Publication: Environmental Determinants of Child Mortality in Rural China : A Competing Risks Approach
Loading...
Published
2004-03
ISSN
Date
2013-09-04
Author(s)
Editor(s)
Abstract
We use a competing risk model to analyze environmental determinants of child mortality using the 1992 China National Health Survey, which collects information on cause of death. Our primary question is whether taking into account of cause of death using a competing risk model, compared with a simple model of all-cause mortality, affects conclusions about the effectiveness of policy interventions. There are two potential analytical advantages in using cause of death information: (1) obtaining more accurate estimates and (2) validating causal relationships. Although, we do not find significant differences between estimates obtained from the competing risk model and those from simpler hazard models, we do find evidence supporting the causal interpretations of the effect of access to safe water on child mortality. Our analysis also suggests that a respondent-based health survey can be used to collect relatively reliable information on cause of death. Modifying future demographic and health survey (DHS) instruments to collect cause of death information inexpensively may be worthwhile for enhancing the analytical strength of the DHS.
Link to Data Set
Citation
“Jacoby, Hanan; Wang, Limin. 2004. Environmental Determinants of Child Mortality in Rural China : A Competing Risks Approach. Policy Research Working Paper;No. 3241. © World Bank. http://hdl.handle.net/10986/15622 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Publication Climate and Social Sustainability in Fragility, Conflict, and Violence Contexts(Washington, DC: World Bank, 2026-01-07)Climate change is widely recognized as a driver of violent conflict, but its broader social effects remain less understood. Ignoring these dimensions risks a vicious cycle where climate policies might undermine socially just adaptation. Evidence is still limited on how climate shocks influence political participation, trust, or migration. This paper helps fill that gap by examining links between climate change, conflict, and social sustainability, with a focus on inclusion, resilience, cohesion, and legitimacy. Using secondary data from 2019–24, the study applies simple correlation-based methods to test three hypotheses on the nature, severity, and composition of these associations. The analysis combines multiple climate impact measures, new conflict classifications, recent social sustainability frameworks, and controls for population and geography. The results reveal strong correlations—not causation—between climate events and contexts of fragility, conflict, and violence. Climate impacts are most pronounced in both national and subnational conflict settings. The study also finds robust links between fragility, conflict, and violence and low levels of social sustainability, reflecting its role as both a driver and consequence of conflict. Some dimensions—such as violent events and insecurity—appear weaker in areas most affected by climate shocks. Two of the hypotheses are supported, and one remains inconclusive.Publication The Macroeconomic Implications of Climate Change Impacts and Adaptation Options(Washington, DC: World Bank, 2025-05-29)Estimating the macroeconomic implications of climate change impacts and adaptation options is a topic of intense research. This paper presents a framework in the World Bank's macrostructural model to assess climate-related damages. This approach has been used in many Country Climate and Development Reports, a World Bank diagnostic that identifies priorities to ensure continued development in spite of climate change and climate policy objectives. The methodology captures a set of impact channels through which climate change affects the economy by (1) connecting a set of biophysical models to the macroeconomic model and (2) exploring a set of development and climate scenarios. The paper summarizes the results for five countries, highlighting the sources and magnitudes of their vulnerability --- with estimated gross domestic product losses in 2050 exceeding 10 percent of gross domestic product in some countries and scenarios, although only a small set of impact channels is included. The paper also presents estimates of the macroeconomic gains from sector-level adaptation interventions, considering their upfront costs and avoided climate impacts and finding significant net gross domestic product gains from adaptation opportunities identified in the Country Climate and Development Reports. Finally, the paper discusses the limits of current modeling approaches, and their complementarity with empirical approaches based on historical data series. The integrated modeling approach proposed in this paper can inform policymakers as they make proactive decisions on climate change adaptation and resilience.Publication Institutional Capacity for Policy Implementation: An Analytical Framework(Washington, DC: World Bank, 2026-01-07)State capacity is an important prerequisite for policy implementation, yet at the country level it is difficult to measure, assess, and reform. This paper proposes a focus on institutional capacity: the ability of public institutions to implement the specific policy mandates