What Matters in Child Health: An Instrumental Variable Analysis
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What Matters in Child Health: An Instrumental Variable Analysis Uzma Afzal
Accepted: 26 February 2013 # Springer Science+Business Media Dordrecht 2013
Abstract This paper studies factors that affect health and the nutritional status of children under the age of five. It attempts to identify the impact of socioeconomic factors such as household characteristics, parental education, community-level infrastructure and health knowledge on the health (measured by height and weight) of children. The study’s theoretical framework is based on the household production model and the instrumental variable technique has been implemented for estimation. Household income, illness from diarrhea and vitamin A supplements for children are treated as endogenous variables and have been instrumented. The paper uses data from Pakistan—Multiple Indicator Cluster Survey (MICS) for 2007/08 for Punjab which is a household level dataset gathered by the Punjab Bureau of Statistics. The results suggest that maternal education, health knowledge and household characteristics are important determinants of child health, among other significant indicators. The channel through which maternal education affects child health is considered to be better nurturing and healthcare since the income effect of education is controlled by household income. Household characteristics—income, the number of household members, ownership of durables—prove to significantly affect the health of children in that household. Another important finding of this paper is that female children under five have better height and weight z-scores than their male counterparts. This finding rejects the common presumption of gender bias at the household level in South Asia in early years of life. Keywords Child health . Nutritional status . Maternal education . Health knowledge . Instrumental variable technique . Pakistan
U. Afzal (*) Center for Research in Economics and Business (CREB), Lahore School of Economics, Main Campus: Intersection Main Boulevard, Phase VI DHA and Burki Road, Burki, 53200 Lahore, Pakistan e-mail: [email protected]
U. Afzal
1 Introduction Child health is considered a key indicator of both economic development and the quality of life in developing countries. It is also closely related to other development indicators such as adult health, educational attainment, income, socioeconomic status, and occupational productivity (see, for instance, Behrman and Deolalikar 1987; Case et al. 2002; Chen and Li 2006; Glewwe 1999). This study focuses on the health and nutritional status of children in Punjab. By conducting a cross-sectional empirical analysis for the year 2007/08, this paper attempts to identify the socioeconomic factors that affect child health at the household level, and presents policy recommendations based on these findings. In 2000, 189 member countries of the United Nations adopted the Millennium Development Goals (MDGs), of which at least four of eight goals directly address the issues of child health or nutritional status (Chen and Li 2006; Un
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