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Are urban children really healthier? Evidence from 47 developing countries

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  • Van de Poel, Ellen
  • O'Donnell, Owen
  • Van Doorslaer, Eddy

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. Using micro-data on child health taken from the most recent Demographic and Health Surveys for 47 developing countries, the purpose of this paper is threefold. First, we document the magnitude of rural-urban disparities in child nutritional status and under-5 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. The results demonstrate that there are considerable rural-urban differences in mean child health outcomes in the entire developing world. The rural-urban gap in stunting does not entirely mirror the gap in under-5 mortality. The most striking difference between the two is in the Latin American and Caribbean region, where the gap in growth stunting is more than 1.5 times higher than that in mortality. On average, the rural-urban risk ratios of stunting and under-5 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%. We confirm earlier findings of higher socioeconomic inequality in stunting in urban areas and demonstrate that this also holds for under-5 mortality. 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.

Suggested Citation

  • Van de Poel, Ellen & O'Donnell, Owen & Van Doorslaer, Eddy, 2007. "Are urban children really healthier? Evidence from 47 developing countries," Social Science & Medicine, Elsevier, vol. 65(10), pages 1986-2003, November.
  • Handle: RePEc:eee:socmed:v:65:y:2007:i:10:p:1986-2003
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    References listed on IDEAS

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    1. Maurice Mutisya & Moses W. Ngware & Caroline W. Kabiru & Ngianga-bakwin Kandala, 2016. "The effect of education on household food security in two informal urban settlements in Kenya: a longitudinal analysis," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 8(4), pages 743-756, August.
    2. Liu, Hong & Fang, Hai & Zhao, Zhong, 2013. "Urban–rural disparities of child health and nutritional status in China from 1989 to 2006," Economics & Human Biology, Elsevier, pages 294-309.
    3. Ellen Poel & Owen O'donnell & Eddy Doorslaer, 2009. "What explains the rural-urban gap in infant mortality: Household or community characteristics?," Demography, Springer;Population Association of America (PAA), vol. 46(4), pages 827-850, November.
    4. Hernández-Quevedo, Cristina & Masseria, Cristina, 2013. "Measuring Income-Related Inequalities in Health in Multi-Country Analysis/Midiendo las desigualdades en salud relacionadas con la renta entre países," Estudios de Economía Aplicada, Estudios de Economía Aplicada, vol. 31, pages 455-476, Septiembr.
    5. Costa-Font, Joan & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores, 2014. "Income inequalities in unhealthy life styles in England and Spain," Economics & Human Biology, Elsevier, vol. 13(C), pages 66-75.
    6. Mesbah Fathy Sharaf & Ahmed Shoukry Rashad, 2016. "Regional inequalities in child malnutrition in Egypt, Jordan, and Yemen: a Blinder-Oaxaca decomposition analysis," Health Economics Review, Springer, pages 1-11.
    7. E. Van de Poel & O. O'Donnell & E. Van Doorslaer, 2009. "The Health Penalty of China's Rapid Urbanization," Tinbergen Institute Discussion Papers 09-016/3, Tinbergen Institute.
    8. FLEURBAEY, Marc & SHOKKAERT, Erik, "undated". "Equity in health and health care," CORE Discussion Papers RP 2373, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
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    10. 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;Population Association of America (PAA), vol. 48(2), pages 531-558, May.
    11. Payal Hathi & Sabrina Haque & Lovey Pant & Diane Coffey & Dean Spears, 2017. "Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries," Demography, Springer;Population Association of America (PAA), vol. 54(1), pages 337-360, February.
    12. 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.
    13. Fernald, Lia C.H. & Hidrobo, Melissa, 2011. "Effect of Ecuador's cash transfer program (Bono de Desarrollo Humano) on child development in infants and toddlers: A randomized effectiveness trial," Social Science & Medicine, Elsevier, vol. 72(9), pages 1437-1446, May.
    14. Erreygers, Guido & Clarke, Philip & Van Ourti, Tom, 2012. "“Mirror, mirror, on the wall, who in this land is fairest of all?”—Distributional sensitivity in the measurement of socioeconomic inequality of health," Journal of Health Economics, Elsevier, vol. 31(1), pages 257-270.
    15. repec:eee:cysrev:v:80:y:2017:i:c:p:41-51 is not listed on IDEAS
    16. Laura B. Nolan, 2016. "Rural–Urban Child Height for Age Trajectories and Their Heterogeneous Determinants in Four Developing Countries," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 35(5), pages 599-629, October.
    17. Lara Cockx & Liesbeth Colen & Joachim De Weerdt, 2017. "From Corn to Popcorn? Urbanization and Food Consumption in sub-Sahara Africa: Evidence From Rural-Urban Migrants in Tanzania," LICOS Discussion Papers 39017, LICOS - Centre for Institutions and Economic Performance, KU Leuven.
    18. 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;Southern Demographic Association (SDA), vol. 29(3), pages 275-296, June.
    19. -, 2008. "Millennium development goals: progress towards the right to health in Latin america and the Caribbean," Libros y Documentos Institucionales, Naciones Unidas Comisión Económica para América Latina y el Caribe (CEPAL), number 2919 edited by Eclac.
    20. Emily Smith-Greenaway & Jenny Trinitapoli, 2014. "Polygynous Contexts, Family Structure, and Infant Mortality in Sub-Saharan Africa," Demography, Springer;Population Association of America (PAA), vol. 51(2), pages 341-366, April.
    21. Paraje, Guillermo, 2009. "Child stunting and and socio-economic inequality in Latin America and the Caribbean," Revista CEPAL, Naciones Unidas Comisión Económica para América Latina y el Caribe (CEPAL), December.
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    23. Günther Fink & Isabel Günther & Kenneth Hill, 2014. "Slum Residence and Child Health in Developing Countries," Demography, Springer;Population Association of America (PAA), vol. 51(4), pages 1175-1197, August.
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