for which they are responsible. Based on a review of existing literature, the paper defines the different dimensions that compose institutional capacity and groups them into two cross-cutting categories: organizational dimensions (personnel, financial resources, information systems, and management practices) and governance dimensions (transparency, independence, and accountability). The paper proposes measures for organizational and governance dimensions using existing data, shows intra-institutional variation of these measures within countries, and discusses how new data could be collected for better measurement of these concepts. Finally, the paper illustrates how the framework can be used to diagnose the sources of common problems related to weak policy implementation.Publication South Africa’s Fragmented Cities: The Unequal Burden of Labor Market Frictions(Washington, DC: World Bank, 2026-01-08)Using high-resolution administrative, census, and satellite data, this paper shows that South African cities are characterized by spatial mismatches between where people live and where jobs are located, relative to 20 global peers. Areas within 5 kilometers of commercial centers have 9,300 fewer residents per square kilometer than expected, which is 60 percent below the global median. Poor, dense neighborhoods are most affected. In Johannesburg, a 10-percentile increase in distance from the nearest business hub corresponds to a 3.7-percentile drop in asset wealth (a proxy of household wellbeing) and 4.9-percentile drop in employment. In Cape Town, the declines are 4.0 and 3.7 percentiles, respectively. Employment is 87 percent lower in the poorest decile than the richest in Johannesburg and 61 percent lower in Cape Town. These findings suggest that South Africa’s spatial organization of people and economic activity constrains agglomeration and reinforces inequality. This methodology provides a scalable and standardized data-driven framework to analyze spatial accessibility and agglomeration frictions in complex, data-constrained urban systems.Publication Investment in Emerging and Developing Economies(Washington, DC: World Bank, 2026-01-07)The world faces a pressing challenge to meet key development objectives amid slowing growth and rising macroeconomic and geopolitical risks. With the number of job seekers rising rapidly, infrastructure shortfalls continuing to be large, and climate costs mounting, the case for a significant investment push has never been stronger. Yet the capacity to respond in many emerging markets and developing economies has eroded. Since the global financial crisis, investment growth has slowed to about half its pace in the 2000s, with both public and private investment weakening. Foreign direct investment inflows—a critical source of capital, technology, and managerial know-how—have also fallen sharply and become increasingly concentrated, leaving low-income countries with only a marginal share. The risks of further retrenchment are significant, as trade tensions, policy uncertainty, and elevated debt levels continue to weigh on investment. Reigniting momentum will require ambitious domestic reforms to strengthen institutions, rebuild macro-fiscal stability, and deepen trade and investment integration—the foundations of a supportive business climate. At the same time, international cooperation is indispensable. A renewed commitment to a predictable system of cross-border trade and investment flows, combined with scaled-up financial support and sustained technical assistance, is essential to help emerging markets and developing economies—especially low-income countries and economies in fragile and conflict situations—bridge financing gaps and implement the domestic reforms needed to restore investment as an engine of growth, jobs, and development.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication The Determinants of Child Health and Nutrition : A Meta-analysis(World Bank, Washington, DC, 2004-05-31)The reduction of infant and child death is one of the eight millennium development goals (MDGs). In addition, one of the goal one indicators is child malnutrition. A central question for the development community is to understand the factors underlying child health and nutritional status. What are the determinants of these indicators, which of these determinants are amenable to policy intervention, and which are the most effective channels for influencing health and nutrition outcomes? Potentially more insightful is analysis using data collected from household surveys which can include such variables. This paper summarizes the conclusions from these statistical studies of the determinants of child health (infant and child mortality) and nutritional status. The results from the various studies are combined using meta-analysis, which calculates the statistical significance of a variable included in more than one study by combining the results of those studies. In this context, the report is structured as follows: part one gives introduction. Part two briefs review of theory to introduce the relevant variables and their classification. Part three discusses data and variable definition and econometric issues, including the use of meta-analysis. The results are presented in part four and part five concludes. Annexes provide