Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries

A long literature in demography has debated the importance of place for health, especially children’s health. In this study, we assess whether the importance of dense settlement for infant mortality and child height is moderated by exposure to local sanitation behavior. Is open defecation (i.e., without a toilet or latrine) worse for infant mortality and child height where population density is greater? Is poor sanitation is an important mechanism by which population density influences child health outcomes? We present two complementary analyses using newly assembled data sets, which represent two points in a trade-off between external and internal validity. First, we concentrate on external validity by studying infant mortality and child height in a large, international child-level data set of 172 Demographic and Health Surveys, matched to census population density data for 1,800 subnational regions. Second, we concentrate on internal validity by studying child height in Bangladeshi districts, using a new data set constructed with GIS techniques that allows us to control for fixed effects at a high level of geographic resolution. We find a statistically robust and quantitatively comparable interaction between sanitation and population density with both approaches: open defecation externalities are more important for child health outcomes where people live more closely together.     

子女教育影响老年父母健康的机制及其异质性

基于2018年中国健康与养老追踪调查(CHARLS)数据,运用Logit计量方法考察子女教育对老年父母健康的影响。结果发现子女教育提高1年,老年父母健康状况改善的可能性显著提高4.28%,异质性检验发现这种影响不存在城乡和性别差异。基于人力资本代际传递理论和社会资本理论,将子女教育影响老年父母健康的渠道归纳为资源转移、健康行为和社会性支持,结果发现:子女教育主要通过向父母转移资源和帮助老年父母优化健康行为习惯来改善父母健康,未能通过社会支持渠道产生健康促进效应。其中通过资源转移渠道和以适度饮酒、运动及休闲为代表的健康行为渠道分别解释了子女教育对老年父母健康促进效应的27.78%和9.78%,提高资源转移能力是子女教育影响老年父母健康的主要渠道。在我国老龄化背景下,需要重视子女教育对父母健康的促进作用。同时,采取积极措施拓展社会支持渠道,降低父母对子女的资源依赖,并加强健康教育,优化健康行为。     

Rural–Urban Child Height for Age Trajectories and Their Heterogeneous Determinants in Four Developing Countries

The large literature on health differentials between rural and urban areas relies almost exclusively on cross-sectional data. Bringing together the demographic literature on area-level health inequalities with the bio-physiological literature on children’s catch-up growth over time, this paper uses panel data to investigate the stability and origins of rural–urban health differentials. Using data from the Young Lives longitudinal study of child poverty, I present evidence of large level differences but similar trends in rural versus urban children’s height for age in four developing countries. Further, observable characteristics of children’s environment such as their household wealth, mother’s education, and epidemiological environment explain these differentials in most contexts. In Peru, where they do not, children’s birthweight and mothers’ health and other characteristics suggest that initial endowments—even before birth—may play an important role in explaining "residual" rural–urban child height inequalities. These latter results imply that prioritizing maternal nutrition and health is essential—particularly where rural–urban height inequalities are large. Interventions to reduce area-level health inequalities should begin even before birth.     

子女外出对农村留守父母健康的影响

老龄化背景下,成年子女的异地流动增加了中老年人的健康负担,本文使用中国健康与养老追踪调查数据和倾向分值匹配法,实证考察了农村地区成年子女跨省外出对留守父母健康的影响。估计结果显示,有子女外出的家庭,中老年父母的主观健康如自评健康、认知状况和抑郁程度较差;客观健康也受到不利影响,患关节炎、胃病和肺病的可能性更大。基于收入考量的子女外出确实增加了对父母的经济支持力度,但同时也增加了父母从事隔代照料的可能性。隔代照料负担的增加可能是子女外出对父母健康有不利影响的原因。     

From Child to Parent? The Significance of Children’s Education for Their Parents’ Longevity

In addition to own education and other socioeconomic resources, the education of one’s children may be important for individual health and longevity. Mothers and fathers born between 1932 and 1941 were analyzed by linking them to their children in the Swedish Multi-generation Register, which covers the total population. Controlling for parents’ education, social class, and income attenuates but does not remove the association between children’s education and parents’ mortality risk. Shared but unmeasured familial background characteristics were addressed by comparing siblings in the parental generation. In these fixed-effects analyses, comparing parents whose children had tertiary education with parents whose children completed only compulsory schooling (the reference group) yields a hazard ratio of 0.79 (95 % CI: 0.70–0.89) when the socioeconomic position of both parents is controlled for. The relationship is certainly not purely causal, but part of it could be if, for example, well-educated adult children use their resources to find the best available health care for their aging parents. I therefore introduce the concept of “social foreground” and suggest that children’s socioeconomic resources may be an important factor in trying to further understand social inequalities in health.     

