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Title: Economic analysis of the socioeconomic determinants of child health : empirical evidence from developing countries and Pakistan
Author: Iram, Uzma
ISNI:       0000 0004 5347 2634
Awarding Body: University of Kent
Current Institution: University of Kent
Date of Award: 2014
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This dissertation is an empirical work dealing with child health issues in developing . countries and specifically in Pakistan where the emphasis is put on the analysis of the relationship between socioeconomic determinants and health impacts. The first chapter includes a general discussion of child health and its importance for economic development in Pakistan and other developing countries. Undoubtedly, the health of children and young people are among the most important health issues. In this regard, the under-five mortality rate is widely used as credible measure of child health in this study. Children tend to be most vulnerable in their first year of life when their health is influenced not only by their own physical condition but also by the social and environmental conditions of the household (Elder & Shanahan, 2006; Lerner et al., 2011). This strong relationship between child mortality and socioeconomic conditions has ensured its continued and widespread use in monitoring social inequalities in health. This is combined· with the fact that preventing early deaths is an effective approach to increasing life expectancy and the monitoring of child mortality rates remains a key component of effective public health action. This dissertation has three objectives. The first objective is to examine the socioeconomic determinants of child health as well as the environmental degradation and child malnutrition variables on child health across the panel countries. The second objective is to develop regression based decomposition analysis to measure the child health inequalities among different socioeconomic groups in Pakistan. The third objective of the study is to investigate the impact of women empowerment and relative bargaining power on child health in Pakistan. In order to reach the first objective, this study used panel data methods to estimate the determinants of child mortality employing World Bank data for 96 low and middle income countries. This study empirically examined the socioeconomic and environmental determinants of child mortality outcomes by applying various panel data estimation methods i.e, Pooled, Fixed Effect, R~dom Effect, 2SLS, 2SLS FE and system GMM. Moreover, the analysis also examined if fertility is causal to child mortality and the effect of fertility on child mortality using 2SLS. The analysis revealed that the System GMM estimate is the best model which suggests a positive and significant coefficient of lagged child mortality, implying that child mortality is persistent over time. The results provide strong evidence that women's education, women's labour participation, immunization coverage and real GDP per capita are important detelminants of child mortality for developing countries. Other important findings are that immunization coverage and environmental degradation have significant effects on child mor,tality. Overall the results suggest that more attention should be given to the economic costs of poor health associated with environmental damage such as air pollution. Immunization coverage and improved sanitation seyms to be much more effective in reducing child mortality in developing countries. Therefore, it is argued that investments in these specific activities will yield significant social benefits within the sample of countries examined. . The second objective is achieved through the application of a decomposition approach to explain socioeconomic inequalities in child health in Pakistan. Inequalities in child health are measured using the concentration index, which is then decomposed into its contributions to socioeconomic inequality in the observed determinants of child health. Data for the analysis came from the 1998/99, 2001102, 2005/06 and 2007/08 Pakistan Social and Living Standard Measurement Survey (PSLM). The analysis reveals that child under five mOliality inequalities are concentrated among socio-economic groups that are poor in Pakistan in all four years of the survey. Furthermore, the results from decomposition analysis shows that household income, urban residency, mother's education, no breastfeeding and having no sanitation facility each made a sizeable contribution to child health inequality. This study recommends that scaling up social and economic policies that are in alignment with child health policies could bridge the current avoidable and unjust gap between the child health of advantaged and disadvantaged groups in Pakistan. .'~ The third objective of this study is to evaluate the hypothesis that women empowerment and relative bargaining power is related to lower child mortality. This hypothesis is again tested using PSLM data from Pakistan. The study attempts to focus light on the status of women and the effect on early childhood mortality controlling for the effect of other associated determinants. To allow for unobservable heterogeneity across birth cohorts and geographical districts, this study constructs a pseudo panel for a sample of children under the age of five from three repeated cross sections observed in 2001/02, 2005/06, and 2007/08. It is evident by the results that women empowerment and women bargaining power seemed to have the strongest effect on child m011ality in Pakistan. This study concludes that empowerment of women bestows further benefit to society indicating that there is the need for increasing the incentives for good care of children. The health status of children clearly increases with lower mortality, and this probability is higher when women are more empowered to make decisions within the household, suggesting the need for interventions that increase women's financial and physical autonomy.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Children, Health care, Economic conditions