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Sanitation, Disease Externalities, and Anemia: Evidence From Nepal

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Listed:
  • Diane Coffey
  • Michael Geruso
  • Dean Spears

Abstract

Anemia impairs physical and cognitive development in children and reduces human capital accumulation. The prior economics literature has focused on the role of inadequate nutrition in causing anemia. This paper is the first to show that sanitation, a public good, significantly contributes to preventing anemia. We identify effects by exploiting rapid and differential improvement in sanitation across regions of Nepal between 2006 and 2011. Within regions over time, cohorts of children exposed to better community sanitation developed higher hemoglobin levels. Our results highlight a previously undocumented externality of open defecation, which is today practiced by over a billion people worldwide.

Suggested Citation

  • Diane Coffey & Michael Geruso & Dean Spears, 2016. "Sanitation, Disease Externalities, and Anemia: Evidence From Nepal," NBER Working Papers 22940, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:22940
    Note: CH DEV EH PE
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    References listed on IDEAS

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    1. Dean Spears & Arabinda Ghosh & Oliver Cumming, 2013. "Open Defecation and Childhood Stunting in India: An Ecological Analysis of New Data from 112 Districts," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-1, September.
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    5. John A. Maluccio & John Hoddinott & Jere R. Behrman & Reynaldo Martorell & Agnes R. Quisumbing & Aryeh D. Stein, 2009. "The Impact of Improving Nutrition During Early Childhood on Education among Guatemalan Adults," Economic Journal, Royal Economic Society, vol. 119(537), pages 734-763, April.
    6. Edward Miguel & Michael Kremer, 2004. "Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities," Econometrica, Econometric Society, vol. 72(1), pages 159-217, January.
    7. David Cutler & Grant Miller, 2005. "The role of public health improvements in health advances: The twentieth-century United States," Demography, Springer;Population Association of America (PAA), vol. 42(1), pages 1-22, February.
    8. Watson, Tara, 2006. "Public health investments and the infant mortality gap: Evidence from federal sanitation interventions on U.S. Indian reservations," Journal of Public Economics, Elsevier, vol. 90(8-9), pages 1537-1560, September.
    9. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 119(1), pages 249-275.
    10. Dean Spears, 2012. "How much international variation in child height can sanitation explain?," Working Papers 1436, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
    11. Hoyt Bleakley, 2007. "Disease and Development: Evidence from Hookworm Eradication in the American South," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(1), pages 73-117.
    12. Gustavo J. Bobonis & Edward Miguel & Charu Puri-Sharma, 2006. "Anemia and School Participation," Journal of Human Resources, University of Wisconsin Press, vol. 41(4).
    13. Donald A P Bundy & Michael Kremer & Hoyt Bleakley & Matthew C H Jukes & Edward Miguel, 2009. "Deworming and Development: Asking the Right Questions, Asking the Questions Right," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 3(1), pages 1-3, January.
    14. Cameron, Lisa & Shah, Manisha & Olivia, Susan, 2013. "Impact evaluation of a large-scale rural sanitation project in Indonesia," Policy Research Working Paper Series 6360, The World Bank.
    15. Amy Finkelstein, 2007. "The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(1), pages 1-37.
    16. Jessica Cohen & Pascaline Dupas, 2010. "Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(1), pages 1-45.
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    Cited by:

    1. Kresch, Evan Plous & Walker, Mark & Best, Michael Carlos & Gerard, François & Naritomi, Joana, 2023. "Sanitation and property tax compliance: Analyzing the social contract in Brazil," Journal of Development Economics, Elsevier, vol. 160(C).
    2. Gelli, Aulo & Headey, Derek D. & Ngure, Francis & Becquey, Elodie & Ganaba, Rasmané & Huybregts, Lieven & Pedehombga, Abdoulaye & Sanou, Armande & Traore, Abdoulaye & Zongo, Florence & Zongrone, Aman, 2017. "Assessing the health and nutrition risks of smallholder poultry production in Burkina Faso: Insights from formative research," IFPRI discussion papers 1665, International Food Policy Research Institute (IFPRI).
    3. Derek Headey & Giordano Palloni, 2019. "Water, Sanitation, and Child Health: Evidence From Subnational Panel Data in 59 Countries," Demography, Springer;Population Association of America (PAA), vol. 56(2), pages 729-752, April.
    4. Kristensen, Frederikke Frehr & Sharp, Paul, 2021. "Disease Surveillance, Mortality and Race: The Case of HIV/AIDS in the United States," CAGE Online Working Paper Series 553, Competitive Advantage in the Global Economy (CAGE).
    5. repec:rre:publsh:v:51:y:2021:i:1 is not listed on IDEAS
    6. Gautam, Sanghmitra, 2023. "Quantifying welfare effects in the presence of externalities: An ex-ante evaluation of sanitation interventions," Journal of Development Economics, Elsevier, vol. 164(C).
    7. Nguyen, Cuong Viet & Phung, Tung Duc, 2024. "Financial incentives for sanitation take-up: A randomized control trial in rural Vietnam," Journal of Health Economics, Elsevier, vol. 97(C).
    8. Johann Caro-Burnett & Ahmed Mushfiq Mobarak & Judith A. Chevalier, 2021. "Is Habit a Powerful Policy Instrument to Induce Prosocial Behavioral Change?," Cowles Foundation Discussion Papers 2275, Cowles Foundation for Research in Economics, Yale University.
    9. Joseph, George & Hoo, Yi Rong & Moqueet, Nazia Sultana & Chellaraj, Gnanaraj, 2023. "Early-life exposure to unimproved sanitation and delayed school enrollment: Evidence from Bangladesh," World Development Perspectives, Elsevier, vol. 32(C).
    10. Ray, Rita & Datta, Rajlakshmi, 2017. "Do separate female toilets in primary and upper primary schools improve female enrollment? A case study from India," Children and Youth Services Review, Elsevier, vol. 79(C), pages 263-273.
    11. Spears, Dean, 2020. "Exposure to open defecation can account for the Indian enigma of child height," Journal of Development Economics, Elsevier, vol. 146(C).
    12. repec:ags:aaea22:335640 is not listed on IDEAS
    13. Ray, Rita, 2020. "Mother’s autonomy and child anemia: A case study from India," Children and Youth Services Review, Elsevier, vol. 112(C).

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    JEL classification:

    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • J1 - Labor and Demographic Economics - - Demographic Economics
    • O1 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development

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