The Effect of Household Socioeconomic Status on the Demand for Child Health Care Services

The health of the child is an important factor for proper childhood development. Unfortunately, efforts to improve child health in many countries have not yielded the desired results as many children do not receive appropriate health care, hence contributing to high child mortality and morbidity from avoidable causes. To address this problem, it is important that we understand the factors that drive the demand for child health care services. This study, employing the binary and multinomial logistic regression models, examines the effect of household socioeconomic status on the demand for child health care in Ghana, Kenya and Zambia using data from the 2014 Demographic and Health Surveys. The results indicate that the likelihood of seeking appropriate health care for the child is higher when both parents make decisions. The findings further indicate that the odds of seeking treatment for the child falls with the birth order and age of the child, but increases with household wealth, insurance status and proximity to the health facility. Working women are more likely to demand child health care than their counterparts who are unemployed. Our results, therefore, suggest that improving child health will need the participation of both parents in the household on such decisions. Besides, there is the need to educate parents on the importance of seeking appropriate care for all the children born irrespective of the birth order and age of the child. There should also be deliberate efforts to improve the economic lot of households to enhance their purchasing power and encourage them to participate in health insurance schemes to enable effective utilization of health care services for the child in the efforts to improve child health.     

Do Parents Invest Less in Worse-Performing Children? Evidence from the Asian Financial Crisis

This article uses data from Indonesia around the time of the 1997–98 Asian financial crisis to examine the role of parental preferences in human capital accumulation. Using a household fixed-effects estimation, I test whether parental education spending is affected by child mathematics test scores. I find that parents are more sensitive to the human capital of younger children, who are penalised for having lower skills than their older siblings. Differences in investment by child gender or birth order are evident in 2000 but not in 1997. This suggests that parents may have an efficiency investment strategy only when resource-constrained, and that education of younger children may be a luxury good.     

Parental Education and Child Health: Evidence from China*

This paper examines the effect of parental, household and community character‐istics on the health of children in China. We find that birth order, death of elder siblings, use of prenatal care and alcohol consumption by the mother when pregnant have statistically significant effects on the health of children. Although parental education does not have a significant direct effect on child health, it does affect mothers’ behavior during pregnancy and inflfluences the use of health inputs, indirectly impacting the health of children. The research findings have important implications for both family planning programs and broader social policies in China.     

健康冲击、社会资本与农户经济脆弱性——基于“CHIP2013”数据的实证分析

健康人力资本在农村经济中发挥着重要作用,农户健康受损时,会通过"劳动效应"、"挤占效应"和"情感效应"影响其经济脆弱性,而社会资本作为一种非正式机制,在血缘、地缘与业缘关系的连接下,通过及时获取信息与资源等对农户经济产生影响。文章利用"中国家庭收入调查2013"数据实证分析了健康冲击和社会资本对农户经济脆弱性的影响及作用机制。通过倾向得分匹配（PSM）和处理效应模型解决内生偏误问题、建立中介效应模型后,回归结果显示：健康冲击会通过挤占效应和情感效应两条渠道机制对农户经济产生负向影响,社会资本分项指标则通过信任渠道机制对农户经济产生正向影响;男性户主更易因遭受健康冲击而陷入经济脆弱困境,处于劳动年龄的户主在利用社会资本缓解经济脆弱性方面更具优势;而社会资本在缓解健康冲击对农户经济脆弱性中的作用并不显著,一个可能的原因是在农村社会中,社会资本等非正式机制逐渐被正式医疗保障机制所替代。在稳健性检验中,构造基于预期贫困定义的贫困脆弱性指标（VEP）进行替换变量回归,进一步证实所得结论。文章的政策涵义在于,应加强对于农户健康风险的管理,并重新挖掘社会资本在农村经济发展中的作用,从而缓解经济脆弱性,阻断贫困。     

Pandemic (COVID‐19) Policy,Regional Cooperation and the Emerging Global Production Network†

In this paper, we explore the possible policy responses to the COVID‐19 pandemic shock as well as the related economic (financial crisis) shocks on trade and global value chains (GVC) in East Asia. We find that regional policy coordination is critical to mitigate and isolate the pandemic shock. It is important to identify the pandemic events early to flatten the pandemic curve at the national and regional level. This supports a recent study by the World Bank (2020), which highlights the importance of early mitigation policies during the pandemic shock. The cost of the pandemic and economic shocks will increase significantly when several countries in the region experience the pandemic shock concurrently. In this case, flattening the regional pandemic curve becomes important. The results also indicate the need for greater coordination in East Asia to mitigate the pending economic shock in terms of unemployment, corporate bankruptcy and financial market fragility. The paper also highlights that the stability of the GVC network is critical during the pandemic in terms of hedging the risk of disruptions to the procurement of critical medical and health products as well as maintaining service linkages to manufacturing, such as the logistics sector. Regional policy coordination and the stability of GVC will be valuable in the post‐pandemic recovery of the region.     

