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


  • Amy Ickowitz


Ghana has the lowest under-five mortality rate in West Africa. Understanding why Ghana's child mortality rate is lower than in neighbouring 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 favourable 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 neighbours—Burkina Faso, the Ivory Coast 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 neighbours. 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 the Ivory Coast. These results suggest that even poor countries that have been ‘cursed’ by bad geography can potentially improve development outcomes and save children's lives. Copyright 2012 , Oxford University Press.

Suggested Citation

  • 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.
  • Handle: RePEc:oup:jafrec:v:21:y:2012:i:2:p:192-227

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    References listed on IDEAS

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    Cited by:

    1. Pérez-Moreno, Salvador & Blanco-Arana, María C. & Bárcena-Martín, Elena, 2016. "Economic cycles and child mortality: A cross-national study of the least developed countries," Economics & Human Biology, Elsevier, vol. 22(C), pages 14-23.

    More about this item

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • O10 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - General
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development
    • O55 - Economic Development, Innovation, Technological Change, and Growth - - Economywide Country Studies - - - Africa


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