nep-hea New Economics Papers
on Health Economics
Issue of 2018‒09‒17
25 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Take-Up, Drop-Out, and Spending in ACA Marketplaces By Diamond, Rebecca; Dickstein, Michael J.; McQuade, Timothy James; Persson, Petra
  2. The Problem of Data Quality in Analyses of Opioid Regulation: The Case of Prescription Drug Monitoring Programs By Jill Horwitz; Corey S. Davis; Lynn S. McClelland; Rebecca S. Fordon; Ellen Meara
  3. Prescription Drug Monitoring Programs, Opioid Abuse, and Crime By Dhaval Dave; Monica Deza; Brady P. Horn
  4. Illicit drugs and the decline of the middle class By Grossmann, Volker; Strulik, Holger
  5. Long-Term Care Hospitals: A Case Study in Waste By Liran Einav; Amy Finkelstein; Neale Mahoney
  6. Long-term care insurance with family altruism: Theory and empirics By KLIMAVICIUTE Justina,; PESTIEAU Pierre,; SCHOENMAECKERS Jérôme,
  7. Altruism and long-term care insurance By KLIMAVICIUTE Justina,; PESTIEAU Pierre,; SCHOENMAECKERS Jérôme,
  8. The dark side of fiscal federalism:evidence from hospital care in Italy By Paolo Berta; Carla Guerriero; Rosella Levaggi
  9. Weight gains from trade in foods: Evidence from Mexico By Osea Giuntella; Matthias Rieger; Lorenzo Rotunno
  10. Working Times and Overweight: Tight Schedules, Weaker Fitness? By Costa-Font, Joan; de Miera Juarez, Belen Saenz
  11. Economic analysis of the link between diet quality and health: Evidence from Kosovar micro-data By Braha, Kushtrim1mailto; Cupák, Andrej; Qineti, Artan; Pokrivčák, Ján; Rizov, Marian
  12. Smokers’ Rational Lexicographic Preferences for Cigarette Package Warnings: A Discrete Choice Experiment with Eye Tracking By Jeffrey E. Harris; Mariana Gerstenblüth; Patricia Triunfo
  13. The (Short-term) Individual Welfare Consequences of an Alcohol Ban By René Petilliot
  14. Changes in inequality in mortality: New evidence for Spain By Libertad González Luna; Ana Rodríguez-González
  15. Health at Birth, short-run health effects and educational outcomes By Furtado, Isabela Brandão; Mattos, Enlinson
  16. Economic Evaluation of Interventions for Screening of Dementia By Saha, Sanjib; Gerdtham, Ulf-G.; Toresson, Håkan; Minthon, Lennart; Jarl, Johan
  17. Estimating the Net Value of Treating Hepatitis C Virus Using a Newly Available Direct-Acting Antiviral in India By Bloom, David E.; Khoury, Alexander; Srinivasan, V.
  18. Enhancing Public Health Outcomes in Developing Countries: From Good Policies and Best Practices to Better Implementation By Michael Woolcock
  19. New Evidence on the Impacts of Early Exposure to the 1918 Influenza Pandemic on Old-Age Mortality: A Research Note By Fletcher, Jason M.
  20. The effect of oil spills on infant mortality By Roland Hodler; Anna Bruderle
  21. Local Industrial Shocks and Infant Mortality By Anja Tolonen
  22. How Much Does Birth Weight Matter for Child Health in Developing Countries? Estimates from Siblings and Twins By Mark E. McGovern
  23. Heat, Humidity, and Infant Mortality in the Developing World By Geruso, Michael; Spears, Dean
  24. Transportation and Health in a Developing Country: The United States, 1820–1847 By Ariell Zimran
  25. Informational shocks and street-food safety: A field study in urban India By Giammarco Daniele; Sulagna Mookerjee; Denni Tommasi

  1. By: Diamond, Rebecca (Stanford University); Dickstein, Michael J. (New York University); McQuade, Timothy James (Stanford University); Persson, Petra
    Abstract: The Affordable Care Act (ACA) established health insurance marketplaces where consumers can buy individual coverage. Leveraging novel credit card and bank account micro-data, we identify new enrollees in the California marketplace and measure their health spending and premium payments. Following enrollment, we observe dramatic spikes in individuals' health care consumption. We also document widespread attrition, with more than half of all new enrollees dropping coverage before the end of the plan year. Enrollees who drop out re-time health spending to the months of insurance coverage. This drop-out behavior generates a new type of adverse selection: insurers face high costs relative to the premiums collected when they enroll strategic consumers. We show that the pattern of attrition undermines market stability and can drive insurers to exit, even absent differences in enrollees' underlying health risks. Further, using data on plan price increases, we show that insurers largely shift the costs of attrition to non-drop-out enrollees, whose inertia generates low price sensitivity. Our results suggest that campaigns to improve use of social insurance may be more efficient when they jointly target take-up and attrition.
