Browsing by Subject "Child health"

This dissertation presents three essays on topics in development economics. Drawing on rich longitudinal data as well as measures of cognitive skills adapted from cognitive neuroscience, the chapters focus on health and human capital through the life course. The first essay isolates the causal impact of public health insurance on child health, measured by height-for-age, by exploiting the roll-out of Seguro Popular, a large-scale program that provides public health insurance to about half of Mexico’s population. Drawing on insights from the biology of human linear growth and using population-representative longitudinal data, we establish that Seguro Popular has had a modest impact on child nutritional status. These effects were larger after the program had been established for several years, suggesting that supply-side factors may have been critical impediments. The second essay turns to the relationship between executive function and labor market outcomes. This project describes how a widely used measure of executive function with foundations in cognitive neuroscience was implemented as part of a large-scale, population-representative survey in Indonesia. I find that higher cognitive functioning is associated with rewards in the labor market, particularly for women, and that executive function is related to labor force participation and the choice between wage work and self-employment. Motivated by the importance of executive function and human capital in later life, the third essay turns to the relationship between parental executive functioning and child outcomes. I find that parental executive function is strongly related to child executive function, and that better parental executive function is associated with better child nutritional outcomes, as measured by height-for-age and weight-for-height. The relationship between parents’ executive functioning and child outcomes depends both on the gender of the child and whether the child is first born or has older siblings. These results suggest that the relationships I observe between parental executive functioning and child development are not simply genetic but reflect parental choices and behaviors. Together, these chapters demonstrate the importance of bringing the tools from cognitive neuroscience to economics to further examine the role that specific cognitive skills like executive function play for success and well-being. They also highlight the critical importance of the early childhood household and environment for development, with long-lasting consequences for later life.

Background: Over the past decade in the Millennium Development Goal Era, China has made great progress at the national level in decreasing the under-five mortality rate, but the progress has varied across China’s regions with different socioeconomic development levels. These regional disparities in the under-five mortality rate (U5MR) raises concerns for improving child survival in the Sustainable Development Goal Era, especially when in depth studies on this particular indicator is absent. This study aimed to examine disparities in child survival and identify factors explaining the regional disparities in the U5MR in China, key lessons, and future priority areas for improving child survival.

Methods: This is a mixed methods study using quantitative data from secondary sources, mainly the National Chinese Statistical Yearbooks with some additional quantitative data from the Institute of Health Metrics and grey and peer-reviewed literature. The qualitative data collection involved key informant interviews of maternal and child health (MCH) administrators and practitioners in urban and rural MCH institutions in Yunnan province in China’s western region and Hubei province in the central region. In Yunnan and Hubei we conducted interviews at institutions both at the city level in the capital cities, Kunming and Wuhan respectively, and at the county/district level in Shaungbai and Caidian respectively.

Results: Socioeconomic, health-system related, and cultural factors were found to explain the regional disparities of U5MR in China. First was the regional income inequality, with Yunnan’s rural population earning about 50% less than Hubei’s rural population and its U5MR was more than one-third higher than Hubei’s U5MR. The greatest gap of the U5MR existed between the urban and rural areas within regions and also across rural areas in different regions, where the human resources for MCH were unevenly distributed. From 2004 to 2017 Yunnan had 32% increase in human resources for MCH whereas Hubei saw an almost 50% increase. The third factor was caregiver-related in which key informants reported parental awareness and taking preventative measures when taking care of children as reason for regional disparities. Secondary data revealed a disparity amongst children left behind in rural areas compared to their urban counterparts in terms of parental presence which can affect the parental awareness. Key lessons in improving child survival in the MDG era came from health financing with the three main social public health insurance schemes and health service delivery with strict management for mothers with increasing rate of systematic maternal management nationally and regionally. Future priority areas for improving child survival were addressing the health workforce shortage in pediatric and neonatal departments and health promotion and education for all caregivers, including mothers, parents and other family members.

Conclusion: Regional disparities in the U5MR revealed rural populations in the western region of China at a great disadvantage in regards to determinants of child survival. Key factors explaining these disparities are clear barriers to improving child survival and highlight the inequities persisting in child health and survival in China. From a human rights perspective, reducing child health disparities and improving child survival in rural areas across and within regions in China will reflect China’s pursuit for health equity in the Sustainable Development Goal era.

More than 26,000 children under the age of 5 die every day on average, mostly in the developing world. Malnutrition accounts for up to half of those deaths, and diarrheal diseases account for another 17 per cent. The concentration of child malnutrition and diarrhea in developing countries should be of particular interest to sociologists because of the potential role of macro, structural and institutional forces in accounting for such cross-national disparities. This study focuses on country-level development, gender inequality, and democracy as three dimensions of structural violence that have important effects on child health in developing countries. In addition, the analysis also incorporates household and maternal characteristics that have already been shown to affect child health at the individual level. Using data from the Demographic and Health Surveys and several other archival sources, I conduct a multi-level analysis of young children nested in a sample of approximately 50 developing countries. Specifically, I estimate a series of hierarchical generalized linear logit models (HGLM) that predict the likelihood that a child is stunted, wasted, underweight, or has had a recent episode of diarrhea, based on a set of country- and individual-level explanatory variables.

The introduction in Chapter 1 describes the concept of "structural violence," the orienting theoretical framework for the dissertation. Chapter 2 combines several theoretical perspectives to examine the effects of household-level socioeconomic resources as well as country-level economic development, water, sanitation, health care, and education. Household wealth and maternal education are the most important predictors of child health at the individual level; whereas, GDP per capita, secondary school enrollment, and a "capability development" scale have the most robust effects at the country level. Chapter 3 focuses on women's decision-making and resource control by examining 5 aspects of gender inequality: education, employment, political participation, reproductive autonomy, and life expectancy. Taken together, the results demonstrate that child health is likely to be better in countries where women have more education, control over their reproduction, representation in national politics, as well as longer life expectancy. Finally, Chapter 4 explores the link between democracy and child health, paying particular attention to various ways of measuring democracy. Surprisingly, bivariate correlations between democracy and child health are weak, and multivariate models do not yield consistent or robust effects. Overall, this dissertation demonstrates how child health is embedded in social, political, and economic contexts of inequality larger than the individual that partially determine who faces increased health risk factors and who is protected from them.