We examine the effectiveness of accountability systems that rely on patient reporting in Kenyan health clinics. Patients and health care providers from public and private health clinics participate in a lab-in-the field experiment focusing on the relationship of trust between patient and provider. Patients decide whether to trust providers, providers have discretion over their reciprocity, and patients can complain. We compare the effectiveness of: (1) a client reporting system where patients’ complaints are disclosed to the providers’ professional peers, possibly leading to non-monetary penalties, (2) a system where complaints lead to monetary penalties, and (3) a system that, like a standard complaint box, attaches no tangible consequences to complaints. Overall, our findings suggest that citizen reporting systems that leverage peer pressure and reputational concerns can improve service delivery.

Stunting, a manifestation of chronic malnutrition, is widespread in India. This, coupled with biased preferences of parents towards their eldest sons, has led to stunting and underweight among girls that grows sharply with increasing birth order. We study the impact of an environmental water pollutant on child growth outcomes in arsenic contaminated regions of India. Using a large, nationally representative household survey and exploiting variation in soil textures across districts as an instrument for arsenic, we find that arsenic exposure beyond the safe threshold level is negatively associated with height-for-age and weight-for-age. Negative effects are larger for girls who are born at higher birth orders relative to the eldest. This, we argue, suggests that the lack of adequate nutrition and health care during early childhood can make girls more vulnerable to external environmental hazards due to their lower immunity and underdeveloped bodies.

We quantify the importance of endogenous human capital and of selection effects for counterfactual analysis of social security (SS) reforms. The literature typically performs these analyses by using structural models featuring exogenous productivity profiles. However, this approach faces two issues: (i) the estimation of productivity is subject to selection bias, and (ii) productivity is endogenous to the SS reforms. In this paper, we estimate a quantitative overlapping generations model featuring endogenous human capital accumulation using US data. First, we eliminate the SS and find a large positive effect on aggregate effective labor supply (${+}10.31\%$). Next, we build variants of this model to quantify the two issues (i) and (ii). We find that the endogeneity issue (ii) is quantitatively more important than the selection bias issue (i).

Following the most dramatic migration episode of the 21st century, Turkey hosted the largest number of Syrian refugees in the world. This paper assesses the impact of the arrival of Syrian refugees on the Turkish children's health, with a focus on height – a standard nutritional outcome. Accounting for the endogenous choice of immigrant location, our results show that Turkish children residing in provinces with a large share of refugees exhibit a significant improvement in their height as compared to those living in provinces with fewer refugees. Against other potential channels, a refugee-induced increase in maternal unemployment and the associated increase in maternal care seem to explain the observed positive effect on children's health.

Access to safe drinking water is among the most important determinants of public health outcomes. We pair household-level data from Iraq together with data on armed conflict and adopt a generalized difference-in-differences approach to study the relationship between household drinking water sources and armed conflict intensity. We find that households located in conflict-affected areas are more likely to use piped water accessed at their homes or bottled water as their primary source of drinking water, but are less likely to use public water sources or tanked water delivered on trucks and carts. We explore the temporal dynamics of these adjustments as well as heterogeneity by household characteristics. We further present direct evidence that conflict-exposed households are less likely to travel to obtain water.

Numerous studies have confirmed the relationship between individual risk and time preference and obesity. Nevertheless, none has studied the effect of these attitudes on chronic (long-term) obesity. This study used Indonesia Family Life Survey (IFLS) data from 16,366 individuals. It tracked their obesity status in 2007 and 2014 by calculating body mass index, the ratio between body weight and square of height. Besides the conventional risk-averse and risk-tolerant behaviour, the IFLS sample includes people who fear uncertainty related to the status quo bias. The ordered logit regression results show that past impatience, risk tolerance, and status quo bias behaviour (in 2007) are associated with transient or chronic obesity, while only current behaviour of status quo bias (in 2014) is associated with obesity. Furthermore, our study confirms that chronic obesity in Indonesia is prevalent among highly educated, high-income, and urban-centric individuals, exacerbated by impatience, risk tolerance, and uncertainty aversion. Thus, providing information on the risk of obesity and food calories, giving the incentive to avoid obesity, and improving the quality of built environments such as public parks, public transportation, and footpath could help prevent the rising obesity prevalence.

