, Volume 42, Issue 3, pp 397–425 | Cite as

Urban poverty and health in developing countries: Household and neighborhood Effects

  • Mark R. Montgomery
  • Paul C. Hewett


In the United States and other high-income countries, there is intense scholarly and programmatic interest in the effects of household and neighborhood living standards on health. Yet few studies of developing-country cities have explored these issues. We investigated whether the health of urban women and children in poor countries is influenced by both household and neighborhood standards of living. Using data from the urban samples of 85 Demographic and Health Surveys and modeling living standards using factor-analytic MIMIC methods, we found that the neighborhoods of relatively poor households are more heterogeneous than is often asserted. Our results indicated that poor urban households do not tend to live in uniformly poor neighborhoods: about 1 in 10 of a poor household’s neighbors is relatively affluent, belonging to the upper quartile of the urban distribution of living standards. Do household and neighborhood living standards influence health? Using multivariate models, we found that household living standards are closely associated with three health measures: unmet need for modern contraception, attendance of a trained health care provider at childbirth, and young children’s height for age. Neighborhood living standards exert a significant additional influence in many of the surveys we examined, especially for birth attendance.


Factor Score Living Standard Poor Household Neighborhood Effect Urban Household 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Aber, J.L., M.A. Gephart, J. Brooks-Gunn, and J.P. Connell. 1997. “Development in Context: Implications for Studying Neighborhood Effects.” Pp. 44–61 in Neighborhood Poverty, Volume I: Context and Consequences for Children, edited by J. Brooks-Gunn, G.J. Duncan, and J.L. Aber. New York: Russell Sage Foundation.Google Scholar
  2. Åberg Yngwe, M., J. Fritzell, O. Lundberg, F. Diderichsen, and B. Burström. 2003. “Exploring Relative Deprivation: Is Social Comparison a Mechanism in the Relation Between Income and Health?” Social Science and Medicine 57:1463–73.CrossRefGoogle Scholar
  3. African Population and Health Research Center. 2002. Population and Health Dynamics in Nairobi’s Informal Settlements: Report of the Nairobi Cross-Sectional Slums Survey (NCSS) 2000. Nairobi: African Population and Health Research Center.Google Scholar
  4. Astone, N., C.A. Nathanson, R. Schoen, R., and Y.J. Kim. 1999. “Family Demography, Social Theory, and Investment in Social Capital.” Population and Development Review 25:1–31.CrossRefGoogle Scholar
  5. Baker, J.L. 2001. “Social Exclusion in Urban Uruguay.” Working paper. Latin America and Caribbean Region, World Bank, Washington, DC.Google Scholar
  6. Behrman, J., H.-P. Kohler, and S. Watkins. 2001. “Social Networks, Family Planning, and Worrying About AIDS.” Paper presented at the 2001 annual meeting of the Population Association of America, Washington, DC, March 29–31.Google Scholar
  7. Bollen, K. 1989. Structural Equations With Latent Variables. New York: John Wiley & Sons.Google Scholar
  8. Caldeira, T.P.R. 1999. “Fortified Enclaves: The New Urban Segregation.” Pp. 114–38 in Cities and Citizenship, edited by J. Holston. Durham, NC: Duke University Press.Google Scholar
  9. — 2000. City of Walls: Crime, Segregation, and Citizenship in São Paulo. Berkeley: University of California Press.Google Scholar
