nep-hea New Economics Papers
on Health Economics
Issue of 2015‒07‒18
25 papers chosen by
Yong Yin
SUNY at Buffalo

  1. Medical spending in the US: facts from the Medical Expenditure Panel Survey Dataset By Pashchenko, Svetlana; Porapakkarm, Ponpoje
  2. Amenity, Diversity and Obesity: Unobserved Heretogeneity in Cities By Stephen Popick; Anthony M. Yezer
  3. Healthy(?), Wealthy, and Wise: Birth Order and Adult Health By Black, Sandra E.; Devereux, Paul J.; Salvanes, Kjell G.
  4. The Effects of the Earned Income Tax Credit on Children's Health, Quality of Home Environment, and Non-Cognitive Skills By Averett, Susan L.; Wang, Yang
  5. Health and Unemployment during Macroeconomic Crises By Bharadwaj, Prashant; Lundborg, Petter; Rooth, Dan-Olof
  6. Birth Weight in the Long-Run By Bharadwaj, Prashant; Lundborg, Petter; Rooth, Dan-Olof
  7. The Effect of Income on Mortality: New Evidence for the Absence of a Causal Link By Ahammer, Alexander; Horvath, Thomas; Winter-Ebmer, Rudolf
  8. Christianity and Infant Health in India By Menon, Nidhiya; McQueeney, Kathleen
  9. The next wave of deaths from Ebola ? the impact of health care worker mortality By Evans,David; Goldstein,Markus P.; Popova,Anna
  10. Assessing Fiscal Space for Health in Nepal By Tekabe Belay; Ajay Tandon
  11. Reasons for Job Separations Among People with Psychiatric Disabilities By Judith A. Cook; Jane K. Burke-Miller; Dennis D. Grey
  12. Impact of Contingent Work on Subsequent Labor Force Participation and Wages of Workers with Psychiatric Disabilities By Judith A. Cook; Jane K. Burke-Miller; Dennis D. Grey
  13. Governance and the Effectiveness of Public Health Subsidies By Rebecca Dizon-Ross; Pascaline Dupas; Jonathan Robinson
  14. Does Retirement Improve Health and Life Satisfaction? By Aspen Gorry; Devon Gorry; Sita Slavov
  15. Do Medical Marijuana Laws Reduce Addictions and Deaths Related to Pain Killers? By David Powell; Rosalie Liccardo Pacula; Mireille Jacobson
  16. The Long-Term Consequences of Vietnam-Era Conscription and Genotype on Smoking Behavior and Health By Lauren Schmitz; Dalton Conley
  17. Household Responses to Severe Health Shocks and the Design of Social Insurance By Itzik Fadlon; Torben Heien Nielsen
  18. What is the job satisfaction and active participation of medical staff in public hospital reform: a study in Hubei province of China By Pengqian Fang; Zhenni Luo; Zi Fang
  19. Fetal origins of mental health: evidence from Africa By Achyuta Adhvaryu; James Fenske; Namrata Kala; Anant Nyshadham
