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FEMISE Janvier8-2008 FEMISE RESEARCH PROGRAMME 2007-2008 Interdependencies of Health, Education & Poverty with Policy Implications for Southern Mediterranean Countries Research n°FEM32-01 Directed By Ahmed Driouchi, Institute of Economic Analysis & Prospective Studies (IEAPS), Al Akhawayn University, Ifrane, Morocco In collaboration with: Ahmad Baijou, School of Business Administration, Al Akhawayn University, Ifrane, Morocco Cristina Boboc, Laboratoire d’Economie d’Orléans (LEO), Orleans, France and Bucharest Academy of Economic Studies, Bucharest, Romania Mouna Cherkaoui, University Mohammed V, Rabat, Morocco Lahcen Oulhaj, University Mohammed V, Rabat, Morocco With the contributions of: Nada Zouag & Amale Achehboune, Institute of Economic Analysis & Prospective Studies (IEAPS) Al Akhawayn University, Ifrane, Morocco With the support of: Jaouad Kerdoudi, IMRI, Casablanca, Morocco December 2008 Ce rapport a été réalisé avec le soutien financier This document has been produced with the financial assis- de l’Union Européenne au travers du Femise. Le tance of the European Union within the context of the FEMISE contenu du rapport relève de la seule responsabilité program. The contents of this document are the sole respon- des auteurs et ne peut en aucun cas être considéré sibility of the authors and can under no circumstances be comme reflétant l’opinion de l’Union Européenne. regarded as reflecting the position of the European Union. Interdependencies of Health, Education & Poverty with Policy Implications for Southern Mediterranean Countries By: Ahmed Driouchi, Institute of Economic Analysis & Prospective Studies (IEAPS), Al Akhawayn University, Ifrane, Morocco In collaboration with: • Ahmad Baijou, School of Business Administration, Al Akhawayn University, Ifrane, Morocco • Cristina Boboc, Laboratoire d’Economie d’Orléans (LEO), Orleans, France and Bucharest Academy of Economic Studies, Bucharest, Romania • Mouna Cherkaoui, University Mohammed V, Rabat, Morocco • Lahcen Oulhaj, University Mohammed V, Rabat, Morocco With the active contributions of: Nada Zouag & Amale Achehboune, Institute of Economic Analysis & Prospective Studies (IEAPS) Al Akhawayn University, Ifrane, Morocco & With: Jaouad Kerdoudi, IMRI, Casablanca, Morocco FEMISE Internal Consultation 2007-2008 Contract FEM 32-01 Note: This document has been produced with the financial assistance of the European Union within the context of the FEMISE program. The contents of this document are the sole responsibility of the authors and can under no circumstances be regarded as reflecting the position of the European Union. January, 2009 Table of Contents Executive Summary Introduction Chapter I: Literature Review on Interdependencies of Health and Wealth 1. Past Studies on Interdependencies of health, education and economic performance 1.1. Relationships of Health and other socioeconomic variables 1.2. Health, Wealth and Income 1.3. Health, nutrition, education and labor: 1.4. Health and governance 2. Interdependencies Health, Education and Poverty in Southern Mediterranean Economies 2.1. Health, nutrition and population: 2.2. The Relationship between Health and Productivity 2.3. The Relationship between Health and Education 2.4. The Relationship between Health and Income 2.5. The Relationship between Health and Employment 2.6. Poverty and education 2.7. Poverty and health Conclusion Chapter II. Overview of the Analytical Methods and Data used 1. The Underlying Theoretical Model(s) 2. Empirical Methods Used 3. Variables a. Education b. Health c. Income 4. Data 4.1 Sources 4.2 Clusters and Years range Conclusion Chapter III. The Importance of Wealth Patterns and Relationships with Health & Education 1. Introduction 2. Descriptive Statistics 3. Wealth Patterns 4. Econometric analysis of the relationship between Education, Health, and Economic Development Conclusion Chapter IV: Interdependency of Health, Education, and Poverty based on Country Data I. Conceptual Framework II. Results of the Dependency Analysis A. Case of Morocco B. Case of Turkey C. Dependency Analysis: Case of Egypt III. Probit Analysis: presentation & Interpretation of the Results A. Morocco B. Egypt C. Turkey IV. Results of the CMBS Sample from Morocco 2 A. Essaouira (Morocco) B. Bouaboud (Morocco) V. Results of the Analysis of 1999 Sample from Household Expenditures Survey Conclusion Chapter V: Interdependencies between Health, Education and Poverty based on Regional Data 1. Using World Bank Data 2. Using the UN most recent database to check for consistencies with the above estimations 3. Interdependencies based on aggregated and composite Indices 4. Testing for Granger- Causality using Country Time series data on some variables 5. Regressions based on institutional profiles Conclusion Chapter VI: