1. Health in the developing world
Nicholas Li, University of Toronto
February 20, 2013

7. Proven nutritional interventions
Iron ($7): seven months of iron supplements in Indonesia increases
self-employed earnings by 30% for anemic males
Deworming ($0.25): children receiving 2-3 years of extra deworming
in Kenya go to school 0.3 years longer, at ages 19-26 work 12% more
hours and earn 20% more
Iodine ($0.62): when given to pregnant women in Tanzania increased
child schooling 0.3-0.5 years (vs. 4-5 average)
Vitamin A to prevent night-blindness, breast-feeding until six months
What doesn’t work: subsidized grains

8. Proven infectious illness interventions
Insecticide-treated malaria bednets ($14, lasts 5 years ): child growing
up malaria free earns up to 50% more over their lifetime
Chlorin ($0.18/month): purify water
Oral rehydration solution (almost free): can significantly reduce
deaths from diarrhea/dehydration
Vaccinations ($3.30): “basic package” of polio, diphtheria,
tuberculosis, pertussis, measles, tetanus
HIV/AIDs: condoms, anti-retrovirals (but not cheap)

9. Low-hanging fruit not being picked!
Bednets: only 47% of children use them in Kenya
ORS: only given to 1/3 of children in India with diarrhea
Chlorin: only 10% of households in Zambia use it
Vaccination: 2-3 million children die from preventable disease each
year, vaccination rates low in some countries (only 80% coverage
globally)
Iron supplements, iodine, deworming not widely used in developing
world
Take-up of these things is not very income-sensitive

10. Do the poor care?
Non-trivial share of household budgets spent on health: 5%-8%
Households sell valuable assets and incur substantial debt, at high
interest rates, to seek treatment
Although many public resources are free, they are underused
Instead spend money on traditional medicine, private doctors who
prescribe steroids, IV drips and antibiotics as “treatment”

11. Why low take-up?
Low quality and utilization of public services: absenteeism (as
high as 50% in some countries), private medicine unregulated
Information: difficult to learn about what works in health
Trust/belief: hence trust in authorities is key, but often low among
poor
Procrastination: current costs but future benefits
Inequality within household: who makes decisions and who
benefits?

12. The way forward: social engineering and “nudges”
Subsidies: take-up price-sensitive, free vs. (low) cost
Convenience: increase chlorin use in Kenya from 10% to 50% with
free public chlorin dispenser at point-of-source and paid local
promoter
Bribery: achieved almost universal vaccination by offering free food,
steel plates for completing vaccination course
Incentive-compatible government intervention: mandating
micronutrients added to desirable food products
Information/awareness only goes so far...

13. WE are not so different
A little paternalism goes a long way
How much do we really know about nutrition? And how much do we
optimize for health?
Information about cigarettes vs. taxes/smoking bans
Vaccines and autism
Chronic/hard to treat conditions: chiropracty/homeopathy
Who decides? US abortion debate
Many health decisions made for us: micronutrients added to food,
chlorine and fluoride added to water, mandatory sanitation and
vaccinations, regulation of doctors, etc.

14. HIV/AIDS
Relevant information: in Kenya, telling girls that HIV rates are
higher for older men is more effective at reducing teen pregnancy,
dropouts than “ABC” (abstinence, be faithful and use condoms)
Bribery: in Tanzania, conditional cash transfer of $20 subject to
negative tests over 12 months substantially reduced prevalence 31%
Behavioral response and moral hazard: ART availability increases
risky behavior, but lowers transmission risk → latter effect dominates
ARTs and development: increase subjective perception of life
expectancy, improved mental health (including of HIV negative) and
increase savings, education