Sanitation, Disease Externalities, and Anemia: Evidence From Nepal
Anemia impairs physical and cognitive development in children and reduces human capital accumulation. The prior economics literature has focused on the role of inadequate nutrition in causing anemia. This paper is the first to show that sanitation, a public good, significantly contributes to preventing anemia. We identify effects by exploiting rapid and differential improvement in sanitation across regions of Nepal between 2006 and 2011. Within regions over time, cohorts of children exposed to better community sanitation developed higher hemoglobin levels. Our results highlight a previously undocumented externality of open defecation, which is today practiced by over a billion people worldwide.
We appreciate comments and suggestions from Harold Alderman, Oliver Cumming, Angus Deaton, Jeffrey Hammer, and Jean Humphrey. We thank seminar participants at Allahabad University, the Delhi School of Economics, and the Population Association of America 2014 annual meeting for helpful feedback. Research reported in this publication was directly supported by the Eunice Kennedy Shriver National Institute Of Child Health and Human Development of the National Institutes of Health under Award Number R03HD081209, administered through the University of Texas at Austin. Coffey and Spears also gratefully acknowledge a center grant for sanitation evidence from the Bill and Melinda Gates Foundation (OPP1125318) to r.i.c.e. r.i.c.e. is a 501(c)(3) non-profit research institute supported by donations and by research grants on sanitation and other topics. Geruso also gratefully acknowledges financial support from center grants 5 R24 HD042849 and 5 T32 HD007081 awarded to the Population Research Center at the University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This manuscript supersedes a previous draft by Diane Coffey entitled "Sanitation externalities, disease, and children's anemia," dated March, 2014. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.
No funder or other agency had the opportunity to review this research prior to circulation. Potentially relevant professional and financial relationships in the past 3 years:
1. Harvard University: post-doc funded by Robert Wood Johnson Foundation (salary)
2. University of Texas at Austin: Assistant Professor (salary)
3. Harvard University: Consulting on US Insurance Market Regulation and Health Plan Design (consulting fees <$10,000)
4. National Bureau of Economic Research (conference travel reimbursement)
5. NIH R03 Grant: “Impacts of Sanitation on Child and Maternal Health” 2014-2016 1R03HD081209-01. PI. ($100,000.)
6. Pfizer center Grant: “Selection Incentives in US Health Plan Design.” PI. ($35,000)Dean Spears
Dean Spears is paid a salary as Executive Director of r.i.c.e., a doing business as name of RICE Institute, Inc, a 501(c) public charity non-profit corporation online at www.riceinstitute.org. Since its initial operations in 2013, r.i.c.e. has received grants from the Bill and Melinda Gates Foundation, from the TRAction project of USAID, from the NIH, and from IGC – all with Dean Spears as a PI or co-PI.
Separately from r.i.c.e., Dean Spears has personally been paid as a Short Term Consultant at the World Bank, as a consultant for IPFRI (as compensation for co-authoring a book chapter), and as a short-term Visiting Fellow and Lecturer at Princeton University’s Woodrow Wilson School. He has had travel funded by the Gates Foundation, the World Bank, FHI 360, the Aix-Marseille School of Economics and Chicago Booth, in each case for a conference or presentation.
Spears attests that no party had the right to review the paper prior to its circulation.
Diane Coffey & Michael Geruso & Dean Spears, 2018. "Sanitation, Disease Externalities and Anaemia: Evidence From Nepal," Economic Journal, Royal Economic Society, vol. 128(611), pages 1395-1432, June. citation courtesy of