Great paper, forthcoming in the Journal of Development Economics on how the length of recall periods in surveys leads to different measurements of health, wellness and health care seeking behavior. Also interesting is how the recall period length effect differs by income status. The authors use their findings to suggest that experiences with illness have become disturbingly become the normal among the poor vis-a-vis the rich:
Between 2000 and 2002, we followed 1621 individuals in Delhi, India using a combination of weekly and monthly-recall health questionnaires. In 2008, we augmented these data with another 8 weeks of surveys during which households were experimentally allocated to surveys with different recall periods in the second half of the survey. We show that the length of the recall period had a large impact on reported morbidity, doctor visits; time spent sick; whether at least one day of work/school was lost due to sickness and; the reported use of self-medication. The effects are more pronounced among the poor than the rich. In one example, differential recall effects across income groups reverse the sign of the gradient between doctor visits and per-capita expenditures such that the poor use health care providers more than the rich in the weekly recall surveys but less in monthly recall surveys. We hypothesize that illnesses--especially among the poor--are no longer perceived as "extraordinary events" but have become part of “normal” life. We discuss the implications of these results for health survey methodology, and the economic interpretation of sickness in poor populations.
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This is really interesting. One of the points of the child nutrition paper I am working on is the methodological flaw of some anthropologists of simply performing an ethnography of crisis, rather than of reflection. By this, I mean that they only do clinical observations and interview patients right at the time of their illnesses, rather than following up with them as well and getting a broader perspective. It's obvious, but interesting, that the period of time you follow up in would affect patients' memory of sickness.
As for the normalization of illness among the poor--another theme we are covering in the child health paper ;) Of course it goes hand in hand with the ethnography of reflection, rather than crisis. We used to get blank stares when we asked caregivers "how long has your child been sick?" because a lack of symptoms is so infrequent.
Nice post, and I'm glad I ran into it (:
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