nep-hea New Economics Papers
on Health Economics
Issue of 2016‒12‒04
twenty-one papers chosen by
Yong Yin
SUNY at Buffalo

  1. Empirical Evidence on Educational Effects of Physical Activity: Four Examples By Lechner, Michael
  2. Empirical Evidence on Educational Effects of Physical Activity: Four Examples By Liebert, Helge; Mäder, Beatrice
  3. Financing elderly care in Italy and Europe. Is there a common vision? By Elenka Brenna; Lara Gitto
  4. Market structure, patient choice and hospital quality for elective patients By Giuseppe Moscelli; Hugh Gravelle; Luigi Siciliani
  5. Is Health Care Infected by Baumol's Cost Disease? Test of a New Model By Akinwande A. Atanda; Andrea K. Menclova; W. Robert Reed
  6. Health and skill formation in early childhood By Pietro Biroli
  7. Heat Stress: The Impact of Ambient Temperature on Occupational Injuries in the US By Lucy Page; Stephen Sheppard
  8. Increasing Anti-Malaria Bednet Uptake Using Information and Distribution Strategies: Evidence from a Randomized Experiment in Senegal By Jacopo Bonan; Philippe LeMay-Boucher; Michel Tenikue
  9. You can be too thin (but not too tall): social desirability bias in self-reports of weight and height By Burke, Mary A.; Carman, Katherine Grace
  10. THE EFFECTS OF BREAST CANCER ON INDIVIDUAL LABOUR MARKET OUTCOMES: AN EVALUATION FROM AN ADMINISTRATIVE PANEL By Thomas Barnay; Mohamed Ali Ben Halima; Emmanuel Duguet; Christine Leclainche; Camille Regaert
  11. Gatekeeping in German Primary Health Care – Impacts on Coordination of Care, Quality Indicators and Ambulatory Costs By Sarah M. Hofmann; Andrea M. Mühlenweg
  12. Health and safety aspects of textile workers from Solapur (India) textile industries By Rahul B Hiremath; Ruth Kattumuri; Bimlesh Kumar; Gurudevi R Hiremath
  13. Educational strategies to enhance reflexivity among clinicians and health professional students: a scoping study By Rachel Landy; Cathy Cameron; Anson Au; Debra Cameron; Kelly O'Brien; Katherine Robrigado; Larry Baxter; Lynn Cockburn; Shawna O'Hearn; Brent Olivier; Stpehanie Nixon
  14. Mortality among European settlers in pre-colonial West Africa: The “White Man’s Grave” revisited By Öberg, Stefan; Rönnbäck, Klas
  15. eHealth: Grundlagen der Digitalen Gesundheitswirtschaft und Leitmarktperspektiven By Paul J.J. Welfens
  16. Do Good Reports Mean Higher Prices? The Impact of Hospital Compare Ratings on Cardiac Pricing By Avi Dor; William Encinosa; Kathleen Carey
  17. Infant Health Care and Long-Term Outcomes By Butikofer, Aline; Løken, Katrine; Salvanes, Kjell G
  18. Trade Liberalization and Mortality : Evidence from U.S. Counties By Justin R. Pierce; Peter K. Schott
  19. Geographical Distribution of Emergency Department Closures and Consequences on Heart Attack Patients By Yu-Chu Shen; Renee Y. Hsia
  20. Revisiting the Determinants of Child Anthropometric Indicators in India Using Seemingly Unrelated Regressions Model By G. Naline; Brinda Viswanathan
  21. Determinants of Child Health: An Empirical Analysis By Sowmya Dhanaraj

  1. By: Lechner, Michael
    Abstract: In this paper, we address the question of how physical activity of children and young adults affect their educational outcomes. To do so, we will take up four examples of our own work to illustrate different aspects of this research agenda. In contrast to the amazingly large literature on health effects, educational outcomes received much less attention. This is surprising given that building-up human capital is an undisputable and very expensive goal of (almost) all countries. Exploiting the ‘side-effects’ of sports and physical activity in this direction may be a cost-efficient way of improving the human capital of young people and thus increasing the future productivity of the economy. Three of the examples are based on German data, while one is based on Swiss data. Essentially, the three papers investigating the question of more versus less sports find that more sports is beneficial for cognitive skills (and some non-cognitive skills as well). Concerning the paper that compares sports activities to music related activities, the advantages of sports (compared to spending the time in structural music activity) on educational outcomes however cannot be established.
