Wealthiest Is Not Always Healthiest: What Explains Differences in Child Mortality in West Africa?

Ickowitz, Amy (2012): Wealthiest Is Not Always Healthiest: What Explains Differences in Child Mortality in West Africa? Published in: Journal of African Economies , Vol. 21, No. 2 (August 2012)

Abstract

Ghana has the lowest under-five mortality rate in West Africa. Understanding why Ghana’s child mortality rate is lower than in neighboring countries may offer useful insights for other developing countries that are trying to improve child health. This paper explores whether Ghana’s lower mortality rate is mostly a result of greater household wealth, better implementation of national health policies, or more favorable geography. The paper uses micro level data for children under five to examine relative child mortality risk between Ghana and each of its three immediate neighbors -- Burkina Faso, Côte d’Ivoire, and Togo. A Cox proportional hazards model is used to test which of the three ‘contenders’ – health policy, wealth, or geography – best explains Ghana’s mortality advantage. The results of the analysis indicate that wealth variables are not able to explain any of the child mortality variation between Ghana and its neighbors. Geography and health policy variables each explain about 40% of the mortality gap between Ghana and Burkina Faso. Health policy differences alone are able to explain about 70% of the child mortality gap between Ghana and Côte d’Ivoire. These results suggest that even poor countries that have been ‘cursed’ by bad geography can potentially improve development outcomes and save children’s lives.

• Item Type: MPRA Paper
• Language: English
• Keywords: child mortality, geography, health, policy, Africa, Ghana, Burkina Faso, Togo, Côte d’Ivoire
• Subjects: I - Health, Education, and Welfare > I1 - Health > I10 - General; I - Health, Education, and Welfare > I1 - Health > I15 - Health and Economic Development; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health; O - Economic Development, Innovation, Technological Change, and Growth > O1 - Economic Development > O10 - General; O - Economic Development, Innovation, Technological Change, and Growth > O1 - Economic Development > O12 - Microeconomic Analyses of Economic Development; O - Economic Development, Innovation, Technological Change, and Growth > O5 - Economywide Country Studies > O55 - Africa

References

American Academy of Pediatrics (AAP) (2005). ‘Policy Statement’, Pediatrics, 15(2): 496-506.

Acemoglu, D., S. Johnson, and J. Robinson (2001) ‘The Colonial Origins of Comparative Development: An Empirical Investigation’, American Economic Review, 91(5): 1369-1401.

Balk, D.,T. Pullum, A. Storeygard, F. Greenwell, and M. Neuman (2004) A spatial analysis of childhood mortality in West Africa’, Population, Space and Place, 10(3): 175–216.

Benson, T. and M. Shekar (2006) ‘Trends and Issues in Child Undernutrition’, in D. T. Jamison , R.G. Feachem , M.W. Makgoba , E.R. Bos , F. K. Baingana , K.J. Hofman , & Khama O. Rogo (eds.), Disease and Mortality in Sub-Saharan Africa. World Bank.

Black, R.E., S.S Morris, and J. Bryce (2003) ‘Where and why are 10 million children dying every year? (Child survival I)’, The Lancet, 361.9376 (June 28, 2003): 2226.

Block, S. (2007) ‘Maternal nutrition knowledge versus schooling as determinants of child micronutrient status’, Oxford Economic Papers, 59 : 330-353

Bloom, D. and J.D. Sachs (1998) ‘Geography, Demography, and Economic Growth in Africa’, Brookings Papers on Economic Activity, 1998:2

Breierova, L. and E. Duflo (2004) ‘The Impact of Education on Fertility and Child Mortality: Do Fathers Really Matter Less than Mothers?’, NBER Working Paper 10513 .

Brunnschweiler, C.N. and E.H. Bulte (2008) ‘The Resource Curse Revisited and Revised: A Tale of Paradoxes and Red Herrings,’ Journal of Environmental Economics and Management, 55: 248-264

Bryce, J., C. Boschi-Pinto, K. Shibuya, and R. E. Black (2005) ‘WHO estimates of the causes of death in children’, The Lancet, 365.9465 1147(6).

Caldwell, B. (1986) ‘Routes to low mortality in poor countries,’ Population and Development Review, 12(2): 171-220.

Carstensen, K. and E. Gundlach.(2006) ‘The Primacy of Institutions Reconsidered: Direct Income of Malaria Prevalence’, World Bank Economic Review, 20(3): 309-339.

Center for International Earth Science Information Network (CIESIN) (2005). Gridded Population of the World Version 3 (GPWv3). Palisades, NY: Socioeconomic Data and Applications Center (SEDAC), Columbia University. http://sedac.ciesin.columbia.edu/gpw.

Christiansen, L. and H. Alderman (2004) ‘Child Malnutrition in Ethiopia: Can Maternal Knowledge Augment the Role of Income?’ Economic Development and Cultural Change, 52 (2): 287-312.