Growing Up Together: Cohort Composition and Child Investment

In sub-Saharan Africa, 60 % of child deaths are preventable by investments in child health as simple as immunizations, bed nets, or water purification. This article investigates how a household’s decisions regarding such investments are affected by the size and gender composition of a child’s cohort. I focus on a previously overlooked type of investment: nonrival, child-specific goods (club goods). I empirically estimate the response of immunization status to cohort characteristics. I carefully address the problem of endogenous fertility, which is common in cohort studies. Because most rural Senegalese households are composed of multiple nuclear families, a child’s cohort is composed of both siblings and nonsibling children. Estimating within households, I instrument cohort characteristics with those of the nonsibling (exogenous) portion. I find that children with larger (or more predominantly male) cohorts of vaccine-eligible age are significantly more likely to receive immunization. These findings suggest that children with larger cohorts may be better off in terms of club investments; this is a significant finding for child health given that many illness prevention methods are of a club good nature.     

Exploring Child Mortality Risks Associated with Diverse Patterns of Maternal Migration in Haiti

Internal migration is a salient dimension of adulthood in Haiti, particularly among women. Despite the high prevalence of migration in Haiti, it remains unknown whether Haitian women’s diverse patterns of migration influence their children’s health and survival. In this paper, we introduce the concept of lateral (i.e., rural-to-rural, urban-to-urban) versus nonlateral (i.e., rural-to-urban, urban-to-rural) migration to describe how some patterns of mothers’ internal migration may be associated with particularly high mortality among children. We use the 2006 Haitian Demographic and Health Survey to estimate a series of discrete-time hazard models among 7,409 rural children and 3,864 urban children. We find that compared with their peers with nonmigrant mothers, children born to lateral migrants generally experience lower mortality, whereas those born to nonlateral migrants generally experience higher mortality. Although there are important distinctions across Haiti’s rural and urban contexts, these associations remain net of socioeconomic factors, suggesting they are not entirely attributable to migrant selection. Considering the timing of maternal migration uncovers even more variation in the child health implications of maternal migration; however, the results counter the standard disruption and adaptation perspective. Although future work is needed to identify the processes underlying the differential risk of child mortality across lateral versus nonlateral migrants, the study demonstrates that looking beyond rural-to-urban migration and considering the timing of maternal migration can provide a fuller, more complex understanding of migration’s association with child health.     

The intergenerational transmission of human capital: the role of skills and health

We provide new evidence on some of the mechanisms reflected in the intergenerational transmission of human capital. Applying both an adoption and a twin design to rich data from the Swedish military enlistment, we show that greater parental education increases sons’ cognitive and non-cognitive skills, as well as their health. The estimates are in many cases similar across research designs and suggest that a substantial part of the effect of parental education on their young adult children’s human capital works through improving their skills and health.     

Does Women’s Empowerment in Agriculture Matter for Children’s Health Status? Insights from Northern Ghana

Given that women in rural communities in developing countries are responsible for the nutrition and health-related decisions affecting children in their care, their empowerment may influence the health status of their children. The association between women’s empowerment, measured by using a recently developed Women’s Empowerment in Agriculture Index, and children’s health status is examined for a sample of households in Northern Ghana applying a Multiple Indicators Multiple Causes (MIMIC) model. The MIMIC approach is used to link multiple indicator variables with multiple independent variables through a “single underlying” latent variable. Height-for-age and weight-for-height z-scores are used as indicators of the underlying children’s health status and women’s empowerment in agriculture and control variables are used as the multiple independent variables. Our results show that neither the composite empowerment score used to capture women’s empowerment in agriculture nor its decomposed components are statistically significant in their association with the latent children’s health status. However, the associations between children’s health status and control variables such as mother’s education, child’s age, household’s hunger scale and residence locale are statistically significant. Results also confirm the existence of the ‘single underlying’ common latent variable. Of the two health status indicators, height-for-age scores and weight-for- height scores, the former exhibited a relatively stronger association with the latent health status. While promoting women’s empowerment to enhance their ability to make strategic life choices, it is important to carefully consider how the achievement of these objectives will impact the women’s well-being and the well-being of the children in their care.     

Children and the Mental Health of Older Adults in China: What Matters?

China is witnessing several major demographic, socioeconomic, and cultural trends that likely intersect in unique and significant ways to influence the health and well-being of its older adult population. Concerns that such trends may be eroding traditional family structures and values raise questions about the continued importance and impact of children on the lives of their older parents. Do children matter and, if so, what is it about having children that makes a difference to the mental health of their parents? This study addressed these issues using baseline data drawn from the Chinese Longitudinal Aging Social Survey, conducted in 2014. Multivariate OLS regression analyses revealed the importance of having children for parental mental health. This relationship was found to be mediated by economic/utilitarian factors (co-residence, the receipt of financial, and instrumental support) as well as psychological/emotional factors (companionship, emotional support), and social/traditional factors (children’s socioeconomic status achievements). These findings support the view that children continue to be important to the mental health of their older parents in contemporary China. Further, what matters most when it comes to understanding the influence that children have on parents’ mental health are their perceived accomplishments in life and their meaningful presence in the day-to-day lives of their parents.