  20. Invest as You Go: How Public Health Investment Keeps Pension Systems Healthy By Paolo Melindi-Ghidi; Willem Sas
  21. A framework for physical growth and child development: By Alderman, Harold; Behrman, Jere R.; Glewwe, Paul
  22. Economic Globalization: Boon or Bane for African Health? By Vishalkumar Jani; Dholakia, Ravindra H.
  23. Smoking and Mortality: New Evidence from a Long Panel By Michael Darden; Donna B. Gilleskie; Koleman Strumpf
  24. Ecosystems and human health: towards a conceptual framework for assessing the co-benefits of climate change adaptation By Pablo Martinez-Juarez; Aline Chiabai; Sonia Quiroga Gómez; Tim Taylor
  25. Working Paper 225 - Measuring the Impact of Micro-Health Insurance on Healthcare Utilization: A Bayesian Potential Outcomes Approach By AfDB AfDB

  1. By: Pashchenko, Svetlana; Porapakkarm, Ponpoje
    Abstract: We document facts about medical spending of the US population using the Medical Expenditure Panel Survey dataset. We find that for the entire population, around 44% of the total medical spending is paid by private insurance but there is a substantial difference in terms of financing medical care by age: for working age adults (25 to 65 years old) private insurance covers around 57% of the total medical spending, whereas for the elderly (older than 65 years old) the largest payor is the government which covers 65% of the total. Inpatient hospital care accounts for a third of the aggregate medical expenditures. Medical spending is highly concentrated: the top 5% of spenders account for more than half of the total expenditure. Even higher concentration is observed among hospital spending where the top 5% of spenders contribute around 80% to the total expenditure. The concentration in medical spending decreases with age: the Gini coefficient of the total medical spending is 0.75 for people aged between 25 and 64 years old and 0.63 for people older than 65 years old. We find that average medical spending of people in the bottom income quintile is higher than that of people in the top income quintile for all age groups. In terms of persistence of medical spending, we find that the correlation of medical expenditure in two consecutive years is 0.36. When persistence is measured by quintile of medical spending distribution, medical spending of people in the bottom and top quintiles has higher persistence relative to other groups.
    Keywords: medical spending, health insurance, health care
    JEL: D12 I13 I14
    Date: 2015–07–15
  2. By: Stephen Popick; Anthony M. Yezer
    Abstract: Some sources of heterogeneity among cities, i.e. age, gender, race, income, and education, have been the object of substantial inquiry. The reasons are obvious. These differences are easily observed and may have important implications for economic activity. This study considers another potentially important population characteristic, obesity. Descriptive statistics reveal that the intercity variance in obesity rates is substantial. Empirical results demonstrate that demographic and regional amenity variables all have a relation to intercity differences in obesity. Because obesity is important for preferences, performance, and productivity, its omission from previous studies and its correlation with amenity and demographic characteristics, could create problems for empirical research.
    JEL: I12 J10 R23
    Date: 2015–06
  3. By: Black, Sandra E. (University of Texas at Austin); Devereux, Paul J. (University College Dublin); Salvanes, Kjell G. (Norwegian School of Economics)
    Abstract: While recent research finds strong evidence that birth order affects children's outcomes such as education, IQ scores, and earnings, the evidence for effects on health is more limited. This paper uses a large dataset on the population of Norway and focuses on the effect of birth order on a range of health and health-related behaviors, outcomes not previously available in datasets of this magnitude. Interestingly, we find complicated effects of birth order. First-borns are more likely to be overweight, to be obese, and to have high blood pressure and high triglycerides. So, unlike education or earnings, there is no clear first-born advantage in health. However, later-borns are more likely to smoke and have poorer self-reported physical and mental health. They are also less likely to report that they are happy. We find that these effects are largely unaffected by conditioning on education and earnings, suggesting that these are not the only important pathways to health differentials by birth order. When we explore possible mechanisms, we find that smoking early in pregnancy is more prevalent for first pregnancies than for later ones. However, women are more likely to quit smoking during their first pregnancy than during later ones, and first-borns are more likely to be breast-fed. These findings suggest a role for early maternal investment in determining birth order effects on health.
    Keywords: parental investment, obesity, siblings
    JEL: I1 J1
    Date: 2015–07
  4. By: Averett, Susan L. (Lafayette College); Wang, Yang (Lafayette College)
    Abstract: In 1993, the benefit levels of the Earned Income Tax Credit (EITC) were changed significantly based on the number of children in the household. Employing a difference-in-differences plus mother fixed-effects framework, we find better mother-rated health for children of unmarried black mothers and married white and Hispanic mothers, lower accident rates for children of married white and Hispanic mothers, and improved home environment quality for children of unmarried white and Hispanic mothers. Our results provide new evidence of the effects of the 1993 EITC expansion and therefore have important policy implications.
