The Impact of Public Health Policy: The Case of Community Health Centers

The aim of this paper is to assess the impact of the Community Health Center (CHC) on health levels in the U.S. Using infant mortality as the underlying health indicator, a time series of large counties as the data set, and multivariate regression techniques, we investigate the extent to which the presence of a program in a county affects future mortality. We find that CHCs have negative and statistically significant impacts on white and black infant mortality rates.The centers have larger effects on black infant mortality than on white infant mortality. The reduction in the black infant mortality rate between 1970 and 1978 due to the CHC system amounts to one death per thousand live births or approximately 12 percent of the observed decline.This result is particularly striking in light of the well-known higher infant mortality rate of blacks. A reduction in the excess mortality rate of black babies has been dentfied as a goal of public health policy for a number of years. Our results suggest that community health centers have the potential to make a substantial contribution to the achievement of this goal.

Interaction of infant mortality and fertility and the effectiveness of health and family planning programs

The interaction of fertility and infant mortality is well established. Lower infant mortality can lead to lower fertility by reducing the need for replacement births. Conversely, birth spacing improves the chances of child survival. To find out how these programs reinforce each other, a study done in Indonesia estimated the effects that family planning programs have on infant mortality and the effects of reduced infant mortality on fertility. The research compared the cost-effectiveness of health and family planning programs and looked at whether the interaction of infant mortality and fertility influenced estimates of the costs of both programs. The results demonstrate a substantial spillover effect, confirming that the interaction does raise the cost-effectiveness of both programs. These findings are sufficiently consistent that policymakers should consider the mortality-fertility interaction as a regular part of the appraisal of health and population projects. Integrated programs offer lower costs and more effective promotion. They also improve efforts to assure infant survival and achieve birth prevention objectives.Health Monitoring&Evaluation,Health Systems Development&Reform,Early Child and Children's Health,Health Economics&Finance,Reproductive Health

DEMOGRAPHIC TRANSITION IN EUROPE

Using panel cointegration analysis, we show that a cointegration relationship exists among fertility choice, infant mortality, real wages and real per capita output. The results suggest that in low mortality economies reductions in infant mortality will decrease fertility.

Toxic exposure in America: estimating fetal and infant health outcomes

We examine the effect of toxic exposure on U.S. infant and fetal mortality rates between 1989 and 2002 from toxic pollution released by facilities reporting to the Toxic Release Inventory (TRI). Unlike previous studies, we control for toxic pollution from mobile sources and from non-TRI reporting facilities. We find significant adverse effects of TRI exposure on infant mortality. There is evidence that health effects vary across media: air and water having a larger impact than land pollution. And, within air, we find that releases of carcinogens are particularly problematic for infant health outcomes. We estimate that the average county-level decreases in TRI concentrations between 1988 and 2002 saved in excess of 13,800 infant lives.Newborn infants - Mortality ; Public welfare

Determinants of infant and child mortality in Zimbabwe: Results of multivariate hazard analysis

This study addresses important issues in infant and child mortality in Zimbabwe. The objective of the paper is to determine the impact of maternal, socioeconomic and sanitation variables on infant and child mortality. Results show that births of order 6+ with a short preceding interval had the highest risk of infant mortality. The infant mortality risk associated with multiple births was 2.08 times higher relative to singleton births (pCox proportional hazards models, Demographic and Health Survey, infant and child mortality, under-five mortality, Zimbabwe

Short and long-term relationship between physician density on infant mortality: a longitudinal econometric analysis

While countries with higher levels of human resources for health typically have better population health, the evidence that increases in the level of human resources for health leads to improvements in population health is limited. We provide estimates of short-run and long-term effects of physician density on infant mortality. We use a dynamic regression model that allows an estimation of both short- and long-run effects of physician density on infant mortality. We also used instrumental variables analysis to identify the causal effect of physician density on health. We estimate that increasing the number of physicians by one per 1,000 population decreases the infant mortality rate by 15% within five years and by 45% in the long-run. We find all countries are moving towards their own steady state at around 3% a year and are only half way there after 15 years. We conclude that the long-run effects of human resources for health are substantially larger than previously estimated. Our results suggest that health sector inputs can play a role in reducing infant mortality. However, meeting the Millennium Development Goal of reducing child mortality rate by two thirds from 1990 to 2015 would have required much earlier action.Physician density, infant mortality, longitudinal, eocnometric

Average age at death in infancy and infant mortality level: reconsidering the Coale-Demeny formulas at current levels of low mortality

The longterm historical decline in infant mortality has been accompanied by increasing concentration of infant deaths at the earliest stages of infancy. The influence of prenatal and neonatal conditions has become increasingly dominant relative to postnatal conditions as external causes of death such as infectious disease have been diminished. In the mid-1960s Coale and Demeny developed formulas describing the dependency of the average age of death in infancy on the level of infant mortality. Almost at the same time as Coale and Demeny’s analysis, as shown in this paper, in the more developed countries a steady rise in average age of infant death began. This paper demonstrates this phenomenon with several different data sources, including the linked individual birth and infant death datasets available from the US National Center for Health Statistics and the Human Mortality Database. A possible explanation for the increase in average age of death in infancy is proposed, and modifications of the Coale-Demeny formulas for practical application to contemporary low levels of mortality are offered.

Nutrition and Infant Health in Japan

The model presented in this paper emphasizes the importance of the mother's nutritional intake as a determinant of infant health. Using cross-sectional market averages for 1980 and 1981 in Japan, we find that the nutrient intake of the mother during pregnancy is a potential determinant of neonatal and infant mortality in Japan, with increased consumption of calcium and iron leading to improved birth outcomes. Using the results obtained from the estimation of neonatal and infant mortality production functions, we note that increases in the prices of food items, in particular milk and meat, would lead to increases in neonatal and infant mortality rates. We discover that the availability of abortion in Japan, unlike in the U.S., is positively related to mortality rates, although never significantly. Finally, we see that cigarette smoking, alcohol consumption, and poor environmental quality all have strongly adverse effects on newborn survival outcomes in Japan.