# **Introduction**

How much does survey design affect survey results and, therefore, our view of the world? Why is it that the rich report more illnesses than the poor in a large number of surveys? These questions seem largely unrelated but are at the core of this paper. Using the length of the recall period as a lens through which to examine these issues, we show that the number used to fill the blank in the standard screening question, ―Were you sick in the last ___ weeks?‖ can change the results. We compare weekly and monthly recall periods using observational and experimental data and find that not only do different recall periods give very different results, but also that these differences are not uniform across income groups. Reported illnesses, use of health care and the reported labor impacts of sickness are lower in monthly reports, with higher declines for the poor. In the case of doctor visits, the recall period used changes the _sign of the gradient_ between doctor visits and per-capita expenditures (PCE)—in weekly recall surveys, the poor visit doctors more than the rich.

This study stems from a project in Delhi examining morbidity and health-seeking behavior among 300 urban households.<sup>2</sup> At the beginning of the project, in 2000, we noted that the patterns of morbidity and health care-seeking behavior observed in the field among richer households accorded well with theoretical and cognitive models frequently used in the health economics literature. The (relatively) wealthy became sick, selfmedicated as a first resort, and then, sought out treatment from a doctor. For example: ― _I fell sick on Monday with a very bad cold; I took aspirin until Wednesday and then, when I was still not better by Friday, I went to the doctor. The doctor gave me antibiotics, which I took until Wednesday, and now I am fine._ ‖ Yet, among households in poor localities and slums, the underlying models of disease and treatment-seeking seemed to be different. People appeared to be sick all the time and going to a doctor seemed less like an ―exceptional‖ event than a common fact of life, well-integrated into a household‘s daily routine. Illness narratives among poor households we interviewed were fractured and temporally confusing.<sup>3</sup> The chaos inherent in preliminary interviews with poor households--including numerous doctor visits, uncertainty about when the disease was diagnosed, whether it was ―cured,‖ and uncertainty about current health status—is very different from what standard health surveys lead us to believe. The health rounds of India‘s National Sample Survey, for instance, allow for a fairly well-developed narrative in which people fall sick with a variety of

> 2 This is a collaborative study between the authors, anthropologists based at Johns Hopkins University, and the Institute of SocioEconomic Research on Development and Democracy (ISERDD) in Delhi.

> 3 In one case, an interviewer speaks with a woman from a poor household about the diagnosis and treatment of her tuberculosis. The interview winds back and forth; the path of treatment is never clear, and the respondent keeps contradicting the temporal sequence of events.  She cannot give clear answers about what treatment was sought when and what the results from these treatments were. Eventually, it emerges that her tuberculosis was discovered in a hospital when she went for an ante-natal checkup (although we remain unsure, since a little later she tells the interviewer that a private doctor asked for a chest X-ray 6 months before the hospital visit) and that she was then put on a treatment regime. It later emerges that her baby died because, on the advice of her neighbors, she did not breastfeed the child, believing that it would transmit TB to her newborn. But this fact only emerges because the interviewer asks at some stage how the child is now doing.

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