Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries

Abstract

A long literature in demography has debated the importance of place for health, especially children's health. In this study, we assess whether the importance of dense settlement for infant mortality and child height is moderated by exposure to local sanitation behavior. Is open defecation (i.e., without a toilet or latrine) worse for infant mortality and child height where population density is greater? Is poor sanitation is an important mechanism by which population density influences child health outcomes? We present two complementary analyses using newly assembled data sets, which represent two points in a trade-off between external and internal validity. First, we concentrate on external validity by studying infant mortality and child height in a large, international child-level data set of 172 Demographic and Health Surveys, matched to census population density data for 1,800 subnational regions. Second, we concentrate on internal validity by studying child height in Bangladeshi districts, using a new data set constructed with GIS techniques that allows us to control for fixed effects at a high level of geographic resolution. We find a statistically robust and quantitatively comparable interaction between sanitation and population density with both approaches: open defecation externalities are more important for child health outcomes where people live more closely together.

Disease externalities and net nutrition: Evidence from changes in sanitation and child height in Cambodia, 2005–2010

“…If so, then because children are more exposed to others’ fecal pathogens where people live nearer together, we would further expect that open defecation should have a steeper association with child height in urban areas, where population density is particularly high (Hathi et al, 2014, Bateman et al, 1993, Bateman and Smith, 1991). We test this by introducing an interaction between prevalence of open defecation in the locality and an urban dummy to the specification in Column 2 of Table 2.…”

Sanitation and child health in India

“…ivt is a vector which incorporates the sanitation status of all other households in village v, and P vt is a vector of prices (including wage) at the village level for a given period, t. 4 The Frish demand functions are of the following form:…”

“…A reduced form expression for toilet ownership can also be derived: 4 Notice that if household i has an important weight in determining ES vt , S −i ivτ might be a function of {X ivτ , Z ivτ , P ivτ , ε 2ivτ , ε 1ivτ } T τ =t+1 . Given this, household's i best response implies that the demands should include moments for all future variables of all individuals in the village{{X ιvτ , Z ιvτ , P ιvτ , ε 2ιvτ , ε 1ιvτ } T τ =t+1 } Iv ι=1 .…”

“…This puts Gwalior above the country average of about 17% of urban households living in slums according to the 2011 slum census. This is an important population to study since on the one hand, they typically live in very crowded conditions, implying more important sanitation externality links (see for example Hathi et al [2014]), while at the same time experiencing on average worse access to sanitation than the already low national average. The 2008-09 National Sample Survey Organisation [NSSO, 2010] survey estimates that 81 per cent of slum-dwellers in India have inadequate access to sanitation, which compares to national urban sanitation coverage rates of 26% in 2011.…”

Sustainable Sanitation for All

“…Sanitation is widely recognized as an important determinant of early child health, especially where population density is high (Cutler and Miller, 2005;Hathi et al, 2014). Poor sanitation spreads bacterial, viral, and parasitic infections, including diarrhoea, polio, cholera, and hookworm (Feachem et al, 1983;Chambers and von Medeazza, 2014).…”