MIT OpenCourseWarehttp://ocw.mit.edu ��MAS.965 / 6.976 / SP.716 NextLab I: Designing Mobile Technologies for the Next Billion UsersFall 2008 For information about citing these materials or our Terms of Use, visit: http://ocw.mit.edu/terms.Jon VarsanikJon Varsanik Nextlab Fall 2008 9/28/08 Collection off several surveys Cll i l  Use them to explain global mortality transitiontransition  Analyze how social factors affect death rates  Thesis:  Social factors or cultural characteristics are more influential in determining mortality levels than is access to medical services, income, or nutritional levelsinfluential in determining mortality levels than is access to medical services, income, or nutritional levels Halstead Walsh Warren Halstead, Walsh, Warren  NOT income or level of health services  Flegg  Literacy –low infant mortality   Equality of income, and level of medical care CaldwellCaldwell  Proportion of females in school a generation earlier   Also, family planning and male school attendance Rodgers and Wofford   Literacy, proportion of population working outside of agriculture GaisieGaisie  Mother education  Behm  Mother education  World Fertility Survey (2 separate analyses)  Parental education   Also, income (evidenced by father’s occupation) Mensch, Lentzer and Preston (analyzed 15 surveys)   Mothers education, ethnicity, and father’s education in urban areas Orubuloye and Caldwell   Mother’s education – controlled for occupation of parents, urban/rural, family structure, family planningp p , , y , y p gCleland and Ginneken  Mother’s education –only half of effect is due to the material advantages associated with mother education DaVanzo, Butz, Habicht  Ethnic groups  World Fertility Surveys  Indian Sample Registration Survey and International Diarrhoeal Diseases Research Center data  Changing African Family Project  One‐per‐Thousand Survey of China“ “…persiisttentt, but undder‐researched, fifindiding iisbt hd that there are major ethnic or culturaldifferentials in mortalityy… ‐ differences that survive controlling for income and education.”  “…societies are largely prisoners of their culturesand histories and that the roots of contemporaryand histories and that the roots of contemporaryhealth successes lie far back in those histories.”  Reasons Pf f h Preference for sons over ddaughters ▪ Girls neglected, get less share of limited resources  Family planninggy p Inffant mortallity  ¼ of all births result in deaths before 5 years of age.  Due to age structure f population, half of all deaths in the society occur to persons under 5 years.  Also more controlled data?  Also, more controlled data?  Years of education  Easy to quantifyEasy to quantify  Related to other cultural factors that are harder to measure EducationEducation  Two impacts: ▪ Changing behavior of individuals ▪▪ Changing society Changing society  Educated Mothers  More effective in gaining resources form their husbands  More likely to be the one to detect that their child is sick More likely to be the one to detect that their child is sick.  More likely to adopt effective home action when there is asickness ▪ Home care accounts for at least half of all treatment in the Third Worldcare ac for at least half of all treatment in the Third WorldHome counts  Spend more time with the doctor giving child’s history  More likely to carry out doctor’s instructions properly  More likely to go back to the doctor if the condition does notlikely to go back to the doctor if the condition does notMore improve Turn of the century in the US was sharp decline in Turn of the century in the US, was sharp decline in mortality rate  Industrial revolution  Hi h l i Higher real incomes  Improved healthcare, hospitals.  Gap in US in 1900 between educated and uneducated classes was smaller than in contemporary Third Worldclasses was smaller than in contemporary Third World.  Because behavioral pattern was still similar between classes.  Reasons for mortality declines in Third World are different than those of the USthan those of the US.  Health‐friendly social norms were already being spread throughmissionaries, media, and education system.  Technology is there it is access and proper use that is importantTechnology is there, it is access and proper use that is important There have always been socioeconomic differentials in mortalityThere have always been socioeconomic differentials in mortality levels.  Dismissed: improved efficacy of medicine –people with more access will benefit more  Interaction with modern medicine  Uncontrolled spread of medicine through unauthorized sources – hardly researched  Dismissed:Dismissed: “breakthrough periods in reducing mortality levels havebreakthrough periods in reducing mortality levels … have been associated with the democratization of services, not increase of quality.”  All facets of the same phenomenon: “social modernization.”  Indddividuallism, Westernization  Belief that sickness is not magical, but that it is possible to do something about it. –“secularization of health behavior.” PPaper iis from 1990. – Wh h df What hhas happened since?  Mostly unorganizedMostly unorganized  Correlation / causation?  Nomenclature: “indicatorindicator” vs “influences”Nomenclature: vs. influences  “...may, in fact, correlate more highly because health investment has been runningg ahead of social investment in terms of the optimum mix.”  Other factors involved with education?  I guess that is his point.Thi d Wld iti  4 Third World societies  3 had ~15 year higher life expectancies than countries with similar incomes 3 years lower countries with similar incomes. 3 years lower than Eastern Europe.  Sri Lanka spends 1.2% of GNP on health (Western civilizided countries is 3.7%), and has 15 times as many people per doctor. Oh i “P b bl iil i ” Other countries “Probably present a similar picture…” “The conclusion is inescapable that neither income nor levels of health services… are the explanation for thelevels of health services… are the explanation