1. Is Trade Good for the Poor? A Second Look Daniel Tirone University of Pittsburgh dct8@pitt.edu Nita Rudra University of Pittsburgh rudra@pitt.edu

2. 1. Economists argue trade improves health of the poor  Recent studies by economists claim that trade leads to enormous health benefits, particularly in the world’s poorest countries (Owen and Wu 2007, Bhagwati 1998, Levine and Rothman 2006, Smith, Blouin and Dreger 2005).  If trade helps improve health in the world’s poorest nations, then low-income countries that have become more open should see improvements in their life expectancy.

3. 1. But life expectancy improved at a faster rate before openness

4. 1. Economists neglect political mediating conditions  Problem: recent studies of the trade-health relationship by economists fail to develop an adequate political theory that supports such a link.  The neglect of the political conditions that enable (or not) better health outcomes in open economies can produce misleading results.  Policy implications may be profound

5. 1. Research Question What are the supporting domestic political conditions necessary to ensure that global integration leads to more beneficial health outcomes in poor countries?

6. 1. Our theory and findings (in brief)  We draw on the literature in political economy and identify three conditions under which the political architecture of poor countries might link openness with beneficial health outcomes: (1) democracy; (2) lower levels of ethnic heterogeneity; and (3) a more equitable income distribution.  Openness is ‘good for your health’ only in developing countries with low levels of socioeconomic diversity (low inequality, less ethnic fragmentation).  Our conclusion: in socially polarized societies, weak institutions of conflict management (independent jury, rule of law, freedom from arbitrary arrests, non-corrupt bureaucracy, etc) are responsible for hindering better outcomes for the poor as markets expand.

7. 2. Existing literature ignores domestic institutional dynamics  The argument that trade leads to better health rests on knowledge spillovers as the primary causal mechanism  Problem: existing literature ignores domestic institutional dynamics: (1) leading causes of death in developing countries are preventable and involve low-tech solutions. (2) Governments have long been subsidizing health of the rich  Governments must have incentives to direct trade benefits towards the well-being of the poor; otherwise, the real danger is that trade might exaggerate the existing two-tiered health-care system (rich vs. poor), slowing overall advancements in health outcomes such as life expectancy.

8. 3. Our hypotheses: democracy, ethnicity, inequality  Democratic nations will focus greater attention to health needs of the poor.  Democracies encourage electoral competition (Meltzer and Richards 1981, Boix 1998)  Allow greater interest group competition ( Brown & Hunter, 1999; Grossman&Helpman, 2002).  Democracies are more likely to provide public goods (Cox 1987, Bueno de Mesquita, Smith, Siverson, & Morrow, 2003; Lake & Baum, 2001).  Ethnically homogeneous societies will have better social welfare outcomes (Easterly and Levine 1997; Alesina, Baqir and Easterly 1999, Alesina and Ferrara 2005)  Different ethnic groups have different preferences over which type of public good to support  Each ethnic group will undervalue the particular public good if other groups also use it.  BUT causality (in terms of health-related public goods) not clear

9. 3. Our hypotheses: democracy, ethnicity, inequality  Countries with more equitable income distribution will have higher public good provision (Perotti 1996, Waldmann 1992, Easterly and Levine 1997,  The rich have incentive to lobby for lower cost specialized care rather than affordable basic public health care services for several reasons:  They already have access to high-cost (substandard) hospital-based care  Higher-income groups in developing countries have long had exit options for healthcare, but this is costly.  More equitable societies tend to have larger middle classes, who have incentives to lobby for affordable public health care

10. 3. Our hypotheses (summary) H1: As trade increases, more democratic nations will experience improvements in overall health outcomes H2: As trade increases, less ethnically diverse nations will experience improvements in overall health outcomes H3: As trade increases, nations with more equitable distribution of income will experience improvements in overall health outcomes Hypotheses

11. 4. Original Owen and Wu results : A Second Look Table 1. Replication of Owen and Wu (2007) using Life Expectancy Model 1Model 2Model 3Model 4Model 5 Owen and Wu Results (Full Sample) Replacing GDP per capita (Full Sample) Replacing Openness (Full Sample) Developing Countries Developed Countries GDP per capita2.93** 2.483***0.211 (1.27) -0.687(0.995) Openness4.99***0.42 0.7381.899** (1.93)(0.37) (0.477)-0.959 Openness X GDP per capita-0.58*** (0.27) Income Level 1 -0.88-0.072 (0.45)(0.891) Openness X Income Level 1 -0.27** (0.11) Health Adjusted Imports -0.337 (1.280) Health Adjusted Imports X Income Level 1 1.691 (2.041) Education0.91***1.33***1.738**0.611***-0.022 (0.27)(0.28)-0.843-0.12(0.056) Population Growth2.653.763.32525.125***-0.201 (2.65)(3.44)(9.255)-5.321(4.797) Constant35.88***57.09***52.919***33.361***58.204*** (9.04)(1.76)-2.52-4.589-8.815 N848687244347303

