AXA Awards


Understanding the impacts of environmental, social and political shocks on the use of health services in low and middle income countries

What does an electricity outage in India and a terrorist attack in Pakistan have in common ? Both these events influence whether or not people use healthcare services. Many different types of shocks threaten health systems around the world, a number of which are new and unprecedented. These risks include those that are due to external forces such as the emergence of new infectious diseases and natural disasters, as well as factors that result from human activity like politics, conflict or migration. The impact of these events will likely disproportionately affect some segments of the population, yet little is known about the socio-economic distribution of the burden of shocks on households. Professor Karen A. Grépin, a specialist on healthcare systems in developing countries, and her team, aim to better understand how risks affect the operation of health systems in low and middle income countries, as well as how households and health systems respond to these shocks.
"A lot of things can have an effect on the use of health services", explains Prof. Karen Grépin. "Very few people are thinking of other shocks than those directly related to health. For instance, earthquakes have highlighted how fragile healthcare systems in developing countries can be". "Other factors can also be very revealing of their vulnerability. I’m particularly interested where women chose to deliver when these shocks happen", prof. Grépin continues. "Fear, for instance, following a terrorist attack or the incovenience of a power outage, may stop women in labor from seeking out help". "I’m looking at changes that might be underway, things that affect health care in anyway, and why people chose or not to use health care systems". Prof. Grépin’s intent is to understand the reality of health systems. She does so by exploring the socio-economic and political factors that have not been previously analyzed, although they are plausibly expected to have an influence.

An innovative approach to non-health care influences on health care.

Even if prof. Karen-Ann Grépin is an economist, her research approach is very interdisciplinary. The study will combine demographic and health surveys from different low and middle income countries – the availability of data will influence the choice of these countries –, with non-traditionally health focused databases, such as those commonly used in political science and other social sciences. These include for instance databases which track recent conflicts and election results. "Pakistan will be an interesting case study, considering there is a large amount of data available on both terrorist activity and access to health care.", prof. Grépin points out. In terms of method, the study will employ novel and increasingly popular research approaches such as spatial impact evaluation methods.

By studying non-health care influences on health, which are critical for health problems in developing countries, prof. Karen A. Grépin has already contributed to deepen our understanding of healthcare systems in developing countries. Building on her previous work, her present study has a great potential for transformative research. The ultimate goal is to provide governments and international organizations with vital information on how to better prepare for future health shocks to mitigate their impact on the health and wellbeing of households.



Wilfrid Laurier University