Intermediary and structural determinants of early childhood health in Colombia: exploring the role of communities

Ana Osorio Mejia, Catalina Bolancé () and Nyovani Madise ()
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Catalina Bolancé: University of Barcelona, Department of Econometrics, Barcelona-Spain
Nyovani Madise: University of Southampton, Division of Social Statistics and Centre for Global Health, Population, Poverty, and Policy, Southampton-United Kingdom

No XREAP2012-13, Working Papers from Xarxa de Referència en Economia Aplicada (XREAP)

Abstract: This study examines how structural determinants influence intermediary factors of child health inequities and how they operate through the communities where children live. In particular, we explore individual, family and community level characteristics associated with a composite indicator that quantitatively measures intermediary determinants of early childhood health in Colombia. We use data from the 2010 Colombian Demographic and Health Survey (DHS). Adopting the conceptual framework of the Commission on Social Determinants of Health (CSDH), three dimensions related to child health are represented in the index: behavioural factors, psychosocial factors and health system. In order to generate the weight of the variables and take into account the discrete nature of the data, principal component analysis (PCA) using polychoric correlations are employed in the index construction. Weighted multilevel models are used to examine community effects. The results show that the effect of household’s SES is attenuated when community characteristics are included, indicating the importance that the level of community development may have in mediating individual and family characteristics. The findings indicate that there is a significant variance in intermediary determinants of child health between-community, especially for those determinants linked to the health system, even after controlling for individual, family and community characteristics. These results likely reflect that whilst the community context can exert a greater influence on intermediary factors linked directly to health, in the case of psychosocial factors and the parent’s behaviours, the family context can be more important. This underlines the importance of distinguishing between community and family intervention programmes.

Keywords: Child health; intermediary determinants; structural determinants; communities; Colombia. (search for similar items in EconPapers)
Pages: 49 pages
Date: 2012-06, Revised 2012-06
New Economics Papers: this item is included in nep-hea
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Citations: View citations in EconPapers (7)

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http://www.xreap.cat/RePEc/xrp/pdf/XREAP2012-13.pdf First version, 2012 (application/pdf)
http://www.xreap.cat/RePEc/xrp/pdf/XREAP2012-13.pdf Revised version, 2012 (application/pdf)

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