    Keywords: Sports economics, human capital, education
    JEL: Z20
    Date: 2016–11
  2. By: Liebert, Helge; Mäder, Beatrice
    Abstract: This paper investigates the effect of changes in the physician coverage ratio on infant mortality, perinatal mortality and the incidence of common childhood diseases. We utilize historical data and variation in the regional physician density provided by discriminatory policies in Germany in 1933, when Jewish physicians were expulsed from health insurance schemes and subsequently emigrated in large numbers. The results indicate substantial health effects. One additional physician per 1,000 of population reduces infant mortality by 23% and perinatal mortality by 16%. We find similar negative effects for gastrointestinal diseases, stillbirths and the incidence of measles, influenza and bronchitis. Using a semiparametric control function approach, we demonstrate that the marginal returns to coverage are nonlinear and decreasing. A coverage ratio of two physicians per 1,000 of population is sufficient to prevent mortality effects in the population.
    Keywords: Infant mortality, physician coverage, health care supply, childhood diseases
    JEL: I10 I18 N34
    Date: 2016–11
  3. By: Elenka Brenna (Università Cattolica del Sacro Cuore; Dipartimento di Economia e Finanza, Università Cattolica del Sacro Cuore); Lara Gitto
    Abstract: There is a general consensus in considering the public financing for LTC as a suitable proxy of the resources committed to elderly care by each Government. But the preciseness of this approximation depends on the extent to which LTC is representative of elderly care within a country. We investigate this issue by estimating the resources specifically spent on elderly assistance in Lombardy, an Italian region which in terms of population, dimension, health care organization and economic development could be compared to many European countries, such as Sweden, Austria or Belgium. The analysis focuses on the public financing on elderly care in Italy and, in particular, in Lombardy, both in terms of organizational level (central/regional/local) and governmental responsibility (Welfare/Social Department). Quantitative data on the financing of elderly care is drawn from the national and regional balances; the provision of services is analyzed using regional and community based data. Results address two main questions. First, they highlight the absence of an appropriate method for assessing the public resources committed by each European country to LTC elderly expenditure. Second, our findings suggest an overestimate of the funding actually spent for elderly care in Italy: this should be of warning for policy makers, especially in view of an increasing ageing of the population.
    Keywords: LTC financing; elderly care; European LTC policies.
    JEL: H53 H72 I38
    Date: 2016–08
  4. By: Giuseppe Moscelli (Centre for Health Economics, University of York, York, UK.); Hugh Gravelle (Centre for Health Economics, University of York, York, UK.); Luigi Siciliani (Department of Economics and Related Studies, University of York, York, UK.)
    Abstract: We examine the change in the effect of market structure on hospital quality for elective procedures (hip and knee replacements, and coronary artery bypass grafts) following the 2006 loosening of restrictions on patient choice of hospital in England. We allow for time-varying endogeneity due to the effect of unobserved patient characteristics on patient choice of hospital using Two Stage Residual Inclusion. We find that the change in the effect of market structure due to the 2006 choice reforms was to reduce quality by increasing the probability of a post-operative emergency readmission for hip and knee replacement patients. There was no effect of the choice reform on hospital quality for coronary bypass patients. We find no evidence of self-selection of patients into hospitals, suggesting that a rich set of patient-level covariates controls for differences in casemix.
    Keywords: competition, quality, hospital, choice, electives.
