How Much International Variation in Child Height Can Sanitation Explain?

55 Pages Posted: 20 Apr 2016

See all articles by Dean Spears

Dean Spears

University of Texas at Austin; Economics and Planning Unit, ISI-Delhi; r.i.c.e.; IZA Institute of Labor Economics

Date Written: January 1, 2013


Physical height is an important economic variable reflecting health and human capital. Puzzlingly, however, differences in average height across developing countries are not well explained by differences in wealth. In particular, children in India are shorter, on average, than children in Africa who are poorer, on average, a paradox called "the Asian enigma" which has received much attention from economists. This paper provides the first documentation of a quantitatively important gradient between child height and sanitation that can statistically explain a large fraction of international height differences. This association between sanitation and human capital is robustly stable, even after accounting for other heterogeneity, such as in GDP. The author applies three complementary empirical strategies to identify the association between sanitation and child height: country-level regressions across 140 country-years in 65 developing countries; within-country analysis of differences over time within Indian districts; and econometric decomposition of the India-Africa height differences in child-level data. Open defecation, which is exceptionally widespread in India, can account for much or all of the excess stunting in India.

Keywords: Population Policies, Early Child and Children's Health, Disease Control & Prevention, Health Monitoring & Evaluation, Youth and Governance

Suggested Citation

Spears, Dean, How Much International Variation in Child Height Can Sanitation Explain? (January 1, 2013). World Bank Policy Research Working Paper No. 6351, Available at SSRN:

Dean Spears (Contact Author)

University of Texas at Austin ( email )

Austin, TX 78712
United States

Economics and Planning Unit, ISI-Delhi ( email )

7 S .J. S.
Sansanwal Marg
New Delhi, 110016


New Delhi


IZA Institute of Labor Economics ( email )

P.O. Box 7240
Bonn, D-53072

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