Education, health and nutrition disparities
reduction in the maternal mortality rate, a 0.23 percent reduction in the under-five mortality rate, and a 0.24 percent reduction in the child malnutrition rate. This finding points to the instrumental importance of poverty reduction in reducing health and nutritional deprivations.
The national income level matters for other non-income dimensions of material well-being (education, health and nutrition), but mainly through the channels of poverty, governance and public spending. Yet the degree of impact of those channels is not uniform across all dimensions of material wellbeing or even across different indicators of the same dimension.
The second most significant channel of impact on health outcomes is governance. Improvements in governance have a significant impact on indicators of health outcomes: maternal mortality and under-five mortality rates. Surprisingly, public spending on health does not appear to have a significant effect on improvements in health outcomes. Part of the reason may be the very high degree of corruption in public social spending. This is indirectly corroborated by the independent significance of the institutional driver such as governance rating. Also noteworthy, educational outcomes do not appear to be significantly determined by any of the channels tested in this regression. The only exception is public spending on education, which has a small and weak significant impact on secondary school enrolment rates.
In sum, the national income level matters for other non-income dimensions of material well-being (education, health and nutrition), but mainly through the channels of poverty, governance and public spending. Yet the degree of impact of those channels is not uniform across all dimensions of material well-being or even across different indicators of the same dimension. Poverty is particularly important for health and nutritional outcomes, while governance appears to be an important determinant of health outcomes in particular. Although the income level loses its independent significance as a determinant of education outcomes, the other channels tested also did not appear to be significant determinants.
4.3b.
The ‘growth plus other drivers’ approach
The preceding discussion tested the channels of growth in relation to their effects on education, health and nutrition outcomes. The second set of tests9 examines whether economic growth alone matters for nonincome inequalities or whether other structural and/ or institutional drivers also matter. To answer this question, the Tendulker model (World Bank, 2007) was used. The Tendulker model primarily examined whether past growth and institutional conditions mattered as independent drivers in explaining the cross-country differences in the current level of education, health and nutrition outcomes. The first step in the Tendulker model involved testing for the effect of long-term growth (measured as the average growth over the period 1991–2010) on education, health and nutrition outcomes (Table 4.4). The analysis also included the level of income and regional dummy variables to capture the effect of interregional differences. As can be seen from Table 4.4, past growth is significant in explaining non-income well-being. The average rate of long-term growth (over the period 1991–2010) is significant for health and nutritional dimensions of well-being, but not for educational attainments.
132 Humanity Divided: Confronting Inequality in Developing Countries