    JEL: H51 I11 I18 L32 L33
    Date: 2016–11
  5. By: Akinwande A. Atanda; Andrea K. Menclova (University of Canterbury); W. Robert Reed (University of Canterbury)
    Abstract: Rising health care costs are a policy concern across the OECD and relatively little consensus exists concerning their causes. One explanation that has received revived attention is Baumol’s Cost Disease (BCD). However, developing a theoretically-appropriate test of BCD has been a challenge. In this paper, we construct a two-sector model firmly based on Baumol’s axioms. We then theoretically derive two propositions that can be tested using observable variables. In particular, we predict that: 1) the relative price index of the health care sector, and 2) the share of total labor employed in the health care sector should both be positively related to economy-wide productivity. Using annual data from 27 OECD countries over the years 1995-2013 and from 14 U.S. industry groups over the years 1947-2015, we show that empirical evidence for the existence of BCD in health care is sensitive to model specification and disappears once we address spurious correlation due to contemporaneous trending and other econometric issues.
    Keywords: Baumol’s Cost Disease, health care industry, panel data
    JEL: I11 J30 E24
    Date: 2016–11–30
  6. By: Pietro Biroli
    Abstract: This paper analyzes the developmental origins and the evolution of health, cognitive, and socio-emotional skills during early childhood, from age 0 to 5. We explicitly model the dynamic interactions of health with the child’s behavior and cognitive skills, as well as the role of parental investment. A dynamic factor model corrects for the presence of measurement error in the proxy for the latent traits. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), we find that children’s capabilities strongly interact and build on each other: health is an important determinant of early socio-emotional development; in turn socio-emotional skills have a positive impact on the evolution of both health and cognitive functions; on the other side, the effect of cognitive abilities on health is negligible. Furthermore, all facets of human capital display a high degree of persistence. Finally, mother’s investments are an important determinant of the child’s health, cognitive, and socio-emotional development early in life.
    Keywords: Human capital, health, early childhood, family investment, intergenerational transmission, ALSPAC
    JEL: J24 J13 I10 I12 I14
    Date: 2016–11
  7. By: Lucy Page; Stephen Sheppard (Williams College)
    Abstract: Work-related injuries in the US generate annual costs exceeding 250 billion, with approximately one third of these costs coming from the direct health care expenses of dealing with the injuries and the remainder coming from the impacts on economic productivity associated with accidental injury. Beyond these costs, considerable expenses and efforts are devoted to avoiding injuries, and monitoring workplaces for compliance with safety rules. There are many factors that can increase the probability of workplace accidents, as well as a variety of regulations and regulatory agencies designed to reduce or limit these factors and to monitor compliance with regulations by employers. Of course there are some factors that even the most well-intentioned employers can not control, or that may not be easy to regulate at the local or even the national level. In this paper we investigate one of these factors: the ambient temperature within which work takes place. Clinical and empirical evidence such as that presented in Colquhoun (1969), Chiles (1958) or Azer, McNall and Leung (1972) indicates that high temperatures and heat stress diminish mental alertness, vigilance and ability to perform complex tasks. In a recent paper, Deschenes and Greenstone (2011) documented the potential impact of climate change on mortality in the US. Their research indicates that between 2010 and 2099, increased temperature could be expected to increase annual mortality rates in the US by about 3%, with about half of the heat-related deaths occurring in the South Atlantic and West South Central regions of the US. We investigate the impact of increased temperature on occupational injuries in heat-sensitive industries in the US, providing what appear to be the first available estimates of the impact of increased ambient temperatures on workplace injuries. Using some approximations from climate models we provide estimates of the potential economic cost of climate change caused by this previously undiscussed mechanism.
    Date: 2016–11
  8. By: Jacopo Bonan (Fondazione Eni Enrico Mattei (FEEM)); Philippe LeMay-Boucher (Heriot-Watt University); Michel Tenikue (Luxembourg Institute of Socio-Economic Research (LISER))
    Abstract: We evaluate the effects of different marketing and distribution techniques on the purchase of Long-Lasting Insecticide-Treated Nets (LL-ITN). Using a randomized controlled trial in urban Senegal, we look at the impacts of receiving information on malaria-related issues and of different sale treatments. We find that overall information has no significant effect on the demand for LL-ITNs, but has a significant effect on individuals who have never attended school and have poor knowledge of malaria. Receiving an offer to purchase an LL-ITN with a voucher valid for 7 days increases purchases by 23 percentage points, compared to an on-the-spot sale offer.
