Unpacking the Causes of Inequalities in Child Survival: The Case of Cebu, The Philippines

The aim of this paper is to “unpack” the socioeconomic causes of inequalities in child survival between poor and better-off children. A two-part model is estimated, comprising a probit to model the child’s prospects of surviving the first year of life, and the second a Weibull to model his survival prospects beyond then. By linking the parameter estimates of the two models with information on the distribution of the various socioeconomic determinants across income groups, it is possible to build up a picture of how far inequalities in each set of determinants contributes to inequalities in survival. The data used are from the Cebu Longitudinal Health and Nutrition Survey. The results point to income inequalities being the largest contributory factor to inequalities in both infant and under-five mortality. Inequalities in mother’s education are also important, as are inequalities in sanitation in the case of infant mortality and inequalities in insurance coverage in the case of survival beyond the first birthday. Inequalities in accessibility and quality of health services, by contrast, appear to contribute very little. In the case of quality, this is not because it does not influence survival, but rather because it does not appear to be especially unequally distributed between poor and better-off households. By contrast, although health services are indeed less accessible for the poor, the impact of proximity on survival varies, from having a strong beneficial effect in the case of a public hospital to an apparently adverse effect in the case of some facilities.