Health and Infrastructure

Yesterday, George Yang and I published our paper on human capital and infrastructure, which emphasizes the fact that financially and environmentally sustainable infrastructure needs a solid base of skills and an educated population in order to build, operate, and profitably use it. The paper does briefly look at the link between health outcomes and infrastructure, but it is worth further emphasizing that a healthy population is needed to produce the workforce that will generate economic returns from new infrastructure capacity.

For a start, health really matters to schooling outcomes. A big reason that school feeding programs are one of the most effective and replicable interventions to keep kids in class and help them learn worldwide is that healthy, well-nourished children can focus on school work. There is a lot of disease-level evidence pointing in the same direction. For example, Hoyt Bleakley suggests a large-scale treatment and education campaign against hookworm in the US South in the 1900s that treated 400,000 people with de-worming medication led to more children going to school. Those new students went on to earn 47 percent more in wages as adults (although David Roodman has pointed to evidence that a number of other factors may have been at work as well). A Mexican development project also suggests an impact from reduced worm loads. ‘Piso Ferme’—firm floor—delivered mixed concrete to the door of households with dirt floors in the country where householders used it to pave them. Children in houses with the new floors saw parasitic infestation rates drop from one third to less than a tenth. Rates of diarrhea halved, anemia fell by over two fifths, and the kids’ test scores dramatically improved as a result. Overall, Daniel Cohen and Laura Leker suggest that, across countries over the past few decades, adding one year to life expectancy at birth is associated with kids being in school an additional three months.

But it isn’t just schooling: better health has impacts at all ages. For example, Bleakley also argues that higher malaria rates in the US South before the 1920s accounted for somewhere around ten percent of the income gap with the richer North, which began to close after eradication. Looking at eradication efforts in Latin America, Bleakley suggests that areas with higher malaria burdens before eradication saw their incomes increase by 30 percent relative to low-burden areas thanks to the eradication effort. Healthy people can work harder and longer.

The relationship between health and economic dynamism runs in both directions, and that includes with infrastructure: there’s considerable evidence that access to clean energy has a significant impact on health outcomes (in part because dirty energy is so deadly). Electricity access in particular is associated with lower mortality and reduced disease burdens. But investments in both health and infrastructure are necessary to ensure the virtuous cycle of more human and infrastructure access continues upward. And all that means the link George and I focused on between education and infrastructure outcomes is complemented by a link between health and infrastructure outcomes: a population facing a lower disease burden will support the workforce needed to build, operate, and benefit from infrastructure services.