    Keywords: Malaria, Senegal, Randomized Experiment, Bednets, Distribution Campaign
    JEL: C93 I12 I15
    Date: 2016–11
  9. By: Burke, Mary A. (Federal Reserve Bank of Boston); Carman, Katherine Grace (RAND Corporation)
    Abstract: Previous studies of survey data for the United States and other countries find that on average women tend to understate their body weight, while on average both men and women overstate their height. Social norms have been posited as a potential explanation for misreporting of weight and height, but researchers disagree on the validity of that explanation. This paper is the first to present a theoretical model of self-reporting behavior for weight and height that explicitly incorporates social desirability bias. The model generates testable implications that can be contrasted with predictions based on alternative explanations for self-reporting errors. Using data from the National Health and Nutrition Examination Survey (NHANES) from 1990–2010, we find that self-reporting patterns for both weight and body mass index (BMI) offer robust evidence of social desirability bias, such that reports are biased (from both sides) towards social norms. The BMI norm inferred for women lies squarely within the range considered “healthy” by public health officials, while the BMI norm inferred for men lies just above this healthy range. Lack of awareness of one’s current body weight may explain the presence of large (negative) self-reporting errors among those with very high values of examined weight, but the evidence of social desirability bias is robust to this alternative explanation over most of the weight distribution. Social desirability bias in self-reporting of height is observed primarily among those of below-average height and no clear height norms are discernible. The framework also helps to explain previous findings that the degree of self-reporting bias in weight depends on the survey mode.
    JEL: D03 I12 I18
    Date: 2016–08–15
  10. By: Thomas Barnay (TEPP - Travail, Emploi et Politiques Publiques - UPEM - Université Paris-Est Marne-la-Vallée - CNRS - Centre National de la Recherche Scientifique); Mohamed Ali Ben Halima (CEE - Centre d'études de l'emploi - M.E.N.E.S.R. - Ministère de l'Éducation nationale, de l’Enseignement supérieur et de la Recherche - Ministère du Travail, de l'Emploi et de la Santé); Emmanuel Duguet (TEPP - Travail, Emploi et Politiques Publiques - UPEM - Université Paris-Est Marne-la-Vallée - CNRS - Centre National de la Recherche Scientifique); Christine Leclainche (CEE - Centre d'études de l'emploi - M.E.N.E.S.R. - Ministère de l'Éducation nationale, de l’Enseignement supérieur et de la Recherche - Ministère du Travail, de l'Emploi et de la Santé); Camille Regaert (IRDES - Institut de Recherche et Documentation en Economie de la Santé - Institut de la Recherche et Documentation en Economie de la Santé)
    Abstract: Using an administrative data set (Hygie), we apply a difference-in differences with dynamic matching estimation method to the onset of breast cancer. The employment probability decreases by 10 percentage points (pp) one year after the onset of cancer compared to the not-treated group. The detrimental effect of breast cancer on employment increases significantly over time, by up to 12 pp after five years. Another aim of our study is to identify some socio-demographic and work-related protective factors against the adverse effects of breast cancer on labour market outcomes. We stress four potential protective factors related to the negative effect of breast cancer. First, a young age at occurrence reduces this deleterious effect. Second, a high first job wage also appears to be a protective factor. Third, having faced less unemployment in the past is associated with a weaker negative effect of breast cancer on employment in the short run. Finally, we find a moderate “generational effect” after stratification by year of cancer onset.
