Elizabeth Frankenberg

Lost but Not Forgotten: Attrition and Follow-up in the Indonesia Family Life Survey

Data from three waves of the Indonesian Family Life Survey (IFLS) are used to examine attrition in the context of a large scale panel survey conducted in a low income setting.

Economic shocks, wealth and welfare

The immediate effects of the Asian crisis on the well-being of Indonesians are examined using the Indonesia Family Life Survey, an ongoing longitudinal household survey. There is tremendous diversity in the effect of the shock: for some households, it was devastating; for others it brought new opportunities. A wide array of mechanisms was adopted in response to the crisis. Households combined to more fully exploit benefits of scale economies in consumption. Labor supply increased even as real wages collapsed. Households reduced spending on semidurables while maintaining expenditures on foods. Rural households used wealth, particularly gold, to smooth consumption.

Health, nutrition and prosperity: a microeconomic perspective

A positive correlation between health and economic prosperity has been widely documented, but the extent to which this reflects a causal effect of health on economic outcomes is very controversial. Two classes of evidence are examined. First, carefully designed random assignment studies in the laboratory and field provide compelling evidence that nutritional deficiency - particularly iron deficiency - reduces work capacity and, in some cases, work output. Confidence in these results is bolstered by a good understanding of the underlying biological mechanisms. Some random assignment studies indicate an improved yield from health services in the labour market. Second, observational studies suggest that general markers of nutritional status, such as height and body mass index (BMI), are significant predictors of economic success although their interpretation is confounded by the fact that they reflect influences from early childhood and family background. Energy intake and possibly the quality of the diet have also been found to be predictive of economic success in observational studies. However, the identification of causal pathways in these studies is difficult and involves statistical assumptions about unobserved heterogeneity that are difficult to test. Illustrations using survey data demonstrate the practical importance of this concern. Furthermore, failure to take into account the dynamic interplay between changes in health and economic status has led to limited progress being reported in the literature. A broadening of random assignment studies to measure the effects of an intervention on economic prosperity, investment in population-based longitudinal socioeconomic surveys, and application of emerging technologies for a better measure of health in these surveys will yield very high returns in improving our understanding of how health influences economic prosperity.

Wages, employment and economic shocks: Evidence from Indonesia

Abstract. After over a quarter century of sustained economic growth, Indonesia was struck by a large and unanticipated crisis at the end of the 20th Century. Real GDP declined by about 12% in 1998. Using 13 years of annual labor force data in conjunction with two waves of a household panel, the Indonesia Family Life Survey (IFLS), this paper examines the impact of the crisis on labor market outcomes.

Self-Rated Health and Mortality: Does the Relationship Extend to a Low Income Setting?*

Although a relationship between poor self-reported health status and excess mortality risk has been well-established for industrialized countries, almost no research considers developing countries. We use data from Indonesia to show that in a low-income setting, as in more advantaged parts of the world, individuals who perceive their health to be poor are significantly more likely to die in subsequent follow-up periods than their counterparts who view their health as good. This result characterizes both men and women, holds for multiple time periods, and remains after inclusion of measures of nutritional status, physical functioning, symptoms of poor physical health and depression, and hypertension. We also consider the correlates of self-rated health. Symptoms and physical functioning are strong predictors of reporting poor rather than good health, but neither these indicators nor other covariates we consider distinguish between reports of excellent rather than good health.

Women’s health and pregnancy outcomes: Do services make a difference?

We use data from the Indonesia Family Life Survey to investigate the impact of a major expansion in access to midwifery services on health and pregnancy outcomes for women of reproductive age. Between 1990 and 1998 Indonesia trained some 50,000 midwives. Between 1993 and 1997 these midwives tended to be placed in relatively poor communities that were relatively distant from health centers. We show that additions of village midwives to communities between 1993 and 1997 are associated with a significant increase in body mass index in 1997 relative to 1993 for women of reproductive age, but not for men or for older women. The presence of a village midwife during pregnancy is also associated with increased birthweight. Both results are robust to the inclusion of community-level fixed effects, a strategy that addresses many of the concerns about biases because of nonrandom program placement.

