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Are Urban Children really healthier?

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Author Info

  • Ellen van de Poel

    ()
    (Erasmus University Rotterdam)

  • Owen O'Donnell

    ()
    (Erasmus University Rotterdam, University of Macedonia, Thessaloniki, Greece)

  • Eddy van Doorslaer

    ()
    (Erasmus University Rotterdam)

Abstract

On average, child health outcomes are better in urban than in rural areas of developing countries. Understanding the nature and the causes of this rural-urban disparity is essential in contemplating the health consequences of the rapid urbanization taking place throughout the developing world and in targeting resources appropriately to raise population health. We use micro data on child health taken from the most recent Demographic and Health Surveys for 47 developing countries. First, we document the magnitude of rural-urban disparities in child nutritional status and under-five mortality across all 47 developing countries. Second, we adjust these disparities for differences in population characteristics across urban and rural settings. Third, we examine rural-urban differences in the degree of socioeconomic inequality in these health outcomes. We find considerable rural-urban differences in mean child health outcomes. The rural-urban gap in stunting does not entirely mirror the gap in under-five mortality. The most striking difference between the two is in the Latin American and Caribbean region, where the gap in stunting is more than 1.5 times higher than that in mortality. On average, the rural-urban risk ratios of stunting and under-five mortality fall by respectively 53% and 59% after controlling for household wealth. Controlling thereafter for socio-demographic factors reduces the risk ratios by another 22% and 25%. In a considerable number of countries, the urban poor actually have higher rates of stunting and mortality than their rural counterparts. The findings imply that there is a need for programs that target the urban poor, and that this is becoming more necessary as the size of the urban population grows. This discussion paper has resulted in a publication in Social Science & Medicine , 2007, 65(10), 1986-2003.

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Bibliographic Info

Paper provided by Tinbergen Institute in its series Tinbergen Institute Discussion Papers with number 07-035/3.

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Date of creation: 10 Apr 2007
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Handle: RePEc:dgr:uvatin:20070035

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Web page: http://www.tinbergen.nl

Related research

Keywords: child health; urban-rural inequality; nutrition; child mortality;

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References

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  1. Adam Wagstaff, 2005. "The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 429-432.
  2. Filmer, Deon & Pritchett, Lant, 1998. "Estimating wealth effects without expenditure data - or tears : with an application to educational enrollments in states of India," Policy Research Working Paper Series 1994, The World Bank.
  3. Sastry, Narayan, 1997. "What explains rural-urban differentials in child mortality in Brazil?," Social Science & Medicine, Elsevier, vol. 44(7), pages 989-1002, April.
  4. Wagstaff, Adam & Watanabe, Naoko, 2000. "Socioeconomic inequalities in child malnutrition in the developing world," Policy Research Working Paper Series 2434, The World Bank.
  5. Misselhorn, Mark & Harttgen, Kenneth, 2006. "A Multilevel Approach to Explain Child Mortality and Undernutrition in South Asia and Sub-Saharan Africa," Proceedings of the German Development Economics Conference, Berlin 2006 20, Verein für Socialpolitik, Research Committee Development Economics.
  6. Wang, Limin, 2003. "Determinants of child mortality in LDCs: Empirical findings from demographic and health surveys," Health Policy, Elsevier, vol. 65(3), pages 277-299, September.
  7. Erreygers, Guido, 2009. "Correcting the Concentration Index," Journal of Health Economics, Elsevier, vol. 28(2), pages 504-515, March.
  8. David E. Sahn & David C. Stifel, 2003. "Urban--Rural Inequality in Living Standards in Africa," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 12(4), pages 564-597, December.
  9. Wagstaff, Adam & Paci, Pierella & van Doorslaer, Eddy, 1991. "On the measurement of inequalities in health," Social Science & Medicine, Elsevier, vol. 33(5), pages 545-557, January.
  10. Fay, Marianne & Leipziger, Danny & Wodon, Quentin & Yepes, Tito, 2005. "Achieving child-health-related Millennium Development Goals: The role of infrastructure," World Development, Elsevier, vol. 33(8), pages 1267-1284, August.
  11. Ruel, Marie T. & Garrett, James L. & Morris, Saul Sutkover & Maxwell, Daniel G. & Oshaug, Arne & Engle, Patrice L. & Menon, Purnima & Slack, Alison T. & Haddad, Lawrence James, 1998. "Urban challenges to food and nutrition security," FCND discussion papers 51, International Food Policy Research Institute (IFPRI).
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Citations

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Cited by:
  1. Ellen Poel & Owen O'donnell & Eddy Doorslaer, 2009. "What explains the rural-urban gap in infant mortality: Household or community characteristics?," Demography, Springer, vol. 46(4), pages 827-850, November.
  2. Casabonne, Ursula & Kenny, Charles, 2012. "The Best Things in Life are (Nearly) Free: Technology, Knowledge, and Global Health," World Development, Elsevier, vol. 40(1), pages 21-35.
  3. ERREYGERS, Guido & CLARKE, Philip & VAN OURTI, Tom, 2010. "Mirror, mirror, on the wall, who in this land is fairest of all? Revisiting the extended concentration index," Working Papers 2010015, University of Antwerp, Faculty of Applied Economics.
  4. D. Omariba & Michael Boyle, 2010. "Rural–Urban Migration and Cross-National Variation in Infant Mortality in Less Developed Countries," Population Research and Policy Review, Springer, vol. 29(3), pages 275-296, June.
  5. Philippe Bocquier & Nyovani Madise & Eliya Zulu, 2011. "Is There an Urban Advantage in Child Survival in Sub-Saharan Africa? Evidence From 18 Countries in the 1990s," Demography, Springer, vol. 48(2), pages 531-558, May.
  6. Amy Ickowitz, 2012. "Wealthiest Is Not Always Healthiest: What Explains Differences in Child Mortality in West Africa?," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 21(2), pages 192-227, March.

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