Background

Education and health are both constituents of human capital that enable people to earn higher wages and enhance people’s capabilities. Human capabilities may lead to fulfilling lives by enabling people to achieve a valuable combination of human functionings—i.e., what people are able to do or be as a result of their capabilities. A better understanding of how these different human capabilities are produced together could point to opportunities to help jointly reduce the wide disparities in health and education across populations.

Methods and findings

We use nationally and regionally representative individual-level data from Demographic and Health Surveys (DHS) for 55 low- and middle-income countries (LMICs) to examine patterns in human capabilities at the national and regional levels, between 2000 and 2017 (N = 1,657,194 children under age 5). We graphically analyze human capabilities, separately for each country, and propose a novel child-based Human Development Index (HDI) based on under-five survival, maternal educational attainment, and measures of a child’s household wealth. We normalize the range of each component using data on the minimum and maximum values across countries (for national comparisons) or first-level administrative units within countries (for subnational comparisons). The scores that can be generated by the child-based HDI range from 0 to 1.

We find considerable heterogeneity in child health across countries as well as within countries. At the national level, the child-based HDI ranged from 0.140 in Niger (with mean across first-level administrative units = 0.277 and standard deviation [SD] 0.114) to 0.755 in Albania (with mean across first-level administrative units = 0.603 and SD 0.089). There are improvements over time overall between the 2000s and 2010s, although this is not the case for all countries included in our study. In Cambodia, Malawi, and Nigeria, for instance, under-five survival improved over time at most levels of maternal education and wealth. In contrast, in the Philippines, we found relatively few changes in under-five survival across the development spectrum and over time. In these countries, the persistent location of geographical areas of poor child health across both the development spectrum and time may indicate within-country poverty traps.

Limitations of our study include its descriptive nature, lack of information beyond first- and second-level administrative units, and limited generalizability beyond the countries analyzed.

Conclusions

This study maps patterns and trends in human capabilities and is among the first, to our knowledge, to introduce a child-based HDI at the national and subnational level. Areas of chronic deprivation may indicate within-country poverty traps and require alternative policy approaches to improving child health in low-resource settings.

中文翻译：

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使用儿童为基础的人类发展指数对165万名5岁以下儿童进行的国家和地区代表性分析：一项多国横断面研究。

背景

教育和卫生都是人力资本的组成部分，人力资本使人们能够赚取更高的工资并增强人们的能力。人的能力可以通过使人们实现人的功能的有价值的组合来实现生活，即人的能力或能力的结果。更好地了解如何共同发挥这些不同的人类能力，可能会提供机会，帮助共同减少人群之间在健康和教育方面的广泛差距。

方法和发现

我们使用来自55个中低收入国家（LMIC）的人口和健康调查（DHS）的国家和地区代表性个人水平数据，研究了2000年至2017年之间国家和地区水平的人的能力模式（N= 1,657,194岁以下的5岁以下儿童）。我们以图形方式分别分析了每个国家的人的能力，并根据五岁以下儿童的生存，孕产妇的受教育程度以及对孩子的家庭财富的衡量标准，提出了一种基于儿童的新型人的发展指数（HDI）。我们使用关于国家（用于国家比较）或国家内一级行政单位（用于国家以下比较）的最小值和最大值的数据来规范每个组件的范围。基于子级的HDI可以生成的分数范围是0到1。

我们发现，各国之间以及国家内部在儿童健康方面存在很大的异质性。在国家一级，基于儿童的人类发展指数从尼日尔的0.140（一级行政单位的平均值= 0.277和标准差[SD] 0.114）到阿尔巴尼亚的0.755（一级行政单位的平均值= 0.603和）。 SD 0.089）。尽管我们研究中的所有国家并非如此，但从2000年代到2010年代，总体上随着时间的推移有所改善。例如，在柬埔寨，马拉维和尼日利亚，在大多数孕产妇教育和财富水平下，五岁以下儿童的生存率随时间而提高。相反，在菲律宾，我们发现在整个发展范围内以及随着时间的推移，五岁以下儿童的存活率变化相对较小。在这些国家

我们研究的局限性包括其描述性，缺乏一级和二级行政单位以外的信息以及可分析国家以外的通用性有限。

结论

这项研究描绘了人类能力的模式和趋势，据我们所知，这是第一项在国家和国家以下各级引入基于儿童的人类发展指数的研究。长期贫困的地区可能表明存在国家内部的贫困陷阱，并要求采取其他政策措施来改善资源贫乏地区的儿童健康。