    Keywords: EITC, child health, home environment, non-cognitive skills
    JEL: I12 I38 J13
    Date: 2015–07
  5. By: Bharadwaj, Prashant (University of California, San Diego); Lundborg, Petter (Lund University); Rooth, Dan-Olof (Linnaeus University)
    Abstract: This paper shows that health is an important determinant of labor market vulnerability during large economic crises. Using data on adults during Sweden's unexpected economic crisis in the early 1990s, we show that early and later life health are important determinants of job loss after the crisis, but not before. Adults who were born with worse health (proxied by birth weight) and those who experience hospitalizations (and especially so for mental health related issues) in the pre-crisis period, are much more likely to lose their jobs and go on unemployment insurance after the crisis. These effects are concentrated in the private sector that happened to be more affected by the crisis. The results hold while controlling for individual education and occupational sorting prior to the crisis, and for controlling for family level characteristics by exploiting health differences within twin pairs. We conclude that poor health (both in early life and as adults) is an important indicator of vulnerability during economic shocks.
    Keywords: early life, birth weight, economic crises, shocks, unemployment
    JEL: I10 I18 J65 E32
    Date: 2015–07
  6. By: Bharadwaj, Prashant (University of California, San Diego); Lundborg, Petter (Lund University); Rooth, Dan-Olof (Linnaeus University)
    Abstract: We study the effect of birth weight on long-run outcomes, including permanent income, income across various stages of the lifecycle, education, social benefits take-up, and adult mortality. For this purpose, we have linked a unique dataset on nearly all Swedish twins born between 1926-1958, containing information on birth weight, to administrative records spanning nearly entire life time labor market histories. We find that birth weight positively affects permanent income and income across large parts of the life cycle, although there is some evidence of a fade out after age 50. Our results indicate that lower birth weight children are more likely to avail of social insurance programs such as unemployment and sickness insurance and that birth weight matters for adult mortality. We supplement our main analysis with more recent data, which enables us to study how the impact of birth weight on income and education of young adults has changed across cohorts born almost 50 years apart.
    Keywords: birth weight, early life, permanent income, unemployment sickness absence, life-cycle, mortality
    JEL: I10 I18
    Date: 2015–07
  7. By: Ahammer, Alexander (University of Linz); Horvath, Thomas (WIFO - Austrian Institute of Economic Research); Winter-Ebmer, Rudolf (University of Linz)
    Abstract: We analyze the effect of income on mortality in Austria using administrative social security data. To tackle potential endogeneity concerns arising in this context, we estimate time-invariant firm-specific wage components and use them as instruments for actual wages. While we do find quantitatively small yet statistically significant effects in our naïve least squares estimations, IV regressions reveal a robust zero-effect of income on ten-year death rates for prime-age workers, both in terms of coefficient magnitude and statistical significance. These results are robust to a number of different sample specifications and both linear and non-linear estimation methods.
    Keywords: income, mortality, wage decomposition
    JEL: J14 J31 I10
    Date: 2015–07
  8. By: Menon, Nidhiya (Brandeis University); McQueeney, Kathleen (Brandeis University)
    Abstract: This paper studies child health in India focusing on differences in anthropometric outcomes between the three main religions – Hindus, Muslims and Christians. The results indicate that Christian infants have higher height-for-age z-scores as compared to infants of other religious identities, and that this is especially true for infant girls in states with a relatively large Christian presence. We instrument for Christian identity today using data on the location of Protestant and Christian missions, the incidence of epidemic diseases and natural disasters, and political crises (wars) that mission establishing countries were engaged in during India's colonial history. The results are robust to a series of checks for instrument validity and omitted variables, and indicate that by inculcating awareness and spreading knowledge on sanitation and the scientific underpinnings of disease, the advent of Christianity has long-term health implications for India's children today.
