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Economic conditions and the health of babies. You won’t believe what the literature says!

 

How do economic conditions affect a person’s health? We can think of three major mechanisms that researchers examine. Firstly, the absolute effect of wealth or income that affects your access to health-influencing goods and services such as healthcare, good housing, high quality food, and exercise. Secondly, the relative effect of your social position through psychosocial mechanisms as widely popularised by Michael Marmot. And thirdly, the fetal origins hypothesis. Initially brought to popular attention by David J. Barker in 1986, the fetal origins hypothesis posits that the nine months in utero influence health over the course of a life through effects on the development of ones body and its organs. This latter mechanism provides a strong reason, beyond improving maternal health, for enacting policies that assist expectant mothers.

There is a growing research interest in identifying how economic conditions and maternal well-being affect the health of the baby. This can be used to inform policies to improve infant health and could take the form of improved maternity leave or social assistance in the form of cash transfers or other goods and services.

At an aggregate level a shift in economic conditions such as a change in the unemployment rate could affect infant health in different ways. Through an income effect mothers may buy more or less goods that affect the health of the baby. For example, some mothers may reduce smoking in the face of a reduction in household income. A substitution effect may lead to mothers to change the amount of time spent on work and more time on leisure or doing more or less health promoting activities. Finally, households may choose to delay or bring forward their fertility decisions. Thus the ultimate effect of economic conditions on the health of the birth cohort remains theoretically ambiguous.

Dehejia and Llera-Muney looked at the relationship between the unemployment rate and the proportion of babies born at low birth weights, a marker of poor infant health, in US states. They found that increases in the unemployment rate reduced the low birth weigh birth rate, which on further investigation appeared to be attributable both to a change in the women who choose to have a baby (they are of higher socioeconomic status) and an improvement in health behaviours. While interesting, however, this does not reveal much to us about what is going on at the level of the individual mother. Lindo showed that this effect is dependent on the level of aggregation of the data; at a more disaggregated level the effect diminishes. Indeed, unemployment is not a policy choice for improving infant health.

A paper featured recently on the journal round-up perhaps provides more useful information for the policy-making context. It showed that mothers participating in a social assistance programme in Uruguay that provided cash transfers to mothers experienced a lower rate of low birth weight births. These mothers showed increased weight gain, reduction in labour supply, and a reduction in smoking, all potentially contributing to infant health. A further paper by Lindo shows a negative impact of husband’s job losses during pregnancy on infant health at birth.

The evidence appears perhaps contradictory at the individual and aggregate levels: a classic case of Simpson’s paradox. This paradox describes the situation where a trend observed at the individual level disappears or even reverses when the data are aggregated. For an individual mother, providing her with extra income, improves the likely health of her baby; but across society as average incomes move, different mothers are making decisions to have children – fewer women of lower incomes are giving birth in times of recession. The appropriate evidence would therefore be that of the individual level.

Better maternity leave and greater social assistance for mothers would seem to be supported by the evidence as not only improving maternal health but also the long term health of her child.

By

  • Sam Watson

    Health economics, statistics, and health services research at the University of Warwick. Also like rock climbing and making noise on the guitar.

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4 years ago

[…] April 2018. I’m not sure I will write out the full blurb again about studies of in utero exposure to difficult or stressful conditions and later life outcomes. There are a lot of them and they continue to make the top journals. […]

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4 years ago

[…] April 2018. I’m not sure I will write out the full blurb again about studies of in utero exposure to difficult or stressful conditions and later life outcomes. There are a lot of them and they continue to make the top journals. […]

trackback
5 years ago

[…] have covered a raft of studies that look at the effects of in-utero health on later life outcomes, the so-called fetal origins hypothesis. A smaller, though by no means small, literature has […]

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5 years ago

[…] here at the blog have covered a long series of papers on the effects of in utero stressors on birth and later life health and economic outcomes. The so-called fetal-origins hypothesis posits that the nine months in the womb are some of the […]

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5 years ago

[…] behaviours on this blog. It is certainly one of the health economic issues du jour and one we have discussed in detail. Generally speaking, when looking at an aggregate level, such as countries or states, all-cause […]

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6 years ago

[…] Papers have come up on the journal round-up here, here, and here, and we previously discussed economic conditions and baby health. So what does this study add? Using data from the 2011 Spanish census on 36 million individuals, […]

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6 years ago

[…] and population health has emerged into a huge research area in the last 20 years. We’ve previously discussed it in a number of blog posts. As the literature grows and understanding and knowledge […]

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6 years ago

[…] fetal origins hypothesis has certainly generated no end of new papers, even in top ranked journals, for this journal round […]

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6 years ago

[…] this week a return to the theme of infant health that we have covered previously. Birth weight is frequently used as an outcome to proxy infant health at birth since it is widely […]

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6 years ago

[…] not one, but two papers on the effects of prenatal conditions and mother and child health! In the last post on this blog, we discussed many of the ways in which economic conditions might affect infant health […]

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