The consequences of health shocks on households: Evidence from China

Unexpected health shocks may bring catastrophic consequences for households. This paper examines the effect of unexpected adverse health shocks on household members' physical and mental health, labor supply, household income and asset, and health behaviors in China by analyzing two nationally representative datasets and adopting a difference-in-differences method augmented with coarsened exact matching. We find that an unexpected health shock results in a discounted out-of-pocket medical expenditure of 16,943 RMB (US$ 2647) over five years for an average household, a reduction of household income per capita of 841 RMB per year (US$ 131, or 6.0% of household annual income per capita), and a loss of net household asset per capita of 13,635 RMB (US$ 2130, or 9.7% of household asset per capita). It raises the probability of an average household applying for public poverty relief allowance by 2.8 percentage points. In addition, we document a strong intra-household spillover effect of health shocks on mental health and health behaviors. A simple back-of-envelope calculation shows that the health shock induces a private cost of 34,966 RMB (US$ 5463) over 5 years for an average household, and incurs a social financial burden of 6066 RMB (US$ 948) in 5 years per household in medical reimbursement and social welfare transfers. At a national scale, the total social burden of health shocks from cardiovascular and cerebrovascular diseases amounts to 1.1 trillion RMB (US$ 172.1 billion) over 5 years.     

Care and Nutrition: Concepts and Measurement

Care is the provision in the household and the community of time, attention, and support to meet the physical, mental, and social needs of the growing child and other household members. The significance of care has best been articulated in the framework developed by the United Nations Children's Fund (UNICEF). This paper extends the UNICEF model of care and summarizes the literature on the relationship of care practices and resources to child nutrition. The paper also summarizes attempts to measure the various dimensions of care. The concept of care is extended in two directions: first, we define resources needed by the caregiver for care and, second, we show that the child's own characteristics play a role in the kind of care that he or she receives. The literature summary and methodological recommendations are made for six types of resources for care and for two of the least studied care practices: complementary feeding and psychosocial care. The other care practices are care for women, breast-feeding, food preparation, hygiene, and home health practices. Feeding practices that affect a child's nutritional status include adaptation of feeding to the child's abilities (offering finger foods, for example); responsiveness of the caregiver to the child (perhaps offering additional or different foods); and selection of an appropriate feeding context. Psychosocial care is the provision of affection and attention to the child and responsiveness to the child's cues. It includes physical, visual, and verbal interactions.     

How do Households Cope with Aggregate Shocks? Evidence from the Mexican Peso Crisis

Household surveys are used to examine the micro-impact of a large aggregate shock: the 1995 Mexican peso crisis. This paper examines how the impact of the crisis differed across households, and the adjustment mechanisms used by households to cope with this shock. The coping strategies examined include changes in household structure, fertility, household labor supply, child schooling, and interhousehold transfers. Many of the mechanisms households use to adapt to idiosyncratic shocks are found not to work with an aggregate shock.     

Selection and Reporting Bias in Household Surveys of Child Labor: Evidence from Tanzania

Abstract: Studies of child labor in developing countries have largely relied on data collected through national household surveys. But government‐sponsored household surveys are arguably prone to both sample selection bias and reporting bias. In this paper, we compare the demographic and labor market characteristics of working street children obtained from the 2000 Tanzanian Integrated Labor Force Survey, a government‐sponsored household survey, with the results obtained in a 2004 survey of working street children in the city of Mwanza in northern Tanzania. Our comparisons help illumine the potential biases introduced when child labor studies rely on household samples; specifically, we show that children in the non‐household based survey work longer hours, have lower educational attainment and suffer worse health outcomes than their counterparts in the government‐sponsored household survey. This suggests that studies based on national household surveys may significantly underestimate both the extent and the consequences of child labor.     