12. 5. Model: domestic political & international economic variables Life Expectancy it = ln(Openness) t-1 + ln(Openness )t-1 * Conditioning Variable + Democracy + Ethnic Fragmentation + Income Inequality + Ln(GDP per capita) t-1 + Education t-1 + Population Growth + u i  Sample: All countries for which data are available between 1960 and 1995, with observations taken in 5-year increments  Estimation: Ordinary Least Squares with country fixed-effects run on two different populations: countries that are members of the Organization for Economic Cooperation and Development (OECD) and non-members  Alternative Dependent Variable: Infant Mortality

13. 6. Results: Beneficial effects of trade decrease at higher levels of diversity  Democracy: little evidence that the benefits of trade are conditional on democracy  Ethnic homogeneity: the beneficial effects of trade decrease, at higher levels of ethnic diversity  Income Inequality: the benefits of trade decrease as income inequality increases. Interpretation of results?  We know from the IPE literature that trade effects distributional conflicts;  Weak institutions of conflict management are responsible for hindering better outcomes for the poor as markets expand.  This implies that institutions supporting electoral competition in developing countries (i.e., democracy) may simply not be enough to help improve the welfare of the poor, particularly in the face of increasing openness.

14. 6. Results: Trade improves health in rich countries Developing Countries OECD Countries

15. 7. Implications: If political preconditions are not in place, trade can hurt the poor  As economists argue, trade can in fact be beneficial for the health of developing nations  However, our results suggest that political factors must be considered when evaluating how the benefits of trade are distributed  Factors such as income inequality and ethnic heterogeneity can affect the extent to which countries benefit from trade, because conflict-management institutions are weak in these countries  Therefore, to maximize these benefits policy-makers must focus not only on trade liberalization, but also on other areas of domestic policy

16. 6. Results (cont) Developing Countries OECD Countries

17. 6. Results (cont) Developing Countries OECD Countries

18. 6. Results (cont) Model 4 S.E. Diversity Life Expectancy Infant Mortality GDP per capita6.93***-40.357*** (1.11)(6.583) Openness6.77***-31.289** (2.33)(13.829) Democracy0.017-0.169 (0.056)(0.331) Socio-Economic Diversity8.78*-38.776 (4.69)(27.680) Population Growth-18.06117.975* (11.84)(68.058) Female Education0.72***-2.395*** (0.13)(0.751) Openness X Socio-Economic Diversity-2.44**11.292* (1.07)(6.301) Constant-15.01472.633*** (10.97)(64.231) N159 Overall R 2 64.859.6

19. 6. Results (cont) Model 3 Income Inequality Life Expectancy Infant Mortality GDP per capita5.993***-35.608*** (1.076)(6.502) Openness9.611***-40.48** (3.279)(19.782) Democracy0.03-0.261 (0.055)(0.333) Income Inequality0.615*-2.259 (0.326)(1.962) Ethnic Fractionalization-0.239**0.916 (0.102)(0.619) Population Growth-14.96105.218 (11.669)(68.258) Female Education0.758***2.49*** (0.130)(0.752) Openness X Income Inequality-0.189**0.762 (0.080)(0.478) Constant-2.441403.435*** (14.176)(85.137) N158 Overall R 2 51.239.2

20. 6. Results (cont) Model 2 Ethnic Fractionalization Life Expectancy Infant Mortality GDP per capita6.064***-34.645*** (1.103)(6.427) Openness4.316**-35.57*** (2.068)(12.095) Democracy0.034-0.221 (0.056)(0.329) Income Inequality-0.139**0.739* (0.066)(0.386) Ethnic Fractionalization-0.037-1.069 (0.162)(0.946) Population Growth-19.843147.243** (12.215)(69.208) Female Education0.683***-2.321*** (0.128)(0.719) Openness X Ethnic Fractionalization-0.0360.435** (0.031)(0.180) Constant15.52388.787*** (11.373)(66.499) N159 Overall R 2 59.045.3