Health Outcomes:
perspectives of a development economist
Philip Verwimp
Ecares and Centre Emile Bernheim
Brussels School of Economics and Management
Université Libre de Bruxelles
Brighton, June 30-July 1, 2011
State-of-the-art (1)
• Health is one of the most important indicators of
human well-being. It is also one of the most
important objectives of policy worldwide and it is
probably the domain in which human beings have
produced the most scientific output
• Research in the domain of human biology and
economics has recently focussed on the long-term
consequences of food deprivation during child hood
(Alderman, Hoddinott, and Kinsey, 2006, Strauss and
Thomas, 1998)
State-of-the-art (2)
• There is a biological mechanism that runs via food
deprivation. Undernutrition leads to stunting, which is an
indicator of the longer-term health status of a child.
(Martorel and Habicht, 1986)
• The medical literature has schown that there is only
partial catch-up in the event that conditions after age 0-5
improve subtantially
• This means that food deprivation in childhood has
consequences that will stay with the child throughout its
life in terms of reduced human development
Key questions
•
•
•
•
How does violent conflict impact health ?
What are the channels ?
Who is affected and under which conditions?
Is impact short term and reversible or longterm and (partly) irreversable
• What is the magnitude of impact ?
• How can policy prevent/lower the impact
New insights from Microcon
• Akresh, et al (2009,2011), Journal of Human
Resources, Economic Development and
Cultural Change
Exposure to violent conflict in child age 0-5 has
long-term negative consequences on the wellbeing of the child, in terms of health, school
participation, grade attainment, cognitive
development and income earnings potential
New insights (2)
• Undernutrition is an import part of the story
of the impact of conflict on child health, but it
is not the only one
• Apart from nutrition the exposure of children
to violent conflict also includes displacement,
no shelter, no access to health service, loss of
family members, trauma, ….
New insights (3)
• Akresh et all point out that the effects of civil war
are not the same as those of a crop failure or a
famine. Both will affect nutrition, but the effect of
the civil war will be more indiscriminate across
gender and income groups.
• At least in their research on Rwanda and Burundi
they find that the health status of boys as well as
girls, from rich as well as poor famillies, was
negatively affected by exposure to war, whereas
this was only the case for girls in poor households
in the event of crop failure
0
-1
-2
-3
-4
1/87
7/87
1/88
7/88
1/89
7/89
1/90
Month & Year of Birth
1/91
7/91
1/92
Rest of Country-Female
-4
-3
-2
-1
0
CropFailureRegion-Female
7/90
1/87
7/87
1/88
7/88
1/89
7/89
1/90
Month & Year of Birth
CropFailureRegion-Male
7/90
1/91
7/91
Rest of Country-Male
1/92
0
-1
-2
-3
-4
1/87
7/87
1/88
7/88
1/89
7/89
1/90
Month & Year of Birth
1/91
7/91
1/92
Rest of Country-Female
-4
-3
-2
-1
0
CivilWarRegion-Female
7/90
1/87
7/87
1/88
7/88
1/89
7/89
1/90
Month & Year of Birth
CivilWarRegion-Male
7/90
1/91
7/91
Rest of Country-Male
1/92
-1.5
-2
-2.5
-3
-20
-15
-10
-5
0
5
10
Months of War Exposure
95% CI
15
Height for Age Z-Score
20
25
New insights (4)
• Magnitude of the effcects ? In both our Burundi and
Rwanda samples the average exposure of our
children is somewhat higher than 1 year.
• We find that this lowers the child’s height-for-age zscore with about 1 standard deviation, As a result,
the child will start schooling on average 6 months,
obtain one grade less of schooling and earn a 15 to
20% lower wage as an adult.
Relevance for policy
• Exposure to violent conflict during childhood,
even short term, will have long-term negative
effects on the well-being of the child
• The effect runs through undernutrition, but
there are also other channels
• The effect is likely to be indiscriminate
• Prevention and intervention in childhood has
large pay-offs in terms of human development