    Keywords: child health, religion, Christian, Hindu, Muslim, India
    JEL: O12 I15 Z12
    Date: 2015–07
  9. By: Evans,David; Goldstein,Markus P.; Popova,Anna
    Abstract: The ongoing Ebola outbreak in West Africa has put a huge strain on already weak health systems. Ebola deaths have been disproportionately concentrated among health care workers, exacerbating existing skill shortages in Guinea, Liberia, and Sierra Leone in a way that will negatively affect the health of the populations even after Ebola has been eliminated. This paper combines data on cumulative health care worker deaths from Ebola, the stock of health care workers and mortality rates pre-Ebola, and coefficients that summarize the relationship between health care workers in a given country and rates of maternal, infant, and under-five mortality. The paper estimates how the loss of health care workers to Ebola will likely affect non-Ebola mortality even after the disease is eliminated. It then estimates the size of the resource gap that needs to be filled to avoid these deaths, and to reach the minimum thresholds of health coverage described in the Millennium Development Goals. Maternal mortality could increase by 38 percent in Guinea, 74 percent in Sierra Leone, and 111 percent in Liberia due to the reduction in health personnel caused by the epidemic. This translates to an additional 4,022 women dying per year across the three most affected countries. To avoid these deaths, 240 doctors, nurses, and midwives would need to be immediately hired across the three countries. This is a small fraction of the 43,565 doctors, nurses, and midwives that would need to be hired to achieve the adequate health coverage implied by the Millennium Development Goals. Substantial investment in health systems is urgently required not only to improve future epidemic preparedness, but also to limit the secondary health effects of the current epidemic owing to the depletion of the health workforce.
    Keywords: Gender and Health,Health Systems Development&Reform,Health Monitoring&Evaluation,Population Policies,Health Economics&Finance
    Date: 2015–07–08
  10. By: Tekabe Belay; Ajay Tandon
    Abstract: Nepal has seen impressive improvements in health outcomes and has done well both in its rate of progress and relative to its income level. Infant mortality has been declining over the past five decades to 38.6 per 1,000 live births in 2009. Similarly, maternal mortality has decreased to 380 per 100,000 live births in 2008. Life expectancy has been steadily increasing to 67 years in 2009. The rate of progress is better than those witnessed by neighboring countries. But challenges remain in addressing inequality, high and increasing out of pocket payments. Geographic and income-related inequalities in population health outcomes remain large and are increasing. For example, not only is the decline in infant mortality not uniform, some regions have seen an increase. The policy response to these challenges has been to expand free care services and pilot protection mechanism against the financial risk of ill health. There is growing demand to expand the package as well as the coverage of existing free essential health care to all Nepalese; to introduce new programs such as health insurance, and other similar initiatives This note identifies efficiency gains as the main potential source of additional fiscal space. The analysis presented herein indicates that improvement in health system efficiency i.e., getting more value for money is by far the most plausible option for realizing additional fiscal space for health in Nepal. As the note demonstrates, the prospects for additional resources for health from all other possible sources from conducive macroeconomic conditions, re-prioritization of health, external resources, and other health-sector specific sources is limited in Nepal. On the other hand, there are many indications of systemic inefficiencies in the health system of the country and the challenge would be to focus on identifying and implementing appropriate interventions to improve the situation and reduce waste. The note highlights some specific areas, such as those related to provider payments, drug procurement mechanisms, and hospital and district grant allocations whereby significant improvements in obtaining better value for money can be realized.
