Sanitation and education: substitute or complementary goods?

Responsible researcher: Viviane Pires Ribeiro

Article title: SANITATION AND EDUCATION: SUBSTITUTE OR COMPLEMENTARY GOODS?

Article authors: Ana Lúcia Kassouf

Location of intervention: Brazil

Sample size: 63 thousand individuals

Big topic: Health

Type of Intervention: Effect of the interaction between maternal education and basic sanitation on child health

Variable of main interest: Child health

Evaluation method: Experimental Evaluation (RTC)

Assessment Context

In 1993, malnutrition and infectious diseases were mainly responsible for the high rate of infant mortality in developing countries, mainly caused by the lack of water supply and sanitation. The United Nations estimated that in 1992 more than 60% of Brazilian children aged zero to four lived in homes with inadequate sanitary facilities, reaching 90% in the Northeast. In this context, Kassouf (1995) realizes that many works carried out at the time show the positive role between the mother's level of education and the health of her children, while some others portray the benefits of the presence of basic sanitation for children's health, however , few focus on studying the interaction between education and sanitation. Realizing 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 Health and Nutrition Survey (PNSN), collected in 1989. The information survey 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 of Applied Economic Research (IPEA). The PNSN sample covers all regions of Brazil and has information at the individual level, with approximately 63 thousand individuals in 17,920 households being interviewed. The authors selected all households with children aged zero to five, identifying the father, mother and other family members in each of them to obtain information such as salary, income, education, age, etc.

Methodology

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 children's health, as this is produced at home through maternal and medical care, nutrition, good phytosanitary housing conditions, absence of pollution, etc. Therefore, the fact that children are healthy increases the parents' utility.

The dependent variable used in reduced forms 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 children are used to control biological characteristics and detect any type of discrimination. Since health demand equations in reduced form only present exogenous variables on the right 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, measured by the height-for-age Z statistic. The reduced form equations for children's health, estimated by OLS, for different age groups, indicate that the mother's educational level, measured in number of years of schooling, unlike the father's, had a large positive effect on the children's health , which increases from newborns to ages up to two years, decreasing again in the age group from three to five years.

In the same sense, basic sanitation, represented by the availability of running water and sewage in homes, showed a great positive effect on children's health. The interaction between these variables, maternal education and basic sanitation, presents a negative coefficient for almost all age groups, showing that there is a substitution relationship between these factors. Children whose mothers are illiterate or have a low level of education need better home infrastructure to maintain an adequate level of health. On the other hand, mothers with a high level of education can protect their children when there is no basic sanitation (running water and sewage system).

Public Policy Lessons

Understanding the relationships between maternal education and basic sanitation on the health of children in different age groups is of great importance to assist government measures that aim to reduce the problems of basic sanitation and education in the country, in order to improve the quality of life of the population.

Inadequate water supply and sanitation, aggravated by low educational levels and, therefore, precarious hygiene, make the domestic environment posing high risks to the health of 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 care 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 Economic Meeting , 1995.