Location and health in an inequal city: evidence for Salvador in Brazil

Abstract

The objective of this paper is to verify the effect of the location of health facilities on amenable and child mortality in the city of Salvador in Brazil. Based on the theory of local public goods, we consider that the provision of public health facilities affects the local health condition, and should therefore be decentralized to achieve better outcomes and avoid congestion costs. Panel data with mortalities data, socioeconomic variables, and the georeferenced location and internal structure of local health facilities for 163 neighbourhoods of the city were used to estimate a panel Poisson model. Simultaneity bias between mortality rate and location of health facilities was controlled using an instrumental variable based on the location of day-care centres, pre-schools, and public elementary schools. The results show that the homogenous spatial urban coverage of health care facilities contributes to reducing mortality. An increase of one unit in the coverage of public health facilities can reduce amenable mortality by 2.57% and under-five mortality by 23.06%. This effect may be greater for neighbourhoods with less unequal socioeconomic conditions.