more details of the studies reviewed in this paper.Publication India - Achieving the Millennium Development Goals (MDG) in India's Poor States : Reducing Child Mortality in Orissa(Washington, DC, 2007-05)This report builds on the World Bank's earlier report on the Millennium Development Goals (MDGs) in India (2004 report number 30266), which highlighted the challenges India faces in meeting a number of the MDGs. The report focuses on the state of Orissa and is organized as follows: the second chapter provides a brief background on Orissa. This is followed by a review of recent trends with infant and child mortality in the state. Chapter 4 introduces a framework for assessing the multitude of factors which have a bearing on infant and child mortality, dividing them into four groups: the individual woman/mother; the family; the community and service provision. Chapter 5 applies the analytical framework to Orissa and this is followed by a chapter 6 which looks at district level patterns. The final chapter of the report pulls it altogether and attempts to answer three questions: what is needed to bring down child mortality rates in Orissa and achieve the 11" Five Year Plan and MDG goal; how well are existing interventions placed to do the job; and where are the gaps and how can they best be filled. The report ends with an outline of a possible multi-sectoral program designed to reduce child mortality in Orissa.Publication Environmental Health and Child Survival : Epidemiology, Economics, Experiences(Washington, DC : World Bank, 2008)This report complements Repositioning Nutrition as Central to Development by looking at environmental health issues that affect child health broadly, while also exploring the links through malnutrition. This report argues that environmental health interventions are preventive measures that are imperative to improve child survival with sustainable results in the long term. Preventive measures, such as improving environmental conditions are effective in reducing a child's exposure to a disease agent and thereby averting infection. The overall aim of this report is to provide information to decision-makers on the optimal design of policies to help reduce premature deaths and illness in children under five years of age. To protect the health, development, and wellbeing of young children, decision-makers must identify and reduce environmental risk factors by providing appropriate interventions that prevent and diminish exposures. This study is intended to advance the understanding of what those risk factors are, when and how to reduce children's exposure to them, and how to mitigate their consequent health impact.Publication Community-based Maternal and Child Nutrition and Health Interventions in Nigeria : A Comparative Case Study Analysis on Best Practices(World Bank, Washington, DC, 2011-02)This study discusses how to effectively engage in community-based nutrition and health programs aimed to improve maternal, newborn, and child nutrition and health outcomes, particularly in Northern Nigeria. It provides the comparative synthesis of four case studies, each of which included a community action component for improving nutrition and health outcomes. It provides a normative base for designing and planning government programs that support reforms in outcome-based programming for maternal, newborn, and child nutrition and health through program support and investment lending. Central to the report is the discussion on the roles played by various stakeholders - state and local government, NGOs, traditional and religious leaders, and communities themselves - in creating and sustaining community mobilization. The factors considered essential or useful contributors to community mobilization are analyzed. The history of government s role in Nigerian health care is discussed, as well as the current situation and future possibilities, especially at the state and local level.Publication A Closer Look at Child Mortality among Adivasis in India(2010-03-01)The authors use data from the National Family Health Survey 2005 to present age-specific patterns of child mortality among India's tribal (Adivasi) population. The analysis shows three clear findings. First, a disproportionately high number of child deaths are concentrated among Adivasis, especially in the 1-5 age group and in those states and districts where there is a high concentration of Adivasis. Any effort to reduce child morality in the aggregate will have to focus more squarely on lowering mortality among the Adivasis. Second, the gap in mortality between Adivasi children and the rest really appears after the age of one. In fact, before the age of one, tribal children face more or less similar odds of dying as other children. However, these odds significantly reverse later. This calls for a shift in attention from infant mortality or in general under-five mortality to factors that cause a wedge between tribal children and the rest between the ages of one and five. Third, the analysis goes contrary to the conventional narrative of poverty being the primary factor driving differences between mortality outcomes. Instead, the authors find that breaking down child mortality by age leads to a much more refined picture. Tribal status is significant even after controlling for wealth.
