Do Cities Improve Our Health Status? A State-Level Analysis in India

Abstract

While several cross-country level studies suggest urbanization increases health outcomes; national-level studies are missing. On the other hand, India is experiencing a very low level of urbanization due to policy failures. In this context, this study assesses the impact of urbanization on health outcomes in Indian states from the period of 1991 to 2011. Urbanization is measured by the total urban population and percentage of urban population as different states are having a different level of urbanization. Health outcomes are measured by total fertility rate, infant mortality rate, and life expectancy at birth. The static panel data models such as fixed-effect and random-effect panel data models suggest that the total urban population and the percentage of the urban population have a positive effect on life expectancy at birth and have a negative effect on the infant mortality rate and total fertility rate. Among the control variables, the percentage of urban households having access to electricity, urban monthly per capita consumption expenditure, and per capita net state domestic product has also had a similar effect on the health outcomes. Other important variables such as rural to urban migration, literacy rate, poverty rate, access to safe drinking water, labor force participation rate, and the extent of inequality also play an important role in increasing health outcomes. We also checked the robustness of our results by using the instrumental variable generalized method of moments. Our results support the Theory of Demographic Transition and suggest that Indian policymakers must support increasing the urbanization rate for achieving higher health outcomes. However, proper management of urbanization by providing basic services to urban dwellers is also very important in this regard.