    Keywords: breast cancer, labour market participation, difference in differences, matching
    Date: 2016–09–01
  11. By: Sarah M. Hofmann (WifOR Darmstadt); Andrea M. Mühlenweg (WifOR Darmstadt)
    Abstract: Evaluation studies on gatekeeping in primary care exist for a variety of countries but provide mixed evidence on utilization and quality of care as well as costs. Our study evaluates the German gatekeeping program, based on claims data of a major statutory health insurance company. The panel structure of the data allows controlling for patients’ characteristics in the year before opting (or not opting) for a GP contract. In contrast to previous studies we are able to draw on multiple identification strategies. We exploit variation in the regional provision of gatekeeping in an instrumental variable (IV) framework. We also analyze GP fixed effects based on the observation of patients opting for one of two different contracts within the same GP office. We find that the gatekeeping contract yields a somewhat higher coordination of care, improved quality (regarding prevention and avoidance of hospitalization) but also higher ambulatory costs. The effects are largely robust between our identification strategies.
    Keywords: primary health care, gatekeeping, health care quality
    JEL: I10 I11 I13
    Date: 2016–09
  12. By: Rahul B Hiremath; Ruth Kattumuri; Bimlesh Kumar; Gurudevi R Hiremath
    Abstract: Introduction: Textile sector in India plays an important role in the country's economy, providing employment to a significant population in rural and urban areas. Objectives: This paper focuses on health and safety aspects of textile workers in Solapur City (one of the key textile cluster) in the state of Maharashtra, India. Methodology: A sample of 180 workers from the identified textile industries of Solapur city were assessed for their generalphysique, muscle tone, lung condition, and eyesight using different techniques. The study aimed at developing a framework for understanding risks to textile workers resulting from lack of health and safety standards in companies. Results: Findings showed that most of the workers have been affected by respiratory problems, increase in muscle tone, eye problems and musculoskeletal problem. It has been also observed that job security or regular work impacts positively to the worker’s long term body health. However, there is an immediate need to adopt and implement measures in accordance with Indian Factories Act (OHSAS 18001/ILO-OSH 2001) which includes directions and procedures in respect of industrial installations, work environment and occupational health and safety guidelines.
    JEL: R14 J01
    Date: 2014–12–15
  13. By: Rachel Landy; Cathy Cameron; Anson Au; Debra Cameron; Kelly O'Brien; Katherine Robrigado; Larry Baxter; Lynn Cockburn; Shawna O'Hearn; Brent Olivier; Stpehanie Nixon
    Abstract: Reflexivity involves the ability to understand how one's social locations and experiences of advantage or disadvantage have shaped the way one understands the world. The capacity for reflexivity is crucial because it informs clinical decisions, which can lead to improvements in service delivery and patient outcomes. In this article, we present a scoping study that explored educational strategies designed to enhance reflexivity among clinicians and/or health profession students. We reviewed articles and grey literature that address the question: What is known about strategies for enhancing reflexivity among clinicians and students in health professional training programs? We searched multiple databases using keywords including: reflexivity, reflective, allied health professionals, pedagogy, learning, and education. The search strategy was iterative and involved three reviews. Each abstract was independently reviewed by two team members. Sixty-eight texts met the inclusion criteria. There was great diversity among the educational strategies and among health professions. Commonalities across strategies were identified related to reflective writing, experiential learning, classroom-based activities, continuing education, and online learning. We also summarize the 19 texts that evaluated educational strategies to enhance reflexivity. Further research and education is urgently needed for more equitable and socially-just health care.
    Keywords: reflexivity; health professional education; practicing health professionals; scoping study
    JEL: R14 J01
    Date: 2016–09
  14. By: Öberg, Stefan (Department of Economic History, School of Business, Economics and Law, Göteborg University); Rönnbäck, Klas (Department of Economic History, School of Business, Economics and Law, Göteborg University)
    Abstract: We have created the first longitudinal dataset following European employees of the English Royal African Company during their time in West Africa, 1683–1766. The mortality was catastrophically high with limited geographical differences. Tropical diseases and epidemics thereof, contributed to the high mortality and strong variations over time. The risk was highest for the men who had just arrived from Europe but remained high also after they had spent several years on the coast. The death rate of the Europeans was increased by both the share of newcomers and by the total number of men present on the coast.
