Principal investigator: Viviane Pires Ribeiro
Article title: SANITATION AND EDUCATION: SUBSTITUTE OR COMPLEMENTARY GOODS?
Article authors: Ana Lúcia Kassouf
Location of the intervention: Brazil
Sample size: 63 thousand individuals
Main theme: Health Insurance
Type of Intervention: The effect of the interaction between maternal education and basic sanitation on child health.
Primary variable of interest: Children's health
Evaluation method: Experimental Evaluation (RTC)
Evaluation Context
In 1993, malnutrition and infectious diseases were the main causes of high infant mortality rates in developing countries, primarily due to lack of water supply and sanitation. United Nations It was estimated that in 1992, more than 60% of Brazilian children aged zero to four lived in homes with inadequate sanitation, reaching 90% in the Northeast. In this context, Kassouf (1995) observes that many studies conducted at the time show the positive relationship between the mother's level of education and the children's health, while some others portray the benefits of basic sanitation for children's health; however, few focus on studying the interaction between education and sanitation. Recognizing this gap, the author's main objective in her work is to observe the effect of the interaction between maternal education and basic sanitation (piped water and sewage) on the health of children in different age groups.
Intervention Details
The data used by Kassouf (1995) were taken from the National Survey on Health and Nutrition (PNSN), collected in 1989. The data collection was sponsored by the National Institute of Food and Nutrition (INAN) and carried out with the technical collaboration of the Brazilian Institute of Geography and Statistics (IBGE) and the Institute for Applied Economic Research (IPEA). The PNSN sample covers all regions of Brazil and has information at the individual level, with approximately 63 individuals interviewed in 17.920 households. The authors selected all households with children aged zero to five years, identifying the father, mother, and other family members in each household to obtain information such as salary, income, education, age, etc.
Exclusive
The model used by Kassouf (1995) is the one developed by Becker (1965), in which health is seen as a non-market good, or, as Becker called it, "Good Z". Therefore, parents are responsible for producing the health of their children, since it is produced at home through maternal and medical care, nutrition, good phytosanitary housing conditions, absence of pollution, etc. Thus, the fact that children are healthy increases the utility of the parents.
The dependent variable used in the reduced form to indicate children's health or nutrition is the height-for-age Z-statistic, a measure that detects levels of chronic malnutrition. Variables such as age, sex, and race of the children are used to control for biological characteristics and to detect any type of discrimination. Since the reduced form of health demand equations only presents exogenous variables on the right-hand side of the equation, the Ordinary Least Squares (OLS) technique is used to estimate the parameters.
Results
The results found by the authors show that almost 13% of children aged zero to five years in Brazil suffered from chronic or long-term malnutrition in 1989, as measured by the height-for-age Z-statistic. The reduced-form equations for children's health, estimated by OLS (Organic Less than Multiplication), for different age groups, indicate that the mother's educational level, measured in years of schooling, unlike the father's, had a large positive effect on the children's health, increasing from newborns to ages up to two years, and decreasing again in the three-to-five-year-old age group.
Similarly, basic sanitation, represented by the availability of piped water and sewage systems in homes, showed a significant positive effect on children's health. The interaction between these variables, maternal education and basic sanitation, shows a negative coefficient for almost all age groups, indicating a substitutable relationship between these factors. Children whose mothers are illiterate or have low levels of education need better home infrastructure to maintain adequate health. On the other hand, mothers with high levels of education can protect their children when basic sanitation (piped water and sewage systems) is lacking.
Lessons in Public Policy
Understanding the relationship between maternal education and basic sanitation on the health of children at different age groups is of great importance in assisting government measures aimed at reducing sanitation and education problems in the country, in order to improve the quality of life of the population.
Inadequate water supply and sanitation, exacerbated by low educational levels and therefore poor hygiene, make the domestic environment a source of high health risks for the population. Governments could raise the population's health and nutrition levels by improving these environments through investments in education and basic sanitation. On the other hand, improving water supply and sewage services in the most precarious regions, for example, would reduce the demand for medical services, which would lead to a reduction in government spending on health.
References
KASSOUF, AL Sanitation and education: Substitute or complementary goods. ANPEC. XXII National Meeting of Economics, 1995.
