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Wealth and health in Africa   Shari Eli
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Wealth and health in Africa Shari Eli


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Shari Eli, assistant professor at the University of Toronto, explores the historic relationship between wealth and health.

Shari Eli, assistant professor at the University of Toronto, explores the historic relationship between wealth and health.

Published in: Health & Medicine

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  • 2. History of Health  What are the key factors which explain the mortality transition in the West over the last 300 years?   PublicHealth Interventions   Improvements in the standard of living   Role of Education  Lessons which can be applied to developing countries today?
  • 3. Crude Death Rate of Infectious Diseases
  • 4. Public Health Interventions  Acceptance of the Germ Theory of Disease in the 1890s  New investments in collective goods - paid for by taxes - such as water treatment   In 1900, 44% of deaths in major cities are from infectious diseases (18% in 1936), 25% from waterborne diseases   Cutler and Miller (2005) find that the chlorination and filtration of water accounts for ½ the mortality reduction between 1900 and 1936 in the US
  • 5. Other public health interventions  Public Health Campaigns:   washing hands & food   breast-feeding & boiling milk  Large-scale interventions:   sewage treatment and chlorination   regulations for milk/meat   garbage collection
  • 6. Increases in the Standard of Living  Many of the public health campaigns/interventions of the early 20th century were targeted at urban populations  But we see great gains in life expectancy outside of urban areas too   1900-1940: Life expectancy rises from 47 to 63 in the US  Both rural and urban populations experience great improvements in the standard of living in this period
  • 7. Increases in GDP per capita
  • 8. Native Born US Male Height
  • 9. Role of Increased Income  Eli (2012) looks at effect of increases in Civil War veteran pensions on health status between 1893 and 1906  Finding: Extra $1 of monthly pension income - 9% of the average veteran’s monthly pension - lowers probability of contracting a respiratory illness by 19%   Equivalent to a decline in the hazard rate from 9 in 1000 to 7 in 1000  Extra $1 of monthly pension income lowers the hazard rate of dying from any illness from 28 in 1000 to 20 in 1000
  • 10. Why such large effects?  With extra income, one can have improve his   Nutrition   Living Conditions   Working Conditions  One can also work less or retire early
  • 11. Choices regarding health  Large-scale public health interventions run by city governments are the result of new information and technology on health  But improvements in health that come from increases in socioeconomic status are most likely not the result of individuals making conscious investments in their health
  • 12. Role of Education  Part of the benefit of education is simply in gathering children in the same place each day (“High School Movement” 1910 – 1940)   Good opportunities for disseminating information on the benefits of hand-washing, etc. as well as for mass vaccinations   Example: Rockefeller Sanitation Commission’s de-worming campaign in the U.S. South, 1905 – 1910   RSC surveyed infection rates in affected areas and found that an avg. of 40% of school-aged children suffered from hookworm infection   Sponsored treatment dispensaries that traveled these areas providing de-worming medications and educating local physicians and the public about prevention   Great effects on school enrollment, literacy and earnings in adulthood
  • 13. Conclusions   U.S. Public Health Interventions which were beneficial were ones   Imposed by local government (water treatment)   Very specific targets (de-worming)   Much of the gains to life expectancy were not the result of individuals making better decisions with regard to their health   Instead,better health was a byproduct of increases in SES or the result of public health interventions