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COMMUNITY SOCIOECONOMIC CONTEXT AND ITS INFLUENCE ON INTERMEDIARY DETERMINANTS OF CHILD HEALTH: EVIDENCE FROM COLOMBIA

Published online by Cambridge University Press:  21 February 2014

ANA MARÍA OSORIO ,
CATALINA BOLANCÉ  and
NYOVANI MADISE
ANA MARÍA OSORIO*
Affiliation:
Department of Econometrics, University of Barcelona, Barcelona, Spain Department of Economics, Pontificia Universidad Javeriana, Cali, Colombia
CATALINA BOLANCÉ
Affiliation:
Department of Econometrics, University of Barcelona, Barcelona, Spain
NYOVANI MADISE
Affiliation:
Division of Social Statistics and Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
*
1Corresponding author. Email: [email protected]
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Summary

Intermediary determinants are the most immediate mechanisms through which socioeconomic position shapes health inequities. This study examines the effect of community socioeconomic context on different indicators representing intermediary determinants of child health. In the context of Colombia, a developing country with a clear economic expansion, but one of the most unequal countries in the world, two categories of intermediary determinants, namely behavioural and psychosocial factors and the health system, are analysed. Using data from the 2010 Colombian Demographic and Health Survey (DHS), the results suggest that whilst the community context can exert a greater influence on factors linked directly to health, in the case of psychosocial factors and parent's behaviours, the family context can be more important. In addition, the results from multilevel analysis indicate that a significant percentage of the variability in the overall index of intermediary determinants of child health is explained by the community context, even after controlling for individual, family and community characteristics. These findings underline the importance of distinguishing between community and family intervention programmes in order to reduce place-based health inequities in Colombia.

Type
Articles
Information
Journal of Biosocial Science , Volume 47 , Issue 1 , January 2015 , pp. 1 - 27
Copyright
Copyright © Cambridge University Press 2014 

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References

Acosta, K. (2012) La desnutrición en los primeros años de vida: un análisis regional para Colombia. Documentos de trabajo sobre Economía Regional 160.Google Scholar
Addai, I. (2000) Determinants of use of maternal–child health services in rural Ghana. Journal of Biosocial Science 32(1), 1–15.Google Scholar
Ahmed, S., Creanga, A. A., Gillespie, D. G. & Tsui, A. O. (2010) Economic status, education and empowerment: implications for maternal health service utilization in developing countries. PloS ONE 5(6), e11190.Google Scholar
Asparouhov, T. (2004) Weighting for Unequal Probability of Selection in Multilevel Modeling. Mplus Web Notes No. 8.Google Scholar
Attanasio, O., Di Maro, V. & Vera-Hernández, M. (2013) Community nurseries and the nutritional status of poor children. Evidence from Colombia. The Economic Journal doi: 10.1111/ecoj.12020.Google Scholar
Bernard, P., Charafeddine, R., Frohlich, K. L., Daniel, M., Kestens, Y. & Potvin, L. (2007) Health inequalities and place: a theoretical conception of neighbourhood. Social Science & Medicine 65 (9), 1839–1852.Google Scholar
Carle, A. C. (2009) Fitting multilevel models in complex survey data with design weights: recommendations. BMC Medical Research Methodology 9(49), 1–13.Google Scholar
Corsi, D. J., Chow, C. K., Lear, S. A., Rahman, M. O., Subramanian, S. V. & Teo, K. K. (2011) Shared environments: a multilevel analysis of community context and child nutritional status in Bangladesh. Public Health Nutrition, 14(6), 951–959.CrossRefGoogle ScholarPubMed
Coulton, C. J. & Fischer, R. L. (2010) Using early childhood wellbeing indicators to influence local policy and services. In Kamerman, S. B., Phipps, S. & Ben-Arieh, A. (eds) From Child Welfare to Child Well-Being. Springer, Netherlands, pp. 101–116.Google Scholar
Coulton, C. J., Korbin, J. E. & McDonell, J. (2009) Editorial: indicators of child well-being in the context of small areas. Child Indicators Research 2(2), 109–110.Google Scholar
