YALE DEPARTMENT OF ECONOMICS
WORKING PAPER NO. 66
Population and Health Policies
T. Paul Schultz
July 2009
The program evaluation literature for population and health policies is
in flux, with many disciplines documenting biological and behavioral linkages from fetal
development to late life mortality, chronic disease, and disability, though their
implications for policy remain uncertain. Both macro and micro economics seek to
understand and incorporate connections between economic development and the demographic
transition. The focus here is on research methods, findings, and questions that economists
can clarify regarding the causal relationships between economic development, health
outcomes, and reproductive behavior, which operate in many directions, posing problems for
identifying causal pathways. The connection between conditions under which people live and
their expected lifespan and health status refers to “health production
functions”. The relationships between an individual’s stock of health and
productivity, well being, and duration of life encompasses the “returns to health
human capital”. The control of reproduction improves directly the well being of
women, and the economic opportunities of her offspring. The choice of population policies
may be country specific and conditional on institutional setting, even though many
advances in biomedical and public health knowledge, including modern methods of birth
control, are now widely available. Evaluation of a policy intervention in terms of
cost-effectiveness is typically more than a question of technological efficiency, but also
the motivation for adoption, and the behavioral responsiveness to the intervention of
individuals, families, networks, and communities. Well-specified research strategies are
required to address (1) the economic production of health capacities from conception to
old age, (2) the wage returns to increasing health status attributable to policy
interventions, (3) the conditions affecting fertility, family time allocation, and human
capital investments, and (4) the consequences for women and their families of policies
which change the timing as well as number of births.
* Funding for research related to this paper is appreciated from the
MacArthur Foundation, as is previous support from the Rockefeller Foundation that
contributed to various empirical studies reviewed in this survey. Comments are appreciated
from an anonymous referee and Germano Mwabu, Mark Rosenzweig, David Sahn and John Strauss,
and various workshop audiences. The programming assistance of Paul McGuire has been of
great value. The usual caveats for omissions and errors must be emphasized, because I have
commented on many areas of research for which I am in no way an expert.
Keywords: Health, Fertility and family planning, Biology of health human
capital, Economic development
JEL Classification: D13, I18, J13, O12