German Title: Messung der Krankheitsbelastung, der Einkommensstruktur und der Ausbildungsrendite im ländlichen Westafrika

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Abstract

Die vorliegende Dissertation will einen Beitrag zur Messung von Krankheitsbelastung, Einkommensstruktur und Ausbildungsrenditen im ländlichen Westafrika leisten. Ihr Forschungsgegenstand ist die Erhebung und Analyse von Mortalitäts-, Morbiditäts- und sozio-ökonomischen Daten im Gesundheitsdistrikt von Nouna im Nordwesten Burkina Fasos. Die Dissertation besteht aus fünf Forschungspapieren. Zwei Artikel wurden bereits in internationalen, referierten Journals (Journal of International Epidemiology und Health Economics) veröffentlicht, nachdem sie zuvor in der Diskussionsschriftenreihe des SONDERFORSCHUNGSBEREICHS 544 "KONTROLLE TROPISCHER INFEKTIONSKRANKHEITEN" veröffentlicht wurden. Ein weiterer Artikel wurde ebenfalls in der genannten Diskussionsschriftenreihe veröffentlicht. Ein Teil der Papiere entstand in den zwei Jahren, während denen ich über den Sonderforschungsbereich 544 finanziert wurde. Besonders profitiert habe ich von der Zusammenarbeit mit dem Gesundheitsforschungszentrum von Nouna (Centre de Recherche en Santé de Nouna, CRSN), das die Haushaltserhebung Nouna Health District Household Survey (NHDHS) vor Ort durchgeführt hat. Innerhalb des Sonderforschungsbereichs war ich verantwortlich für das Umfragedesign der NHDHS. In Zusammenarbeit mit Mitgliedern des CRSN und Mitarbeitern der Abteilung für Tropenhygiene und Öffentliches Gesundheitswesen der Universität Heidelberg entwickelte ich den Fragebogen und war verantwortlich für die Piloterhebung und den zeitlichen Rahmen und verschiedene praktische Aspekte der Erhebung. Darüber hinaus war ich verantwortlich für die Aufbereitung und Säuberung der Daten in Heidelberg, sowie für das Erstellen einer endgültigen STATA-Version des Datensatzes. Die empirischen Ergebnisse von Kapitel 6 der vorliegenden Arbeit wurden mit diesem aufbereiteten Datensatz erstellt. Im ersten Papier – Kapitel 2 der Dissertation – wird das Design und die Implementierung der Haushaltserhebung NHDHS beschrieben. Kapitel 3 beschreibt das Säubern und Aufbereiten der Rohdaten sowie die Konstruktion von Einkommensvariablen. Kapitel 4 gibt die Ergebnisse einer Studie zur Messung der Krankheitsbelastung wieder. Die Studie verwendet Mortalitätsdaten, die das CRSN zwischen 1997 und 1999 erhoben hat. Kapitel 5 beschäftigt sich mit methodologischen Fragestellungen der Messung der Krankheitsbelastung. Kapitel 6 befaßt sich mit der Schätzung von Ausbildungsrenditen.

Translation of abstract (English)

The success of health economics and its guidance for health policy heavily rests on the availability of reliable empirical evidence on the demographic, economic, and epidemiological environment, on behavioral relationships, and on the impact of policy interventions. For Sub-Saharan Africa, especially the epidemiological situation is unclear, since comprehensive systems of mortality and health statistics are often absent [Kaufman et al. (1997), Cooper et al. (1998)]. There is a growing literature on the design and analysis of health surveys [see for example Aday (1996) and Korn and Graubard (1999)], indicating the increasing demand for health surveys in academia and politics. The economic analysis of health naturally places a special focus on the interrelation between health and economic well-being [see for example Grossman (1972), Deaton and Paxson (1999), and Smith (1999)]. On country level, for example, two well-documented empirical findings demonstrate the relation between health and well-being: (i) the overall disease burden decreases when a country grows richer, and (ii) the share of communicable diseases decreases in the process of economic development, whereas the share of non-communicable diseases increases – a phenomenon known as the Epidemiological Transition [Murray and Lopez (1996a)]. In those parts of Sub-Saharan Africa that are mainly dominated by traditional subsistence farming, however, it is difficult to examine questions of income and health for simple fundamental reasons. A vital prerequisite for an empirical investigation is the thorough and accurate measurement of income. Thus, both the measurement of the burden of disease and the measurement of income are research tasks that are far from being fulfilled for Sub-Saharan Africa. A further issue that is related with economic well-being and health is education. A seminal paper on the relationship between health and schooling is provided by Grossman (1975). He states that the often observed high correlation between health and completed years of formal schooling can be interpreted in three ways that are not necessarily mutually exclusive: (i) increases in schooling lead to an increase in health, (ii) increases in health lead to a higher demand for formal schooling, and (iii) there is no causal relationship between schooling and health but other exogenous factors such as physical and mental endowments affect both health and schooling. He suggests to model the relationship between health and schooling in a demand model for health or in a recursive system of human capital formation where the demand for schooling and the demand for health are simultaneously determined. This thesis intends to produce empirical evidence on the measurement of the burden of disease, the structure of income, and returns to education in rural West Africa. It deals with the collection and analysis of mortality, morbidity, and socio-economic data in the Nouna Health District in the North-West of Burkina Faso. The thesis consists of five papers. Two of them have already been published in international peer-reviewed journals (Journal of International Epidemiology and Health Economics), and one has been published in the working paper series of the SONDERFORSCHUNGSBEREICH 544 'CONTROL OF INFECTIOUS DISEASES' – a research grant of the DEUTSCHE FORSCHUNGSGEMEINSCHAFT. In part, the papers have been written while I was financed by the Sonderforschungsbereich 544. They profit extensively from the collaboration with the Nouna Health Research Center (Centre de Recherche en Santé de Nouna, CRSN) which implemented the Nouna Health District Household Survey (NHDHS) in the field. Within the Sonderforschungsbereich 544, I was responsible for the design of the NHDHS. In collaboration with members of the CRSN and staff of the Department of Tropical Hygiene and Public Health of the University of Heidelberg, I developed the questionnaire and was responsible for the pretest, the time-frame, and various practical aspects of the survey. Furthermore, I was responsible for the supervision and cleaning of the data in Heidelberg and for the compilation of a final STATA version with which the empirical results of chapter 6 have been produced. In the first paper – chapter 2 of this thesis – the design and the implementation of the NHDHS is described. Chapter 3 depicts the cleaning of the raw data and the construction of income data. Chapter 4 presents a study on the measurement of the burden of disease. The study uses mortality data collected by the CRSN between 1997 and 1999. Chapter 5 deals with some methodological problems of the measurement of the burden of disease, whereas in chapter 6, returns to education are estimated using NHDHS data.