Graciela Teruel

EVALUATING CONDITIONAL SCHOOLING AND HEALTH PROGRAMS

We analyze in this chapter the development and evaluation of a new genre of social programs termed conditional cash transfer programs which have become widespread across Latin America and are now extending outside the region. Conditional transfer programs typically link monetary transfers to human capital investment, generally education, health or a combination of both. These transfer programs are considered innovative because they condition the receipt of monetary benefits on such behaviors as regular school attendance and preventive clinic visits. Effectively they are a subsidy to schooling and health, reducing the shadow price of human capital acquisition. We focus here primarily on a case study of Progresa (the Education, Health and Nutrition Program), a Mexican anti-poverty program which has served as a model for the implementation of conditional programs in other countries, and on which most evidence exists on impacts. We also review results from the newer conditional cash transfer programs. The chapter thus analyzes what we know about the success of conditional cash transfer programs as a mechanism for reducing poverty and identifies what research which is still needed in order for broader conclusions to be drawn.

Randomization and Social Program Evaluation: The Case of Progresa

In this article, the authors analyze the development of Progresa, a Mexican antipoverty program that conditions monetary transfers to human capital investment of its beneficiary families. The program is the principal antipoverty strategy of the Mexican government and has served as a model for similar programs in a number of countries in Latin America. Progresa is also noteworthy because it was subject to a rigorous evaluation effort in rural areas, which included an experimental design. The authors first describe the rationale behind the design of Progresa, in particular, the conditioning of monetary transfers to childrens school attendance and regular health clinic visits. The authors then turn to the evaluation effort, analyzing the randomized trial, the evaluation results, and the effect of the evaluation on the evolution of the program. Finally, the authors consider the limitations of the evaluation as well as areas where more research is needed.

Migrant networks and pathways to child obesity in Mexico.

The purpose of this paper is twofold: 1) to assess the link between migrant networks and becoming overweight or obese and 2) to explore the pathways by which migrant networks may contribute to the increasing overweight and obese population of children in Mexico. Using two waves of the Mexican Family Life Survey (MxFLS), we find that children and adolescents (ages 3 to 15) living in households with migrant networks are at an increased risk of becoming overweight or obese over the period of observation, relative to their peers with no migrant networks. Sedentary behavior and household-level measures of economic wellbeing explain some of the association between networks and changes in weight status, but the role of extended networks remains significant. Community-level characteristics related to migration do not account for any of the observed relationship between household-level networks and becoming overweight or obese.

The Consequences of Migration to the United States for Short-Term Changes in the Health of Mexican Immigrants

Although many studies have attempted to examine the consequences of Mexico-U.S. migration for Mexican immigrants’ health, few have had adequate data to generate the appropriate comparisons. In this article, we use data from two waves of the Mexican Family Life Survey (MxFLS) to compare the health of current migrants from Mexico with those of earlier migrants and nonmigrants. Because the longitudinal data permit us to examine short-term changes in health status subsequent to the baseline survey for current migrants and for Mexican residents, as well as to control for the potential health selectivity of migrants, the results provide a clearer picture of the consequences of immigration for Mexican migrant health than have previous studies. Our findings demonstrate that current migrants are more likely to experience recent changes in health status—both improvements and declines—than either earlier migrants or nonmigrants. The net effect, however, is a decline in health for current migrants: compared with never migrants, the health of current migrants is much more likely to have declined in the year or two since migration and not significantly more likely to have improved. Thus, it appears that the migration process itself and/or the experiences of the immediate post-migration period detrimentally affect Mexican immigrants’ health.

Schooling Inequality and Language Barriers

This article estimates the impact of language barriers on school achievement and the potential ameliorating role of bilingual education. Using large household data sets from poor rural communities in Mexico, we find that parental language (failure to speak Spanish) represents an important barrier to the schooling of indigenous children. We provide an empirical test suggesting that this largely reflects parental human capital related to culture/language, rather than unobserved wealth effects. Using double difference estimators with community fixed effects to address endogenous program placement, we demonstrate that schools with bilingual education narrow the gap in the educational performance of children with monolingual mothers versus bilingual and nonindigenous mothers.

Return Migration to Mexico: Does Health Matter?