    Keywords: Economic History; Mortality; West Africa; Pre-colonial; “White Man’s Grave”
    JEL: J10 N37
    Date: 2016–11–22
  15. By: Paul J.J. Welfens (Europäisches Institut für Internationale Wirtschaftsbeziehungen (EIIW))
    Abstract: The expansion of the digital health economy represents a strategic challenge for both the wider economy and society of the Federal Republic of Germany. In this context, economic policy actors need to set adequate framework conditions, such that competition in the health system, i.e. the interaction of statutory and private health insurance providers, will lead to optimal innovation dynamics and efficiency gains. Statutory and private health insurance funds each follow their own strategies. Amongst other strategies, private insurance providers make use of the possibility that firms are also involved in the area of occupational health management. There are, however, considerable obstacles to a digital modernization of the health sector, while Germany was also relatively late in introducing a digital health card. Among the significant benefits, for patients, insurers and care providers, are innovations in the area of digital check-ups and preventative care, telemedicine, digitalized after-care and an optimization of billing processes. Germany – in an EU context – ranks mid-table with regard to eHealth applications in the hospital industry, however, on the basis of a good positioning in terms of ICT and the large domestic market, Germany has the potential to become both a leading actor and a leading market in the medium term. From an economic perspective, eHealth progress can help to curb the rise of insurance contributions – digital advances have cost dampening effects, patient benefits and positive effects in the competitive process. Non-uniform health economy standards in EU countries largely prevent national software solutions and other eHealth concepts from easily being scaled-up, i.e. exported. Here, action by the EU is clearly required; including in the promotion and support of cooperation projects.
    Keywords: Health, Insurance, Innovation, Research
    JEL: I1 I18 O3
    Date: 2016–10
  16. By: Avi Dor; William Encinosa; Kathleen Carey
    Abstract: Previous research found that the initiation of Hospital Compare (HC) quality reporting had little impact on patient outcomes. However little is known about its impact on hospital prices, which may be significant since insurers are positioned to respond to quality information when engaging hospitals in price negotiations. To explore this issue we estimate variants of difference-in-difference models allowing HC impacts to vary by levels of quality scores. We separately examine the effects of the three main scores (heart attack, heart failure, and combined mortalities) on transaction prices of two related cardiac procedures: bypass surgery and angioplasty. States which had mandated reporting systems preceding HC form the control group. Analyzing claims data of privately insured patients, we find that HC exerted downward pressure on prices, which we attribute to competitive pressures. However, hospitals ranked “above average” captured higher prices, thereby offsetting the overall policy effect. We conclude that HC was effective at constraining prices without penalizing high performers.
    JEL: I11 L11
    Date: 2016–11
  17. By: Butikofer, Aline; Løken, Katrine; Salvanes, Kjell G
    Abstract: A growing literature documents the positive long-term effects of policy-induced improvements in early-life health and nutrition. However, there is still scarce evidence on early-life health programs targeting a large share of the population and the role of such programs in increasing intergenerational mobility. This paper uses the rollout of mother and child health care centers in Norway, which commenced in the 1930s, to study the long-term consequences of increasing access to well-child visits. These well-child visits included a physical examination and the provision of information about adequate infant nutrition. Our first results show that access to mother and child health care centers in the first year of life increased the completed years of schooling by 0.15 years and earnings by two percent. Our second set of results reveals that these effects were stronger for children from a low socioeconomic background and contribute to a 10 percent reduction in the persistence of educational attainment across generations. Our third set of findings suggest that better nutrition within the first year of life is the main mechanism. In particular, we find positive effects on adult height and that individuals suffer from fewer health risks at age 40. In addition, we show that access to well-child visits decreased infant mortality from diarrhea whereas infant mortality from pneumonia, tuberculosis, or congenital malformations are not affected. Finally, we investigate the costs of the program and show that investments in mother and child health care centers pass a simple cost--benefit analysis.
    Keywords: Earnings; education; health; Infant health care; Welfare state
    JEL: J13 J48
    Date: 2016–11
  18. By: Justin R. Pierce; Peter K. Schott
    Abstract: We investigate the impact of a large economic shock on mortality. We find that counties more exposed to a plausibly exogenous trade liberalization exhibit higher rates of suicide and related causes of death, concentrated among whites, especially white males. These trends are consistent with our finding that more-exposed counties experience relative declines in manufacturing employment, a sector in which whites and males are over-represented. We also examine other causes of death that might be related to labor market disruption and find both positive and negative relationships. More-exposed counties, for example, exhibit lower rates of fatal heart attacks.
