How does health promotion work? Evidence from the dirty business of eliminating open defecation

Autores
Gertler, Paul; Shah, Manisha; Alzua, Maria Laura; Cameron, Lisa; Martinez, Sebastian; Patil, Sumeet
Año de publicación
2015
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
We investigate the mechanisms underlying health promotion campaigns designed to eliminate open defecation in at-scale randomized field experiments in four countries: India, Indonesia, Mali, and Tanzania. Health promotion works through a number of mechanisms, including: providing information on the return to better behavior, nudging better behavior that one already knows is in her self-interest, and encouraging households to invest in health products that lower the marginal cost of good behavior. We find that health promotion generally worked through both convincing households to invest in in-home sanitation facilities and nudging increased use of those facilities. We also estimate the causal relationship between village open defecation rates and child height using experimentally induced variation in open defecation for identification. Surprisingly we find a fairly linear relationship between village open defecation rates and the height of children less than 5 years old. Fully eliminating open defecation from a village where everyone defecates in the open would increase child height by 0.44 standard deviations. Hence modest to small reductions in open defecation are unlikely to have a detectable effect on child height and explain why many health promotion interventions designed to reduce open defecation fail to improve child height. Our results suggest that stronger interventions that combine intensive health promotional nudges with subsidies for sanitation construction may be needed to reduce open defecation enough to generate meaningful improvements in child health.
Fil: Gertler, Paul. University Of California Berkeley; Estados Unidos
Fil: Shah, Manisha. University of California at Los Angeles; Estados Unidos
Fil: Alzua, Maria Laura. Universidad Nacional de La Plata; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Cameron, Lisa. Monash University; Australia
Fil: Martinez, Sebastian. Banco Interamericano de Desarrollo; Estados Unidos
Fil: Patil, Sumeet. University Of California Berkeley; Estados Unidos
Materia
Randomized Controlled Trial
Sanitation
Health
Developing Countries
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/13644

id CONICETDig_94e72a100846b3047936b0c95f2dd797
oai_identifier_str oai:ri.conicet.gov.ar:11336/13644
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling How does health promotion work? Evidence from the dirty business of eliminating open defecationGertler, PaulShah, ManishaAlzua, Maria LauraCameron, LisaMartinez, SebastianPatil, SumeetRandomized Controlled TrialSanitationHealthDeveloping Countrieshttps://purl.org/becyt/ford/5.2https://purl.org/becyt/ford/5We investigate the mechanisms underlying health promotion campaigns designed to eliminate open defecation in at-scale randomized field experiments in four countries: India, Indonesia, Mali, and Tanzania. Health promotion works through a number of mechanisms, including: providing information on the return to better behavior, nudging better behavior that one already knows is in her self-interest, and encouraging households to invest in health products that lower the marginal cost of good behavior. We find that health promotion generally worked through both convincing households to invest in in-home sanitation facilities and nudging increased use of those facilities. We also estimate the causal relationship between village open defecation rates and child height using experimentally induced variation in open defecation for identification. Surprisingly we find a fairly linear relationship between village open defecation rates and the height of children less than 5 years old. Fully eliminating open defecation from a village where everyone defecates in the open would increase child height by 0.44 standard deviations. Hence modest to small reductions in open defecation are unlikely to have a detectable effect on child height and explain why many health promotion interventions designed to reduce open defecation fail to improve child height. Our results suggest that stronger interventions that combine intensive health promotional nudges with subsidies for sanitation construction may be needed to reduce open defecation enough to generate meaningful improvements in child health.Fil: Gertler, Paul. University Of California Berkeley; Estados UnidosFil: Shah, Manisha. University of California at Los Angeles; Estados UnidosFil: Alzua, Maria Laura. Universidad Nacional de La Plata; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Cameron, Lisa. Monash University; AustraliaFil: Martinez, Sebastian. Banco Interamericano de Desarrollo; Estados UnidosFil: Patil, Sumeet. University Of California Berkeley; Estados UnidosNational Bureau Economic Research2015-03info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/13644Gertler, Paul; Shah, Manisha; Alzua, Maria Laura; Cameron, Lisa; Martinez, Sebastian; et al.; How does health promotion work? Evidence from the dirty business of eliminating open defecation; National Bureau Economic Research; NBER Working Paper; 20997; 3-2015; 1-460898-2937enginfo:eu-repo/semantics/altIdentifier/doi/10.3386/w20997info:eu-repo/semantics/altIdentifier/url/http://www.nber.org/papers/w20997.pdfinfo:eu-repo/semantics/altIdentifier/url/http://www.nber.org/papers/w20997info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-03T10:10:05Zoai:ri.conicet.gov.ar:11336/13644instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-03 10:10:05.423CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv How does health promotion work? Evidence from the dirty business of eliminating open defecation
title How does health promotion work? Evidence from the dirty business of eliminating open defecation
spellingShingle How does health promotion work? Evidence from the dirty business of eliminating open defecation
Gertler, Paul
Randomized Controlled Trial