The measurement and interpretation of health in social surveys

Abstract : Health status is hard to measure. It is widely recognized that health is multi-dimensional reflecting the combination of an array of factors that include physical, mental and social well-being, genotype and phenotype influences as well as expectations and information. A multitude of health indicators have been used in scientific studies drawing on data from both the developed and developing world. Understanding what those indicators measure is central if the results reported in the studies are to be interpreted in a meaningful way. Whether one is interested in summarizing the health of a population or understanding the links between health and other measures of well-being at the individual level, poor measurement will likely yield poor inferences. There is a large literature that discusses the validity and limitations of different health measures. Murray and Chen (1992) and Sadana (2001) provide excellent reviews and discussion. Some of the most insightful empirical studies have compared indicators of specific morbidities reported by respondents in health interview surveys with indicators based on health examinations of the same individuals conducted by trained health workers. Other very influential studies have examined the extent to which self-reported health predicts health problems later in life. A third class of studies contrasts prevalence rates based on health interviews with other sources.

Mental Health in Sumatra after the Tsunami

OBJECTIVES We assessed the levels and correlates of posttraumatic stress reactivity (PTSR) of more than 20,000 adult tsunami survivors by analyzing survey data from coastal Aceh and North Sumatra, Indonesia. METHODS A population-representative sample of individuals interviewed before the tsunami was traced in 2005 to 2006. We constructed 2 scales measuring PTSR by using 7 symptom items from the Post Traumatic Stress Disorder (PTSD) Checklist-Civilian Version. One scale measured PTSR at the time of interview, and the other measured PTSR at the point of maximum intensity since the disaster. RESULTS PTSR scores were highest for respondents from heavily damaged areas. In all areas, scores declined over time. Gender and age were significant predictors of PTSR; markers of socioeconomic status before the tsunami were not. Exposure to traumatic events, loss of kin, and property damage were significantly associated with higher PTSR scores. CONCLUSIONS The tsunami produced posttraumatic stress reactions across a wide region of Aceh and North Sumatra. Public health will be enhanced by the provision of counseling services that reach not only people directly affected by the tsunami but also those living beyond the area of immediate impact.

Education, Vulnerability, and Resilience after a Natural Disaster

The extent to which education provides protection in the face of a large-scale natural disaster is investigated. Using longitudinal population-representative survey data collected in two provinces on the island of Sumatra, Indonesia, before and after the 2004 Indian Ocean tsunami, we examine changes in a broad array of indicators of well-being of adults. Focusing on adults who were living, before the tsunami, in areas that were subsequently severely damaged by the tsunami, better educated males were more likely to survive the tsunami, but education is not predictive of survival among females. Education is not associated with levels of post-traumatic stress among survivors 1 year after the tsunami, or with the likelihood of being displaced. Where education does appear to play a role is with respect to coping with the disaster over the longer term. The better educated were far less likely than others to live in a camp or other temporary housing, moving, instead, to private homes, staying with family or friends, or renting a new home. The better educated were more able to minimize dips in spending levels following the tsunami, relative to the cuts made by those with little education. Five years after the tsunami, the better educated were in better psycho-social health than those with less education. In sum, education is associated with higher levels of resilience over the longer term.

Can expanding access to basic healthcare improve children's health status? Lessons from Indonesia's ‘midwife in the village’ programme

In the 1990s, the Indonesian government placed over 50,000 midwives in communities throughout the country. We examine how this expansion in health services affected childrens height-for-age. To address the problem that midwives were not randomly allocated to communities, the estimation exploits the biology of childhood growth, the timing of the introduction of midwives to communities, and rich longitudinal data. The evidence indicates that the nutritional status of children fully exposed to a midwife during early childhood is significantly better than that of their peers of the same age and cohort in communities without a midwife. The former are also better off than children assessed at the same age from the same communities but who were born before the midwife arrived. Within communities, the improvement in nutritional status across cohorts is greater where midwives were introduced than where they were not. This result is robust to the inclusion of community fixed effects.