Users also downloaded
Showing related downloaded files
Publication Mongolia Country Climate and Development Report(Washington, DC: World Bank, 2024-10-22)Mongolia’s development prospects are uniquely challenged by both the impacts of climate change and the global shift toward a low-carbon economy. The country’s efforts toward decarbonization pose significant challenges given the structurally high-emission intensity of its economy. While challenging, climate action also presents Mongolia with opportunities to achieve important development benefits. The effects of climate risks and the shift away from coal will have diverse impacts across different regions, communities, and socioeconomic levels. The report assesses the critical interconnections between Mongolia’s development ambitions and climate change action and identifies ways to transition to a more economically diversified, inclusive, and resilient development path. It highlights key climate and transition risks affecting Mongolia’s future development and presents a pathway to enhance climate mitigation and adaptation. The report also makes a case for strengthening policies to enhance resilience to climate change and ensure a just transition, particularly for the most vulnerable. The report is structured as follows: section 1 gives introduction. Section 2 delves into the linkages between development and climate in Mongolia and presents model-based findings on the economic and poverty impacts of climate change under different scenarios. Section 3 covers four in-depth sectoral analyses. The first two mainly focus on adaptation to climate change in the agriculture and water sectors. The third considers prospects for the extraction sector, while the fourth sectoral analysis focuses on decarbonizing power and heat generation. Section 4 shifts the focus to how the government can boost resilience for climate-vulnerable populations. Section 5 outlines options for mobilizing private and public financing and private investments to support the green transition. Section 6 examines the existing institutional and governance structure for climate action and presents recommendations to improve its effectiveness, and section 7 concludes with a framework for prioritizing the policy actions outlined in this report.Publication Comoros Country Climate and Development Report(Washington, DC: World Bank, 2025-06-18)The Union of the Comoros (The Comoros) has significant vulnerability to climate change-related risks but has considerable opportunities to strengthen preparedness and resilience against these challenges. According to the Notre Dame Global Adaptation Index, the Comoros is the 29th-most vulnerable country to climate change and the 163rd most ready to adapt (out of 191). The Comoros archipelago is exposed to many natural hazards that adversely affect the country’s natural capital, people, and physical infrastructure. In 2014, the economic cost of climate-related disasters was estimated at 5.7 million dollars annually, equivalent to 9.2 percent of Gross Domestic Product (GDP). Between 2018 and 2023, as many as 11 tropical depressions or cyclones impacted the country, with Cyclone Kenneth causing the greatest damage, equivalent to 14 percent of GDP, resulting in total economic growth falling from 3.6 percent in 2018 to 1.9 percent in 2019. More than 345,000 people (40 percent of the population) were affected by the cyclone, with 185,000 people experiencing severe impacts and 12,000 people displaced. However, there is an opportunity for the country to grow more robust and shock-responsive, and to establish pre-positioned funding mechanisms to enhance future crisis response efforts. For the Comoros, adaptation and climate-resilient development are the key climate change focus areas, with the country projected to face 836 million dollars 2050 in additional costs due to climate-related impacts. Current plans to adapt to the impacts of climate change in the Comoros include efforts to improve water management, strengthen coastal protection, and develop climate-smart agriculture practices. Given the country’s reliance on its natural resource base for economic growth and mobility, protection of these resources from climate change will be essential for promoting resilient growth and development. In addition to growing the adaptive capacity of the country’s natural resource sectors, strategic economic diversification will be important to help minimize future climate impacts, and development activities will need to be undertaken in such a way as to attract low-carbon co-benefits. The Union of the Comoros is committed to addressing climate change through its Nationally Determined Contribution (NDC) and national priorities. The country’s NDC (which was revised in 2021 for a ten-year horizon) sets ambitious targets, with a goal of reducing greenhouse gas emissions by 23 percent by 2030. The country also plans to significantly increase the share of renewable energy in its energy portfolio, reaching 33 MW by 2030. This will not only promote low-carbon development but also reduce the country’s dependency on imported oil and coal, which currently make up 95 percent of the energy mix. Additionally, the Comoros has declared its intention to increase CO2 removals by 47 percent by 2030, compared to BAU.Publication Guinea-Bissau Country Climate and Development Report(Washington, DC: World Bank, 2024-10-23)Guinea-Bissau is endowed with a wealth of natural resources, with the highest natural capital per capita in West Africa (US3,874 dollars per capita), which could be leveraged for sustainable and resilient growth. However, Guinea-Bissau faces significant