nep-hea New Economics Papers
on Health Economics
Issue of 2005‒05‒23
eight papers chosen by
Yong Yin
SUNY at Buffalo, USA

  1. Reading, writing, and raisinets: are school finances contributing to children’s obesity? By Patricia M. Anderson; Kristin Butcher
  2. Are Objective, Official Measures of Disability Reliable? By Johansson, Per; Skedinger, Per
  3. Time Discounting and the Body Mass Index By Lex Borghans; Bart H. H. Golsteyn
  4. Gender, Body Mass and Economic Status By Dalton Conley; Rebecca Glauber
  5. A Proposed Method for Monitoring U.S. Population Health: Linking Symptoms, Impairments, Chronic Conditions, and Health Ratings By Susan T. Stewart; Rebecca M. Woodward; David M. Cutler
  6. Work Disability is a Pain in the *****, Especially in England, The Netherlands, and the United States By James Banks; Arie Kapteyn; James P. Smith; Arthur van Soest
  7. Unraveling the SES-Health Connection By James P. Smith
  8. Poverty, Dietary Imbalance and Sickness among Casual Labourer Households in Shillong (India) By SK Mishra; JW Lyngskor

  1. By: Patricia M. Anderson; Kristin Butcher
    Abstract: The proportion of adolescents in the United States who are obese has nearly tripled over the last two decades. At the same time, schools, often citing financial pressures, have given students greater access to “junk” foods and soda pop, using proceeds from these sales to fund school programs. We examine whether schools under financial pressure are more likely to adopt potentially unhealthful food policies. Next, we examine whether students’ Body Mass Index (BMI) is higher in counties where a greater proportion of schools are predicted to allow these food policies. Because the financial pressure variables that predict school food policies are unlikely to affect BMI directly, this two step estimation strategy addresses the potential endogeneity of school food policies. ; We find that a 10 percentage point increase in the proportion of schools in a county that allow students access to junk food leads to about a one percent increase in students’ BMI, on average. However, this average effect is entirely driven by adolescents who have an overweight parent, for whom the effect of such food policies is much larger (2.2%). This suggests that those adolescents who have a genetic or family susceptibility to obesity are most affected by the school food environment. A rough calculation suggests that the increase in availability of junk foods in schools can account for about one-fifth of the increase in average BMI among adolescents over the last decade.
    Keywords: Overweight children ; Education ; Junk food
    Date: 2004
  2. By: Johansson, Per (Institute for Labour Market Policy Evaluation (IFAU)); Skedinger, Per (The Research Institute of Industrial Economics)
    Abstract: The issue considered in this study is whether objective, official reports on disability status are reliable. While there is a rather large literature on the reliability of self-reported disability, evidence regarding objective data is scant. It seems to be a widely held view among researchers that, since individuals out of work are inclined to respond towards poor health, it would be best to have official data provided by the relevant administrative bodies. But we argue that such administrative data should be regarded with some suspicion, since the administrators also may have incentives to misreport. The empirical evidence, based on a large sample of Swedish jobseekers, suggests systematic misreporting by the Public Employment Service of objective, official disability measures due to incentives to exaggerate disability.
    Keywords: Work Disability; Classification Error; Public Employment Service
    JEL: I12 J28 J68
    Date: 2005–05–16
  3. By: Lex Borghans (ROA, University of Maastricht and IZA Bonn); Bart H. H. Golsteyn (ROA, University of Maastricht)
    Abstract: In many Western countries, the relative weight of people - measured by the Body Mass Index (BMI) - has increased substantially in recent years, leading to an increasing incidence of overweight and related health problems. As with many forms of risky behavior, it is plausible that overweight is related to the individual discount rate. Increases in credit card debts, the rise in gambling and the development of a more hedonic life style, suggest that the average discount rate has increased over time. This increase may have been the cause of the increase in BMI. Applying a large set of indicators for the individual discount rate, this paper analyzes whether changes in time discounting can account for differences in body mass between individuals at a given point in time and whether changes in the average individual discount rate can explain the remarkable increase in BMI experienced in recent years. We find some evidence for a link between time discounting and differences in BMI between people, but this relationship depends strongly on the choice of the proxy for the discount rate. Giving our hypothesis the best chance, we analyze the development of the time discounting proxies that are most strongly related to BMI. We find no evidence for a change of these proxies over time. Our main conclusion therefore is that overweight might be related to the way people discount future health benefits, but the increase in BMI has to be explained by shifts in other parameters that determine the intertemporal decisions regarding the trade-off of current and future health and satisfaction.
    Keywords: body mass index (BMI), risky behavior, time discounting
    JEL: I1
    Date: 2005–05
  4. By: Dalton Conley; Rebecca Glauber
    Abstract: Previous research on the effect of body mass on economic outcomes has used a variety of methods to mitigate endogeneity bias. We extend this research by using an older sample of U.S. individuals from the PSID. This sample allows us to examine age-gender interactive effects. Through sibling-random and fixed effects models, we find that a one percent increase in a woman's body mass results in a .6 percentage point decrease in her family income and a .4 percentage point decrease in her occupational prestige measured 13 to 15 years later. Body mass is also associated with a reduction in a woman's likelihood of marriage, her spouse's occupational prestige, and her spouse's earnings. However, consistent with past research, men experience no negative effects of body mass on economic outcomes. Age splits show that it is among younger adults where BMI effects are most robust, lending support to the interpretation that it is BMI causing occupational outcomes and not the reverse.
    JEL: I0
    Date: 2005–05
  5. By: Susan T. Stewart; Rebecca M. Woodward; David M. Cutler