Each year, 295,000 women die during and just after pregnancy, and 2.4 million babies die in the first month of their lives. In 2019, 2,160,000 neonatal deaths and 275,000 maternal deaths occurred in low-income and lower-middle-income countries alone, translating to a welfare loss equivalent to $426 billion and $36 billion for neonatal and maternal deaths, respectively. The total loss was $462 billion or almost 6 % of these countries’ combined GDP. In the sustainable development goals pledge, the world promised to reduce maternal deaths to 0.07 % and neonatal mortality to below 1.2 %, saving about 200,000 women and 1.2 million children from dying annually. However, on the current trajectory, maternal mortality is expected to decline to only 0.16 % and neonatal deaths to only 1.5 % by 2030. This article analyses the most cost-effective way to reduce maternal and neonatal deaths – Increase coverage of basic emergency obstetric and newborn care from 68 to 90 % combined with increased family planning services in 55 low-income and lower-middle-income countries which account for around 90 % of the burden of maternal and neonatal mortality globally. The proposed package will require $3.2 billion per year more investment and will deliver benefits worth $278 billion per year in avoided deaths and higher economic growth. It will also yield a demographic dividend benefit equivalent to $25 billion annually. For every $1 invested, the social and economic benefits are estimated to be $87. The benefit-cost ratio is 87.

In the first half of the twentieth century, deaths from infectious disease, especially among the very young, fell dramatically in American cities. However, as infant mortality fell and life expectancy rose, racial inequality in urban infectious disease mortality grew. In this paper, we show that the fall in mortality and the rise in racial inequality in mortality reflected two countervailing processes. The dramatic decline in infant mortality from waterborne diseases drastically reduced the total urban infectious disease mortality rate of both Black and white Americans while having a comparatively small effect on the total racial disparity in urban infectious disease mortality. In contrast, the unequal fall in tuberculosis mortality, particularly in the prime of life, widened racial inequality in infectious disease mortality in US cities.

Given change in the universal developmental agenda and the quality of governance in the last two decades, this paper re-examines the relationship between governance, health expenditure and maternal mortality using panel data for 184 countries from 1996 to 2019. By employing the ‘dynamic panel data regression model’, the study reveals that a one-point improvement in the governance index decreases maternal mortality by 10–21%. We also find that good governance can better translate health expenditure into improved maternal health outcomes through effective allocation and equitable distribution of available resources. These results are robust to alternative instruments, alternative dependent variables (such as infant mortality rate and life expectancy), estimation by different governance dimensions and at the sub-national level. Additional findings using ‘Quantile regression’ estimates show that the quality of governance matters more than the health expenditure in countries with a higher level of maternal mortality. While the ‘Path regression’ analysis exhibits the specific direct and indirect mechanisms through which the causal inference operates between governance and maternal mortality.

In about last three decades, many developing countries have experienced a large decline in maternal mortality rates. Global initiatives leading to better maternal health policies may have contributed to this decline. In this paper, we investigate whether maternal health intervention also improves the fetal survival rate. For this purpose, we consider the Village Midwife Program in Indonesia, which was launched in 1989 as a part of the safe motherhood strategy. Using the Indonesian Family Life Survey (IFLS), we investigate the impact of midwives on fetal survival rate in terms of a change in the likelihood of a live birth being male. Our results show that the provision of a midwife in a community increases the probability of a live birth being male by about 3 percentage points. Greater antenatal care, skilled birth-attendance, and an improvement in nutrition among reproductive-age women—in terms of greater BMI—are the likely pathways. We do not find the results to be driven by pre-treatment trends, and they remain robust to a number of checks.

This study evaluates the impact of the Global Alliance for Vaccines and Immunization (GAVI) on children's health outcomes in developing countries. Using a difference-in-differences identification strategy, we find that GAVI has reduced neonatal, infant and under-five mortality rates. The impact of GAVI on children's health outcomes is larger in countries with lower per capita income. Our findings underscore the relevance of health interventions in improving children's health outcomes in developing economies.

We introduce contraceptives and social norms in an overlapping generations growth model of fertility and human capital. Parents can use costly modern contraceptives to control their family size, and each household’s fertility decision is influenced by the decisions made by others. Given the number of children born, parents decide how much education to provide and how much to save out of their income. We characterize the local dynamics of a stable steady-state equilibrium. Around this steady state, family planning interventions, which reduce the price of modern contraceptives, decrease fertility and increase human and physical capital. The effects of family planning interventions are larger when reproductive externalities are stronger.

Schistosomiasis is caused by a vector-borne parasite, commonly found in low- and middle-income countries. People become infected by direct contact with contaminated water through activities such as collecting water, bathing and fishing. Water becomes contaminated when human waste is not adequately contained. We administered a discrete choice experiment to understand community preferences for interventions that would reduce individuals' risk of contracting, or transmitting, Schistosoma mansoni. These focused on water access, sanitation and hygiene (WASH) interventions. We compared interventions that target behaviours that mainly put oneself at higher risk versus behaviours that mainly put others at risk. We used two payment vehicles to quantify what individuals are willing to give up in time and/or labour for interventions to be implemented. Key findings indicate that new sources of potable water and fines on open defecation are the highest valued interventions.

