How does health promotion work?: evidence from the dirty business of eliminating open defecation
- Autores
- Gertler, Paul; Shah, Manisha; Alzúa, María Laura; Cameron, Lisa; Martínez, Sebastián; Patil, Sumeet
- Año de publicación
- 2015
- Idioma
- inglés
- Tipo de recurso
- documento de trabajo
- Estado
- versión enviada
- 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.
Facultad de Ciencias Económicas - Materia
-
Ciencias Económicas
Health, education, and welfare health
Development and growth
Children
Development economics
Health economics
Public economics - Nivel de accesibilidad
- acceso abierto
- Condiciones de uso
- http://creativecommons.org/licenses/by-nc-sa/4.0/
- Repositorio
- Institución
- Universidad Nacional de La Plata
- OAI Identificador
- oai:sedici.unlp.edu.ar:10915/127609
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How does health promotion work?: evidence from the dirty business of eliminating open defecationGertler, PaulShah, ManishaAlzúa, María LauraCameron, LisaMartínez, SebastiánPatil, SumeetCiencias EconómicasHealth, education, and welfare healthDevelopment and growthChildrenDevelopment economicsHealth economicsPublic economicsWe 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.Facultad de Ciencias Económicas2015info:eu-repo/semantics/workingPaperinfo:eu-repo/semantics/submittedVersionDocumento de trabajohttp://purl.org/coar/resource_type/c_8042info:ar-repo/semantics/documentoDeTrabajoapplication/pdfhttp://sedici.unlp.edu.ar/handle/10915/127609enginfo:eu-repo/semantics/altIdentifier/doi/10.3386/w20997info:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by-nc-sa/4.0/Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)reponame:SEDICI (UNLP)instname:Universidad Nacional de La Platainstacron:UNLP2025-09-03T11:02:58Zoai:sedici.unlp.edu.ar:10915/127609Institucionalhttp://sedici.unlp.edu.ar/Universidad públicaNo correspondehttp://sedici.unlp.edu.ar/oai/snrdalira@sedici.unlp.edu.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:13292025-09-03 11:02:58.46SEDICI (UNLP) - Universidad Nacional de La Platafalse |
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 Ciencias Económicas Health, education, and welfare health Development and growth Children Development economics Health economics Public economics |
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 Alzúa, María Laura Cameron, Lisa Martínez, Sebastián Patil, Sumeet |
author |
Gertler, Paul |
author_facet |
Gertler, Paul Shah, Manisha Alzúa, María Laura Cameron, Lisa Martínez, Sebastián Patil, Sumeet |
author_role |
author |
author2 |
Shah, Manisha Alzúa, María Laura Cameron, Lisa Martínez, Sebastián Patil, Sumeet |
author2_role |
author author author author author |
dc.subject.none.fl_str_mv |
Ciencias Económicas Health, education, and welfare health Development and growth Children Development economics Health economics Public economics |
topic |
Ciencias Económicas Health, education, and welfare health Development and growth Children Development economics Health economics Public economics |
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. Facultad de Ciencias Económicas |
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 |
dc.type.none.fl_str_mv |
info:eu-repo/semantics/workingPaper info:eu-repo/semantics/submittedVersion Documento de trabajo http://purl.org/coar/resource_type/c_8042 info:ar-repo/semantics/documentoDeTrabajo |
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workingPaper |
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submittedVersion |
dc.identifier.none.fl_str_mv |
http://sedici.unlp.edu.ar/handle/10915/127609 |
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http://sedici.unlp.edu.ar/handle/10915/127609 |
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eng |
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eng |
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info:eu-repo/semantics/altIdentifier/doi/10.3386/w20997 |
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openAccess |
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http://creativecommons.org/licenses/by-nc-sa/4.0/ Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) |
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