Economist Uses Science to Alleviate Poverty, Promote Health
CREDIT: Helene Giacobino
When economist Esther Duflo, Ph.D., was asked what she would like to accomplish by the end of her career, she laughed good-naturedly. "Well, I hope my career is not ending right away," she replied. Indeed, she can be forgiven for finding the idea of retirement amusing. It was only a few years ago that the American Economic Association named Dr. Duflo the most promising U.S. economist younger than 40.
Dr. Duflo's position at the Massachusetts Institute of Technology says much about her long-term goals. She is both the Abdul Latif Jameel professor of poverty alleviation and development economics and the director of the Abdul Latif Jameel Poverty Action Lab (J-PAL). She is one of a small group of economists who use randomized controlled trials—the gold standard of scientific research—to answer a fundamental question about programs to improve the health of poor people in developing countries: Do they work?
"The big problem with the work to alleviate poverty is not a lack of good intention, it's a lack of good implementation," Dr. Duflo said. "And often good implementation is lacking because we don't know what works and what doesn't work. We don't take the time to evaluate programs."
"The NICHD has supported Dr. Duflo's work for more than a decade," said Rebecca L. Clark, Ph.D., chief of the NICHD Population Dynamics Branch (PDB). "During this time, her research has provided an evidence base that demonstrates that economic and poverty alleviation interventions can improve the health, development, and productivity of women, children, and families."
Addressing Child Health Globally
The issue of child health is among the most pressing in the developing world. More than 9 million children die before their fifth birthday each year from preventable diseases such as malaria and diarrhea, Dr. Duflo said. Her studies in India show that when the status of some women is elevated, the health of village residents, particularly children, is likely to improve. Her work in Kenya on the effectiveness of HIV prevention education suggests that keeping young girls in school may be as important as the HIV prevention curriculum in preventing sexually transmitted infections (STIs) such as HIV.
Dr. Duflo's research, which the NICHD has funded since 2001, has provided empirical evidence about which health interventions work and which ones do not. This work―her approach, findings, and popular writing on the topic of global poverty―has been recognized by many prominent groups and organizations. For example, the MacArthur Foundation awarded her a "genius grant" fellowship in 2009. In 2010, Dr. Duflo received the John Bates Clark Medal from the American Economic Association, the second-most prestigious award in economics after the Nobel Prize.
In late 2012, President Barack Obama announced his intent to appoint her to the President's Global Development Council, an advisory panel.
Yet Dr. Duflo does not make note of these honors. In her French accent, she speaks of her research activities and achievements as the result of a team effort. It is always "we," not "I." She speaks quickly, but talks about her research methodically and confidently. These characteristics likely serve her well in her spare time, as well, as she pursues her hobby of rock climbing.
Raising the Status of Women in India
As part of her NICHD-funded research, Dr. Duflo conducted a series of experiments in India to examine the effects of women's leadership in rural areas. In each election cycle, the Indian government requires one-third of its village councils to elect a woman leader, randomly selecting the villages that will fulfill this mandate.
Dr. Duflo and her team compared the woman-led villages to those that had never had a woman leader. They found that more children were immunized in villages with women leaders, an important health benefit for the children. Also, women leaders were more likely to invest in clean drinking water. Although the team did not specifically measure the health effects of clean water in the villages, poor water infrastructure can increase the chance of diarrhea, one of the most common causes of illness and death among children in India.
The Duflo team documented far-reaching social effects as well. Parents' aspirations for their teenage daughters rose significantly in villages that had had a woman leader for at least 7 years, they found. They also discovered that girls in villages that had had a woman leader were less likely to drop out of school.
To test ideas about people's behavior and decisions, Dr. Duflo's research often gives her a close look at people's daily lives. She finds that the participants in her studies are very open to her work.
"Poor people in developing countries are quite happy when somebody is interested in what they have to say," Dr. Duflo said. "That does not happen very often."
Her research in villages around the world is a source of inspiration for her.
"Because of my work, I spend a lot of time in the field," Dr. Duflo says. "Some of my most interesting encounters—and where I get many of my research ideas—are from conversations with people in the field. It's a rewarding aspect of the job."
Health Education in Kenyan Schools
Dr. Duflo's work also includes an ongoing project in Kenya, where for seven years her team has worked with students in more than 300 Kenyan schools to gauge the effectiveness of a national abstinence-based education program to stop the spread of HIV. She noted that nearly 7% of Kenyans have been infected with HIV.
"There is surprisingly little evidence about the effectiveness of programs to reduce risky sexual behavior," Dr. Duflo said. While the AIDS curriculum is mandatory, not all students necessarily receive the education. In some cases, teachers are reluctant to teach it, Dr. Duflo said. As part of the study, she and her team trained teachers in half the schools to give the curriculum.
In addition, the team provided uniforms to students in half of the schools. All students in Kenya are required to wear a uniform, and children in families that can't afford one are likely to drop out. Providing uniforms gave the researchers an opportunity to test the idea that children who stay in school are also less likely to engage in unprotected sex.
Ultimately, students in one quarter of the schools received both a uniform and education in the HIV-prevention curriculum. In another quarter of the schools, students received neither. In the other schools, students received either a uniform or the curriculum. Across these four groups of schools, Dr. Duflo compared student dropout rates, as well as rates of pregnancy and HIV and other sexually transmitted infections (STIs). The students were 13 years old when the study began.
The study found that HIV prevention education alone did not prevent STIs, although students in the schools with the curriculum were more likely to be knowledgeable about the disease and were more understanding of people who had AIDS.
In fact, STI rates were the lowest in schools where girls got both the curriculum and school uniforms. In schools where girls received uniforms but no HIV prevention education, STI rates were not reduced. However, dropout and pregnancy rates were lower.
The study suggests that providing uniforms to children may be worthwhile if the aim is to reduce the dropout rate and early pregnancy among girls.
Building the Body of Evidence
By evaluating these types of programs, Dr. Duflo's research contributes evidence to help correlate effective programs in local communities with larger public health goals.
"We should seek to help people attain good health in a way that is easiest for them," she said. "So that may be a value that is imposed from the outside, but it meets very little resistance from anyone."
When she thinks about her long-term goals, Dr. Duflo says she would like to play a small part in making a difference in how policies are implemented. And she would like to inspire others to do the same.
"It will require the efforts of many people to tease out what works, what doesn't work, and why," she said. But their efforts are beginning to make a difference. "We now see policy makers look at studies and act. This is starting to happen."
For more information on Dr. Duflo and the work of the PBD, please review the following links: