81211 enGender Impact: The World Bank’s Gender Impact Evaluation Database Causal effect of health on labor market outcomes: Evidence from a random assignment iron supplementation intervention Author(s) Duncan Thomas, Elizabeth Frankenberg, Jed Friedman et al. Contact jfriedman@worldbank.org Country Indonesia Organizing Theme Health, Economic Opportunities and Access to Assets, Voice and Agency Status The Project is ongoing but the evaluation is complete Intervention Category Iron Supplements Sector Health, Nutrition & Population Iron deficiency is widespread throughout the developing world. We provide new evidence on the effect of iron deficiency on economic and social prosperity of older adults drawing on data from a random assignment treatment-control design intervention. The Work and Iron Status Evaluation is an on-going study following over 17,000 individuals in Central Java, Indonesia. Half the respondents receive a treatment of 120 mg of iron every week for a year; the controls receive a placebo. Compliance is monitored carefully. Results from the first six months of the intervention are presented for adults age 30 through 70 years. Males who were iron deficient prior to the intervention and who are assigned to the treatment are Abstract better off in terms of physical health, psycho-social health and economic success. These men are more likely to be working, sleep less, lose less work time to illness, are more energetic, more able to conduct physically arduous activities and their psycho-social health is better. There is evidence that economic productivity of these males also increased. Among iron-deficient males assigned to the treatment who were also self-employed prior to the baseline, hourly earnings rose substantially and so they earned more on a monthly basis. Benefits for women are in the same direction but the effects are more muted. The results provide unambiguous evidence in support of the hypothesis that health has a causal effect on economic prosperity of males during middle and older ages. Gender Connection Gender Informed Analysis Gender disaggregated nutrition, psychological agency, labor force participation, Gender Outcomes productivity IE Design Randomized Control Trial The Work and Iron Status Evaluation (WISE) randomly assigns a weekly iron supplement to half the subjects with the rest being given a placebo. A local facilitator was recruited in each of the WISE enumeration areas. Typically the facilitator lives in the area and is often Intervention active in the local community. During the first months of the intervention, the facilitator visited each household in his or her area two times a week in order to encourage (or remind) respondents to take the tablets, answer any questions and deal with any problems or side effects. The program is ongoing but started in 1996. The intervention for this study occurred in Intervention Period 2002. Last updated: 14 August 2013 1 enGender Impact: The World Bank’s Gender Impact Evaluation Database Slightly over 17,500 respondents living in 4300 households were included. Men aged 25-75 Sample population and women aged 40-75 were oversampled. Comparison conditions The control group received a placebo pill. Unit of analysis Individual Level There was a screener survey in October/December 2001. Every 4 months there was an Evaluation Period additional survey through 24 months in April 2004. Adults were age 30 through 70 at the time of the baseline. Benefits of the intervention were concentrated among those who are iron deficient prior to the intervention. After six months of supplementation, there is evidence that iron-deficient older adults who received the treatment, are better off in terms of physical health, psycho-social health and economic success. Relative to the control group, males who were iron deficient prior to the intervention and received the treatment are more likely to be working, earn more and lose less work time to illness. These men are also more energetic, sleep less, they are more able Results to conduct physically arduous activities and their psycho-social health is better. The effects for females are generally in the same direction but tend to be more muted. Treated females who were iron deficient at baseline are more likely to be working, have higher hourly earnings if they earn income and tend to have better physical and psycho-social health. The intervention leads to 20% increase in wages for males but only 6% higher earnings for females. The results provide unambiguous evidence in support of the hypothesis that health has a causal effect on economic and social prosperity of adults during middle and older ages. Primary study limitations It is possible that people had low iron blood levels due to helminthe infections. Funding Source National Institutes on Aging, Fogarty International Center, Global Development Network Thomas, D., Frankenberg, E., Friedman, J., Habicht, J. P., Jones, N., McKelvey, C., ... & Reference(s) Suriastini, W. (2004). Causal effect of health on labor market outcomes: Evidence from a random assignment iron supplementation intervention. Link to Studies http://isites.harvard.edu/fs/docs/icb.topic1222150.files/Session%208/thomas- 040430.pdf Microdata Last updated: 14 August 2013 2