  10. Casterline, J.B., ed. 2001. Diffusion Processes and Fertility Transition: Selected Perspectives. Washington, DC: National Academies Press.Google Scholar
  11. Casterline, J.B., M.R. Montgomery, D.K. Agyeman, P. Aglobitse, and G.-E. Kiros. 2001. “Social Networks and Contraceptive Dynamics in Southern Ghana.” Paper presented at the 2001 annual meeting of the Population Association of America, Washington, DC, March 29-31.Google Scholar
  12. Casterline, J.B. and S.W. Sinding. 2000. “Unmet Need for Family Planning in Developing Countries and Implications for Population Policy.” Population and Development Review 26: 691–723.CrossRefGoogle Scholar
  13. Coleman, J.S. 1988. “Social Capital in the Creation of Human Capital.” American Journal of Sociology 94(Suppl.):S95-S120.CrossRefGoogle Scholar
  14. Coulton, C., J. Korbin, T. Chan, and M. Su. 1997. “Mapping Residents’ Perceptions of Neighborhood Boundaries: A Methodological Note.” Working Paper. Center on Urban Poverty and Social Change, Case Western Reserve University, Cleveland, OH.Google Scholar
  15. Drukker, M., C. Kaplan, F. Feron, and J. van Os. 2003. “Children’s Health-Related Quality of Life, Neighbourhood Socio-economic Deprivation and Social Capital. A Contextual Analysis.” Social Science and Medicine 57:825–41.CrossRefGoogle Scholar
  16. Ferguson, B.D., A. Tandon, E. Gakidou, and C.J.L. Murray. 2003. “Estimating Permanent Income Using Indicator Variables.” Discussion Paper No. 42. Global Programme on Evidence for Health Policy, World Health Organization, Geneva.Google Scholar
  17. Filmer, D. and L. Pritchett. 1999. “The Effect of Household Wealth on Educational Attainment: Evidence From 35 Countries.” Population and Development Review 25:85–120.CrossRefGoogle Scholar
  18. — 2001. “Estimating Wealth Effects Without Expenditure Data-Or Tears: An Application to Educational Enrollments in States of India.” Demography 38:115–32.Google Scholar
  19. Freedman, R. and J.Y. Takeshita. 1969. Family Planning in Taiwan: An Experiment in Social Change. Princeton, NJ: Princeton University Press.Google Scholar
  20. Furstenberg, F.F. 1993. “How Families Manage Risk and Opportunity in Dangerous Neighborhoods.” Pp. 231–58 in Sociology and the Public Agenda, edited by W.J. Wilson. Newbury Park, CA: Sage.Google Scholar
  21. Furstenberg, F.F. and M.E. Hughes. 1997. “The Influence of Neighborhoods on Children’s Development: A Theoretical Perspective and a Research Agenda.” Pp. 23–47 in Neighborhood Poverty, Volume II: Policy Implications in Studying Neighborhoods, edited by J. Brooks-Gunn, G.J. Duncan, and J.L. Aber. New York: Russell Sage Foundation.Google Scholar
  22. Ginther, D., R. Haveman, and B. Wolfe. 2000. “Neighborhood Attributes as Determinants of Children’s Outcomes: How Robust Are the Relationships?” Journal of Human Resources 35:603–33.CrossRefGoogle Scholar
  23. Gordon, D., S. Nandy, C. Pantazis, S. Pemberton, and P. Townsend. 2003. Child Poverty in the Developing World. Bristol, England: Policy Press.Google Scholar
  24. Hardman, A. and Y.M. Ioannides. 2004. “Income Mixing and Housing in U.S. Cities: Evidence From Neighborhood Clusters of the American Housing Survey.” Working paper. Department of Economics, Tufts University, Medford, MA.Google Scholar
  25. Harpham, T. and M. Tanner, eds. 1995. Urban Health in Developing Countries: Progress and Prospects. New York: St. Martin’s Press.Google Scholar
  26. Herr, H. and G. Karl. 2002. “Estimating Global Slum Dwellers: Monitoring the Millennium Development Goal 7, Target 11.” Monitoring Systems Branch, Global Urban Observatory. Nairobi: UN-HABITAT.Google Scholar
