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This three-paper dissertation examines the social determinants of early childhood and in-utero health. The first chapter examines the impact of early childhood stunting on educational outcome in Tanzania. Using the extent of third-trimester overlap with the Tanzania hunger season to create an exogenous variation in stunting, I find that a one standard deviation stunting decreases educational achievement by .88 school years compared to a child's siblings. A placebo group not affected by the hunger season is used to confirm that in-utero nutrition deprivation is the cause of the education differences. The second paper utilizes the food price shocks and price increases to examine the impact of nutritional sufficiency on child development in four sub-Saharan countries. I find adverse effects of third-trimester and early-childhood exposure to food price increases, but get inconsistent results on infancy that requires additional research. The final paper uses an instrumental variable method to determine the impact of public health spending on infant mortality in India. The results imply that a one percent of state-level GDP increase in public health prevents seven children deaths for every 1,000 live births. Together the three papers highlight the possible role investments in early childhood health could have in increasing human capabilities and well-being.
The early years of children's lives are crucial to their future health and development. Disparities in health and skills that emerge during children's first few years increase with age. Many factors affect children's health. At an individual level, mother's education is an influential factor. At a societal level, public policies affect children's surrounding environment that influences their health. Therefore it is critical that public policies and other determinants of children's health be studied carefully. As a nation, U.S. has made significant improvements in children's health over the past century. However, there is a significant increase in the number of children in the U.S. today that suffer from conditions and diseases that have emerged in recent years, including asthma and obesity. These conditions are impediments to children's healthy development and have long lasting effects. Investment in children's health yields long term payoffs at the individual as well as societal levels. Healthy children have more opportunities to succeed in schools and more likely to become healthy, productive adults. Benefits extend to society as a whole including reduced dependency and disability, a healthier future workforce, and consequently a stronger economy. Due to these reasons, it is important to understand how health care use and health among children in the U.S. have been affected by some of their key determinants in recent decades. This dissertation is divided into three chapters. The first chapter examines the feasibility of using compulsory schooling policies as instruments for mother's schooling to examine the causal effect of mother's schooling on children's health care use and health. The second chapter examines the causal effect of insurance coverage on children's health care use and health using evidence from the Medicaid and SCHIP expansions. The third chapter examines the causal effect of welfare reform on children's health care use and health. Findings from this dissertation provide informative insights on key factors that shape children's health and wellbeing and highlight important methodological issues involving such empirical research.
Despite advances in scientific research and the increased emphasis on and promotion of health interventions by international organizations, mortality and morbidity in young children remain high in Burkina Faso and close to half of the deaths in children under five each year are related to illnesses that can be treated such that death may be avoided. This paper contributes to the literature by offering a better understanding of the failures related to and the actions that could prevent these types of death in the Orodara region of Southwest Burkina Faso. I present an analysis of the determinants of health care decisions as they relate to children suffering from diarrhea, which is accountable for over 10% of under-five deaths in Burkina Faso each year. Next, I explore broader patterns of care-seeking behavior. Specifically, I examine correlations across time and space of care-seeking behavior as it relates to treating ill children. Finally, I estimate and compare the cost-effectiveness of three different scenarios for zinc distribution and delivery to young children for the treatment and/or prevention of diarrhea. Two themes emerge from this body of work. First: policy-makers should encourage investment in village-level health services. Second: information-sharing can result in vicious or virtuous cycles of care-seeking behavior, as it relates to early childhood care, and so investments should be made in improvements to educational programs related to child health care. Specifically, health services and education should be accessible to remote caregivers and should be sensitive to different beliefs, practices, and dialects of different ethnic groups in different regions as well as seasonal constraints specific to agricultural households.