin; when the king is wise, the people prosper ”. 2
It is therefore necessary to understand that it is not convenient and it is counterproductive to vote
for presidential candidates without experience or demonstrable skills or with corrupt and questionable
trajectories, even with good government plans and resumes. Guatemala needs highly competent
politicians with leadership skills; but what is most required today are honest and upright people. The
honesty; that is, sincerity, veracity, and acting in accordance with principles, and integrity; that is
to say, respect and consideration towards others, self-awareness with a spirit of service, and an
attitude that always does the right thing, for which reason one does not lie, cheat, steal or cheat,
are the ideal characteristics for which have to vote.
II. STATEMENT OF THE PROBLEM : THE CHALLENGE: abuse, inefficiencies, fraud and
institutionalized corruption
The Government of Guatemala faces a myriad of constraints, challenges, and difficulties in operating
efficiently and effectively. Each change of government promises to improve the system, but
succumbs to a culture of continuity, weak administrations, and institutionalized corruption.
Corruption, large, small or political, covert or overt, permeates all strata of society, and has become
the operating system of many people, organizations, political parties and governments. 3
Abuse of power, inefficiencies in the state's executive, legislative, and judicial bodies, legal fraud,
and institutionalized corruption reflect the prevalent and omnipresent culture of illegality and
impunity in Guatemala. What has happened? Why did corrupt practices take root in Guatemalan
society?
The answer lies in the loss of ethical, moral, human, universal and Christian values. Guatemala needs
its best men and women, but, unfortunately, in all strata of society there are many people and
officials who act without scruples, without conscience, and without taking into account the criteria
that are socially considered good or correct, to which they are only interested in obtaining and
keeping perks, commissions and personal benefits. This leads to dehumanization, indolence,
arrogance, greed, selfishness, and impudence, and this replaces discernment between good and bad,
right and wrong, fair and unfair, and what works and what doesn'. Therefore, the lack of honesty,
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*Autor para correspondencia: Mario Ricardo Calderón Pinzón. Correo electrónico: mrcalderon@aol.com
Recibido el 11 de abril de 2023. Aceptado 29 de mayo de 2023.
Rev. CMV. 2023;1(1-3):e015 e-ISSN: 2958-9533 5
responsibility, transparency and integrity prevails in most politicians, but also in officials in the private
and non-profit sector, and in international technical cooperation and development agencies. 3
The loss of values has a negative and devastating economic, political and social impact. At the
economic level, it impedes the country's growth and development, reduces competitiveness, and
undermines the social and political fabric of society. At the political level, they undermine democratic
institutions, reduce the efficiency and effectiveness of government, and exacerbate inequalities. At
the social level, trust is lost, reduces access to basic services, reinforces inequalities, hinders
development, and normalizes unethical behavior.
The fight against a culture of illegality and impunity is dangerous but necessary, and the personal
dimension cannot be underestimated. When abuse and corrupt practices are spoken out, confronted,
denounced and combated, whistleblowers experience a variety of personal and professional
retaliation such as transfer to another position or location, recurring audits to find faults and justify
actions of personal harassment, workplace harassment among peers, subordinates or superiors,
inequity and salary inequality, closure of opportunities for promotion, stability and growth, early
termination of contract or unjustified dismissal, damage to career and professional reputation,
humiliation and even physical aggression and attempted or carried out kidnappings and murders.
Whistleblowers are necessary because they ensure fairness, transparency, and accountability, 4
though corrective action and justice are slow to come, true friendships and loyalties come to light,
and hypocrisy and betrayal become apparent.
No government or institution is perfect, they all have shortcomings, but what the population needs
most are citizens and officials willing to combat abuse, inefficiency, fraud, and corruption as an
attitude and life project, since everything needed for corruption to succeed are good people who do
nothing about it.
III. POSSIBLE SOLUTION: MOVING TOWARDS THE IDEAL: the social determinants of
health
The “circumstances in which people are born, grow, live, work and age, including the broader set of
forces and systems that influence the conditions of daily life, determine the state of health and well-
being of people”. 5,6 This concept, known as Social Determinants of Health, includes aspects related
to access and quality of education, the physical and built environment, economic and employment
stability, security and the community and social context, and the access and quality of care in health
and food safety. 7 Improving individual, family, and community well-being has a positive impact on
the population in general and the nation, improving their productivity, social cohesion, health,
education, public safety, and governance.
Extrapolating the concept of the individual to the population, the health, well-being, and sustainable
growth and development of Guatemala depend on environmental, biological, behavioral, social,
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Rev. CMV. 2023;1(1-3):e015 e-ISSN: 2958-9533 6
economic, labor, cultural, and political determinants that require an organized and specialized
response from society with simultaneous and interdependent policies and interventions at the
individual, environmental, structural and suprastructural levels. 8,9 These determinants are classified
as predisposing factors, precipitating factors, protective factors, and perpetuating factors; which is
why this presidential vision is based on the social determinants of health, 10 since the purpose is to
develop a national plan that exercises corrective action on the referred social determinants so that
they are conducive to good health, well-being, development and prosperity in every aspect of the
nation.