  27. Herr, H. and G. Mboup. 2003. “Slum Dweller Estimation Methodology.” Unpublished paper. Nairobi: UN-HABITAT.Google Scholar
  28. Jöreskog, K.G. 2000. “Latent Variable Scores and Their Uses.” Unpublished paper. Available online at Scholar
  29. Jöreskog, K.G. 2002. “Structural Equation Modeling With Ordinal Variables Using LISREL.” Unpublished paper. Available on-line at Scholar
  30. Kaufman, C.E., S. Clark, N. Manzini, and J. May. 2002. “How Community Structures of Time and Opportunity Shape Adolescent Sexual Behavior in South Africa.” Working Paper No. 159. Policy Research Division, Population Council, New York.Google Scholar
  31. Kravdal, Ø. 2003. “Community Mortality in India: Individual and Community Effects of Women’s Education and Autonomy.” East-West Center Working Papers, Population Series, no. 112. East-West Center, Honolulu, HI.Google Scholar
  32. Lawley, D.N. and A.E. Maxwell. 1962. “Factor Analysis as a Statistical Method.” Statistician 12:209–29.CrossRefGoogle Scholar
  33. Massey, D.S. 1990. “American Apartheid: Segregation and the Making of the Underclass.” American Journal of Sociology 96:329–57.CrossRefGoogle Scholar
  34. — 1996. “The Age of Extremes: Concentrated Affluence and Poverty in the Twenty-first Century.” Demography 33:395–412.CrossRefGoogle Scholar
  35. McCulloch, A. 2003. “An Examination of Social Capital and Social Disorganisation in Neighbourhoods in the British Household Panel Study.” Social Science and Medicine 56: 1425–38.CrossRefGoogle Scholar
  36. McDade, T.W. and L.S. Adair. 2001. “Defining the ’Urban’ in Urbanization and Health: A Factor Analysis Approach.” Social Science and Medicine 53:55–70.CrossRefGoogle Scholar
  37. Montgomery, M.R. and A.C. Ezeh. 2005. “Urban Health in Developing Countries: Insights From Demographic Theory and Practice.” Pp. 317–60 in The Handbook of Urban Health, edited by S. Galea and D. Vlahov. New York: Springer.CrossRefGoogle Scholar
  38. Montgomery, M.R., M. Gragnolati, K.A. Burke, and E. Paredes. 2000. “Measuring Living Standards With Proxy Variables.” Demography 37:155–74.CrossRefGoogle Scholar
  39. Montgomery, M.R. and P.C. Hewett. 2004. “Urban Poverty and Health in Developing Countries: Household and Neighborhood Effects.” Working Paper No. 184. Policy Research Division, Population Council, New York. Available on-line at Scholar
  40. Montgomery, M.R., C. Lloyd, P.C. Hewett, and P. Heuveline. 1997. “The Consequences of Imperfect Fertility Control for Children’s Survival, Health, and Schooling.” Demographic and Health Surveys Analytical Reports No. 7. Macro International, Calverton, MD.Google Scholar
  41. Oakes, J.M. 2004. “The (Mis)estimation of Neighborhood Effects: Causal Inference for a Practicable Social Epidemiology.” Social Science and Medicine 58:1929–52.CrossRefGoogle Scholar
  42. Panel on Urban Population Dynamics, National Research Council. 2003. Cities Transformed: Demographic Change and Its Implications in the Developing World, edited by M.R. Montgomery, R. Stren, B. Cohen, and H. Reed. Washington, DC: National Academies Press.Google Scholar
  43. Pebley, A.R., N. Goldman, and G. Rodríguez. 1996. “Prenatal and Delivery Care and Childhood Immunization in Guatemala: Do Family and Community Matter?” Demography 33:231–47.CrossRefGoogle Scholar
  44. Pebley, A.R. and N. Sastry. 2003. “Concentrated Poverty vs. Concentrated Affluence: Effects on Neighborhood Social Environments and Children’s Outcomes.” Paper presented at the 2003 annual meeting of the Population Association of America, Minneapolis, MN, May 1-3.Google Scholar