This article evaluates the long-term impacts of the Chicago Child-Parent Centers (CPC), a comprehensive early childhood program launched in the 1960s, on physical and mental health outcomes. This study follows a cohort of 1539 participants born in 1979–1980 and surveyed most recently at age 35–37 by employing a matched study design that included all 989 children who entered CPCs at ages 3 and 4 (1983-1985) and 550 comparison children of the same age from randomly selected schools participating in the usual district early childhood programs in kindergarten. Using propensity score weighting that addresses potential issues with differential attrition and non-random treatment assignment, results reveal that CPC preschool participation is associated with significantly lower rates of adverse health outcomes such as smoking and diabetes. Further, evaluating the economic impacts of the preschool component of the program, the study finds a benefit-cost ratio in the range of 1.35–3.66 (net benefit: $3896) indicating that the health benefits of the program by themselves offset the costs of the program even without considering additional benefits arising from increased educational attainment and reduced involvement in crime reported in earlier cost-benefit analyses. The findings are robust to corrections for multiple hypothesis testing, sensitivity analysis using a range of discount rates, and Monte Carlo analysis to account for uncertainty in outcomes.

Developing countries experience both household air pollution resulting from the use of biomass fuels for cooking and industrial air pollution. We conceptualise and estimate simultaneous exposure to both outdoor and household air pollution by adapting the Total Exposure Assessment model from environmental health sciences. To study the relationship between total exposure and health, we collected comprehensive data from a region (Goa) in India that had extensive mining activity. Our data allowed us to apportion individuals’ exposure to pollution in micro-environments: indoor, outdoor, kitchen, and at work. We find that higher cumulative exposure to air pollution is positively associated with both self-reported and clinically- diagnosed respiratory health issues. Households in regions with higher economic (mining) activity had higher incomes and had switched to cleaner cooking fuels. In other words, household air pollution due to higher biomass use had been substituted away for outdoor air pollution in regions with economic activity.

This paper evaluates the short-term health effects of in utero drought shock using repeated cross-section household data on Malawi. The main finding reveals that the effects of in utero harvest variability caused by rainfall shocks on child growth indices are driven by the deleterious effects of negative rainfall deviations, namely droughts. Negative rainfall deviation during the agricultural season prior to the gestational period of a child leads to a 21.8 per cent average local level reduction in age-standardized height scores, with the counterpart positive rainfall deviation having no apparent effect. The paper also uses harvest and consumption patterns to establish an important link between early-life malnutrition and growth serving as a precursor for the fetal period programming hypothesis in the literature. The direct impact of embryonic period shocks on growth provides supportive evidence on potential interaction between nutritional and environmental pathways.

There is growing evidence that early life conditions are important for outcomes during adolescence, including cognitive development and education. Economic conditions at the time children enter school are also important. We examine these relationships for young adolescents living in a low-income drought-prone pastoral setting in Kenya using historical rainfall patterns captured by remote sensing as exogenous shocks. Past rainfall shocks measured as deviations from local long-term averages have substantial negative effects on the cognitive development and educational achievement of girls. Results for the effects of rainfall shocks on grades attained, available for both girls and boys, support that finding. Consideration of additional outcomes suggests the effects of rainfall shocks on education are due to multiple underlying mechanisms including persistent effects on the health of children and the wealth of their households, underscoring the potential value of contemporaneous program and policy responses to such shocks.

With the increasing number of natural disasters, understanding the links between these events and child health has become timely and pertinent. Using a panel dataset, this paper empirically investigates the persistent effects on child health due to exposure to a series of natural disasters that occurred from 2002 to 2007 in Indonesia. We find that girls exposed to multiple disaster events are 0.19 standard deviations shorter and are 7 per cent more likely to be stunted when measured 7 to 12 years later. We find no persistent effect on boys. From a public policy perspective, we highlight the need for coping strategies beyond access to credit or remittances in order to mitigate growth retardation in children.

We examine the net benefits of social distancing to slow the spread of COVID-19 in USA. Social distancing saves lives but imposes large costs on society due to reduced economic activity. We use epidemiological and economic forecasting to perform a rapid benefit–cost analysis of controlling the COVID-19 outbreak. Assuming that social distancing measures can substantially reduce contacts among individuals, we find net benefits of about $5.2 trillion in our benchmark case. We examine the magnitude of the critical parameters that might imply negative net benefits, including the value of statistical life and the discount rate. A key unknown factor is the speed of economic recovery with and without social distancing measures in place. A series of robustness checks also highlight the key role of the value of mortality risk reductions and discounting in the analysis and point to a need for effective economic stimulus when the outbreak has passed.

This paper explores the relationship between the physical stature of Colombians born during the 20th century and several socio-economic and demographic variables. Using a dataset of more than 225,000 individuals built with information from judicial background certificates, we found a sustained growth of the average height of women and men during the 20th century. The results show significant differences in stature according to gender, level of education, occupation, and place and date of birth. Similarly, health conditions and access to aqueducts significantly affect height. We found that departmental average height disparities decreased and the gap across regions closed throughout the century.