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Public health provision weakens the intergenerational transmission of health in developing countries

November 10, 2010

Sonia Bhalotra

The intergenerational transmission of health is substantially weakened by improvements in public health provision, income, and mother’s education timed around the conception and birth of the child. Turned around, this means that children are more likely to bear the penalty exerted by poor maternal health if they are conceived or born in adverse socio-economic conditions. The effects are sizeable. An extra year of education amongst mothers of children in the country and cohort of the index child lowers the intergenerational correlation of health by 17%. Attenuation of the correlation associated with one standard deviation increases in log per capita GDP and immunization rates respectively is about 29% and 18.5% respectively.

Gains from improvements in immunization are evenly distributed but gains flowing from improvements in the socioeconomic environment are greatest for children who are initially most disadvantaged by being born of relatively unhealthy mothers. This is consistent with mothers’ health acting as a shock absorber whereby events in the extrinsic environment such as recessions impact the foetus most when the mother’s absorptive capacity is weakest. While the importance of maternal health during pregnancy is well established and hence the common focus on smoking and alcohol consumption during pregnancy, our results suggest a wider focus, showing that the mother’s stock of health, accumulation of which begins at her birth is relevant to the health and life-chances of her offspring. This is pertinent in developing countries where there tends to be systematic under-investment in the health of girls from the start. The findings defend the increasing prevalence of the view that government policies to promote early accumulation of human capital should be targeted to children of disadvantaged families. These results emerge from analysis of individual data on 2.24 million children born of about 0.6 million mothers in 38 developing countries in the 31 year period, 1970-2000. They contribute unique evidence on an important and under-studied aspect of persistent inequality in developing countries, where underdeveloped markets and states result in children often being unable to escape from the family circumstances that they are born into.


Bhalotra S and S Rawlings 2009 Gradients of the Intergenerational Transmission of Health in Developing Countries. CMPO Discussion Paper 09/218.


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