  45. Sahn, D.E. and D.C. Stifel. 2000. “Poverty Comparisons Over Time and Across Countries in Africa.” World Development 28(12):2123–55.CrossRefGoogle Scholar
  46. Sampson, R.J., J.D. Morenoff, and T. Gannon-Rowley. 2002. “Assessing ’Neighborhood Effects’: Social Processes and New Directions in Research.” Annual Review of Sociology 28:443–78.CrossRefGoogle Scholar
  47. Sastry, N. 1996. “Community Characteristics, Individual and Household Attributes, and Child Survival in Brazil.” Demography 33:211–29.CrossRefGoogle Scholar
  48. Sastry, N., A. Pebley, and M. Zonta. 2002. “Neighborhood Definitions and the Spatial Dimension of Daily Life in Los Angeles.” Paper presented at the 2002 annual meeting of the Population Association of America, Atlanta, GA, May 9–11.Google Scholar
  49. Szwarcwald, C.L., C.L.T. de Andrade, and F.I. Bastos. 2002. “Income Inequality, Residential Poverty Clustering and Infant Mortality: A Study in Rio de Janeiro, Brazil.” Social Science and Medicine 55:2083–92.CrossRefGoogle Scholar
  50. Tandon, A., E. Gakidou, C.J.L. Murray, and B. Ferguson. 2002. “Cross-Population Comparability and PPPs: Using Micro-data on Indicators of Consumer Durables.” Evidence and Information for Policy Cluster draft paper. World Health Organization, Geneva.Google Scholar
  51. Timæus, I.M. and L. Lush. 1995. “Intra-urban Differentials in Child Health.” Health Transition Review 5:163–90.Google Scholar
  52. United Nations. 2000. World Urbanization Prospects: The 1999 Revision: Data Tables and Highlights. New York: Department of Economic and Social Affairs, Population Division, United Nations.Google Scholar
  53. van den Eeden, P. and H.J.M. Hüttner. 1982. “Multi-level Research.”” Current Sociology 30(3): 1–182.CrossRefGoogle Scholar
  54. Wellman, B. and B. Leighton. 1979. “Networks, Neighborhoods, and Communities: Approaches to the Study of the Community Question.” Urban Affairs Quarterly 14:363–90.CrossRefGoogle Scholar
  55. Wen, M., C.R. Browning, and K.A. Cagney.] 2003. “Poverty, Affluence, and Income Inequality: Neighborhood Economic Structure and Its Implications for Health.” Social Science and Medicine 57:843–60.CrossRefGoogle Scholar
  56. Westoff, C.F. and A. Bankole. 1995. Unmet Need 1990-1994. Demographic and Health Surveys Comparative Studies. Calverton, MD: Macro International.Google Scholar
  57. Westoff, C.F. and A.R. Pebley. 1981. “Alternative Measures of Unmet Need for Family Planning in Developing Countries.” International Family Planning Perspectives 7(4):126–36.CrossRefGoogle Scholar
  58. White, M.J. 1987. American Neighborhoods and Residential Differentiation. New York: Russell Sage Foundation.Google Scholar
  59. — 2001. “Residential Concentration/Segregation, Demographic Effects of.” Pp. 13250–54 in International Encyclopedia of the Social and Behavioral Sciences, Vol. 19, edited by N.J. Smelser and P.B. Baltes. Oxford, England: Elsevier Science.Google Scholar
  60. Wilkinson, R. G. 1996. Unhealthy Societies: The Afflictions of Inequality. London: Routledge.CrossRefGoogle Scholar
  61. Wilson, W.J. 1987. The Truly Disadvantaged: The Inner City, the Underclass and Public Policy. Chicago: University of Chicago Press.Google Scholar
  62. World Bank. 2002. Cali, Colombia: Toward a City Development Strategy. Washington, DC: World Bank.Google Scholar

Copyright information

© Population Association of America 2005

Authors and Affiliations

  • Mark R. Montgomery
    • 1
    • 2
  • Paul C. Hewett
    • 1
    • 2
  1. 1.State University of New York at Stony BrookUSA
  2. 2.Policy Research DivisionPopulation CouncilNew York

Personalised recommendations