    Keywords: absenteeism, administrative management, adult mortality, Adult mortality rate, allocative efficiency, Annual reports, basic health care, budget constraint, budget process ... See More + budgetary resources, Bulletin, Cancer, capital flight, capitation, capitation payment, capitation payments, cost-effectiveness, crowding, debt, debt interest, demand for health, demand for health services, disease control, diseases, dissemination, distribution system, doctors, economic growth, economic growth rate, Economic Policy, economies of scale, efficiency gains, employment, environmental health, essential drugs, essential health care, existing resources, expenditure envelope, expenditures, expenditures on health, externalities, family planning, family planning commodities, fee for service, female education, financial barriers, financial crisis, financial position, financial protection, financial risk, fiscal conditions, fiscal policy, fiscal stability, fixed costs, forecasts, government budget, government budget constraint, government expenditure, government expenditures, government revenue, government revenues, government spending, growth rate, health care, Health Care Financing, Health Care Policy, Health Care Provider, HEALTH CARE PROVIDERS, health care services, health centers, Health Economics, health expenditure, health expenditures, health facilities, health financing, health indicators, health insurance, health insurance contributions, health insurance system, Health Organization, health outcomes, Health Policy, health posts, Health Promotion, health resources, health results, health sector, health service, health services, health share, health spending, health spending share, health status, health strategy, health system, health system efficiency, health system performance, Health Systems, health workers, health-sector, hospital, hospital beds, hospital revenues, hospitalization, hospitals, Human Development, Human Resources, ill health, illness, immunization, income, income countries, Infant, Infant mortality, infant mortality rate, infant mortality rates, informal sector, insurance premiums, interest payments, life expectancies, Life expectancy, lifestyles, live births, Living Standards, low income, macroeconomic conditions, macroeconomic environment, Malaria, maternal health, maternal mortality, Medical Care, Medical Care Expenditure, medical education, medical supplies, Millennium Development Goals, Ministry of Finance, Ministry of Health, mortality, multilateral donors, national dialogue, national goals, national health, national health insurance, national health systems, national income, National Planning, needs assessment, nurses, Nutrition, official development assistance, payment system, pocket payments, policy makers, policy response, political instability, political turmoil, Poor health, Population Discussion, potential users, Poverty Reduction, price of health care, primary care, Private financing, private hospitals, private sector, private spending, programs, progress, provider payment, provision of health services, provision of services, public expenditure, Public Expenditure on Health, public expenditure review, public expenditures, public health, public health concerns, public hospitals, public sector, public spending, quality of services, reform agenda, remittance, remittances, resource allocations, Richer countries, safe motherhood, sanitation, segments of society, service delivery, share of health spending, skilled birth attendance, social health insurance, social health insurance schemes, social insurance, social protection, teaching hospitals, tolerance, Total expenditure, total spending, transportation, Tuberculosis, Under-five mortality, urbanization, Vaccines, vulnerability, waste, workers, World Health Organization
    Date: 2015–04
  11. By: Judith A. Cook; Jane K. Burke-Miller; Dennis D. Grey
    Keywords: Job Separations, Psychiatric Disabilities
    JEL: I J
    Date: 2015–05–30
  12. By: Judith A. Cook; Jane K. Burke-Miller; Dennis D. Grey
    Keywords: Labor Force, Wages, Psychiatric Disabilities
    JEL: I J
    Date: 2015–05–30
  13. By: Rebecca Dizon-Ross; Pascaline Dupas; Jonathan Robinson
    Abstract: Heavily subsidizing essential health products through existing health infrastructure has the potential to substantially decrease child mortality in sub-Saharan Africa. There is, however, widespread concern that poor governance and in particular limited accountability among health workers seriously undermines the effectiveness of such programs. We performed innovative audits on bed net distribution programs in three countries (Ghana, Kenya and Uganda) to investigate local agency problems and their determinants in the allocation of targeted subsidies. Overall, agency concerns appear modest. Around 80% of the eligible receive the subsidy as intended and leakage to the ineligible appears limited, even when the ineligible have a high willingness to pay. The estimated level of mistargeting only modestly affects the cost-effectiveness of free distribution.
    JEL: D73 H11 I15 I38
    Date: 2015–07
  14. By: Aspen Gorry; Devon Gorry; Sita Slavov
    Abstract: We utilize panel data from the Health and Retirement Study to investigate the impact of retirement on physical and mental health, life satisfaction, and health care utilization. Because poor health can induce retirement, we instrument for retirement using eligibility for Social Security and employer sponsored pensions and coverage by the Social Security earnings test. We find strong evidence that retirement improves both health and life satisfaction. While the impact on life satisfaction occurs within the first 4 years of retirement, many of the improvements in health show up 4 or more years later, consistent with the view that health is a stock that evolves slowly. We find little evidence that retirement influences health care utilization.
