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Disease externalities and net nutrition: Evidence from changes in sanitation and child height in Cambodia, 2005–2010

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  • Vyas, Sangita
  • Kov, Phyrum
  • Smets, Susanna
  • Spears, Dean
Abstract
Child height is an important indicator of human capital and human development, in large part because early life health and net nutrition shape both child height and adult economic productivity and health. Between 2005 and 2010, the average height of children under 5 in Cambodia significantly increased. What contributed to this improvement? Recent evidence suggests that exposure to poor sanitation – and specifically to widespread open defecation – can pose a critical threat to child growth. We closely analyze the sanitation height gradient in Cambodia in these two years. Decomposition analysis, in the spirit of Blinder-Oaxaca, suggests that the reduction in children’s exposure to open defecation can statistically account for much or all of the increase in average child height between 2005 and 2010. In particular, we see evidence of externalities, indicating an important role for public policy: it is the sanitation behavior of a child’s neighbors that matters more for child height rather than the household’s sanitation behavior by itself. Moving from an area in which 100% of households defecate in the open to an area in which no households defecate in the open is associated with an average increase in height-for-age z-score of between 0.3 and 0.5. Our estimates are quantitatively robust and comparable with other estimates in the literature.

Suggested Citation

  • Vyas, Sangita & Kov, Phyrum & Smets, Susanna & Spears, Dean, 2016. "Disease externalities and net nutrition: Evidence from changes in sanitation and child height in Cambodia, 2005–2010," Economics & Human Biology, Elsevier, vol. 23(C), pages 235-245.
    • Handle: RePEc:eee:ehbiol:v:23:y:2016:i:c:p:235-245
    DOI: 10.1016/j.ehb.2016.10.002
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    3. Bühler, Dorothee & Hartje, Rebecca & Ulrike Grote, 2017. "Can household food security predict individual undernutrition? Evidence from Cambodia and Lao PDR," Hannover Economic Papers (HEP) dp-594, Leibniz Universität Hannover, Wirtschaftswissenschaftliche Fakultät.
    4. Spears, Dean, 2020. "Exposure to open defecation can account for the Indian enigma of child height," Journal of Development Economics, Elsevier, vol. 146(C).
    5. Dorothee Bühler & Rebecca Hartje & Ulrike Grote, 2018. "Matching food security and malnutrition indicators: evidence from Southeast Asia," Agricultural Economics, International Association of Agricultural Economists, vol. 49(4), pages 481-495, July.
    6. Hanif Ammazia & Yuko Nakano & Midori Matsushima, 2022. "The impact of access to improved sanitation facilities on child health in Pakistan," Tsukuba Economics Working Papers 2022-003, Faculty of Humanities and Social Sciences, University of Tsukuba.
    7. Otterbach, Steffen & Rogan, Michael, 2017. "Spatial differences in stunting and household agricultural production in South African: (re-)examining the links using national panel survey data," Hohenheim Discussion Papers in Business, Economics and Social Sciences 13-2017, University of Hohenheim, Faculty of Business, Economics and Social Sciences.
    8. Carolin Schmidt, 2018. "Home is where the health is: Housing and adult height from the late 19th to the mid-20th centuries," ERES eres2018_33, European Real Estate Society (ERES).

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