What should be done then? What would be the presidential vision for Guatemala based on the social
determinants of health? In order to deal with the predisposing, precipitating, protective and
perpetuating factors that determine the efficiency and effectiveness or inefficiency in government
administration and corruption in public management, a tripartite strategy is proposed below that
consolidates the determinants in three thematic areas, namely, the leadership style required (1), to
carry out a governmental transformation (2), under a singular strategic conceptualization for all
sectors of society (3).
BUILDING SUPPORT: AN AGENDA FOR REAL CHANGE: from a government that fails to one
that works
Everyone knows the importance of a government plan with intersectoral support ( cooperation
between public and private entities ) and a multisectoral agenda ( cooperation of many/all sectors
including the non-profit and international sector ). However, despite multiple efforts by national
institutions and international agencies, the education, health, work, social protection, housing, basic
public services, nutrition, and diet of the Guatemalan population have not improved substantially.
On the contrary, inequities, inequalities, unemployment, crime and poverty have increased.
The social needs of the population require a different government due to deficiencies in the current
model, citizen dissatisfaction and insufficiencies demonstrated by low levels of access and coverage
in health and education, and high rates of morbidity, mortality and crime. However, the change from
a government that fails to one that works is possible.
As a picture is worth a thousand words, complex and multiple interventions are consolidated in three
table-images to convey the essence and meaning of the proposed strategy in a more effective and
easy way, compared to a long written description or narrative. Here is the tripartite strategy for an
effectively functioning government:
(1) Implementation plan subject to a Philosophy of Futuristic, Shared and Service Leadership in
highly qualified, committed, experienced, versatile and outstanding Guatemalan experts in
their national and international careers.
Table-Image 1: Futuristic, Shared and Service Leadership Philosophy 8
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Rev. CMV. 2023;1(1-3):e015 e-ISSN: 2958-9533 7
FUTURISTIC LEADERSHIP
SHARED LEADERSHIP
SERVANT LEADERSHIP
Decision making based on the
visualization of final goals and
future results, including
creative thinking, innovation
and change management that
adds value and comparative
and competitive advantage.
Change “from” one person who
leads, motivates, inspires, and
makes decisions, “to” a group
of collaborators, partners, and
team members who take
leadership and responsibility
for making government work
efficiently and effectively.
Achievement of results and
government impact focused on
health and well-being, needs
and priorities, and the growth
and integral development of
citizens and the entire
population so that they reach
their maximum potential and
performance.
(2) Government Restructuring and Revitalization Program (Table 2), understanding
Restructuring as the reorganization of functions, structures, programs, services and benefits,
and Revitalization as the creation of a culture of excellence, high performance, transparency
and accountability.
Table-Image 2: Government Restructuring and Revitalization Program 8
Goal 1
MODERNIZE THE TECHNICAL,
PROGRAMMATIC, MANAGEMENT
AND FINANCIAL CAPACITY
Goal 2
STRENGTHEN, EXPAND
AND INNOVATE
PROGRAMS, SERVICES
AND BENEFITS
Goal 3
ACHIEVE LOCAL,
REGIONAL, NATIONAL
AND INTERNATIONAL
IMPACT
1.1. Leadership development
2.1. Optimization and
development of resources
3.1. Evaluation and
accountability systems
1.2. Systems and technology
development
2.2. Creation of models and
expansion of access and
coverage of services
3.2. Community liaison
program and public/private
partnerships
1.3. Effective infrastructure
development
23. Creating Healthy
Community Environments
3.3. Exchange and
dissemination of information
(3) The conceptualization and implementation of a national project and single strategic agenda,
which we are going to call Integral Security for Guatemala, consisting of four types of security
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–- medical, educational, citizen, economic (SIMECE), which involves all sectors, infrastructure
and resources from society and the international community, under the same vision, mission,
goals, objectives, strategies, approach, performance indicators and responsibilities.
