Skip to main content

Urban poverty and health in developing countries: Household and neighborhood Effects

Abstract

In the United States and other high-income countries, there is intense scholarly and programmatic interest in the effects of household and neighborhood living standards on health. Yet few studies of developing-country cities have explored these issues. We investigated whether the health of urban women and children in poor countries is influenced by both household and neighborhood standards of living. Using data from the urban samples of 85 Demographic and Health Surveys and modeling living standards using factor-analytic MIMIC methods, we found that the neighborhoods of relatively poor households are more heterogeneous than is often asserted. Our results indicated that poor urban households do not tend to live in uniformly poor neighborhoods: about 1 in 10 of a poor household’s neighbors is relatively affluent, belonging to the upper quartile of the urban distribution of living standards. Do household and neighborhood living standards influence health? Using multivariate models, we found that household living standards are closely associated with three health measures: unmet need for modern contraception, attendance of a trained health care provider at childbirth, and young children’s height for age. Neighborhood living standards exert a significant additional influence in many of the surveys we examined, especially for birth attendance.

This is a preview of subscription content, access via your institution.

References

  • Aber, J.L., M.A. Gephart, J. Brooks-Gunn, and J.P. Connell. 1997. “Development in Context: Implications for Studying Neighborhood Effects.” Pp. 44–61 in Neighborhood Poverty, Volume I: Context and Consequences for Children, edited by J. Brooks-Gunn, G.J. Duncan, and J.L. Aber. New York: Russell Sage Foundation.

    Google Scholar 

  • Åberg Yngwe, M., J. Fritzell, O. Lundberg, F. Diderichsen, and B. Burström. 2003. “Exploring Relative Deprivation: Is Social Comparison a Mechanism in the Relation Between Income and Health?” Social Science and Medicine 57:1463–73.

    Article  Google Scholar 

  • African Population and Health Research Center. 2002. Population and Health Dynamics in Nairobi’s Informal Settlements: Report of the Nairobi Cross-Sectional Slums Survey (NCSS) 2000. Nairobi: African Population and Health Research Center.

    Google Scholar 

  • Astone, N., C.A. Nathanson, R. Schoen, R., and Y.J. Kim. 1999. “Family Demography, Social Theory, and Investment in Social Capital.” Population and Development Review 25:1–31.

    Article  Google Scholar 

  • Baker, J.L. 2001. “Social Exclusion in Urban Uruguay.” Working paper. Latin America and Caribbean Region, World Bank, Washington, DC.

    Google Scholar 

  • Behrman, J., H.-P. Kohler, and S. Watkins. 2001. “Social Networks, Family Planning, and Worrying About AIDS.” Paper presented at the 2001 annual meeting of the Population Association of America, Washington, DC, March 29–31.

  • Bollen, K. 1989. Structural Equations With Latent Variables. New York: John Wiley & Sons.

    Google Scholar 

  • Caldeira, T.P.R. 1999. “Fortified Enclaves: The New Urban Segregation.” Pp. 114–38 in Cities and Citizenship, edited by J. Holston. Durham, NC: Duke University Press.

    Google Scholar 

  • — 2000. City of Walls: Crime, Segregation, and Citizenship in São Paulo. Berkeley: University of California Press.

    Google Scholar 

  • Casterline, J.B., ed. 2001. Diffusion Processes and Fertility Transition: Selected Perspectives. Washington, DC: National Academies Press.

    Google Scholar 

  • Casterline, J.B., M.R. Montgomery, D.K. Agyeman, P. Aglobitse, and G.-E. Kiros. 2001. “Social Networks and Contraceptive Dynamics in Southern Ghana.” Paper presented at the 2001 annual meeting of the Population Association of America, Washington, DC, March 29-31.

  • Casterline, J.B. and S.W. Sinding. 2000. “Unmet Need for Family Planning in Developing Countries and Implications for Population Policy.” Population and Development Review 26: 691–723.