     

Environment,Access to Health Care,and Other Factors Affecting Infant and Child Survival Among the African and Coloured Populations of South Africa, 1989–94

Some maintain that environmental factors are unimportant for infant and child survival once mother's education and other characteristics have been taken into account. However, an analysis of survival of African and Coloured children based on the 1994 October Household Survey supports the importance of environmental factors in relatively high mortality populations. Among African households, the source of domestic water is important, but for Coloured households, almost all of which have safe water, the type of sanitation is important. If safe drinking water is available, the type of sanitation influences survival; if safe drinking water is not available, sanitation seems to matter little.     

Tracking Poverty Reduction in Bhutan: Income Deprivation Alongside Deprivation in Other Sources of Happiness

This paper analyses poverty reduction in Bhutan between two points in time—2003 and 2007—from a multidimensional perspective. The measures estimated include consumption expenditure as well as other indicators which are directly (when possible) or indirectly associated to valuable functionings, namely, health, education, access to electricity, safe water, improved sanitation, enough room per person in dwelling, access to roads and land ownership. Interestingly, most of these indicators have been identified as sources of happiness in the 2007 Gross National Happiness Survey. Twelve different measures are estimated with a variety of values for the different parameters involved for robustness analysis. Also, estimates are bootstrapped creating 95 % confidence intervals. We find that over the study period there was an unambiguous reduction in multidimensional poverty regardless of the indicators’ weights, deprivation cutoffs and identification criterion of the poor. This reduction was mainly led by a reduction in the proportion of the poor which was accompanied by a reduction in the intensity of poverty among those who were less intensively poor, although not among those who were more intensively poor. Rather than accomplishing this poverty reduction by improving achievements in one or two indicators, there were significant reductions in several deprivations, especially in access to roads, electricity, water, sanitation, and education. We also find that when income alone is used to target the poor, inclusion errors are marginal but exclusion errors are sizeable. Despite Bhutan’s significant progress, challenges remain as poverty is still high in rural areas. A multidimensional measure in the lines proposed in this paper can prove useful for monitoring poverty reduction, prioritizing groups and evaluating upon investment.     

流动儿童精神健康状况分析

与以往主要关注家庭因素、基本人口特征的流动儿童精神健康研究不同,本研究将分析视野扩展到社会经济地位、社会支持和个体抗逆力。数据表明,流动儿童的精神健康差于非流动儿童,社会经济地位、家庭支持和个体抗逆力均对其产生影响,其他社会支持的影响不显著。流动儿童由于面临着社会经济地位和家庭流动方面的"双重劣势",单纯提升个体抗逆力不足以改变其精神健康不良的事实。因此,一方面努力提升流动儿童的个体抗逆力,充分发挥其面对逆境的主体性;另一方面,在宏观层面上不断地瓦解产生"双重劣势"的制度基础。通过两方面的共同作用能改善流动儿童的精神健康状况。     

Factors associated with mobile health information seeking among Singaporean women

This study examined effects of age and social psychological factors on women’s willingness to be mobile health information seekers. A national survey of 1,878 Singaporean women was conducted to obtain information on women’s mobile phone usage, experiences of health information seeking, and appraisals of using mobile phones to seek health information. Results showed that young, middle-aged, and older women exhibited distinct mobile phone usage behaviors, health information-seeking patterns, and assessments of mobile health information seeking. Factors that accounted for their mobile information-seeking intention also varied. Data reported in this study provide insights into mobile health interventions in the future.     

Slum Residence and Child Health in Developing Countries

Continued population growth and increasing urbanization have led to the formation of large informal urban settlements in many developing countries in recent decades. The high prevalence of poverty, overcrowding, and poor sanitation observed in these settlements—commonly referred to as “slums”—suggests that slum residence constitutes a major health risk for children. In this article, we use data from 191 Demographic and Health Surveys (DHS) across 73 developing countries to investigate this concern empirically. Our results indicate that children in slums have better health outcomes than children living in rural areas yet fare worse than children in better-off neighborhoods of the same urban settlements. A large fraction of the observed health differences appears to be explained by pronounced differences in maternal education, household wealth, and access to health services across residential areas. After we control for these characteristics, children growing up in the slums and better-off neighborhoods of towns show levels of morbidity and mortality that are not statistically different from those of children living in rural areas. Compared with rural children, children living in cities (irrespective of slum or formal residence) fare better with respect to mortality and stunting but not with respect to recent illness episodes.     