Cummins, S., Curtis, S., Diez-Roux, A. V. & Macintyre, S. (2007) Understanding and representing “place” in health research: a relational approach. Social Science & Medicine 65(9), 1825–1838.Google Scholar
Cummins, S., Macintyre, S., Davidson, S. & Ellaway, A. (2005) Measuring neighbourhood social and material context: generation and interpretation of ecological data from routine and non-routine sources. Health and Place 11(3), 249–260.CrossRefGoogle ScholarPubMed
DNP (2005) Conpes Social 091: Metas y Estrategias de Colombia para el logro de los Objetivos de Desarrollo del Milenio – 2015, p. 69. URL: https://www.dnp.gov.co/Portals/0/archivos/documentos/Subdireccion/Conpes%20Sociales/091.pdfGoogle Scholar
DNP (2007) Conpes Social 109: Política pública nacional de primera infancia: Colombia por la primera infancia, p. 39. URL: http://www.mineducacion.gov.co/primerainfancia/1739/articles-177828_archivo_pdf_conpes109.pdfGoogle Scholar
DNP (2011a) Conpes Social 140: Modificación a Conpes Social 091 del 14 de junio de 2005, p. 55. URL: https://www.dnp.gov.co/LinkClick.aspx?fileticket=ZFHVVmnE1s8%3d&tabid=340Google Scholar
DNP (2011b) Convergencia y desarrollo regional – Caracterización, dinámica y desafíos. Plan Nacional de Desarrollo Colombia 2010–2014: Prosperidad para todos, p. 621. URL: https://www.dnp.gov.co/LinkClick.aspx?fileticket=zbyPnvJTgW0%3d&tabid=1238Google Scholar
DNP (2012) Conpes Social 152: Distribución de los recursos del sistema general de participaciones, p. 20. URL: http://www.mineducacion.gov.co/primerainfancia/1739/articles-177828_archivo_pdf_conpes_152.pdfGoogle Scholar
Diez Roux, A. V. (2000) Multilevel analysis in public health research. Annual Review of Public Health, 21, 171–192.Google Scholar
Diez Roux, A. V. (2001) Investigating neighborhood and area effects on health. American Journal of Public Health 91(11), 1783–1739.Google Scholar
Duncan, C., Jones, K. & Moon, G. (1998) Context, composition and heterogeneity: using multilevel models in health research. Social Science & Medicine, 46(1), 97–117.CrossRefGoogle ScholarPubMed
Elo, I. (1992) Utilization of maternal health-care services in Peru?: the role of women's education. Health Transition Review 2, 1–20.Google Scholar
Filmer, D. & Pritchett, L. H. (2001) Estimating wealth effects without expenditure data – or tears: an application to educational enrollments in states of India. Demography 38(1), 115–132.Google Scholar
Flórez, C. E. & Nupia, A. (2001) Desnutrición infantil en Colombia: Inequidades y Determinantes. Documentos de trabajo CEDE, Universidad de Los Andes.Google Scholar
Fotso, J. C. & Kuate-Defo, B. (2005) Socioeconomic inequalities in early childhood malnutrition and morbidity: modification of the household-level effects by the community SES. Health and Place 11(3), 205–225.Google Scholar
Fotso, J. C. & Kuate-Defo, B. (2006) Household and community socioeconomic influences on early childhood malnutrition in Africa. Journal of Biosocial Science 38(3), 289–313.Google Scholar
Gaviria, A. & Palau, M. (2006) Nutrición y salud infantil en Colombia?: determinantes y alternativas de política. Coyuntura Económica 36(2), 33–63.Google Scholar
Goldstein, H. (1999) Multilevel Statistical Models. Institute of Education, Multilevel Models Project, London.Google Scholar
Griffiths, P., Madise, N., Whitworth, A. & Matthews, Z. (2004) A tale of two continents: a multilevel comparison of the determinants of child nutritional status from selected African and Indian regions. Health and Place 10(2), 183–199.Google Scholar
Hatt, L. E. & Waters, H. R. (2006) Determinants of child morbidity in Latin America: a pooled analysis of interactions between parental education and economic status. Social Science & Medicine 62(2), 375–386.Google Scholar
Hoff, E., Laursen, B. & Tardif, T. (2002) Socioeconomic status and parenting. In Bornstein, M. H. (ed.) Handbook of Parenting: Biology and Ecology of Parenting, Vol. 2. Lawrence Erlbaum Associates, London, pp. 231–252.Google Scholar
Hox, J. J. (2002) Multilevel Analysis: Techniques and Applications. Routledge, London.CrossRefGoogle Scholar