    Article  Google Scholar 

  • Coleman, J.S. 1988. “Social Capital in the Creation of Human Capital.” American Journal of Sociology 94(Suppl.):S95-S120.

    Article  Google Scholar 

  • Coulton, C., J. Korbin, T. Chan, and M. Su. 1997. “Mapping Residents’ Perceptions of Neighborhood Boundaries: A Methodological Note.” Working Paper. Center on Urban Poverty and Social Change, Case Western Reserve University, Cleveland, OH.

    Google Scholar 

  • Drukker, M., C. Kaplan, F. Feron, and J. van Os. 2003. “Children’s Health-Related Quality of Life, Neighbourhood Socio-economic Deprivation and Social Capital. A Contextual Analysis.” Social Science and Medicine 57:825–41.

    Article  Google Scholar 

  • Ferguson, B.D., A. Tandon, E. Gakidou, and C.J.L. Murray. 2003. “Estimating Permanent Income Using Indicator Variables.” Discussion Paper No. 42. Global Programme on Evidence for Health Policy, World Health Organization, Geneva.

    Google Scholar 

  • Filmer, D. and L. Pritchett. 1999. “The Effect of Household Wealth on Educational Attainment: Evidence From 35 Countries.” Population and Development Review 25:85–120.

    Article  Google Scholar 

  • — 2001. “Estimating Wealth Effects Without Expenditure Data-Or Tears: An Application to Educational Enrollments in States of India.” Demography 38:115–32.

    Google Scholar 

  • Freedman, R. and J.Y. Takeshita. 1969. Family Planning in Taiwan: An Experiment in Social Change. Princeton, NJ: Princeton University Press.

    Google Scholar 

  • Furstenberg, F.F. 1993. “How Families Manage Risk and Opportunity in Dangerous Neighborhoods.” Pp. 231–58 in Sociology and the Public Agenda, edited by W.J. Wilson. Newbury Park, CA: Sage.

    Google Scholar 

  • Furstenberg, F.F. and M.E. Hughes. 1997. “The Influence of Neighborhoods on Children’s Development: A Theoretical Perspective and a Research Agenda.” Pp. 23–47 in Neighborhood Poverty, Volume II: Policy Implications in Studying Neighborhoods, edited by J. Brooks-Gunn, G.J. Duncan, and J.L. Aber. New York: Russell Sage Foundation.

    Google Scholar 

  • Ginther, D., R. Haveman, and B. Wolfe. 2000. “Neighborhood Attributes as Determinants of Children’s Outcomes: How Robust Are the Relationships?” Journal of Human Resources 35:603–33.

    Article  Google Scholar 

  • Gordon, D., S. Nandy, C. Pantazis, S. Pemberton, and P. Townsend. 2003. Child Poverty in the Developing World. Bristol, England: Policy Press.

    Google Scholar 

  • Hardman, A. and Y.M. Ioannides. 2004. “Income Mixing and Housing in U.S. Cities: Evidence From Neighborhood Clusters of the American Housing Survey.” Working paper. Department of Economics, Tufts University, Medford, MA.

    Google Scholar 

  • Harpham, T. and M. Tanner, eds. 1995. Urban Health in Developing Countries: Progress and Prospects. New York: St. Martin’s Press.

    Google Scholar 

  • Herr, H. and G. Karl. 2002. “Estimating Global Slum Dwellers: Monitoring the Millennium Development Goal 7, Target 11.” Monitoring Systems Branch, Global Urban Observatory. Nairobi: UN-HABITAT.

    Google Scholar 

  • Herr, H. and G. Mboup. 2003. “Slum Dweller Estimation Methodology.” Unpublished paper. Nairobi: UN-HABITAT.

    Google Scholar 

  • Jöreskog, K.G. 2000. “Latent Variable Scores and Their Uses.” Unpublished paper. Available online at http://www.ssicentral.com/lisrel.column6.pdf

  • Jöreskog, K.G. 2002. “Structural Equation Modeling With Ordinal Variables Using LISREL.” Unpublished paper. Available on-line at http://www.ssicentral.com/lisrel/corner.htm

  • Kaufman, C.E., S. Clark, N. Manzini, and J. May. 2002. “How Community Structures of Time and Opportunity Shape Adolescent Sexual Behavior in South Africa.” Working Paper No. 159. Policy Research Division, Population Council, New York.