Further Risk Factors Connected to Health, Education and Poverty 1. Accounting for Gender Inequality 2. The effects of Rural and Urban interconnections 3. The Aggravating effects of disabilities 4. The issue of children in the region 5. Migration of Medical Skilled Labor Conclusion Chapter VII: Economic & Social Policies accounting for Interdependencies of Health, Education and Poverty 1. The Millennium Development Goals 2. Major Findings from Global, Regional and National Engagement in Human Development 3. Domestic Social & Economic Policies 3.1 Overall Political, Economic & Social Reforms 4. Need of further Policy coordination and Integration 4.1 The Overall framework 4.2 Strengthening Social Policies Towards further inclusion of Women Conclusion Chapter VIII: Implications of the Findings, Report Limitations and Future Directions of Research A. Report findings and their Implications 1. Overall accomplishment, 2. Gains towards understanding and evaluating poverty alleviation programs , 3. The central role of Education and Health in Poverty alleviation programs 4. Importance of transversal policies with further coordination and integration B. Strengthening of local development C. Strengthening means o ensure enterprise and job creation D. Limitations E. Further Directions of Research Overall conclusion Overall references Appendices. 3 Résumé Exécutif L’objectif majeur de cette étude est de montrer l’importance des interdépendances entre les secteurs de la santé, de l’éducation et la performance économique des pays du Sud de la Méditerranée. Ce travail a été motivé par le souci de recherches de gains vraisemblables dans chaque pays si les politiques socio-économiques sont plus transversales et plus intégrées. Les investigations empiriques menées sur différents types de données internationales qui incluent celles de pays mais aussi sur des informations plus agrégées et plus régionales ont permis de dresser les contours de la question des interdépendances entre la santé, l’éducation et la pauvreté. Les implications de telles interdépendances sur les segments vulnérables notamment sur les femmes et les enfants ont aussi été élucidées. Les politiques économiques et sociales en mesure de mieux valoriser ces interdépendances ont aussi été discutées. Ainsi, ce travail a pu confirmer le rôle central des femmes, des enfants et des handicapés dans le processus global de développement. Il a aussi souligné l’importance des interdépendances entre la santé, l’éducation de la pauvreté et ce, aussi bien au niveau de pays que de la région entière, malgré l’existence de différences en matière de richesses économique entre les pays. Le milieu rural et la forte urbanisation de la région constituent des facteurs d’accélération du processus de pauvreté avec ses dimensions interdépendantes dont l’économie, la santé et l’éducation. De hauts niveaux d’éducation qui existent souvent en milieu urbain, seraient à l’origine d’une bonne perception du rôle de la santé mais les bas niveaux d’éducation en milieu rural n’ont pas permis de tester les effets sur l’attitude en matière de prévention sanitaire bien qu’une relation positive ait été trouvée en milieu urbain. Les déperditions scolaires paraissent être aussi liées aux conditions de vie des ménages et aux difficultés de prise en charge de la santé. Les tests de causalité au sens de Granger, ont permis de déceler l’effet moteur de la santé et de l’éducation sur le reste des variables, malgré les limitations des données chronologiques. Ces déficits continuent d’exister malgré les engagements des pays étudiés dans des réformes économiques, sociales et politiques et malgré leurs engagements dans la poursuite des objectifs du millénaire et de développement humain. Le renforcement des politiques socio- économiques transversales et plus intégrées seraient en mesure de permettre à la région du Sud de la Méditerranée de changer ces déficits en opportunités de développement. Le rôle des femmes et des enfants dans un tel processus est évidemment porteur pour aujourd’hui mais surtout pour les générations futures. Le présent rapport est ainsi composé de huit chapitres qui sont aussi interdépendants. Pendant, que le huitième chapitre est entièrement consacré à la synthèse et à la discussion des résultats, le septième est centré sur le renforcement des politiques économiques et sociales d’intégration et de transversalité telles que liées aux interdépendances décelées dans les chapitres antérieurs. Ainsi, les résultats sont respectivement détaillés aux niveaux des chapitres 3, 4, 5 et 6. Le chapitre 3 est basé sur une analyse descriptive des données régionales et aussi des données des pays Européens. En même temps que ces analyses ont permis des comparaisons, elles ont aussi aidé dans le ciblage des investigations qui
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