Dissertation Title: "Community and Environmental Determinants of Child Health"
The first and third papers of this dissertation provide evidence on one piece of a broad debate over decentralizing health sectors in developing countries: the popular but undocumented claim that transferring public money to local governments will not affect population health because these governments cannot produce public goods effectively. After 1992, the Philippines increased markedly the amount of national tax revenues transferred annually to local governments in block grants. The formula used to distribute funds among the local governments includes a portion based on equal sharing, providing exogeneity in the per capita block grants (conditioning on correlates of initial population). Within this context, the first chapter explores whether child health responds to locally controlled public resources. I find that children living in localities (barangays) with higher increases in per capita block grants between 1991 and 1995 exhibited differentially higher growth in body mass index and fewer hospitalizations than those in jurisdictions with lower per capita block grants. In the third paper, I estimate the health return to local funds across tiers of local government at the province/city level, again in the context of the Philippine devolution. In a fixed effects model, I estimate the effect of the total per capita block grant on infant mortality rates using vital statistics data. My estimates imply that 30% of the decrease in the registered infant mortality rate in cities between 1990 and 1997 is explained by the increase in the per capita transfer over that period. By contrast, I do not find a significant effect for provinces, suggesting there were offsetting detrimental effects of the concurrent transfer to provinces of administrative responsibility for public health.
In the second paper, joint with Dean Yang, we estimate the socioeconomic returns to health human capital for Indonesian women using rainfall shocks in the year and location of birth to instrument for adult height. We find that above-average rainfall at birth leads to an additional half a centimeter of height. Instrumented height significantly covaries with other measures of good health and is positively associated with years of schooling and per capita household expenditures.