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© 1990 Oxford University Press

research-article

People are not Passive Acceptors of Threats to Health: Endogeneity and its Consequences

JOHN BRISCOE*, JOHN AKIN** and DAVID GUILKEY**

*The World Bank, Washington DC 20433, USA.
**Department of Economics and Carolina Population Center,University of North Carolina Chapel Hill, NC 27514, USA.

Briscoe J (The World Bank, Washington DC 20433, USA) Akin J and Guilkey D. People are not passive acceptors of threats to health. Endogeneity and its consequences. International Journal of Epidemiology 1990, 19: 147–153.

The effect of behaviour on health is a major area of contemporary epidemiological enquiry. Most epidemiological studies of the effect of behaviour on health assume that the levels of the behaviour-related variables are determined by factors other than those under study. However, in many instances, obvious examples are breastfeeding and smoking, not only do behaviours affect health but, conversely, individuals take into account their (observable and non-observable) health conditions when making behavioural decisions. In models which allow for the joint determination of health and behaviour, both health and behavioural variables are ‘endogenous’, that is, determined by forces acting within the model. Through some simple didactic examples it is shown that estimates of the effect of behaviour on health are biased if endogeneity is ignored. Review of the small empirical literature on this subject shows perverse results, such as a negative relationship between the use of prenatal care and infant mortality, when endogeneity is ignorod. Standard procedures for taking account of the effects of endogeneity are described briefly.

Revised 1 April 1989


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