Socioeconomic Determinants of Child Health: Empirical Evidence from Indonesia

This paper characterizes the socioeconomic determinants of child health using height‐for‐age z‐score (HAZ), a long‐run measure of chronic nutritional deficiency. We construct a panel data that follows children between ages 3 and 59 months in 1993 through the 1997 and 2000 waves of the Indonesian Family Life Survey. We use this data to identify the various child‐level, household‐level and community‐level factors that affect children's health. Our findings indicate that household income has a large and statistically significant role in explaining improvements in HAZ. We also find a strong positive association between parental height and HAZ. At the community level, we find that provision of electricity and the availability of paved roads are positively associated with improvements in HAZ. Finally, in comparison to community‐level factors, household‐level characteristics play a large role in explaining the variation in HAZ. These findings suggest that policies that address the demand‐side constraints have greater potential to improve children's health outcomes in the future.     

FAMILY SIZE,UNWANTEDNESS, AND CHILD HEALTH AND HEALTH CARE UTILISATION IN INDONESIA

This paper presents and estimates a model of the determinants of child health and health care utilisation in Indonesia. In particular, it estimates the impact of unwantedness and number of siblings on health outcomes and treatment. It finds evidence that children who are unwanted at birth are more likely than other children to become ill and less likely to receive treatment for illnesses. No evidence is found that children from larger families suffer adverse health consequences.     

Parental Education and child Nutrition in Indonesia

This study uses 1989 Susenas household data to examine the impact of parental education on pre-school children's nutritional status, as measured by weight-for-age Z-scores. Reduced form regressions are estimated separately for boys and girls in rural and urban areas; explanatory variables include mother's and household head's education; per capita household expenditure; and aspects of the household sanitary environment. The analysis controls for influence of unobserved heterogeneity at village level, e.g. differences in prices and medical service provision. The estimates show a significant effect of parental schooling on child health status, varying between urban and rural areas, and by child gender and age. Mothers with secondary education typically have healthier boys than those with less schooling, while this effect is seen for girls only if the mother has more than secondary education. Maternal schooling significantly affects 2–5 year olds' health, but has little direct effect on that of younger children.     

The Effect of Health and Poverty on Early Childhood Cognitive Development

Although evidence of a link between socioeconomic status and child health has been researched extensively, much less attention has been devoted to studying the link between child health and cognitive development. This paper seeks to determine whether early childhood illnesses and poverty significantly impede cognitive development. The empirical model attempts to control for observed and unobserved heterogeneity through the use of panel data models. Results indicate that a child’s cognitive development is not directly related to health problems acquired after birth or socioeconomic standing. Rather, cognitive development is primarily influenced by unobserved child- and family-specific factors that happen to be correlated with health and socioeconomic status. On the other hand, birth weight appears to affect cognitive performance later in childhood, even after taking unobserved heterogeneity into account.     

Fertility decline and the heights of children in Britain, 1886–1938

In this paper we argue that the fertility decline that began around 1880 had substantial positive effects on the health of children, as the quality–quantity trade-off would suggest. We use microdata from a unique survey from 1930s Britain to analyse the relationship at the household level between the standardised heights of children and the number of children in the family. Our results suggest that heights are influenced positively by family income per capita and negatively by the number of children or the degree of crowding in the household. The evidence suggests that family size affected the health of children through its influence on both nutrition and disease. Applying our results to long-term trends, we find that rising household income and falling family size contributed significantly to improving child health between 1886 and 1938. Between 1906 and 1938 these variables account for 40% of the increase in heights, and much of this effect is due to falling family size. We conclude that the fertility decline is a neglected source of the rapid improvement in health in the first half of the twentieth century.     

健康冲击、数字普惠金融与家庭消费

基于中国家庭金融调查(CHFS)数据和"北京大学数字普惠金融指数",分析健康冲击对家庭消费的影响,以及数字普惠金融在其中所起的作用。基于固定效应模型的实证结果表明,健康冲击显著降低了家庭的非医疗消费支出,但数字普惠金融能有效地减轻这种影响;同时就分指标而言,数字普惠金融指标体系一级维度中的覆盖广度和使用深度,二级维度中的信贷、保险、货币基金以及支付这四个子指标均显著地平滑了冲击下的家庭消费。就作用机制而言,数字普惠金融主要通过缓解家庭流动性约束和强化非正式社交网络来帮助家庭应对健康冲击对消费的影响。异质性分析的回归结果显示,健康冲击对中西部地区、户主受教育水平较低以及金融素养水平较低的家庭影响更大,同时这种影响还与冲击的程度正相关,进而数字普惠金融的积极作用在这部分家庭中表现得更为明显。文章的研究结论进一步阐述了数字普惠金融发展对改善金融包容性的重要现实意义,并在微观层面上解释了数字普惠金融发展对改善家庭福利、防止因病致贫返贫的积极作用。     

