Socioeconomic Determinants of Child Health: Empirical Evidence from Indonesia

• Date: 01 March 2014
• Published date: 01 March 2014
• Author: Subha Mani
• DOI: http://doi.org/10.1111/asej.12026

Socioeconomic Determinants of Child Health:

Empirical Evidence from Indonesia*

Subha Mani†

Received 1 March 2011; accepted 16 July 2013

This paper characterizes the socioeconomic determinants of child health using

height-for-age z-score (HAZ), a long-run measure of chronic nutritional deficiency.

We construct a panel data that follows children between ages 3 and 59 months in

1993 through the 1997 and 2000 waves of the Indonesian Family Life Survey. We

use this data to identify the various child-level, household-level and community-

level factors that affect children’s health. Our findings indicate that household

income has a large and statistically significant role in explaining improvements in

HAZ. We also find a strong positive association between parental height and HAZ.

At the community level, we find that provision of electricity and the availability of

paved roads are positively associated with improvements in HAZ. Finally, in

comparison to community-level factors, household-level characteristics play a

large role in explaining the variation in HAZ. These findings suggest that policies

that address the demand-side constraints have greater potential to improve chil-

dren’s health outcomes in the future.

Keywords: child health, panel data, Indonesia, height.

JEL classification codes: I10, 012, R20, D10.

doi: 10.1111/asej.12026

I. Introduction

Chronic malnourishment experienced at a young age is associated with poor

cognitive development, fewer grades of schooling completed, and lower wage

earnings in the long run (Stein et al., 2003, 2006, 2008; Hoddinott et al., 2008,

2010; Victora et al., 2008; Behrman et al., 2009; Maluccio et al., 2009). Further-

more, most of the permanent deficits in height attainment, a long-run measure of

chronic malnutrition, occur during early life, with only partial catch-up potential

in the future (Adair, 1999; Hoddinott and Kinsey, 2001; Mani, 2012). Therefore,

*Financial support was provided by the Grand Challenges Canada (Grant 0072-03 to the Grantee,

The Trustees of the University of Pennsylvania), United Nations University-World Institute for

Development Economics Research and the College of Letters, Arts, and Sciences, University of

Southern California. I would like to thank John Hoddinott, Jeffrey B. Nugent, seminar participants at

the University of Melbourne, Monash University, and the University of Southern California for

helpful comments and suggestions. I am especially indebted to John Strauss for guidance, continuous

encouragement, and support. All remaining errors are mine.

†Mani: Department of Economics and Center for International Policy Studies, Fordham University;

Population Studies Center, University of Pennsylvania. Email: smani@fordham.edu.

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Asian Economic Journal 2014, Vol. 28 No. 1, 81–104 81

© 2014 The Author

Asian Economic Journal © 2014 East Asian Economic Association and Wiley Publishing Pty Ltd

identifying the socioeconomic determinants that shape a child’s future physical

and economic well-being is crucial.

The most widely-used indicators of child health are height-for-age z-score

(HAZ), weight-for-height z-score (WHZ) and weight-for-age z-score (WAZ).1

Among these three indicators, HAZ is identified as a long-run measure of health

as it captures the entire stock of nutrition accumulated since birth (Waterlow,

1988). Stunting is a form of health deprivation, where children’s observed height

is at least two standard deviations below the height of a well-nourished child in

the reference population and, therefore, remains a serious source of concern

among policy-makers in several developing countries, including Indonesia.

During 1990–1996, Indonesia experienced a period of rapid economic growth,

with average growth in GDP per capita remaining around 6 percent. Despite such

high levels of economic growth, 40.6 percent of children under the age of 5

suffered from chronic nutritional deficiencies; that is, they were identified as

being stunted. Indonesia suffered a sharp reversal in its economic performance in

late 1997 and early 1998. The sudden depreciation of the Indonesian rupiah led to

an increase in the relative price of tradable goods, especially foodstuffs. Nominal

prices of food increased, resulting in 150-percent inflation within months.

However, by 2000, Indonesia witnessed rapid recovery in the growth rate of GDP

per capita, along with lower inflation rates. During the recovery period, the

country also witnessed significant declines in the percentage of stunted children.

However, in absolute terms, the percentage of children suffering from chronic

nutritional deficiencies still remained high, at 35.1 percent.

The goal of the present paper is to identify the socioeconomic determinants

of HAZ, an important measure of long-run health among children. Panel data

are constructed to follow children between the ages of 3 and 59 months (under

the age of 5 years) in 1993 through the 1997 and 2000 waves of the Indonesian

Family Life Survey (IFLS). The panel structure of the data allows us to identify

both time-invariant (example: parental height) and time-varying (example: house-

hold income) factors that influence child health. In addition, without focusing

directly on any specific intervention, we attempt to provide evidence on the

relative role of the household vis-a-vis the community in improving child health.

We estimate a static conditional health demand function to identify the deter-

minants of child health. Our findings indicate that at the household level, parental

height and household income are important determinants of child health. A 1-cm

increase in mother’s height is associated with a 0.047 standard deviation improve-

ment in the child’s HAZ. Similarly, a 1-cm increase in father’s height corresponds

to a 0.034 standard deviation improvement in the child’s HAZ. Household

income has a large and statistically significant role in explaining improvements

in child health in Indonesia, where a 100-percent increase in real per capita

1 HAZ is standardized height calculated using the 1977 National Center for Health Services (NCHS)

tables drawn from the US population conditional upon age (in months) and sex. WHZ and WAZ

are standardized weights calculated using the 1977 NCHS tables drawn from the US population

conditional upon height in centimeters and age, respectively.

ASIAN ECONOMIC JOURNAL 82

© 2014 The Author

Asian Economic Journal © 2014 East Asian Economic Association and Wiley Publishing Pty Ltd