    Abstract: We propose a method of quantifying non-fatal health that details the mechanisms through which chronic conditions affect health. Self-rated health status and time-tradeoff ratings of current health are regressed on impairments and symptoms from the Quality of Well-Being Scale, using OLS regression and ordered probit. This yields estimates of their effects analogous to disutility weights but not based on counterfactual scenarios, and accounts for complex non-additive relationships. Data are from 1420 adults age 45-89 in the Beaver Dam Health Outcomes Study. Chronic condition weights and summary measures of health are derived, laying the groundwork for a detailed national summary measure of health.
    JEL: I10 I12
    Date: 2005–05
  6. By: James Banks (Institute for Fiscal Studies & University College, London); Arie Kapteyn (RAND Corporation); James P. Smith (RAND Corporation); Arthur van Soest (RAND Corporation & Tilburg University)
    Abstract: This paper investigates the role of pain in determining self-reported work disability in the US, the UK, and The Netherlands. Even if identical questions are asked, cross-country differences in reported work disability remain substantial. In the US and The Netherlands, respondent evaluations of work limitations of hypothetical persons described in pain vignettes are used to identify the extent to which differences in self-reports between countries or socio-economic groups are due to systematic variation in the response scales.
    Keywords: Work limiting disability, Vignettes, Reporting bias
    JEL: J
    Date: 2005–05–19
  7. By: James P. Smith (RAND Corporation)
    Abstract: While a debate rages on about competing reasons why SES may affect health, there is little recognition that the so-called reverse causation from health to economic status may be pretty fundamental as well. Even if the direction of causation is that SES mainly affects health, what dimensions of SES actually matter—the financial aspects such as income or wealth or non-financial dimensions like education? Finally, is there a life course component to the health gradient so that we may be mislead in trying to answer these questions by only looking at people of a certain age—say those past 50. This paper, which is divided into four sections, provides my answers to these questions. The first section examines the issue of reverse causation or whether a new health event has a significant impact on four dimensions of SES—out-of-pocket medical expenses, labor supply, household income, and household wealth. The next section switches the perspective by asking whether the so-called direct causation from SES to health really matters all that much. If the answer is yes and it will be, a sub-theme in this section concerns which dimensions of SES—income, wealth, or education—matter for individual health. Since the answer to that question turns out to be education, Section 3 deals with the very much more difficult issue of why education matters so much. The evidence in these first three sections relies on data for people above age 50. In the final section of the paper, I test the robustness of my answers to these basic questions of the meaning of the SES-health gradient using data that span the entire life-course.
    JEL: J
    Date: 2005–05–19
  8. By: SK Mishra (Dept. of Economics, NEHU, Shillong); JW Lyngskor (Department of Economics, North Eastern Hill University, Shillong India)
    Abstract: The objective of this study is to bring out the case of poverty, undernourishment and health conditions of casual labourers in Shillong, the capital city of Meghalaya, India. A large section of the unskilled labourers work as casual workers. Casual labourers are those workers who work for a very short duration (for a few hours, a day or at most a few days under a single contract) for an employer, and who are (usually) paid for their labour either at the end of the contract or at the end of a day. Casual workers are often unskilled or semi-skilled; they usually do not own any other factors of production (such as land, capital or implements needed to perform the job) except their labour power. Casual labourers earn their livelihood by selling their labour power and often regenerate their labour power by 'investing', so to say, a very large part of their wage earning on food articles. Thus, in case of a casual labourer, the dichotomy of consumption and investment collapses into a single category. Due to low level of consumption, casual labourers are often poor performers - their efficiency is low. The market forces often impose on them the vicious circle of inefficiency - low wage rates - deficient consumption - inefficiency. The study is based on the primary data collected from 125 casual labourer households with 688 family members. Overall, it is found that casual labourer households in Shillong are poor; their per capita income (per month) is Rs. 516.6 on an average and they spend a meager amount (Rs. 252.9 only or 48.95 percent of income) on food articles yielding energy. Some 38.4 percent of these households are below poverty line (fixed at Rs. 396 per capita per month). Poorer households have larger family size. Consequently, some 46.5 percent persons in the sample households are below poverty line. The mean energy intake of these households is slightly less than 1600 calories per person per day. The average energy intake among the BPL households is a meager 1307.66 calories per person per day. Only 19 households have calorie intake larger than 2000, and of them only 14 get more than 2200 calories. Of 125 households, the majority (93) have no milk consumption. Overall, carbohydrates supply 76.5 percent of the energy intake and the contribution of proteins to the calorie intake is ranging between 9.55 and 10.64 percent across different income and food habit groups with the mean value of 10.16 percent. Irrespective of the per capita income group that they belong to, the casual labourer households, without a single exception, eat diets deficient in proteins far below the prescribed norms. Of the total number of 688 persons in 125 households, 72 (10.47 percent) are found chronically sick. Among the 72 sick persons, 56 (77.78 percent) are in the BPL income group, 34 (47.22 percent) are children in 0-14 years age group, and 23 (31.94 percent) are adult women. Among the sick, the overwhelming majority indicates nutritional deficiency. Children and women are hit most hard by the dietary imbalance in food. Logit analysis on incidence of sickness suggests that the probability of a person being sick is very high (0.5 or more) in the extremely poor households. The probability of finding a sick person at about per capita income of Rs. 600 per month is 0.10 and it declines sharply with an increase in income.
    Keywords: Poverty, malnutrition, nutrition, deficiency disease, Shillong, Meghalaya, India, primary data, calorie, carbohydrate, protein, fat, logit analysis
    JEL: I12 I31 I32
    Date: 2005–05–19

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