    JEL: I10 I31 J26
    Date: 2015–07
  15. By: David Powell; Rosalie Liccardo Pacula; Mireille Jacobson
    Abstract: Many medical marijuana patients report using marijuana to alleviate chronic pain from musculoskeletal problems and other sources. If marijuana is used as a substitute for powerful and addictive pain relievers in medical marijuana states, a potential overlooked positive impact of medical marijuana laws may be a reduction in harms associated with opioid pain relievers, a far more addictive and potentially deadly substance. To assess this issue, we study the impact of medical marijuana laws on problematic opioid use. We use two measures of problematic use: treatment admissions for opioid pain reliever addiction from the Treatment Episode Data Set (TEDS) and state-level opioid overdose deaths in the National Vital Statistics System (NVSS). Using both standard differences-in-differences models as well as synthetic control models, we find that states permitting medical marijuana dispensaries experience a relative decrease in both opioid addictions and opioid overdose deaths compared to states that do not. We find no impact of medical marijuana laws more broadly; the mitigating effect of medical marijuana laws is specific to states that permit dispensaries. We evaluate potential mechanisms. Our findings suggest that providing broader access to medical marijuana may have the potential benefit of reducing abuse of highly addictive painkillers.
    JEL: I12 I28
    Date: 2015–07
  16. By: Lauren Schmitz; Dalton Conley
    Abstract: Research is needed to understand the extent to which environmental factors mediate links between genetic risk and the development of smoking behaviors. The Vietnam-era draft lottery offers a unique opportunity to investigate whether genetic susceptibility to smoking is influenced by risky environments in young adulthood. Access to free or reduced-price cigarettes coupled with the stress of military life meant conscripts were exposed to a large, exogenous shock to smoking behavior at a young age. Using data from the Health and Retirement Study (HRS), we interact a genetic risk score for smoking initiation with instrumented veteran status in an instrumental variables (IV) framework to test for genetic moderation (i.e. heterogeneous treatment effects) of veteran status on smoking behavior and smoking-related morbidities. We find evidence that veterans with a high genetic predisposition for smoking were more likely to become regular smokers, smoke heavily, and are at a higher risk of being diagnosed with cancer or hypertension at older ages. Smoking behavior was significantly attenuated for high-risk veterans who attended college after the war, indicating post-service schooling gains from veterans’ use of the GI Bill may have reduced tobacco consumption in adulthood.
    JEL: I1 I12 I14
    Date: 2015–07
  17. By: Itzik Fadlon; Torben Heien Nielsen
    Abstract: This paper studies how households respond to severe health shocks and the insurance role of spousal labor supply. In the empirical part of the paper, we provide new evidence on individuals' labor supply responses to spousal health and mortality shocks. Analyzing administrative data on over 500,000 Danish households in which a spouse dies, we find that survivors immediately increase their labor supply and that this effect is entirely driven by those who experience significant income losses due to the shock. Notably, widows – who experience large income losses when their husbands die – increase their labor force participation by more than 11%, while widowers – who are significantly more financially stable – decrease their labor supply. In contrast, studying over 70,000 households in which a spouse experiences a severe health shock but survives – for whom income losses are well-insured in our setting – we find no economically significant spousal labor supply responses, suggesting adequate insurance coverage for morbidity (vs. mortality) shocks. In the theoretical part of the paper, we develop a method for welfare analysis of social insurance using only spousal labor supply responses. In particular, we show that the labor supply responses of spouses fully identify the welfare gains from insuring households against health and mortality shocks. Our findings imply large welfare gains from transfers to survivors and identify efficient ways for targeting government transfers.