Cogneau, D., C. Guénard, S. Mesplé-Somps,G. Spielvogel, and C. Torelli (2006) ‘Development at the Border: A study of national idiosyncrasies in post-colonial West-Africa,’ DIAL/Université de Paris unpublished working paper.

Curtis, S. (1995) ‘Assessment of the Quality of Data Used for Direct Estimation of Infant and Child Mortality in DHS-II Surveys,’ Occasional Papers No. 3. Calverton, MD: Macro International Inc.

Cutler, D. A. Deaton and A. Lleras-Muney (2006) ‘The Determinants of Mortality,’ Journal of Economic Perspectives, 20: 97-120.

Deaton, A. (2006) ‘Global Patterns of Income and Health: Facts, Interpretations, and Policies,’ NBER Working Paper 12735.

Dollar, D. and A. Kraay. (2000) ‘Trade, growth, and poverty’, World Bank Policy Research Working Paper 2615.

Easterlin, R. (1999) ‘How Beneficent is the Market? A Look at the Modern History of Mortality,’ European Review of Economic History, 3(3): 257-294.

Easterly, W. and R. Levine (2003) ‘Tropics, germs, and crops: the role of endowments in economic development’, Journal of Monetary Economics, 50:1.

Engerman, S. L., and K. L. Sokoloff (1997) ‘Factor Endowments, Institutions, and Differential Paths of Growth Among New World Economies: A View from Economic Historians of the United States’ in S. Haber (ed.), How Latin America Fell Behind. Stanford, Calif.: Stanford University Press.

Food and Agricultural Organization. FAOClim-Net. http://geonetwork3.fao.org/climpag/agroclimdb_en.php?act=:@&act2=0.2

Food and Agricultural Organization (2003) The Digital Soil Map of the World Version 3.6, Land and Water Development Division, FAO, Rome.

Filmer, D. & Pritchett, L. (1997) ‘Child mortality and public spending on health : how much does money matter?’ World Bank Policy Research Working Paper No. 1864.

Filmer, D. and L. Pritchett (1998) ‘The Effect of Household Wealth on Educational Attainment: Demographic and Health Survey Evidence’, World Bank Policy Research Working Paper No. WPS1980.

Filmer, D. and K. Scott (2008) ‘Assessing asset indices,’ World Bank Policy Research Working Paper No. 4605.

Fotso, J.C. (2007) ‘Urban-rural differentials in child malnutrition: trends and socioeconomic correlates in sub-Saharan Africa,’ Health and Place, 13(1): 205-23.

Frankel and Romer (1999) ‘Does Trade Cause Growth?’ American Economic Review, 89:379-399.

Gallup, J., J. Sachs, and A. Mellinger (1999) ‘Geography and Economic Development,’ International Regional Science Review, 22(2): 179-232.

Glewwe, Paul. (1999) ‘Why Does Mother’s Schooling Raise Child Health in Developing Countries? Evidence from Morocco’, The Journal of Human Resources, 34 (1): 124-159

Griffiths, I. (1986) ‘The Scramble for Africa: Inherited Political Boundaries’, The Geographical Journal, 152(2): 204-216.

Guo, G., and L.M. Grummer-Strawn (1993) ‘Child Mortality among Twins in Developed Countries’, Population Studies, 47(3): 495-510.

Gyimah, S. Obeng (2006). ‘Cultural background and infant survival in Ghana’, Ethnicity and Health, 11(2): 101-120.

Haaga, J.G. (1991) ‘Mechanisms for the Association of Maternal Age, Parity, and Birth Spacing with Infant Health’, RAND Note N-2991-RF.

Heffner, L. (2004) ‘Advanced Maternal Age - How Old is Too Old?’ New England Journal of Medicine, 351(19):1927-29.

Hobcraft, J.N., J.W. McDonald, and S.O. Rutstein (1983) ‘Child-Spacing Effects on Infant and Early Child Mortality’, Population Index, 49(4):585-618.

Hobcraft, J.N., J.W. McDonald, and S.O. Rutstein (1985) ‘Demographic determinants of infant and early child mortality: A comparative analysis’, Population Studies, 39:363-85.

Jones, G., R. W Steketee, R. E. Black, Z. A Bhutta, and S. S Morris (2003) ‘How many child deaths can we prevent this year? (Child survival II)’, The Lancet, 362.9377:65.

Justesen A & Kunst A (2000) ‘Postneonatal and child mortality among twins in Southern and Eastern Africa’, International Journal of Epidemiology, 29: 678–683.

Mahy, M. (2003) ‘Childhood mortality in the developing world: a review of evidence from the demographic and health surveys’, DHS comparative reports no. 4 Calverton, MD: ORC Macro.