    Google Scholar 

  • Kravdal, Ø. 2003. “Community Mortality in India: Individual and Community Effects of Women’s Education and Autonomy.” East-West Center Working Papers, Population Series, no. 112. East-West Center, Honolulu, HI.

    Google Scholar 

  • Lawley, D.N. and A.E. Maxwell. 1962. “Factor Analysis as a Statistical Method.” Statistician 12:209–29.

    Article  Google Scholar 

  • Massey, D.S. 1990. “American Apartheid: Segregation and the Making of the Underclass.” American Journal of Sociology 96:329–57.

    Article  Google Scholar 

  • — 1996. “The Age of Extremes: Concentrated Affluence and Poverty in the Twenty-first Century.” Demography 33:395–412.

    Article  Google Scholar 

  • McCulloch, A. 2003. “An Examination of Social Capital and Social Disorganisation in Neighbourhoods in the British Household Panel Study.” Social Science and Medicine 56: 1425–38.

    Article  Google Scholar 

  • McDade, T.W. and L.S. Adair. 2001. “Defining the ’Urban’ in Urbanization and Health: A Factor Analysis Approach.” Social Science and Medicine 53:55–70.

    Article  Google Scholar 

  • Montgomery, M.R. and A.C. Ezeh. 2005. “Urban Health in Developing Countries: Insights From Demographic Theory and Practice.” Pp. 317–60 in The Handbook of Urban Health, edited by S. Galea and D. Vlahov. New York: Springer.

    Chapter  Google Scholar 

  • Montgomery, M.R., M. Gragnolati, K.A. Burke, and E. Paredes. 2000. “Measuring Living Standards With Proxy Variables.” Demography 37:155–74.

    Article  Google Scholar 

  • Montgomery, M.R. and P.C. Hewett. 2004. “Urban Poverty and Health in Developing Countries: Household and Neighborhood Effects.” Working Paper No. 184. Policy Research Division, Population Council, New York. Available on-line at www.popcouncil.org/publications

    Google Scholar 

  • Montgomery, M.R., C. Lloyd, P.C. Hewett, and P. Heuveline. 1997. “The Consequences of Imperfect Fertility Control for Children’s Survival, Health, and Schooling.” Demographic and Health Surveys Analytical Reports No. 7. Macro International, Calverton, MD.

    Google Scholar 

  • Oakes, J.M. 2004. “The (Mis)estimation of Neighborhood Effects: Causal Inference for a Practicable Social Epidemiology.” Social Science and Medicine 58:1929–52.

    Article  Google Scholar 

  • Panel on Urban Population Dynamics, National Research Council. 2003. Cities Transformed: Demographic Change and Its Implications in the Developing World, edited by M.R. Montgomery, R. Stren, B. Cohen, and H. Reed. Washington, DC: National Academies Press.

    Google Scholar 

  • Pebley, A.R., N. Goldman, and G. Rodríguez. 1996. “Prenatal and Delivery Care and Childhood Immunization in Guatemala: Do Family and Community Matter?” Demography 33:231–47.

    Article  Google Scholar 

  • Pebley, A.R. and N. Sastry. 2003. “Concentrated Poverty vs. Concentrated Affluence: Effects on Neighborhood Social Environments and Children’s Outcomes.” Paper presented at the 2003 annual meeting of the Population Association of America, Minneapolis, MN, May 1-3.

  • Sahn, D.E. and D.C. Stifel. 2000. “Poverty Comparisons Over Time and Across Countries in Africa.” World Development 28(12):2123–55.