Lights out? COVID-19 containment policies and economic activity

This paper estimates how strongly COVID-19 containment policies have impacted aggregate economic activity. We use a difference-in-differences methodology to estimate how containment zones of different severity across India impacted district-level nighttime light intensity, as well as household income and consumption. From May to July 2020, nighttime light intensity was 9.1 % lower in districts with the most severe restrictions compared with districts with the least severe restrictions, which could imply between 5.8 % and 6.6 % lower GDP. Nighttime light intensity was only 1.6 % lower in districts with intermediate restrictions. The differences were largest in May during the graded lockdown, and tapered in June and July. Lower house-hold income and consumption corresponding to zone-wise restrictions corroborate these results. Stricter containment measures had larger impacts in districts with greater population density, older residents, and more services employment. The large magnitudes of the findings suggest that governments should carefully consider the economic costs of country-wide pandemic containment policies while weighing the trade-offs against public health benefits. Keywords: Containment policies, COVID-19, Nighttime lights, India     

Bargaining Power within Couples and Health Care Provider Choice in Tanzania

This paper examines the pattern of health care provider choice in relation to couples’ bargaining power, in a country where most communities are basically patriarchal, with limited legal protection for women. We use the Tanzanian Demographic and Health Survey (2010) and a nested multinomial logit model to distinguish between public and private facility choice. Evidence suggests that cooperation in decision‐making, female discretion over household resources and low domestic violence increase the probability of childbirth in a health facility. We find that cooperation in household decision‐making and low incidence of domestic violence significantly increase the probability of private facility use. The effects of these social and economic dimensions of the distribution of power between spouses on health care use remain significant after controlling for household resource endowment. A policy option that encourages cooperation between couples, reduces domestic violence and/or ensures female empowerment is more likely to enhance the use of reproductive health services.     

COVID-19 pandemic,health risks,and economic consequences: Evidence from China

This paper introduces the Susceptible-Infectious-Recovered model into the Bewley-type incomplete market model and uses it to study the impact of the coronavirus disease (COVID-19) pandemic on China's macroeconomics. The calibrated model predicts that the average propensity to consume household wealth will decline, while the demand for money will increase, and these predictions are consistent with the data. Monetary policy is effective because it provides enough liquidity for households to buffer health risks. Monetary stimulus is more effective in an economy with greater health risks and consumption uncertainty. Counterfactual experiments show that abandoning the containment policy too early would avoid a sharp drop in output and employment in the short term, but it would greatly increase mortality and ultimately lead to a decline in social welfare.     

Changes in women’s empowerment in the household,women’s diet diversity,and their relationship against the background of COVID-19 in southern Bangladesh

The COVID-19 pandemic in Bangladesh, associated public health measures, and people’s reactions were projected to have caused job losses among women, a decline in women’s empowerment and reduced women’s diet diversity. Using a November 2020 telephone survey to re-interview adult female respondents of a November 2019 in-person survey, contrary to expectations we find that more women found than lost jobs, and women’s diet diversity increased over the year partly marked by the COVID-19 pandemic. We did not find evidence of a decline in women’s involvement in food purchase decisions, nor women’s autonomy over use of household income. The change in women’s outside employment is neither statistically related to changes in women’s involvement in food purchase decisions, changes women’s autonomy over use of household income, nor changes in women’s diet diversity. Change in women’s involvement in food purchase decisions is positively related with change in women’s diet diversity and change in women’s autonomy over income use is negatively related with change in women’s diet diversity.     

A decade's story of childhood malnutrition inequality in China: Where you live does matter

A concentration index methodology to analyze the inequality in childhood malnutrition in China is outlined. Height-for-age z-score is used as a measure of childhood malnutrition. Using household survey data from nine Chinese provinces, we found that per capita household income, household head's education, urban residence and access to a bus stop are associated with lower malnutrition. Child's age has a nonlinear relationship with the malnutrition status. Income growth and access to public transportation are associated with less severe inequality, while rural–urban gap, provincial differentials, and unequal distribution of household head's education are associated with higher levels of inequality in childhood malnutrition. Gender is not relevant for either malnutrition status or inequality. Investments in infrastructure and welfare programs are recommended to ameliorate the inequality in childhood malnutrition.