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
- Institución
- Consejo Nacional de Investigaciones Científicas y Técnicas
- OAI Identificador
- oai:ri.conicet.gov.ar:11336/13644
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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 |
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reponame:CONICET Digital (CONICET) instname:Consejo Nacional de Investigaciones Científicas y Técnicas |
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CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas |
repository.mail.fl_str_mv |
dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar |
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