Urban Poverty and Health in Developing Countries: Household and Neighborhood Effects

In the U.S. and other high-income countries, where most of the population lives in urban areas, there is intense scholarly and program interest in the effects of household and neighborhood living standards on health. Yet very few studies of developing-country cities have examined these issues. This paper investigates whether in these cities, the health of women and young children is influenced by both household and neighborhood standards of living. Using data from the urban samples of some 85 Demographic and Health surveys, and modelling living standards using factor-analytic MIMIC methods, we find, first, that the neighborhoods of poor households are more heterogeneous than is often asserted. To judge from our results, it appears that as a rule, poor urban households do not tend to live in uniformly poor communities; indeed, about 1 in 10 of a poor household's neighbors is relatively affluent, belonging to the upper quartile of the urban distribution of living standards. Do household and neighborhood living standards influence health? Applying multivariate models with controls for other socioeconomic variables, we discover that household living standards have a substantial influence on three measures of health: unmet need for modern contraception; birth attendance by doctors, nurses, or trained midwives; and children's height for age. Neighborhood living standards exert significant additional influence on health in many of the surveys we examine, especially in birth attendance. There is considerable evidence, then, indicating that both household and neighborhood living standards can make a substantively important difference to health.