Journal of Infectious Diseases
Volume 211 Issue 16 May 1, 2015
http://jid.oxfordjournals.org/content/current

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Can epidemiology inform global health and development targets?
Alan D Lopez
Author Affiliations
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
[Initial text]
In 2015, the global health and development community will collectively assess the progress of nations towards achieving the Millennium Development Goals (MDGs), an ambitious framework for human development based on broad principles of equity, solidarity and poverty reduction. Of the 12 goals established to measure social and economic progress, three (MDG4, MDG5 and MDG6) relate directly to health development; reduction of child mortality, reduction of maternal mortality; and progress against the global epidemics of HIV/AIDS, malaria and tuberculosis, respectively.1 There has been much debate about whether global goals with explicit targets are useful or not in stimulating action by countries and donors to improve health. Whereas broad development goals are likely to receive strong endorsement by countries, the addition of specific targets might well be unwelcome, particularly if they are perceived as being too ambitious. Worse, the global focus on targets for the MDGs has driven a culture of accountability with an almost singular focus on whether a country is likely to achieve the specified targets or not, to the detriment of other important measures of progress. The political imperative that countries have no doubt felt to accelerate progress with health development because of the existence of the MDGs is laudable, and real, but it has not necessarily been the ideal policy environment to do so, for five principal reasons.

First, recent global assessments have suggested that only about one-quarter of all countries, and less than one in five developing countries, will achieve MDGs 4 and 5, obscuring the very substantial progress in reducing child mortality, for example, that has occurred in sub-Saharan Africa, India and much of eastern Europe since 2000.2–4 In many countries, these accelerated declines have been due to the success of bold public policies, and financing, to scale-up and ensure delivery of bed nets …

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Effect on child cognitive function of increasing household expenditure in Indonesia: application of a marginal structural model and simulation of a cash transfer programme
Amelia Maika1,2,*, Murthy N Mittinty1, Sally Brinkman1,3 and John Lynch1,4
Author Affiliations
1School of Population Health, University of Adelaide, SA, Australia, 2Department of Sociology, Faculty of Social and Political Science, Gadjah Mada University, Yogyakarta, Indonesia, 3Telethon Kids Institute, University of Western Australia, Perth, WA, Australia and 4School of Social and Community Medicine, University of Bristol, Bristol, UK
Abstract
Background:
Parental investments in children are an important determinant of human capability formation. We investigated the causal effect of household expenditure on Indonesian children’s cognitive function between 2000 and 2007. We also investigated the effect of change in mean cognitive function from a simulation of a hypothetical cash transfer intervention.
Methods:
A longitudinal analysis using data from the Indonesian Family Life Survey (IFLS) was conducted including 6136 children aged 7 to 14 years in 2000 and still alive in 2007. We used the inverse probability of treatment weighting of a marginal structural model to estimate the causal effect of household expenditure on children’s cognitive function.
Results:
Cumulative household expenditure was positively associated with cognitive function z-score. From the marginal structural model, a 74534 rupiah/month (about US$9) increase in household expenditure resulted in a 0.03 increase in cognitive function z-score [β = 0.32, 95% confidence interval (CI) 0.30–0.35] Based on our simulations, among children in the poorest households in 2000 an additional ≈ US$6–10 of cash transfer resulted in a 0.01 unit increase in cognitive function z-score, equivalent to about 6% increase from the mean z-score prior to cash transfer. In contrast, children in the poorest household in 2007 did not benefit from an additional ≈ US$10 cash transfer. We found no overall effect of cash transfers at the total population level.
Conclusions:
Greater household expenditure had a small causal effect on children’s cognitive function. Although cash transfer interventions had a positive effect for poor children, this effect was quite small. Multi-faceted interventions that combine nutrition, cash transfer, improved living conditions and women’s education are required to benefit children’s cognitive development in Indonesia.