Structural Violence and Child Health: A Multi-Level Analysis of Development, Gender Inequality, and Democracy in Developing Countries
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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.
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