We use data from three rounds of the Mexican Family Life Survey to examine whether migrants in the United States returning to Mexico in the period 2005–2012 have worse health than those remaining in the United States. Despite extensive interest by demographers in health-related selection, this has been a neglected area of study in the literature on U.S.-Mexico migration, and the few results to date have been contradictory and inconclusive. Using five self-reported health variables collected while migrants resided in the United States and subsequent migration history, we find direct evidence of higher probabilities of return migration for Mexican migrants in poor health as well as lower probabilities of return for migrants with improving health. These findings are robust to the inclusion of potential confounders reflecting the migrants’ demographic characteristics, economic situation, family ties, and origin and destination characteristics. We anticipate that in the coming decade, health may become an even more salient issue in migrants’ decisions about returning to Mexico, given the recent expansion in access to health insurance in Mexico.

Links between childhood and adult social circumstances and obesity and hypertension in the Mexican population.

Objectives: This study examines links between early life circumstances and adult socioeconomic status and obesity and hypertension in the adult Mexican population. Method: We use data from the Mexican Family Life Survey (MxFLS) collected in 2002 for people aged 20 or older (N = 14,280). Results: We found that men with low education and women with more education have significantly lower obesity. Women with higher education also have significantly less hypertension. Obesity triples the likelihood of hypertension among both men and women. Better childhood experiences are associated with less hypertension among women, but more hypertension among men in rural areas. Discussion: Recent changes in income, nutrition, and infection in Mexico may be responsible for the observed high prevalence of overweight and obesity and the extremely high odds of hypertension among obese young adults.

Schooling Inequality Among the Indigenous: A Problem of Resources or Language Barriers?

Using large household data sets from rural Mexican communities, where a majority of indigenous people live, we analyze the potential explanatory factors for low educational attainment of indigenous children. We find that, overall, indigenous children fare worse than their non-indigenous classmates. Nevertheless, there is important heterogeneity within the indigenous group. In particular, monolingual indigenous children (those who speak only an indigenous language) perform much worse in school than bilingual indigenous children who speak Spanish as a second language.

Links Between Socio-Economic Circumstances and Changes in Smoking Behavior in the Mexican Population: 2002–2010

While deleterious consequences of smoking on health have been widely publicized, in many developing countries, smoking prevalence is high and increasing. Little is known about the dynamics underlying changes in smoking behavior. This paper examines socio-economic and demographic characteristics associated with smoking initiation and quitting in Mexico between 2002 and 2010. In addition to the influences of age, gender, education, household economic resources and location of residence, changes in marital status, living arrangements and health status are examined. Drawing data from the Mexican Family Life Survey, a rich population-based longitudinal study of individuals, smoking behavior of individuals in 2002 is compared with their behavior in 2010. Logistic models are used to examine socio-demographic and health factors that are associated with initiating and quitting smoking. There are three main findings. First, part of the relationship between education and smoking reflects the role of economic resources. Second, associations of smoking with education and economic resources differ for females and males. Third, there is considerable heterogeneity in the factors linked to smoking behavior in Mexico indicating that the smoking epidemic may be at different stages in different population subgroups. Mexico has recently implemented fiscal policies and public health campaigns aimed at reducing smoking prevalence and discouraging smoking initiation. These programs are likely to be more effective if they target particular socio-economic and demographic sub-groups.

The impact of education and health heterogeneity on Generational Support Ratios: a cross-national comparison between Mexico and Korea

ABSTRACT Policy makers are concerned about the socio-economic consequences of population ageing. Policies often rely on estimations of support ratios based solely on the population age structure. We estimate Generational Support Ratios (GSRs) considering health heterogeneity of the population age 60+ and education heterogeneity of their offspring. We explore the effect of a public policy that changes the education of a targeted sub-group of women when they are young on their health once they become older, taking into account changes in demographic processes (i.e. marriage, fertility, offsprings education). We used the model presented by Kye et al. for the Korean context and examine the Mexican context. Our paper has three objectives. First, by applying this framework to the Mexican context we aim to find that improvements in womens education may mitigate the negative consequences of population ageing directly and indirectly through subsequent demographic behaviours that altogether affect GSRs. Second, by making a cross-national comparison between Korea and Mexico, we aim to quantify how policies of educational expansion have different impacts in contexts in which the population age 60+ have universal access to health care compared to contexts in which access to health care is selective. Third, by comparing cross-nationally we aim to show how differences in family processes across countries alter the pathways through which improvements in education affect GSRs.