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Inexpensive flooring switch improves child health

Concrete changes seen in young slum dwellers' cognitive abilities, too

| 19 March 2009

Replacing dirt floors with concrete in the homes of urban slum dwellers makes for more comfortable living — but more importantly, it significantly improves children's health by interrupting the transmission of intestinal parasites, according to a new study conducted for the campus's Center of Evaluation for Global Action (CEGA). Compounding the benefits, youngsters' cognitive abilities are also enhanced by the change.

The study concludes that replacing dirt floors with concrete appears to be at least as effective for health as nutritional supplements and as helpful for brain development as early-childhood development programs.

Not only are young children better off when their homes have concrete rather than dirt floors, the study found, but their mothers are less depressed, less stressed, and happier — possibly because, in the words of the report, "they are living in a better environment and . . . their children are healthier." says the report.

Paul Gertler, the Li Ka Shing Professor of Economics in the Haas School of Business and the School of Public Health, led the investigation. The CEGA researchers note that inadequate housing poses serious health risks for 600 million urban residents worldwide, almost half of them living in slums. These problems also contribute to the deaths of 3 million children every year from parasitic infections related to diarrhea and the effects of micronutrient malnutrition — especially anemia, a widespread problem that slows cognitive development.

Diverse data sources

The researchers tracked a Mexican government program, Piso Firme ("firm floor"), launched in 2000 in the northern state of Coahuila, that sought to improve living standards and health in high-density, low-income communities by offering homeowners with dirt floors up to 538 square feet of concrete flooring. The program cost the government about $150 per home. The owners prepared and laid the new flooring themselves, or with volunteer help.

By 2005, the Coahuila program had covered more than 34,000 homes in 650 neighborhoods and 200 suburban communities. The overall program, which expanded into other Mexican states starting in late 2003, has so far installed concrete floors in about 300,000 of the3 million homes identified in the country's 2000 census as having dirt floors.

Researchers also collected information about the incidence of diarrhea in children; results of fecal samples and blood tests for anemia; and height and weight data, to reveal stunting of growth. They also assessed the youngsters' communication and language abilities.

Additional data came from a cross-sectional household survey conducted with the Mexican National Institute of Public Health in spring 2005, the 2000 Mexican census, vital-statistics mortality files, and national household surveys taken from 1994 to 2000.

Homeowners in the Coahuilan city of Torreón reported a nearly 20 percent reduction in the presence of parasites. Further, when compared to their neighbors, their children under the age of 6 showed a nearly 13 percent reduction in episodes of diarrhea; a 20 percent reduction in incidences of anemia; higher scores (by 30 percent) on language and communication skills for toddlers ages 12 to 30 months; and scores 9 percent higher on vocabulary tests for children between the ages of 3 and 6.

The study, commissioned by the Mexican government, was influential in Mexico's decision to scale up the program nationally, Gertler says. The researchers caution, however, that the dirt-to-concrete strategy probably would not have the same results in rural areas without access to safe water supplies.

The CEGA study, "Housing, Health, and Happiness," appears in the February issue of American Economic Journal: Economic Policy.