Parental retirement timing: the role of unanticipated events in the lives of adult children

Although anecdotal evidence of older parents postponing retirement to financially support their grown children is common, the empirical evidence is scarce. In this paper, we use data from the 1992 to 2010 waves of the Health and Retirement Study to identify a broad set of pivotal events in the lives of adult children. First, we determine whether these events affect subsequent financial transfers from parents to children over multiple years. Next, we determine whether those events that result in subsequent transfers also shift parental retirement expectations. Finally, we quantify the impact of the unexpected children’s events on retirement realizations, moving beyond the correlational analyses in prior literature. Our findings show that a child’s move out of a parental home decreases both expectations and realizations of working after age 65. The magnitude of this effect is similar to that of an own health shock experienced during pre-retirement years.     

A Four-Country Study on the Relationship Between Parental Educational Homogamy and Children’s Health from Infancy to Adolescence

This study explores the relationship between parental educational similarity—educational concordance (homogamy) or discordance (heterogamy)—and children’s health outcomes. Its contribution is threefold. First and foremost, I use longitudinal data on children’s health outcomes tracking children from age 1 to 15, thus being able to assess whether the relationship changes at key life-course and developmental stages of children. This is an important addition to the relevant literature, where the focus is solely on outcomes at birth. Second, I look at different health outcomes, namely height-for-age (HFA) and BMI-for-age (BFA) z-scores, alongside their dichotomized counterparts, stunting and thinness. Third, I conduct the same set of analyses in Ethiopia, India, Peru, and Vietnam, thus providing multi-context evidence from countries at different levels of development and with different socio-economic characteristics and gender dynamics. Results reveal important heterogeneity across contexts. In Ethiopia and India, parental educational homogamy is associated with worse health outcomes in infancy and childhood, while associations are positive in Peru and, foremost, Vietnam. Complementary estimates from matching techniques show that these associations tend to fade after age 1, except in Vietnam, where the positive relationship persists through adolescence, thus supporting the homogamy-benefit hypothesis not only at birth, but also across the early life course. Insights from this study contribute to the inequality debate on the intergenerational transmission of advantage and disadvantage and shed additional light on the relationship between early-life conditions and later-life outcomes in critical periods of children’s lives.

     

The Effects of Childhood SNAP Use and Neighborhood Conditions on Adult Body Mass Index

The disproportionate number of individuals who are obese or overweight in the low-income U.S. population has raised interest in the influence of neighborhood conditions and public assistance programs on weight and health. Generally, neighborhood effects and program participation effects have been explored in separate studies. We unite these two areas of inquiry, using the 1968-2005 Panel Study of Income Dynamics (PSID) to examine the long-term effects of childhood Supplemental Nutrition Assistance Program (SNAP) participation, neighborhood conditions, and the interaction of these two, on adult body mass index (BMI). Using sibling fixed-effects models to account for selection bias, we find that relative to children in other low-income families, children in SNAP-recipient households have higher average adult BMI values. However, the effects of childhood SNAP usage are sensitive to both residential neighborhood and age at receipt. For those growing up in advantaged neighborhoods, projected adult BMI is higher for children in SNAP-recipient households than for children in low-income, nonrecipient households. In contrast, for those growing up in less-advantaged areas, adult BMI differences between children in SNAP-recipient and those in low-income, nonrecipient households are small. SNAP usage during preschool years (0 to 4) has no impact on adult BMI scores. However, at later childhood ages, the time elapsed receiving SNAP income increases adult BMI values relative to a condition of low-income nonreceipt.     

家庭结构对老年人代际支持的影响研究

本文利用中国老年健康影响因素跟踪调查（CLHLS）项目2008年的数据,分析了家庭结构的变迁（表现为居住安排与子女数量两方面）对老年人所获得的来自子女的代际支持的影响。研究结论显示,是否与子女同住会影响老年人获得的经济支持、情感支持与照料支持,而子女数量对代际支持的获得有正向作用。     

Investigating important interactions between water and food security for child health in Burkina Faso

Failures in either water systems or food systems, or a combination of system failures, could provide the underlying explanation for continued high levels of malnutrition in many regions. We focus on child health and offer the first spatially explicit analysis of the interaction between water source and food insecurity on children’s health in Burkina Faso, an African nation that continues to struggle with poor children’s health. We combine data from the 2010 Demographic and Health Survey, a small USAID water quality survey collected from community wells, and remotely sensed imagery. Results suggest that, in a few cases, reliable and clean water sources are positively correlated to children’s linear growth and weight gain, although in many regions, the interaction with community-level food production is critical to understanding health outcomes. The results also suggest that maternal health and nutrition during pregnancy and breastfeeding are foundational to the healthy development of young children. In all, the findings provide evidence of the importance of multi-sectoral interventions targeted at improving children’s health.