Consequences of High Morbidity and Mortality in a Low-Income Country

描述（由申请人提供）：人们经常声称，撒哈拉以南非洲（SSA）正遭受疾病和死亡的摧残。然而，有有限但有趣的证据表明，农村家庭和社区出人意料地具有复原力，健康冲击的直接影响随着时间的推移会因大家庭和农村社区的人力和社会资本的调整而得到调节。然而，没有数据支持对多代农村家庭采用的广泛的相互关联的应对机制进行计量经济学上复杂和动态的分析。拟议项目的总体目标是：(1)建立马拉维家庭与健康纵向研究（MLSFH），该研究将提供世界上最贫穷国家之一十多年来人口、社会经济和健康状况的罕见记录；(2)研究贫困农村个人、家庭、家庭和社区应对高发病率和高死亡率影响的机制。建议研究的具体目的包括：(1)利用新的特殊人群样本和新的微观数据扩展现有的纵向调查和生物标志物数据，以创建可公开获取的MLSFH，其中(a)涵盖1998-2010年期间，(b)涵盖儿童、青少年、成年人和老年人，(c)提供三代人健康方面的综合调查、人体测量学和生物标志物数据；(d)包括创新方面，例如易受伤害的高风险人群和向家庭和社区提供金钱保健奖励的实验性设计；(2)分析MLSFH，以估计对高发病率和死亡率的多重和潜在竞争或加强的反应的后果，其中包括(a)家庭应对机制，如改变时间使用，对许多主题的捐赠控制，未观察到的特征，内生决策过程和选择性参与健康预防工作，这在SSA中是第一次，人力资本投资和家庭内部转移以及利用各种形式的累积社会资本，(b)与健康有关的期望的模式、形成和行为后果，(c)健康状况不佳和死亡率的短期和长期微观后果，以及(d)重要的公共卫生干预措施的长期影响，例如推行一项雄心勃勃的国家方案，提供检测和治疗或金钱健康奖励。

DESCRIPTION (provided by applicant): It is often claimed that Sub-Saharan African (SSA) is being decimated and devastated by illness and death. There is, however, limited but intriguing evidence that rural families and communities are unexpectedly resilient and that the immediate impact of health shocks are modulated over time by the adjustments in the human and social capital of extended families and rural communities. However, no data exist in SSA that allow an econometrically-sophisticated and dynamic analysis of a broad range of interrelated coping mechanisms employed by multi-generational rural families. The general aim of the proposed project is to (1) create the Malawi Longitudinal Study of Families and Health (MLSFH), which will provide a rare record of more than a decade of demographic, socioeconomic and health conditions in one of the world's poorest countries, and (2) study the mechanisms through which poor rural individuals, families, households, and communities cope with the impacts of high morbidity and mortality. The specific aims of the proposed study include: (1) extend already existing longitudinal survey and biomarker data with new samples of special populations and new microdata to create a publicly available MLSFH that (a) covers the period 1998-2010, (b) encompasses children, adolescents, adults, and elderly, (c) provides comprehensive survey, anthropometric and biomarker data on health across three generations, and (d) includes innovative aspects such as vulnerable high-risk populations and experimental designs offering monetary health incentives to families and to communities; and (2) analyze the MLSFH to estimate the consequences of multiple and potentially competing or reinforcing responses to high morbidity and mortality with - on many topics for first time in SSA- controls for endowments, unobserved characteristics, endogenous decision processes and selective participation in health prevention efforts, including analyses of (a) household coping mechanisms such as altering time use, human capital investments and intrafamilial transfers and using various forms of accumulated social capital, (b) the patterns, formation and behavioral consequences of health-related expectations, (c) both short- and long-term micro-consequences of poor health and mortality and (d) the impact over time of important public-health interventions such as the introduction of an ambitious national program providing testing and treatment or monetary health incentives.