development hurdles, such as high poverty rates, political instability, and economic challenges, including an over-reliance on cashew nuts. Rural poverty has increased, and the nation's infrastructure, education, and health care systems are underdeveloped. Climate change poses a severe threat, potentially impacting agriculture, fisheries, and infrastructure. Without adaptation, it could lead to a significant cut in real GDP per capita (minus 7.3 percent by 2050) and increase in poverty (with up to over 200,000 additional poor by 2050, that is, 5 percent of the expected population, in the worst scenario). The country's low greenhouse gas emissions are expected to rise, mainly due to agriculture and land-use changes, with deforestation being a major contributing factor. Although Guinea-Bissau is a low emitter, it has high mitigation ambitions, targeting a 30 percent reduction in greenhouse gas emissions by 2030. The Nationally Determined Contribution outlines significant climate actions, with initiatives focused on forest conservation, sustainable agriculture, and community development. However, the country's political instability, institutional weaknesses, and limited financial resources pose challenges to implementing these climate commitments, which depend heavily on external funding. The financial sector's underdevelopment and vulnerability to external shocks limit its ability to support green investments, though reforms could enhance resilience. Guinea-Bissau must consider its climate financing as development financing and vice-versa, engage the private sector, and integrate climate goals with national development plans to ensure a sustainable future. Concessional climate financing is vital due to the underdeveloped financial sector and the government’s limited borrowing capacity. Addressing Guinea-Bissau's vulnerability to climate change and its structural issues requires a cohesive approach that integrates development and climate strategies. This could involve improving governance, diversifying the economy, protecting natural capital, developing human capital, and investing in sustainable agriculture and infrastructure. The transition to a more sustainable and inclusive development pathway that supports economic growth is possible, but requires focusing on key strategic sectors, enhancing institutional capacity, and creating the conditions to mobilize finance. As a highly vulnerable country, there are myriad needs in the different sectors; however, to be more efficient and effective, Guinea-Bissau should prioritize actions in a few sectors, especially actions on biodiversity, agriculture, and social protection. Low carbon development, especially in energy and forestry sectors, could provide cost-efficient solutions and attract climate finance, including from the private sector, which will support the overall development agenda.Publication Jobs in a Changing Climate: Insights from World Bank Group Country Climate and Development Reports Covering 93 Economies(Washington, DC: World Bank, 2025-11-05)The World Bank Group’s Country Climate and Development Reports (CCDRs) provide a crosscutting look at how countries’ development prospects, and the job opportunities they offer to their people, can be threatened by climate impacts and supported by climate policies. Climate change and policies affect jobs through impacts on productivity, energy and material efficiency, and physical, human, and natural capital. They can also transform employment opportunities, especially through complementary measures that help workers and firms adapt to and benefit from new technologies and production practices. Prepared by the World Bank, the International Finance Corporation (IFC), and the Multilateral Investment Guarantee Agency (MIGA), CCDRs integrate country perspectives, climate science and economic modeling, private sector information, and policy analysis to assess how countries can successfully grow and develop their economies and create jobs despite increasing climate risks and while achieving their climate objectives and commitments. Each CCDR starts from the country’s development priorities, opportunities, and challenges, and is developed in close consultation with governments, businesses, and civil society, ensuring the recommendations reflect national priorities. By combining evidence on adaptation, resilience, and emissions pathways, CCDRs highlight where climate action can reinforce development and job creation, and where targeted policies are needed to manage risks and smooth labor market transitions. Taken together, these elements can help create local jobs, ensure economic transitions are just and inclusive, and equip workers and firms to navigate the disruptions and opportunities of a changing climate and changing technologies.Publication Kyrgyz Republic Country Climate and Development Report(Washington, DC: World Bank, 2025-11-03)This Country Climate and Development Report (CCDR) on the Kyrgyz Republic aims to support the country’s development goals amid a changing climate. The CCDR considers two policy scenarios up to 2050: the business-as-usual (BAU) and high-growth scenarios. As it quantifies the likely impacts of climate change on the Kyrgyz economy between now and 2050, the report highlights key government actions to best prepare for and adapt to climate impacts (referred to as “with adaptation” measures), with a particular focus on the time horizon up to 2030. The CCDR also outlines a path to net zero emissions by 2050 (referred to as “with mitigation” measures, “decarbonization,” or, simply, “net zero 2050”), highlighting associated development co-benefits.