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Urban poverty and health in developing countries: Household and neighborhood Effects

  • Mark Montgomery

    ()

  • Paul Hewett

In the U.S. and other high-income countries, where most of the population lives in urban areas, there is intense scholarly and program interest in the effects of household and neighborhood living standards on health. Yet very few studies of developing-country cities have examined these issues. This paper investigates whether in these cities, the health of women and young children is influenced by both household and neighborhood standards of living. Using data from the urban samples of some 85 Demographic and Health surveys, and modelling living standards using factor-analytic MIMIC methods, we find, first, that the neighborhoods of poor households are more heterogeneous than is often asserted. To judge from our results, it appears that as a rule, poor urban households do not tend to live in uniformly poor communities; indeed, about 1 in 10 of a poor household's neighbors is relatively affluent, belonging to the upper quartile of the urban distribution of living standards. Do household and neighborhood living standards influence health? Applying multivariate models with controls for other socioeconomic variables, we discover that household living standards have a substantial influence on three measures of health: unmet need for modern contraception; birth attendance by doctors, nurses, or trained midwives; and children's height for age. Neighborhood living standards exert significant additional influence on health in many of the surveys we examine, especially in birth attendance. There is considerable evidence, then, indicating that both household and neighborhood living standards can make a substantively important difference to health.

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File URL: http://hdl.handle.net/10.1353/dem.2005.0020
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Article provided by Springer & Population Association of America (PAA) in its journal Demography.

Volume (Year): 42 (2005)
Issue (Month): 3 (August)
Pages: 397-425

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Handle: RePEc:spr:demogr:v:42:y:2005:i:3:p:397-425
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  1. Mark Montgomery & Paul Hewett, 2005. "Urban poverty and health in developing countries: Household and neighborhood Effects," Demography, Springer;Population Association of America (PAA), vol. 42(3), pages 397-425, August.
  2. Åberg Yngwe, Monica & Fritzell, Johan & Lundberg, Olle & Diderichsen, Finn & Burström, Bo, 2003. "Exploring relative deprivation: Is social comparison a mechanism in the relation between income and health?," Social Science & Medicine, Elsevier, vol. 57(8), pages 1463-1473, October.
  3. Sahn, David E. & Stifel, David C., 2000. "Poverty Comparisons Over Time and Across Countries in Africa," World Development, Elsevier, vol. 28(12), pages 2123-2155, December.
  4. Nan Marie Astone & Constance A. Nathanson & Robert Schoen & Young J. Kim, 1999. "Family Demography, Social Theory, and Investment in Social Capital," Population and Development Review, The Population Council, Inc., vol. 25(1), pages 1-31.
  5. Deon Filmer & Lant Pritchett, 1999. "The Effect of Household Wealth on Educational Attainment: Evidence from 35 Countries," Population and Development Review, The Population Council, Inc., vol. 25(1), pages 85-120.
  6. World Bank, 2002. "Cali, Colombia : Toward a City Development Strategy," World Bank Publications, The World Bank, number 14086, April.
  7. Donna Ginther & Robert Haveman & Barbara Wolfe, 2000. "Neighborhood Attributes as Determinants of Children's Outcomes: How Robust Are the Relationships?," Journal of Human Resources, University of Wisconsin Press, vol. 35(4), pages 603-642.
  8. McDade, Thomas W. & Adair, Linda S., 2001. "Defining the "urban" in urbanization and health: a factor analysis approach," Social Science & Medicine, Elsevier, vol. 53(1), pages 55-70, July.
  9. John B. Casterline & Steven W. Sinding, 2000. "Unmet Need for Family Planning in Developing Countries and Implications for Population Policy," Population and Development Review, The Population Council, Inc., vol. 26(4), pages 691-723.
  10. Anna Hardman & Yannis Ioannides, 2004. "Income Mixing and Housing in U.S. Cities: Evidence from Neighborhood Clusters of the American Housing Survey," Discussion Papers Series, Department of Economics, Tufts University 0420, Department of Economics, Tufts University.
  11. Mark Montgomery & Michele Gragnolati & Kathleen Burke & Edmundo Paredes, 2000. "Measuring living standards with proxy variables," Demography, Springer;Population Association of America (PAA), vol. 37(2), pages 155-174, May.
  12. Wen, Ming & Browning, Christopher R. & Cagney, Kathleen A., 2003. "Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health," Social Science & Medicine, Elsevier, vol. 57(5), pages 843-860, September.
  13. Gilson, Lucy, 2003. "Trust and the development of health care as a social institution," Social Science & Medicine, Elsevier, vol. 56(7), pages 1453-1468, April.
  14. Narayan Sastry, 1996. "Community characteristics, individual and household attributes, and child survival in brazil," Demography, Springer;Population Association of America (PAA), vol. 33(2), pages 211-229, May.
  15. McCulloch, Andrew, 2003. "An examination of social capital and social disorganisation in neighbourhoods in the British household panel study," Social Science & Medicine, Elsevier, vol. 56(7), pages 1425-1438, April.
  16. Anne Pebley & Noreen Goldman & Germán Rodríguez, 1996. "Prenatal and delivery care and childhood immunization in guatemala: Do family and community matter?," Demography, Springer;Population Association of America (PAA), vol. 33(2), pages 231-247, May.
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