Irwin, L., Siddiqi, A. & Clyde, H. (2007) Desarrollo de la Primera Infancia: Un Potente Ecualizador. World Health Organization. URL: http://www.who.int/social_determinants/publications/early_child_dev_ecdkn_es.pdf (accessed 26th July 2011).Google Scholar
Johnson, F. A., Padmadas, S. S. & Brown, J. J. (2009) On the spatial inequalities of institutional versus home births in Ghana: a multilevel analysis. Journal of Community Health 34(1), 64–72.Google Scholar
Kaiser, H. F. (1960) The application of electronic to factor analysis. Educational and Psychological Measurement 20, 141–151.CrossRefGoogle Scholar
Kawachi, I. & Berkman, L. F. (2003) Neighbourhoods and Health. Oxford University Press, Oxford.CrossRefGoogle Scholar
Kim, D. & Saada, A. (2013) The social determinants of infant mortality and birth outcomes in Western developed nations: a cross-country systematic review. International Journal of Environmental Research and Public Health 10(6), 2296–2335.Google Scholar
Kohen, D. E., Brooks-Gunn, J., Leventhal, T. & Hertzman, C. (2002) Neighborhood income and physical and social disorder in Canada: associations with young children's competencies. Child Development 73(6), 1844–1860.Google Scholar
Kolenikov, S. & Angeles, G. (2009) Socioeconomic status measurement with discrete proxy variables: is principal component analysis a reliable answer? Review of Income and Wealth 55(1), 128–165.Google Scholar
Larrea, C. & Freire, W. (2002) Social inequality and child malnutrition in four Andean countries. Revista panamericana de salud pública/Pan American Journal of Public Health 11(5–6), 356–364.Google Scholar
Linnemayr, S., Alderman, H. & Ka, A. (2008) Determinants of malnutrition in Senegal: individual, household, community variables, and their interaction. Economics and Human Biology 6(2), 252–263.Google Scholar
Luke, N. & Xu, H. (2011) Exploring the meaning of context for health: community influences on child health in South India. Demographic Research 24, 345–374.Google Scholar
Maas, C. J. M., & Hox, J. J. (2005) Sufficient sample sizes for multilevel modeling. Methodology 1(3), 86–92.CrossRefGoogle Scholar
Macintyre, S., Ellaway, A. & Cummins, S. (2002) Place effects on health: how can we conceptualise, operationalise and measure them? Social Science & Medicine 55(1), 125–139.Google Scholar
Magadi, M. A, Madise, N. J. & Rodrigues, R. N. (2000) Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities. Social Science & Medicine 51(4), 551–561.Google Scholar
Målqvist, M., Hoa, D. T. P. & Thomsen, S. (2012) Causes and determinants of inequity in maternal and child health in Vietnam. BMC Public Health 12, 641.Google Scholar
Marmot, M., Friel, S., Bell, R., Houweling, T. A. J.et al. (2008) Closing the gap in a generation: health equity through action on the social determinants of health. The Lancet, 372(9650), 1661–1669.Google Scholar
Mcquestion, M. J. (2001) Los comportamientos de salud correlacionados y la transición de la mortalidad en América Latina. Notas de Población 72, 189–228.Google Scholar
Menagahan, E. G. & Parcel, T. L. (1995) Social sources of change in children's home environments: the effects of parental occupational experiences and family conditions. Journal of Marriage and Family 57(1), 69–84.Google Scholar
Ministerio de la Protección Social (MPS) (2009) Plan Nacional para la Niñez y la Adolescencia, p. 94. URL: https://www.dnp.gov.co/LinkClick.aspx?fileticket=jDfZ3HpZfJ0%3D&tabid=341Google Scholar
Olsson, U. (1979) Maximum likelihood estimation of the polychoric correlation coefficient. Psychometrika 44(4), 443–460.Google Scholar
Olsson, U., Drasgow, F. & Dorans, N. J. (1982) The polyserial correlation coefficient. Psychometrika 47(3), 337–347.Google Scholar
Osorio, A., Bolance, C. & Alcañiz, M. (2013) Measuring intermediary determinants of early childhood health: a composite index comparing Colombian departments. Child Indicators Research 6(2), 297–319.CrossRefGoogle Scholar
Pfeffermann, D., Skinner, C. J., Holmes, D. J., Goldstein, H.et al. (1998) Weighting for unequal selection probabilities weighting in multilevel models. Journal of the Royal Statistical Society: Series B (Statistical Methodology) 60(1), 23–40.CrossRefGoogle Scholar
