ECON4410: Issues in Economic

Policy
Session 7: Health I
Relationship between income and health
• Improvements in health and nutrition are likely
to affect the capacity to work, and therefore
income
• Higher income is expected to lead to improved
health via:
▫ Nutrition
▫ Access to health care
▫ Awareness and education
Health Policies
• Prevention • Diagnosis/Cure
▫ Sanitation ▫ Access to medical
▫ Nutrition personnel and
▫ Immunisation infrastructure
▫ Education ▫ Prices
▫ Social Security system
▫ Development of
Drugs/Vaccines
Map of module
• Today
▫ MDGs and SDGs related to health and statistics
related to health
▫ Improving Immunisation
• Session 2
▫ Nutrition and healthcare
• Session 3
▫ De-worming
Health in the
Sustainable
Development Goals
Era
 Health Related SDGs:
• Goal 1. End poverty in all its forms everywhere
• Goal 2. End hunger, achieve food security and improved nutrition and
promote sustainable agriculture
• Goal 3. Ensure healthy lives and promote well-being for all at all ages
• Goal 4. Ensure inclusive and equitable quality education and promote lifelong
learning opportunities for all
• Goal 5. Achieve gender equality and empower all women and girls
• Goal 6. Ensure availability and sustainable management of water and
sanitation for all
• Goal 7. Ensure access to affordable, reliable, sustainable and modern energy
for all
• Goal 8. Promote sustained, inclusive and sustainable economic growth, full
and productive employment and decent work for all
• Goal 10. Reduce inequality within and amonGoal 11. Make cities and human
settlements inclusive, safe, resilient and sustainable
• g countries
• Goal 12. Ensure sustainable consumption and production patterns
 SDG 3: “Ensure healthy lives and promote wellbeing for all at all
ages”
• 3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100 000 live births.
• 3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries
aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as
low as 25 per 1000 live births.
• 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat
hepatitis, water-borne diseases and other communicable diseases.
• 3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through
prevention and treatment and promote mental health and well-being.
• 3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and
harmful use of alcohol.
• 3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents.
• 3.7 By 2030, ensure universal access to sexual and reproductive health-care services, including for
family planning, information and education, and the integration of reproductive health into national strategies and
programmes.
• 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-
care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
• 3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals
and air, water and soil pollution and contamination.
SDG 3: “Ensure healthy lives and promote wellbeing for all at all
ages” (cont.)

• 3.a Strengthen the implementation of the WHO Framework Convention

on Tobacco Control in all countries, as appropriate.
• 3.b Support the research and development of vaccines and
medicines for the communicable and non-communicable diseases
that primarily affect developing countries, provide access to affordable
essential medicines and vaccines, in accordance with the Doha Declaration on
the TRIPS Agreement and Public Health, which affirms the right of developing
countries to use to the full the provisions in the Agreement on Trade-Related
Aspects of Intellectual Property Rights regarding flexibilities to protect public
health, and, in particular, provide access to medicines for all.
• 3.c , development, training and retention of the health workforce in
developing countries, especially in least developed countries and small
island developing States.
• 3.d Strengthen the capacity of all countries, in particular developing
countries, for early warning, risk reduction and management of national and
global health risks.
Trends
PDHS Estimates for Fully Immunized Children
(2012-13)
Immunization Coverage in Pakistan 2006/07 vs 2012/13:
Increase in Overall Coverage only from 47.3 per cent in 2006-07 to a mere 53.8 per
cent in 2012-13.
 Infant Morality and Under Five Mortality Rates
200

180

160

140

120

100

80

60

40

20

0
Pakistan World Low income Lower middle income Upper middle income High income

Infant mortality rate per 1,000 live births 1990 Infant mortality rate per 1,000 live births 2015
Under-five mortality rate Total per 1,000 live births 1990 Under-five mortality rate Total per 1,000 live births 2015
“Improving Immunization Coverage”
• Setting
▫ Disadvantaged part of Udaipur, rural Rajasthan
▫ 2% Immunization rate, compared to 22% for rural
Rajasthan and 44% for India
• Question
▫ Explore the relationship between provision of
incentives and take-up of vaccination
▫ Problems in establishing a causation?
• Evaluation technique
▫ Randomised Control Trial (clustered)
▫ Effect of access to treatment, rather than
treatment itself by randomising at village level i.e.
Intention to Treat
Immunisation details
• Full course of immunisation
▫ Completed in one year
▫ Requires at least 5 visits
Intervention
• Camp A: Improve supply of immunization
▫ Regular, well publicized immunisation camps
▫ 30 hamlets
• Camp B: Improve supply plus demand
▫ As above, plus small incentive: 1 kg of lentils per
immunization adminsistered, and a set of thalis
upon completion of full schedule
▫ 30 hamlets
• Camp C: Control, 74 hamlets
 Data time-line
Baseline survey Treatment Endline survey

June 2004 February 2005 July 2006 February 2007

Discussion
• Shows that the effect of a supply intervention is
strong
• The effect of a supply intervention, coupled with
a demand intervention is even stronger
• Cost per immunized child is lowered
▫ $27.94 in a reliable camp with incentives as
compared to $55.83 in a reliable camp without
incentives
• Additional health improvement via nutrition?
Sunil Mullainathan:
Psychology and Economics
• http://www.ted.com/talks/sendhil_mullainatha
n.html
Health Indicators for 2016
Health Indictors for 2016
Millennium Development Goals Report
Pakistan,2010
Indicator: Deliveries by Skilled Birth Attendant
(2012-2013 PSLM)
Millennium Development Goals Report Pakistan,2010
Millennium Development Goals Report
Pakistan,2010
 Status
MDG 2015
(WB
Indicator Target
Estimates)

Under-5 MR 52 81.1 (2015)

65.8
IMR 40
(2015)
MMR 140 178 (2015)
Births by Skilled 52.1%
90%
Attendant (2013)
Contraceptive 35.4
55%
Prevelance Rate (2013)
0.1%
HIV Prevalence <0.1%
(2014)
Millennium Development Goals for Health
• Goal 1: Eradicate extreme poverty and hunger
▫ Halve, between 1990 and 2015, the proportion of people whose income is less than $1 a
day
▫ Halve, between 1990 and 2015, the proportion of people who suffer from hunger
• Goal 4: Reduce Child Mortality
▫ Reduce by two thirds, between 1990 and 2015, the under-five mortality rate
• Goal 5: Improve maternal health
▫ Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
▫ Achieve, by 2015, universal access to reproductive health
• Goal 6: Combat HIV/AIDS, malaria & other diseases
▫ Have halted by 2015 and begun to reverse the spread of HIV/AIDS
▫ Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it
▫ Have halted by 2015 and begun to reverse the incidence of malaria and other major
diseases
• Goal 7: Ensure environmental sustainability
▫ Halve, by 2015, the proportion of the population without sustainable access to safe
drinking water and basic sanitation