Abstract:
Health outcomes and health-related behaviours vary markedly across and within countries globally. Some populations achieve long, healthy lives, while others continue to face enduring disadvantages in health, development, and survival. This dissertation contributes to the empirical evidence on the effects of human capital and institutions on health outcomes and behaviours. It examines how historical and contemporary dimensions of human capital and institutional development influence population health across sub-Saharan Africa and beyond. The first study investigates whether elite numeracy during the seventeenth to nineteenth centuries continues to affect contemporary health outcomes. Using subnational data from 44 sub-Saharan African countries and an instrumental variable approach based on proximity to historical centres, the analysis shows that regions with higher historical elite numeracy show higher life expectancy and lower malaria prevalence today. These effects persist after controlling for historical, geographic, and contemporary factors, highlighting the path-dependent influence of early human capital on modern health outcomes.
The second examines how contemporary individual-level health literacy and health
numeracy relate to malaria prevention and treatment behaviours in Gabon. Drawing
on a cross-sectional household survey and validated psychometric scales, the results
show that health literacy and numeracy are associated with behaviours. Numeracy
supports treatment-seeking decisions, while literacy promotes correct dosing and
engagement with healthcare providers. Mediation analysis demonstrates that literacy
influences behaviours indirectly through information-seeking, emphasising the role of
knowledge in shaping health actions. The third study analyses the role of institutional
quality and development aid in shaping the malaria burden across 38 sub-Saharan
African countries (2010 to 2022). Using spatial econometric methods, the study finds that
stronger institutions, higher health worker density, and increased aid are associated
with higher reported malaria burden, likely reflecting improved detection and reporting.
Malaria outcomes are driven more by local conditions, with limited spillovers revealing
a need for localised health system strengthening alongside coordinated regional
interventions. The fourth study evaluates the effect of compulsory education laws on
health inequality, using height inequality as a biological marker of nutritional and
developmental disparities across 62 countries from 1810 to 2000. Employing a
staggered difference-in-differences design, the results indicate that compulsory
education reduced height inequality on average. The findings suggest that education
policies can meaningfully narrow health disparities over time, but their success hinges
on both the institutional environment and the timing of adoption.
Health outcomes