A child health production function estimated from longitudinal data. Cebu Study Team

Collaborating researchers used a multi equation model to analyze 3080 mother-infant pairs living on the island of Cebu in the central Philippines and to estimate a child health production function. The econometric methods used eliminated obstacles such as heterogeneity and endogeneity of significant explanatory factors. They also maximized the longitudinal quality of the data. The results showed that morbidity in 1 period reduced infant weight in following periods. For example, diarrhea and febrile respiratory infection reduced growth in the time period following the illnesses. Further effects of some contributing factors were great near birth not diminished with age. For example, breast feeding promoted growth and protected against infection, especially diarrhea and febrile respiratory infection, more substantially near birth than it did later. Further, in urban areas, preventive health care positively affected growth independently of its indirect influence on reducing respiratory infection. Yet it had little effect on diarrhea. Diarrhea had a strong adverse effect on growth. Exposure of the infant to enteric pathogens had the greatest influence on production of diarrhea. In urban areas, exposure included water supply contamination, exposure to feces, a more pathogenic diet, and community crowding. In rural areas, however, exposure included community crowding and increased rainfall which presumably washed feces into the water supply. Household crowding in both urban and rural areas and irritation from smoke in urban areas only tended to bring about febrile respiratory infection.     

Single Mothers in Russia: Household Strategies for Coping with Poverty

During the 1990s, the proportion of female-headed households as well as their poverty risk has increased rapidly. Seven rounds of the Russian Longitudinal Monitoring Survey (RLMS) are used to investigate the role that household living arrangements play in single-mother family income dynamics and the major factors that affect the income status of mother-only families in Russia. Enhanced earning power of the single parent as well as a higher level of child benefits increases the likelihood that the single parent family lives separately from other relatives. Increasingly single mothers are choosing to co-reside with other relatives or adults in times of economic stress.     

Price and income elasticities of demand for modern health care: the case of infant delivery in the Philippines.

In the Philippines most women choose to deliver at home despite the presence of modern facilities. Policy-making requires a knowledge of the factors that determine that choice, especially in terms of variables like price and location, which are amenable to policy intervention. Over 2/3 of the babies born in low-income countries are delivered by traditional birth attendants who are uneducated and have no formal training. They are, however, available in rural areas, whereas 70-90% of the modern practitioners are in the cities. Recently efforts have been made to expand modern obstetrical services in developing countries, but few surveys are available documenting the impact of modern facilities on delivery patterns. The present survey collected data from 3075 women who had singleton births on the island of Cebu between 1983 and 1984, as well as data from 48 modern public and private health facilities and 88 modern and traditional health practitioners. For the analysis of these data an economic demand model was built, using the mixed multinomial logit technic to estimate relationships between delivery characteristics, mothers' characteristics, and delivery choice. Money prices were not a significant factor in the choices, but time prices were a significant consideration for the rural sample. Hours of availability were a significant factor for both urban and rural mothers, and availability of drugs was significant for the urban sample. Both rural and urban women preferred delivery by a midwife, trained or not, to delivery by a combination of doctors, nurses, and midwives. With few exceptions, income was not a significant factor, and having insurance (10% of the sample) increased the probability of choosing a modern private practitioner. Money price effects were inelastic; i.e., a price increase by modern facilities would not have much effect on the choice of these facilities, and lowering the price of modern public delivery services would do little to increase demand for them. Locating more public practitioners and facilities in rural areas could effectively increase the use of modern facilities by rural women. Both urban and rural women would increase their use of modern public away-from-home facilities if these facilities would increase their hours of operation. Having drugs available would also increase the use of the public away-from-home facilities. In both urban and rural samples, trained midwives were the practitioners of choice. Among rural women a rise in income would increase the likelihood of their choosing public and private away-from-home deliveries and home deliveries by private practitioners. From the point of view of public policy, the most significant implications of the study are: 1) decreasing travel time for rural women by locating modern facilities and practitioners in rural areas would increase the use of modern delivery services; 2) increasing hours of operation, increasing the availability of drugs, and providing trained midwives at public facilities would increase the use of modern delivery services; 3) decreasing money prices would not increase use of modern public delivery services; and 4) increasing the price for cost recovery would not decrease the use of modern public delivery services.     

Prenatal care and pregnancy outcome in Cebu, Philippines

This paper examines the direct and indirect effects of patterns of prenatal care usage on birth weight and gestational age for a randomly selected sample of 3,080 rural and urban women. We analyze indirect effects of prenatal care on intermediate maternal factors (nutritional, stress, smoking, and drinking), then the impacts of these factors along with prenatal care on pregnancy outcome. The simultaneous equations statistical approach corrects for endogeneity of prenatal care and the intermediate maternal factors. Results of simulations of the effects of changes in the number of prenatal visits on intermediate and health outcome factors have important policy implications.     

Technology, transport, globalization and the nutrition transition food policy

Diet and activity have been affected by the rapid worldwide shifts in technological innovations reducing energy expenditures during leisure, transportation, and work; globalized modern food processing, marketing and distribution techniques; global mass media. The increases occur increasingly in rural areas on all continents. The resultant global increase in obesity increasingly is shifting the burden of obesity to the poor. While few direct linkages between globalization of trade in goods, services, and technology can be directly linked to diet and activity, a strong case exists for globalization’s role as a key underlying force behind this stage of the nutrition transition.     

Estimation of a dynamic model of weight

The ongoing debate about the economic causes of obesity has focused on the changing relative prices of diet and exercise. This paper uses a model that explicitly includes time and spatially varying community-level urbanicity and price measures as instruments to obtain estimates of the effects of diet, physical activity, drinking, and smoking on weight. The instruments control for bias due to unobservables that may be common determinants of weight and these explanatory variables. We apply a dynamic panel system GMM estimation model to longitudinal (1991–2006) data from China to model weight and find that among adult men in China, about 5.4% of weight gain was due to declines in physical activity and 2.8–3.1% was due to dietary changes over this period. Combined, changes in physical activity and diet only explain around 8% of the short run gain in weight and about 11% of the long-run gain in weight among Chinese men.     

THE INTEGRATION OF A SYSTEM OF PRICE AND QUANTITY STATISTICS WITH DATA ON RELATED VARIABLES

This paper has two main points. First, the usefulness of the industry detail called for in the SNA would be increased if it were altered to facilitate the construction of price and quantity aggregates classified by stage-of-process sectors. Second, the price and quantity data so arranged should be augmented by data on behaviorally related variables classified the same way. The feasibility of the stage-of-process approach is demonstrated by a table showing the high degree to which the U.S. input-output table for 1967 can be triangularized. The analytical usefulness of the approach is demonstrated through analysis of changes in prices, output, unfilled orders and finished goods inventories for primary and for finished goods manufacturers.