Table-Image 3: Comprehensive Security for Guatemala (SIMECE)
1
MEDICAL SAFETY
3
CITIZEN SECURITY
3
ECONOMIC SECURITY
Strategies and policies
that improve the state
of health and well-
being of everyone
through access and
universal health
coverage, and
effective health
stewardship and inter-
and multisectoral
coordination
Strategies and policies
that guarantee justice
and security for every
person, community
and nation, and the
integrity and
protection of citizens
and their assets and
human rights
Strategies and policies
that improve the ability
of individuals,
households and
communities to meet
their basic needs and
prosper in all spheres
and aspects
1. Disease prevention
and promotion of
optimal health and
longer and healthier
life expectancy with
quality of life
1. Prevention and
control of crimes, and
eradication of acts of
violence, extortion,
crime, money
laundering and drug
trafficking
1. Reduction of the cost
of bureaucracy and
redirection of savings
and efficiencies in a
strategic and priority
manner for sustainable
development
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Rev. CMV. 2023;1(1-3):e015 e-ISSN: 2958-9533 9
2. Expansion of
primary care and
strengthening of
secondary and tertiary
health care, including
mental health
promotion, digital
health, and
regionalized trauma
and emergency care
2. Criminal
prosecution,
assurance of
compliance with
sentences, and
selective social
reinsertion of deprived
of liberty
2. Fight against abuse,
inefficiencies, fraud and
corruption in the public,
private and non-profit
sectors, and
international technical
cooperation and
development agencies
3. Community
development including
healthy physical, built,
economic and service
environments and
water and food
security
3. Prevention of traffic
accidents and
fatalities, and
improvement of the
country's road
capacity and quality
3. Building a
government with a
culture of excellence,
high performance,
transparency and
accountability
DISCUSSION AND CONCLUSION
The rhetoric of the presidential binomials is similar to each other. Only one has heard of Integral
Security. All the others talk about education, health, security, roads, infrastructure, malnutrition,
anti-corruption, etc., individually, but none conceptualizes, systematizes, mainstreams, integrates
or innovates their government plan under a key, singular and universal, so their plans and thinking
remain traditional, fragmented, segmented, vertical and disjointed.
That is the reason for this post; that is, to show an integral and different way of thinking to act
outside the box, not to feel limited by traditions, status quo, or ways of doing things, to take risks
and make decisions that no one else makes to do more with less, to be more efficient and effective,
achieve the greatest impact and best return on investment, and create a new vision, path,
methodology, solution, and future for Guatemala, and sustainable development with equity, justice,
and social inclusion.
Each described goal and objective of the proposed tripartite nation plan should be strengthened and
complemented by strategies, tactics and indicators that would be the subject of another publication.
The purpose of this publication is solely to present an alternative presidential vision. The new
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government elected for the period 2024-2027 must decide whether to continue with the traditional
model that has resulted in governments that fail with a mentality of bureaucrats, looters and
receivers, or implement a model that works with a mentality of entrepreneurs, protectors and clients
based on the integration of functions, infrastructure and resources of the entire society under the
concept of Comprehensive Security proposed.
Comprehensive Security, based on medical, educational, citizen and economic security,
conceptualizes a set of prevention and protection systems against risks and dangers that negatively
affect the health, well-being, development and prosperity of the nation, with the purpose of building
a better and healthier, safer, inclusive, equitable and sustainable world for the Guatemalan
population.
CONFLICTS OF INTEREST
No conflicts of interest are declared.
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https://editorial.udv.edu.gt/index.php/RCMV
*Autor para correspondencia: Mario Ricardo Calderón Pinzón. Correo electrónico: mrcalderon@aol.com
Recibido el 11 de abril de 2023. Aceptado 29 de mayo de 2023.
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OTHER PUBLICATIONS OF THE AUTHOR RELATED TO THE SUBJECT
1. Calderon MR. Corrupción y Salud 4: Liderando el Sistema Integral de Atención en Salud en
Guatemala [Internet]. Cuban Magazine of Health Technology. 2021:12(1):1-15. Available at:
http://www.revtecnologia.sld.cu/index.php/tec/article/view/2128 .
2. Calderon MR. Corrupción y Salud 2: Los retos para mejorar el sistema de salud pública en
Guatemala [Internet]. Cuban Magazine of Health Technology. 2020:11(2):3-17. Available at:
https://revtecnologia.sld.cu/index.php/tec/article/view/1895 .
3. Calderon MR. Corrupción y Salud 3: Desarrollo de liderazgo para transformar sistemas de salud
[online]. Cuban Magazine of Health Technology. 2020:11(4):3-16. Available at:
https://revtecnologia.sld.cu/index.php/tec/article/view/1913 .
4. Calderon MR. Los Pilares de Costo-Efectividad: Una guía práctica para tomar decisiones costo-
efectivas sobre nuevas tecnologías de la salud [Internet]. Rev. CTS. 2019:10(3):97-102. Available
at: http://www.revtecnologia.sld.cu/index.php/tec/article/view/1594 .
5. Calderon MR. Reformando el sector salud de Guatemala [Internet]. Rev. CTS. 2019:10(4):20-32.
Available at: http://www.revtecnologia.sld.cu/index.php/tec/article/view/1609 .
6. Calderon MR. Revisin Tcnica de la Propuesta de Reforma del Sector Salud en Guatemala
[Internet]. Cuban Magazine of Health Technology. 2018;9(4):40-48. Available at:
http://www.revtecnologia.sld.cu/index.php/tec/article/view/1303 .
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