    Article  Google Scholar 

  • Sampson, R.J., J.D. Morenoff, and T. Gannon-Rowley. 2002. “Assessing ’Neighborhood Effects’: Social Processes and New Directions in Research.” Annual Review of Sociology 28:443–78.

    Article  Google Scholar 

  • Sastry, N. 1996. “Community Characteristics, Individual and Household Attributes, and Child Survival in Brazil.” Demography 33:211–29.

    Article  Google Scholar 

  • Sastry, N., A. Pebley, and M. Zonta. 2002. “Neighborhood Definitions and the Spatial Dimension of Daily Life in Los Angeles.” Paper presented at the 2002 annual meeting of the Population Association of America, Atlanta, GA, May 9–11.

  • Szwarcwald, C.L., C.L.T. de Andrade, and F.I. Bastos. 2002. “Income Inequality, Residential Poverty Clustering and Infant Mortality: A Study in Rio de Janeiro, Brazil.” Social Science and Medicine 55:2083–92.

    Article  Google Scholar 

  • Tandon, A., E. Gakidou, C.J.L. Murray, and B. Ferguson. 2002. “Cross-Population Comparability and PPPs: Using Micro-data on Indicators of Consumer Durables.” Evidence and Information for Policy Cluster draft paper. World Health Organization, Geneva.

    Google Scholar 

  • Timæus, I.M. and L. Lush. 1995. “Intra-urban Differentials in Child Health.” Health Transition Review 5:163–90.

    Google Scholar 

  • United Nations. 2000. World Urbanization Prospects: The 1999 Revision: Data Tables and Highlights. New York: Department of Economic and Social Affairs, Population Division, United Nations.

    Google Scholar 

  • van den Eeden, P. and H.J.M. Hüttner. 1982. “Multi-level Research.”” Current Sociology 30(3): 1–182.

    Article  Google Scholar 

  • Wellman, B. and B. Leighton. 1979. “Networks, Neighborhoods, and Communities: Approaches to the Study of the Community Question.” Urban Affairs Quarterly 14:363–90.

    Article  Google Scholar 

  • Wen, M., C.R. Browning, and K.A. Cagney.] 2003. “Poverty, Affluence, and Income Inequality: Neighborhood Economic Structure and Its Implications for Health.” Social Science and Medicine 57:843–60.

    Article  Google Scholar 

  • Westoff, C.F. and A. Bankole. 1995. Unmet Need 1990-1994. Demographic and Health Surveys Comparative Studies. Calverton, MD: Macro International.

    Google Scholar 

  • Westoff, C.F. and A.R. Pebley. 1981. “Alternative Measures of Unmet Need for Family Planning in Developing Countries.” International Family Planning Perspectives 7(4):126–36.

    Article  Google Scholar 

  • White, M.J. 1987. American Neighborhoods and Residential Differentiation. New York: Russell Sage Foundation.

    Google Scholar 

  • — 2001. “Residential Concentration/Segregation, Demographic Effects of.” Pp. 13250–54 in International Encyclopedia of the Social and Behavioral Sciences, Vol. 19, edited by N.J. Smelser and P.B. Baltes. Oxford, England: Elsevier Science.

    Google Scholar 

  • Wilkinson, R. G. 1996. Unhealthy Societies: The Afflictions of Inequality. London: Routledge.

    Book  Google Scholar 

  • Wilson, W.J. 1987. The Truly Disadvantaged: The Inner City, the Underclass and Public Policy. Chicago: University of Chicago Press.

    Google Scholar 

  • World Bank. 2002. Cali, Colombia: Toward a City Development Strategy. Washington, DC: World Bank.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Funding for this article was provided by the William and Flora Hewlett Foundation and the Andrew W. Mellon Foundation.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Montgomery, M.R., Hewett, P.C. Urban poverty and health in developing countries: Household and neighborhood Effects. Demography 42, 397–425 (2005). https://doi.org/10.1353/dem.2005.0020

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1353/dem.2005.0020

Keywords

  • Factor Score
  • Living Standard
  • Poor Household
  • Neighborhood Effect
  • Urban Household