    Keywords: International Trade ; Mortality ; Trade Policy ; Unemployment
    Date: 2016–11
  19. By: Yu-Chu Shen; Renee Y. Hsia
    Abstract: We develop a conceptual framework and empirically investigate how a permanent emergency department (ED) closure affects patients with acute myocardial infarction (AMI). We first document that large increases in driving time to closest ED are more likely to happen in low-income communities and communities that had fewer medical resources at baseline. Then using a difference-in-differences design, we estimate the effect of an ED closure on access to cardiac care technology, treatment, and health outcomes among Medicare patients with AMI who lived in 24,567 ZIP codes that experienced no change, an increase of
    JEL: I11 I14
    Date: 2016–11
  20. By: G. Naline (Madras School of Economics); Brinda Viswanathan (Madras School of Economics)
    Abstract: This study uses the NFHS-3 data to estimate SUR model for HAZ, WAZ and WHZ to understand how the determinants of intergenerational transmission, feeding and care practices and ICDS vary in their impact when these commonly used measures of child nutritional status are considered together in a systems framework. Asexpected mother’s height, BMI and anemia levels are all highly important in explaining the variations with large impact of height on HAZ, of BMI on WAZ and more widespread impact of anemia on WHZ. Initiation of breastfeeding within an hour of child’s birth, exclusive breastfeeding in the first six months, and inclusion of protein rich diets for the older children has a large impact on HAZ and so does access of daily food supplements from ICDS by rural children. Other predictors such as wealth status, safe water access, sanitation and use of clean cooking fuel by the households, are found to be strongly associated with all the indicators. The results from this study strengthen the evidence that though multiple determinants play a role in child’s growth the key factors are in the mother to child transmission and in quality of early child care of feeding habits and preventive and curative health care practices.
    Keywords: Child under-nutrition, stunting, underweight, wasting, Seemingly Unrelated Regression, India Classification-JEL: C51, I12, I13, I14, J13, O15.
  21. By: Sowmya Dhanaraj (Madras School of Economics)
    Abstract: Infant and child mortality rates in India have fallen by almost half from the time of adoption of millennium development goals to 2012 but there has not been a concurrent decrease in morbidity and under-nutrition rates. This may be due to a greater focus on treatment interventions vis-à-vis preventive interventions that reduce child deaths; the latter helps in overall child wellbeing by reducing under-nourishment and number of days lost due to illness. This study seeks to identify the mechanisms through which household and community-level socioeconomic factors affect child health and thereby identify preventive interventions that are of greatest consequence. We use the longitudinal data of Young Lives project that tracks the lives of two birth cohorts: 2000 children born in 2001-02 and 1000 children in 1994-95 and has information on multiple indicators of child health: morbidity episodes, health status as perceived by the caregiver, and nutritional status. Using multi-level analysis and structural equation modeling, we simultaneously analyse the effect of socioeconomic factors on multiple proximate factors like drinking water, sanitation and breastfeeding and, the effect of these factors on child health and nutrition. We find that household wealth, mother’s education and community level factors determine the socioeconomic status (SES) of the household. Low SES is in turn associated with high exposure (through crowding, open defecation, mud flooring), and low resistance (through inappropriate complementary feeding practices and partial immunization care) to diseases. However, we find that children belonging to households of low SES are more likely to be breastfed for longer duration. Among the proximate factors, open defecation, and inappropriate feeding practices and birth characteristics like low gestational age and birth weight significantly increase infant morbidity rates. These factors combined with drinking unsafe water, receiving partial or no immunization care and poor living conditions lead to high under-nutrition rates in infants.
    Keywords: child health, nutrition, SEM, multilevel analysis, determinants Classification-JEL: I10, I14, I18
    Date: 2015–12

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