Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany.
Department of Humanities, Social and Political Sciences, ETH Zurich, Zurich, Switzerland.
PLoS Med. 2020 Mar 16;17(3):e1003054. doi: 10.1371/journal.pmed.1003054. eCollection 2020 Mar.
Education and health are both constituents of human capital that enable people to earn higher wages and enhance people's capabilities. Human capabilities may lead to fulfilling lives by enabling people to achieve a valuable combination of human functionings-i.e., what people are able to do or be as a result of their capabilities. A better understanding of how these different human capabilities are produced together could point to opportunities to help jointly reduce the wide disparities in health and education across populations.
We use nationally and regionally representative individual-level data from Demographic and Health Surveys (DHS) for 55 low- and middle-income countries (LMICs) to examine patterns in human capabilities at the national and regional levels, between 2000 and 2017 (N = 1,657,194 children under age 5). We graphically analyze human capabilities, separately for each country, and propose a novel child-based Human Development Index (HDI) based on under-five survival, maternal educational attainment, and measures of a child's household wealth. We normalize the range of each component using data on the minimum and maximum values across countries (for national comparisons) or first-level administrative units within countries (for subnational comparisons). The scores that can be generated by the child-based HDI range from 0 to 1. We find considerable heterogeneity in child health across countries as well as within countries. At the national level, the child-based HDI ranged from 0.140 in Niger (with mean across first-level administrative units = 0.277 and standard deviation [SD] 0.114) to 0.755 in Albania (with mean across first-level administrative units = 0.603 and SD 0.089). There are improvements over time overall between the 2000s and 2010s, although this is not the case for all countries included in our study. In Cambodia, Malawi, and Nigeria, for instance, under-five survival improved over time at most levels of maternal education and wealth. In contrast, in the Philippines, we found relatively few changes in under-five survival across the development spectrum and over time. In these countries, the persistent location of geographical areas of poor child health across both the development spectrum and time may indicate within-country poverty traps. Limitations of our study include its descriptive nature, lack of information beyond first- and second-level administrative units, and limited generalizability beyond the countries analyzed.
This study maps patterns and trends in human capabilities and is among the first, to our knowledge, to introduce a child-based HDI at the national and subnational level. Areas of chronic deprivation may indicate within-country poverty traps and require alternative policy approaches to improving child health in low-resource settings.
教育和健康都是人力资本的组成部分，能够使人们获得更高的工资并提高人们的能力。人类能力可以通过使人能够实现有价值的人类功能组合来实现充实的生活，即人们由于自身能力而能够做或成为的结果。更好地了解这些不同的人类能力是如何共同产生的，可能会为帮助共同减少人口中广泛存在的健康和教育差距提供机会。
我们使用来自人口与健康调查（DHS）的具有全国和区域代表性的个人层面数据，研究了 2000 年至 2017 年间（N=1657194 名 5 岁以下儿童）国家和区域层面的人类能力模式。我们分别为每个国家绘制了人类能力图，并提出了一种基于 5 岁以下儿童生存、母亲教育程度和儿童家庭财富衡量标准的新型儿童人类发展指数（HDI）。我们使用各国（用于国家比较）或国家内第一级行政单位（用于次国家比较）数据中最小和最大值对每个组成部分的范围进行归一化。儿童人类发展指数生成的分数范围为 0 到 1。我们发现各国之间以及各国内部的儿童健康状况存在很大差异。在国家层面，儿童人类发展指数在尼日尔为 0.140（第一级行政单位平均值=0.277，标准差[SD]为 0.114），在阿尔巴尼亚为 0.755（第一级行政单位平均值=0.603，SD 为 0.089）。总体而言，与 2000 年代相比，2010 年代期间有所改善，但并非所有纳入我们研究的国家都如此。例如，在柬埔寨、马拉维和尼日利亚，5 岁以下儿童的生存状况在大多数母亲教育和财富水平上都有所提高。相比之下，在菲律宾，我们发现 5 岁以下儿童的生存状况在整个发展阶段和时间跨度内都没有太大变化。在这些国家，儿童健康状况不佳的地理区域在发展阶段和时间上的持续存在可能表明存在国内贫困陷阱。我们研究的局限性包括其描述性性质、超出第一级和第二级行政单位的信息缺乏以及超出分析国家的普遍适用性有限。
本研究绘制了人类能力的模式和趋势，并且据我们所知，是第一个在国家和次国家层面引入儿童人类发展指数的研究。长期贫困地区可能表明国内存在贫困陷阱，需要采取替代政策方法来改善资源匮乏环境下的儿童健康状况。
