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The Economics of Child Health and Other Aspects of Childhood Development

Paper Session

Saturday, Jan. 5, 2019 8:00 AM - 10:00 AM

Hilton Atlanta, 309-310-311
Hosted By: International Health Economics Association
  • Chair: Albert A. Okunade, University of Memphis

Minimum Wages and Child Health in Indonesia

Jere Behrman
University of Pennsylvania
Farhan Majid
Rice University


Early life environmental conditions play a critical role in well-being over the life-course. Most studies have treated extreme and less commonly observed shocks, such as famines, as natural experiments to study the causal impact of early life conditions. However, little attention is paid to the potential of labor market institutions, specifically income protection legislation, in shaping opportunities for investing in early life health and the subsequent impact on early life health outcomes.
We study minimum wages around the time of birth and their effects on child stunting in Indonesia up to 5 years after birth. Indonesia is interesting not only because it carries the fifth highest burden of stunted children in the world, but also because minimum wages are an integral part of their social policy debate where protests by workers are a regular occurrence.
To the extent that minimum wages influence parental wage income, they might affect parental investments in child health. For example, if wages were to increase, families might be more likely to avail themselves of health services and engage in other salutary behaviors which may be particularly effective around the time of birth. However, mothers may also be more likely to spend more time in the labor market at the expense of care-giving activities. The time around birth is widely understood to be critical period in shaping child nutrition and stunting levels, so that changes in parental economic conditions may have particularly large effects on child health and nutrition
Using variation in annual fluctuations in real minimum wages in different provinces of Indonesia, we find that children exposed to increases in minimum wages in the year of birth have higher height-for-age (HAZ) scores in the first five years of their lives.

How Do Early-Life Shocks Interact with Subsequent Human Capital Investments? Evidence from Administrative Data

Valentina Duque
University of Sydney


We explore how early-life shocks interact with subsequent human capital investments to influence children’s long-term outcomes. Using large-scale administrative data from Colombia, we combine a difference-in-difference framework with a regression discontinuity design to exploit two sources of exogenous variation: i) early-life exposure to adverse weather shocks that reduce children’s initial skills and ii), the introduction of conditional cash transfers (CCT) that promote investments in children’s health and education. We show that the timing and type of CCT-induced investments matter for both the effects of CCTs and their interactive effects with weather shocks. When the CCT-induced investments occur in sensitive periods of human capital formation (e.g., early childhood), the effects are large and their interactive effects with weather conditions suggest that the returns of the program are even larger for children exposed to “normal” weather conditions. In contrast, CCT-induced investments that come relatively late in childhood (e.g., adolescence), have a smaller “main” effect and a smaller or zero interactive effect with weather shocks. We also find that initial CCT-induced health investments tend to have larger returns than initial CCT-induced educational investments. These findings shed new light on the developmental production function for human capital and the role of social policies in closing gaps generated by early-life adversities.

Constitutional Social and Environmental Human Rights and Child Health Outcomes in Latin American Countries

Hiroaki Matsuura
Shoin University


This paper analyzes the health-improving effects of introducing four different constitutional social and environmental human rights (health, free education, adequate living or welfare, and environment) and the American Convention on Human Rights (ACHR) into national constitution and jurisprudence in Latin America, where human rights litigations are particularly active. By using retrospective fertility surveys conducted in 15 Latin American countries from the Demographic and Health Surveys (DHS), I compare the survival of infants born to the same mother before and after the introduction of four different constitutional human rights and the ACHR. This is to disentangle the effects of these rights from changes in other country-level characteristics. The major results are as follows. (1) No constitutional social and environmental rights significantly change the total amount and composition of government spending. (2) Introducing a right to health into the national constitution is associated with a 2.6 percent subsequent reduction in infant deaths among poor mothers, but not associated with infant deaths among the general population. (3) The right to education, welfare, and environment and the ratification of the ACHR are not associated with a subsequent reduction in infant deaths. (4) The effects of a right to health are robust after allowing for total government spending and its composition (health, education, and social security and welfare spending), which indicates that the allocation of government health spending rather than an absolute amount of spending induced by the constitutional right to health might be important to reduce infant deaths among poor mothers.

Child Mortality After a Natural Disaster: An Estimation of the Long-Term Effect of the Indian Ocean Tsunami on Under-5 Mortality

Aurelia Lepine
London School of Hygiene and Tropical Medicine
Eric Strobl
University of Bern
Maria Restuccio
Advisory Board Company


The 2004 Indian Ocean tsunami was an international natural disaster unlike any seen before, killing 166,561 people in Aceh province, Indonesia. The tsunami prompted an unprecedented humanitarian response and was a catalyst in ending almost 30 years of civil conflict in Aceh. We use a synthetic control method to estimate the effect of the 2004 tsunami in Aceh on child mortality indicators the years that followed the disaster. We find that the tsunami led to a significant increase in under-5 mortality the year that followed the tsunami. Children aged 1-4 years were affected in 2005; we show that this is likely to be explained by the lack of access to safe water and sanitation. We however find that children under-1 were affected both in 2005 but also in 2009, which coincides with the end of aid relief. The resilience of Aceh province points to the importance of coordinated and sustainable international disaster response as well as the use of international disaster diplomacy to strengthen peace and governance. However, the results also highlight the importance of capacity building to strengthen health systems.
R. Vincent Pohl
University of Georgia
Eeshani Kandpal
World Bank
Ana Balsa
University of Montevideo
David Bishai
Johns Hopkins University
JEL Classifications
  • I1 - Health
  • I1 - Health