Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK.
Centre for Health Economics, University of York, Heslington, York YO10 5DD, UK.
Econ Hum Biol. 2022 Jan;44:101074. doi: 10.1016/j.ehb.2021.101074. Epub 2021 Oct 28.
Internal armed conflicts have become more common and more physically destructive since the mid-20th century, with devastating consequences for health and development in low- and middle-income countries. This paper investigates the causal impacts of the long-term internal conflict on child health in Colombia, following an identification strategy based on the temporal and geographic variation of conflict intensity. We estimate the effect of different levels of conflict intensity on height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height z-scores among children under five years old, and explore the underlying potential mechanisms, through maternal health behavior and health care utilization. We find a harmful effect of exposure to conflict violence in utero and in early childhood for HAZ and WAZ, in the full sample and even more strongly in the rural sample, yet these estimates are smaller than those found for shorter term conflicts. The underlying pathways appear to operate around the time of the pregnancy and birth (in the form of maternal alcohol use, use of antenatal care and skilled birth attendance), rather than during the post-birth period (via breastfeeding or vaccination), and the impacts accumulate over the childhood. The most adverse impacts of conflict violence on child health and utilization of maternal healthcare were observed in municipalities which suffered from intermittent presence of armed groups.
自 20 世纪中期以来，内部武装冲突变得更加普遍和具有物理破坏性，给中低收入国家的健康和发展带来了毁灭性的后果。本文采用基于冲突强度的时间和地理变化的识别策略，研究了哥伦比亚长期内部冲突对儿童健康的因果影响。我们估计了不同程度的冲突强度对五岁以下儿童身高-年龄（HAZ）、体重-年龄（WAZ）和体重-身高 z 分数的影响，并通过母婴健康行为和医疗保健利用，探讨了潜在的机制。我们发现，在整个样本中，暴露于胎儿期和幼儿期的冲突暴力对 HAZ 和 WAZ 都有有害影响，在农村样本中更为强烈，但这些估计值比短期冲突的估计值要小。潜在的途径似乎在怀孕和分娩期间（表现为母亲饮酒、使用产前护理和熟练分娩护理）起作用，而不是在出生后期间（通过母乳喂养或接种疫苗）起作用，并且影响会在整个儿童时期积累。在间歇性存在武装团体的市政当局中，冲突暴力对儿童健康和母婴医疗保健利用的最不利影响最为明显。