    JEL: H0 I1 J1 J2
    Date: 2015–07
  18. By: Pengqian Fang; Zhenni Luo; Zi Fang
    Abstract: Background: In China, public hospital reform has been underway for almost 5 years, and 311 pilot county hospitals are the current focus. This study aimed to assess the job satisfaction and active participation of medical staff in the reform. A total of 2268 medical staff members in pilot and non-pilot county hospitals in Hubei, China, were surveyed. Methods: Questionnaires were used to collect data. The Pearson chi-square statistical method was used to assess the differences between pilot and non-pilot county hospitals and identify the factors related to job satisfaction as well as the understanding and perception of the reform. Binary logistic regression was performed to determine the significant factors that influence the job satisfaction of medical staff in pilot county hospitals. Results: Medical staff members in pilot county hospitals expressed higher satisfaction on current working situation, performance appraisal system, concern showed by leaders, hospital management, and compensation packages (P < 0.05). They were exposed to work-related stress at a higher extent (P < 0.05) and half of them worked overtime. Within pilot county hospitals, less than half of the medical staff members were satisfied with current job and they have evidently less satisfaction on compensation packages and learning and training opportunities. The working hours and work stress were negatively related to the job satisfaction (P < 0.05). Satisfaction on the performance appraisal system, hospital management, compensation packages, and learning and training opportunities were positively related to job satisfaction (P < 0.05). Medical staff in pilot county hospitals exhibited better understanding of and more positive attitude towards the reform (P < 0.05). Conclusions: Pilot county hospitals have implemented some measures through the reform, but there still are deficiencies. The government officials and hospital administrators should pay attention to influencing factors of job satisfaction and focus on the reasonable demands of medical staff. In addition, the medical staff in pilot county hospitals exhibited a better understanding of the public hospital reform programme and showed more firm confidence, but there still were some medical staff members who hold negative attitude. The publicity and education of the public hospital reform still need improvement. Keywords: Medical staff, China, Public hospital reform, Working situation, Satisfaction, Understanding, Perception
    Keywords: Medical staff; China; public hospital reform; working situation; satisfaction; understanding; perception
    JEL: R14 J01
    Date: 2015
  19. By: Achyuta Adhvaryu; James Fenske; Namrata Kala; Anant Nyshadham
    Abstract: Mental health disorders are a substantial portion of the global disease burden, yet their determinants are understudied, particularly in developing countries. We find that temperature shocks in utero increase depressive symptoms in adulthood in Africa. A ten percent increase in heat exposure increases our depression indices .05 to .07 standard deviations. We find no evidence that the effects of these shocks are smaller for more recent birth cohorts, nor do shocks predict greater treatment of depressive symptoms. Temperature fluctuations, increasingly frequent due to climate change, worsen the mental health disease burden and health care systems in Africa do not mitigate these impacts.
    Keywords: Fetal origins; in-utero; mental health; climate change; Africa
    JEL: I15 O12
    Date: 2015
  20. By: Paolo Melindi-Ghidi (Aix-Marseille University (Aix-Marseille School of Economics), CNRS & EHESS); Willem Sas (Center for Economic Studies (CES), KU Leuven)
    Abstract: Better health not only boosts longevity in itself, it also postpones the initial onset of disability and chronic infirmity to a later age. In this paper we examine the potential effects of such 'compression of morbidity' on pensions, and introduce a health-dependent dimension to the standard pay-as-you-go (PAYG) pension scheme. Studying the long-term implications of such a system in a simple overlapping generations framework, we find that an increase in public health investment can augment capital accumulation in the long run. Because of this, the combination of health investment with a partially health-dependent PAYG scheme may in fact outperform a purely PAYG system in terms of lifetime welfare.