Sanitation
Health
Developing Countries
title_short How does health promotion work? Evidence from the dirty business of eliminating open defecation
title_full How does health promotion work? Evidence from the dirty business of eliminating open defecation
title_fullStr How does health promotion work? Evidence from the dirty business of eliminating open defecation
title_full_unstemmed How does health promotion work? Evidence from the dirty business of eliminating open defecation
title_sort How does health promotion work? Evidence from the dirty business of eliminating open defecation
dc.creator.none.fl_str_mv Gertler, Paul
Shah, Manisha
Alzua, Maria Laura
Cameron, Lisa
Martinez, Sebastian
Patil, Sumeet
author Gertler, Paul
author_facet Gertler, Paul
Shah, Manisha
Alzua, Maria Laura
Cameron, Lisa
Martinez, Sebastian
Patil, Sumeet
author_role author
author2 Shah, Manisha
Alzua, Maria Laura
Cameron, Lisa
Martinez, Sebastian
Patil, Sumeet
author2_role author
author
author
author
author
dc.subject.none.fl_str_mv Randomized Controlled Trial
Sanitation
Health
Developing Countries
topic Randomized Controlled Trial
Sanitation
Health
Developing Countries
purl_subject.fl_str_mv https://purl.org/becyt/ford/5.2
https://purl.org/becyt/ford/5
dc.description.none.fl_txt_mv We investigate the mechanisms underlying health promotion campaigns designed to eliminate open defecation in at-scale randomized field experiments in four countries: India, Indonesia, Mali, and Tanzania. Health promotion works through a number of mechanisms, including: providing information on the return to better behavior, nudging better behavior that one already knows is in her self-interest, and encouraging households to invest in health products that lower the marginal cost of good behavior. We find that health promotion generally worked through both convincing households to invest in in-home sanitation facilities and nudging increased use of those facilities. We also estimate the causal relationship between village open defecation rates and child height using experimentally induced variation in open defecation for identification. Surprisingly we find a fairly linear relationship between village open defecation rates and the height of children less than 5 years old. Fully eliminating open defecation from a village where everyone defecates in the open would increase child height by 0.44 standard deviations. Hence modest to small reductions in open defecation are unlikely to have a detectable effect on child height and explain why many health promotion interventions designed to reduce open defecation fail to improve child height. Our results suggest that stronger interventions that combine intensive health promotional nudges with subsidies for sanitation construction may be needed to reduce open defecation enough to generate meaningful improvements in child health.
Fil: Gertler, Paul. University Of California Berkeley; Estados Unidos
Fil: Shah, Manisha. University of California at Los Angeles; Estados Unidos
Fil: Alzua, Maria Laura. Universidad Nacional de La Plata; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Cameron, Lisa. Monash University; Australia
Fil: Martinez, Sebastian. Banco Interamericano de Desarrollo; Estados Unidos
Fil: Patil, Sumeet. University Of California Berkeley; Estados Unidos
description We investigate the mechanisms underlying health promotion campaigns designed to eliminate open defecation in at-scale randomized field experiments in four countries: India, Indonesia, Mali, and Tanzania. Health promotion works through a number of mechanisms, including: providing information on the return to better behavior, nudging better behavior that one already knows is in her self-interest, and encouraging households to invest in health products that lower the marginal cost of good behavior. We find that health promotion generally worked through both convincing households to invest in in-home sanitation facilities and nudging increased use of those facilities. We also estimate the causal relationship between village open defecation rates and child height using experimentally induced variation in open defecation for identification. Surprisingly we find a fairly linear relationship between village open defecation rates and the height of children less than 5 years old. Fully eliminating open defecation from a village where everyone defecates in the open would increase child height by 0.44 standard deviations. Hence modest to small reductions in open defecation are unlikely to have a detectable effect on child height and explain why many health promotion interventions designed to reduce open defecation fail to improve child height. Our results suggest that stronger interventions that combine intensive health promotional nudges with subsidies for sanitation construction may be needed to reduce open defecation enough to generate meaningful improvements in child health.
publishDate 2015
dc.date.none.fl_str_mv 2015-03
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/13644
Gertler, Paul; Shah, Manisha; Alzua, Maria Laura; Cameron, Lisa; Martinez, Sebastian; et al.; How does health promotion work? Evidence from the dirty business of eliminating open defecation; National Bureau Economic Research; NBER Working Paper; 20997; 3-2015; 1-46
0898-2937
url http://hdl.handle.net/11336/13644
identifier_str_mv Gertler, Paul; Shah, Manisha; Alzua, Maria Laura; Cameron, Lisa; Martinez, Sebastian; et al.; How does health promotion work? Evidence from the dirty business of eliminating open defecation; National Bureau Economic Research; NBER Working Paper; 20997; 3-2015; 1-46
0898-2937
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/doi/10.3386/w20997
info:eu-repo/semantics/altIdentifier/url/http://www.nber.org/papers/w20997.pdf
info:eu-repo/semantics/altIdentifier/url/http://www.nber.org/papers/w20997
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv National Bureau Economic Research
publisher.none.fl_str_mv National Bureau Economic Research
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
_version_ 1842270105599213568
score 13.13397