Masters, W.A. and M.S. McMillan (2001) ‘Climate and Scale in Economic Growth’, Journal of Economic Growth, 6: 167-186.

McArthur, J. W. and J. D. Sachs (2001) ‘Institutions and Geography: Comment on Acemoglu, Johnson and Robinson’, NBER Working Paper No. 8114.

McKeown T. (1976) The Modern Rise of Population. New York, NY: Academic Press.

Mehlum, H. K Moene, and R. Torvik (2006) ‘Institutions and the Resource Curse,’ Economic Journal 116:1-20.

Mosley, W.H, and L.C. Chen (1984) ‘An analytic framework for the study of child survival in developing countries,’ Population and Development Review 10: 25- 45.

National Imagery and Mapping Agency. VMAP0. Download from http://gis-lab.info/qa/vmap0-eng.html.

Penders, C.and J. Staatz (2001) ‘The Impact of Household-Level Determinants on Child Health and Nutrition: Cross-Country Evidence from West Africa’, Staff Paper, Michigan State University, Department of Agricultural, Food, and Resource Economics Paper 11579.

Preston, S. (1975) ‘The Changing Relation between Mortality and Level of Development,’Population Studies 29: 23-48.

Preston, S. (1985) ‘Mortality and development revisited,’ Population Bulletin of the United Nations, No. 18 : 34-40.

Pritchett, Lant, and Lawrence H. Summers (1996) ‘Wealthier is Healthier’, Journal of Human Resources 31(4):841-868.

Ravallion, M. (1997) ‘Good and Bad Growth: the Human Development Reports,’ World Development 25(5): 631-38.

Razzaque, A., N. Alam, L.Wai, and A. Foster (1990) ‘Sustained Effects of the 1974-5 Famineon Infant and Child Mortality in a Rural Area of Bangladesh,’ Population Studies 44(1): 145-154

Rodrik, D., A. Subramanian, and F. Trebbi (2004) ‘Institutions Rule: The Primacy of Institutions over Geography and Integration in Economic Development’, Journal of Economic Growth 9: 131-165.

Rutstein, S.O. (2008) ‘Further evidence of the effects of preceding birth intervals on neonatal, infant, and under-five-years mortality and nutritional status in developing countries : evidence from the demographic and health surveys,’ DHS working papers, no. 41.

Sachs, J.D. (2003) ‘Institutions Don’t Rule: Direct Effects of Geography on Per Capita Income’, NBER Working Paper No. 9490.

Sachs, J.D. (2001) ‘Tropical Underdevelopment’, NBER Working Paper No. 8119.

Sachs, Jeffrey D., and Andrew Warner. (2001). ‘The Curse of Natural Resources,’ European Economic Review 45: 827-838.

Soares, R. (2007) “On the Determinants of Mortality Reductions in the Developing World,” Population and Development Review 33: 247-87.

Svedberg, P. (1996) ‘Gender biases in sub-Saharan Africa: Reply and further evidence,’Journal of Development Studies 32(6):933-943.

Svedberg, P. (1990)`Undernutrition in Sub-Saharan Africa: Is There a Gender Bias? Journal of Development Studies. 26 (3): pp.469-86.

Sullivan, J.M. S.O. Rutstein, G.T. Bicego. (1994) ‘Infant and Child Mortality,’ DHS Comparative Studies # 15.

UNAIDS (2000) AIDS in Africa: country by country. UNAIDS: Geneva, Switzerland.

UNICEF (2010) A successful start in life: Improving breastfeeding in West and Central Africa. www.unicef.fi/files/unicef/tutkimukset/Improving_breastfeeding_en.pdf

U.S. Department of State (1972) International Boundary Study No. 126 Ghana-Togo Boundary.

U.S. Department of State (1973) International Boundary Study No. 138 Cote D’Ivoire-Ghana Boundary.

Van de Poel, E., O. O’Donnell, and E. van Doorslaer (2007) ‘Are Urban Children Really Healthier?’ Tinbergen Institute Discussion Paper: TI 2007-035/3.

Wagstaff, A. and N. Watanabe (2003) ‘What difference does the choice of SES make in health inequality measurement?,’ Health Economics 12(10): 885-890.

Wilmoth T.A. and J.P. Elder (1995) ‘An assessment of research on breastfeeding promotion strategies in developing countries,’ Soc Sci Med 41:579-594. World Health Organization (2006) http://www.afro.who.int/home/countries/fact_sheet.

World Health Organization (2008) ‘HIV transmission through breastfeeding : a review of available evidence : 2007 update,’ http://whqlibdoc.who.int/publications/2008/9789241596596_eng.pdf.

Zartman, W. (1965) ‘The Politics of Boundaries in North and West Africa’, The Journal of Modern African Studies 3(2): 155-173.