    Keywords: health investment, disability pension, long-term care, PAYG pension system, OLG model
    JEL: I15 J26 O41
    Date: 2015–07–04
  21. By: Alderman, Harold; Behrman, Jere R.; Glewwe, Paul
    Abstract: It is widely recognized that there is a continuum of physical growth and social-emotional and cognitive development across the life course, from the preconception health status of the mother through adulthood. This paper lays out a core economic model that illustrates the interrelationship of investments over the life cycle. It then shows how this framework can be used to the relative cost-effectiveness analysis and benefit-cost analysis of interventions during early childhood development with both physical growth and cognition as key outcomes.
    Keywords: nutrition, human nutrition, children, health, Human capital, child development,
    Date: 2015
  22. By: Vishalkumar Jani; Dholakia, Ravindra H.
    Abstract: The effect of globalization, especially economic liberalization, on socioeconomic development has long been debated in development economics. There is a view that globalization is not beneficial to the underdeveloped and developing world. Africa is always put forward as an example. So it is important to see what is really the impact of international integration and increasing trade on countries of Africa. Evidence for this is very limited and inconclusive. The present study attempts to decipher how health status of African countries is impacted by the economic liberalization. It aims to bridge the gap between the two strands of literature: (i) impact of economic liberalization on growth, and (ii) effect of economic growth on health status. The findings show a positive effect of globalization on the health status of African countries with those having lower income and underdeveloped status in initial period benefiting more.
  23. By: Michael Darden (Department of Economics, Tulane University); Donna B. Gilleskie (Department of Economics, University of North Carolina at Chapel Hill); Koleman Strumpf (School of Business, University of Kansas)
    Abstract: Using data from Framingham Heart Study participants interviewed and examined at frequent intervals over much of their adult lifetime, we discover a relationship between smoking and mortality that differs significantly in magnitude from findings in the medical and epidemiological literature. We attribute the finding of smaller deleterious health impacts of smoking to a failure by previous studies to appropriately account for the non- random nature of lifetime smoking patterns and health histories. We provide causal and consistent estimates of the expected longevity consequences of current smoking, smoking cessation, smoking duration, and smoking experience by jointly modeling individual health heterogeneity, by including supply-side factors such as cigarette advertising and prices, and by allowing for permanent and time-varying unobserved heterogeneity in a flexible yet comprehensive multiple equation joint estimation procedure. We simulate our estimated empirical model under a variety of lifetime smoking patterns, and we compare the resulting mortality differences to the epidemiological literature that treats smoking behavior as random. Our results suggest that difference-in-means statistics significantly overstate the expected longevity loss from various patterns of lifetime smoking. For comparison, the (biased) unconditional difference-in-means in age of death between lifelong smokers and nonsmokers is 9.3 years in our research sample, while simulations from our estimated dynamic model suggest the difference is only 4.3 years. Additionally, our results examine the importance of smoking cessation and relapse avoidance.
  24. By: Pablo Martinez-Juarez; Aline Chiabai; Sonia Quiroga Gómez; Tim Taylor
    Abstract: This paper focuses on the impact that changes in natural ecosystems can have on human health. Green and blue areas promoted as adaptation measures may provide a wide range of co-benefits which should be taken into account when designing adaptation options. Otherwise sub-optimal policy may result. Here we first present an overview of some key adaptation measures, their possible impacts on the natural environment and associated health implications. Second, we discuss the benefits associated with the exposure to green and blue areas and build a theoretical framework for analysing co-benefits of adaptation to climate change, where such adaptation affects the natural environment. Third, we present an overview of the key literature addressing the relationship between health and exposure to natural environment, while classifying the studies according to the methodological approaches, and discussing main results and key issues. Results in the literature show a positive correlation between health and green areas, while blue areas have attracted less attention. The wide range of differentiated approaches in the literature highlights the need for an integrated conceptual framework to assess the health co-benefits of adaptation that interrelates with the natural environment. We provide the basis for such a conceptual framework that allows identifying the different aspects of this interaction.
    Keywords: Ecosystems and human health, green and blue areas, co-benefits, climate change adaptation
    Date: 2015–04
  25. By: AfDB AfDB
    Date: 2015–07–08

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