Pickett, K. E. & Pearl, M. (2001) Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. Journal of Epidemiology and Community Health 55(2), 111–122.Google Scholar
Rabe-Hesketh, S. & Skrondal, A. (2006) Multilevel modelling of complex survey data. Journal of the Royal Statistical Society: Series A (Statistics in Society) 169(4), 805–827.CrossRefGoogle Scholar
Rice, N. & Jones, A. (1997) Multilevel models and health economics. Health Economics 6, 561–575.Google Scholar
Rosenzweig, M. & Schultz, P. (1982) Child mortality and fertility in Colombia: individual and community effects. Health Policy and Education 2(3–4), 305–348.Google Scholar
Sagna, M. & Sunil, T. (2012) Effects of individual and neighborhood factors on maternal care in Cambodia. Health and Place 18, 415–423.Google Scholar
Sastry, N. (1996) Community characteristics, individual and household attributes, and child survival in Brazil. Demography 33(2), 211–229.Google Scholar
Saltelli, A. (2007) Composite indicators between analysis and advocacy. Social Indicators Research 81(1), 65–77.Google Scholar
Shankardass, K. & Dunn, J. R. (2012) How goes the neighbourhood? Rethinking neighbourhoods and health research in social epidemiology. In O'Campo, P. & Dunn, J. R. (eds) Rethinking Social Epidemiology: Towards a Science of Change. Springer, Netherlands. doi:10.1007/978-94-007-2138-8, pp. 137–156.Google Scholar
Solar, O. & Irwin, A. (2010) A conceptual framework for action on the social determinants of health. Discussion Paper 2 (Policy and Practice). World Health Organization, Geneva. URL: http://www.who.int/social_determinants/corner/SDHDP2.pdfGoogle Scholar
Steele, F. (2008) Module 5: Introduction to Multilevel Modelling (Concepts), Vol. 5. Centre for Multilevel Modelling, University of Bristol.Google Scholar
Stephenson, R., Baschieri, A., Clements, S., Hennink, M.et al. (2006) Contextual influences on the use of health facilities for childbirth in Africa. American Journal of Public Health 96(1), 84–93.Google Scholar
Theall, K. P., Scribner, R., Broyles, S., Yu, Q.et al. (2011) Impact of small group size on neighbourhood influences in multilevel models. Journal of Epidemiology and Community Health 65(8), 688–695.Google Scholar
Tovar, L. M. & García, G. A. (2007) La producción de salud infantil en Colombia: una aproximación. Desarrollo y Sociedad 59, 21–61.Google Scholar
Uthman, O. (2009) A multilevel analysis of individual and community effect on chronic childhood malnutrition in rural Nigeria. Journal of Tropical Pediatrics 55(2), 109–115.CrossRefGoogle ScholarPubMed
UNDP (2013) Human Development Report 2013. The Rise of the South: Human Progress in a Diverse World. United Nations Development Programme. URL: http://issuu.com/undp/docs/hdr_2013_en?e=3183072/1754153 (accessed 16th May 2013).Google Scholar
UNICEF (2009) The State of the World's Children 2011. United Nations Children's Fund. URL: http://www.unicef.org/rightsite/sowc/pdfs/SOWC_Spec%20Ed_CRC_Main%20Report_EN_090409.pdf (accessed 15th September 2010).Google Scholar
UNICEF (2011) The State of the World's Children 2011. Adolescence: An Age of Opportunity. United Nations Children's Fund. URL: http://www.unicef.org/sowc2011/pdfs/SOWC-2011-Main-Report_EN_02092011.pdf (accessed 2nd October 2012).Google Scholar
UNICEF (2012) Levels and Trends in Child Mortality 2012. Report 2012. United Nations Children's Fund. URL: http://apromiserenewed.org/files/UNICEF_2012_child_mortality_for_web_0904.pdf (accessed 30th January 2013.Google Scholar
UNICEF/WHO (2013) Immunization Summary. A Statistical Reference Containing Data through 2011. United Nations Children's Fund and World Health Organization. URL: http://www.childinfo.org/files/NutritionReport_April2013_Final.pdf (accessed 2nd May 2013).Google Scholar
Wagstaff, A., Bustreo, F., Bryce, J. & Claeson, M. (2004) Child health?: reaching the poor. American Journal of Public Health 94(5), 726–736.Google Scholar
Whitbeck, L. B., Simons, R. L., Conger, R. D., Wickrama, K. A. S.et al. (1997) The effects of parents' conditions and family economic hardship on parenting behaviors and children's self-efficacy. Social Psychology Quarterly 60(4), 291–303.CrossRefGoogle Scholar