Long-term Effects of Health and Development Interventions in Rural Bangladesh

描述(申请人提供)：我们计划研究卫生和人力资本干预在发展中国家的长期影响。孟加拉国的MatLab是少数几个将有针对性的干预措施、长期的跟踪(超过30年)和对一系列异常丰富的成果和几代潜在受益者的消耗进行详细跟踪相结合的环境之一。自20世纪70年代中期以来，人口一直超过20万。20世纪70年代末引入了准随机妇幼保健和计划生育(妇幼保健/计划生育)方案。大量证据表明，在妇幼保健/计划生育和比较领域，规划前的关键相似之处。当后来采用防洪和小额信贷干预措施时，村庄无法获得任何干预措施或1-3项干预措施。NIA资助的MatLab健康和社会经济调查(MHSS1)于1996年进行。我们建议对MHSS1进行后续调查，并对1974年至2011年的现有纵向数据进行新的存档。MHSS2将提供关于健康、人力资本、劳动力和婚姻结果、养老支持以及在妇幼保健/计划生育干预开始30年后的社会经济状况的详细信息。该项目的预期产出是纵向健康和人口研究的独特数据集；一份详细的第一份报告；以及与具体目标有关的几项初步研究。我们解决了三个具体目标。第一：研究妇幼保健/计划生育干预措施对干预措施所针对的两代人--方案安排时的育龄妇女(2011年为38-73岁)和方案变化期间的儿童(2011年为22-34岁)--的长期健康和福利结果的影响。干预前SES的数据和MHSS1之前离开人群的信息允许分析项目效果，并对自我选择和自然减员进行异常有效的核算。第二：研究妇幼保健/计划生育干预通过代际关系和贫困传播的影响。我们问，儿童健康的改善和家庭规模的减少如何影响老年人的社会支持和福祉，以及该计划如何影响计划参与者的子女。1996年和2011年有关家庭关系的丰富数据将有助于了解该计划的代际影响。第三：在小额信贷和防洪干预以及社会、人口和文化变化的背景下，研究妇幼保健/计划生育干预措施的影响。详细的社区数据，包括基础设施和设施的历史地图，允许测试关于卫生、信贷和基础设施干预在人类发展道路上的相对贡献和相互作用的详细假设。这些干预措施--妇幼保健和计划生育、减贫和环境保护--与联合国八项千年发展目标中的四项有关。单一和多项干预措施对健康、财富和生活机会的影响可以研究四代人，以获得干预措施的年龄为标准。 公共卫生相关性：妇幼保健和计划生育方案对世界各地的公共卫生方案至关重要；它们在改善发展中国家儿童健康方面的有效性及其与降低生育率的关系是公认的。存在大量持续收集的优秀记录，其中30年前引入了妇幼保健/计划生育方案，最近又推出了两个改善经济福祉的方案。这些数据与后续调查相结合，可以审查对个人和家庭、社会和经济福祉的健康和其他方面的长期影响。这项研究将为基于证据的公共卫生政策和改善健康的战略提供信息。

DESCRIPTION (provided by applicant): We plan to study long-term effects of health and human capital interventions in the developing world. Matlab, Bangladesh, is one of the few settings that combines targeted interventions, long duration of follow-up (over 30 years), and detailed tracking of attrition across an unusually rich set of outcomes and for several generations of potential beneficiaries. A population of over 200,000 has been followed since the mid-1970s. A quasi- randomized maternal and child health and family planning (MCH/FP) program was introduced in the late 1970s. Considerable evidence demonstrates key pre-program similarities in the MCH/FP and comparison areas. When flood control and microcredit interventions were later introduced, villages had access to none or 1-3 interventions. The NIA-funded Matlab Health and Socioeconomic Survey (MHSS1) was carried out in 1996. We propose a follow-up survey to MHSS1 and a new archive of existing longitudinal data from 1974- 2011. MHSS2 will provide detailed information on health, human capital, labor and marriage outcomes, old-age support, and socioeconomic status 30 years after the initiation of the MCH/FP intervention. The intended outputs of this project are unique datasets for longitudinal health and demographic research; a detailed first report; and several initial studies related to the specific aims. We address three specific aims. First: Study the impacts of MCH/FP interventions on long-term health and welfare outcomes in the two generations targeted by interventions - women of reproductive age at program placement (age 38-73 in 2011) and individuals who were children during a period of program variation (age 22- 34 in 2011). Data on SES prior to intervention and information on those who left the population prior to MHSS1 permit analysis of program effects with unusually effective accounting of self-selection and attrition. Second: Study the impact of the MCH/FP interventions through intergenerational relationships and transmission of poverty. We ask how improvements in child health and reduced family size affect social support and well-being of elders and how the program affected children of program participants. Rich data on family connections in 1996 and 2011 will facilitate understanding intergenerational effects of the program. Third: Study the impact of the MCH/FP interventions in the context of microcredit and flood control interventions as well as social, demographic, and cultural changes. Detailed community data, including historical mapping of infrastructure and facilities, permit testing detailed hypotheses about relative contributions of and interactions between health, credit, and infrastructure interventions on the path to human development. These interventions - in maternal and child health and family planning, poverty alleviation, and environmental protection - pertain to four of the eight UN Millennium Development Goals. Impacts of single and multiple interventions on health, wealth, and life chances can be studied for four generations defined by age at access to interventions. PUBLIC HEALTH RELEVANCE: Maternal and child health and family planning programs are essential to public health programs worldwide; their effectiveness in improving child health and their relationship to fertility reduction in developing countries is well-established. Excellent continuously collected records exist for a large population in which an MCH/FP program was introduced 30 years ago and two programs to improve economic wellbeing were introduced more recently. These data combined with a follow-up survey permit examination of long-term effects on health and other aspects of individual and family social and economic well-being. The study will inform evidence-based public health policy and strategies to improve health.