    Date: 2018–06
  2. By: Jill Horwitz; Corey S. Davis; Lynn S. McClelland; Rebecca S. Fordon; Ellen Meara
    Abstract: States, which have the primary legal role in regulating the prescribing and dispensing of prescription medications, have created Prescription Drug Monitoring Programs (PDMP) to try to reduce inappropriate prescribing, dispensing, and related harm. Research assessing whether these interventions are effective has produced inconclusive and contradictory results. Here we examine whether different data sources may have contributed to the varying results. Specifically, we: 1) identify the decisions inherent in creating such a dataset; 2) discuss the public data sources used by researchers in previous work; 3) develop and apply a detailed research protocol to create a novel PDMP law dataset; and 4) to illustrate potential consequences of data choice, apply various data sources to analyze the relationship between PDMP laws and prescribing and dispensing of opioids among disabled Medicare beneficiaries. We find that our dates differ from those in existing datasets, sometimes by many years. The regression analyses generated a twofold difference in point estimates, as well as different signed estimates, depending on the data used. We conclude that the lack of transparency about data assembly in existing datasets, differences among dates by source, and the regression results raise concerns for PDMP researchers and policymakers.
    JEL: I1 I12 I18 K32 K42
    Date: 2018–08
  3. By: Dhaval Dave; Monica Deza; Brady P. Horn
    Abstract: The past two decades have witnessed a substantial increase in opioid use and abuse in the United States. In response to this opioid epidemic, prescription drug monitoring programs (PDMPs) have been implemented in virtually all states. These programs collect, monitor, and analyze prescription opioid data with the goal of preventing the abuse and diversion of controlled substances. A growing literature has found that voluntary PDMPs, which do not require doctors to access PDMPs before prescribing controlled substances, have had little effect on opioid use and misuse. However, PDMPs that do mandate access have been found to be effective in reducing opioid misuse and other related health outcomes. In this paper we study the broader impact of voluntary and mandatory-access PDMPs on crime, and in the process inform the causal link between prescription opioid abuse and crime. Using information on offenses known to law enforcement and arrests from the Uniform Crime Reports (UCR), combined with a difference-in-differences empirical strategy, we find that voluntary PDMPs did not significantly affect crime whereas mandatory-access PDMPs have reduced crime by approximately 3.5%. Reductions in crime are largely associated with violent crimes, particularly homicide and assault. Also, we find evidence that young adults experienced the largest decrease in crime, which is consistent with prior work that also finds relatively larger declines in prescription opioid abuse for this group. Overall, these results provide additional evidence that prescription drug monitoring programs are an effective social policy tool to mitigate the negative consequences of opioid misuse, and more broadly indicate that opioid policies can have important spillover effects into other non-health related domains such as crime.
    JEL: H0 I1 K0
    Date: 2018–08
  4. By: Grossmann, Volker; Strulik, Holger
    Abstract: Empirical evidence for the U.S. suggests that the consumption of intoxicants increases in association with the socio-economic deprivation of the middle-class. To explore the underlying mechanisms, we set up a task-based labor market model with endogenous mental health status and a health care system. The decline of tasks that were historically performed by the middle class and the associated decline in relative wages and socio-economic status increases the share of mentally ill middle class workers. Mentally ill workers can mitigate their hardships by the intake of illicit drugs or by consuming health goods. We argue that explaining the drug epidemic of the U.S. middle class requires an interaction of socio-economic decline and falling opioid prices. One factor in isolation is typically insufficient. Our analysis also points to a central role of the health care system. In our model, extending mental health care could motivate the mentally ill to abstain from illicit drug consumption.
    Keywords: Socio-economic deprivation,Intoxicants,Health insurance,Mental health,Middle class
    JEL: I10 H51
    Date: 2018
  5. By: Liran Einav; Amy Finkelstein; Neale Mahoney
    Abstract: There is substantial waste in U.S. healthcare, but little consensus on how to identify or combat it. We identify one specific source of waste: long-term care hospitals (LTCHs). These post-acute care facilities began as a regulatory carve-out for a few dozen specialty hospitals, but have expanded into an industry with over 400 hospitals and $5.4 billion in annual Medicare spending in 2014. We use the entry of LTCHs into local hospital markets and an event study design to estimate LTCHs’ impact. We find that most LTCH patients would have counterfactually received care at Skilled Nursing Facilities (SNFs) – post-acute care facilities that provide medically similar care to LTCHs but are paid significantly less – and that substitution to LTCHs leaves patients unaffected or worse off on all measurable dimensions. Our results imply that Medicare could save about $4.6 billion per year – with no harm to patients – by not allowing for discharge to LTCHs.
    JEL: H51 I11 I18
    Date: 2018–08
  6. By: KLIMAVICIUTE Justina, (Université de Liège); PESTIEAU Pierre, (Université de Liège, CORE, Université catholique de Louvain, and Paris School of Economics); SCHOENMAECKERS Jérôme, (Université de Liège)
    Abstract: This paper studies long-term care (LTC) insurance in the presence of family altruism. In the first, theoretical, part of the paper, we explore whether and how family solidarity affects the application to LTC of Arrow’s (1963) theorem of the deductible, which is shown to apply in models without family by a number of papers. We consider two tyes of family altruism, perfect and imperfect, and find that Arrow’s theorem generally holds, even though some departures from the standard model and some differences between the types of altruism exist. Oour analysis highlights a complex interplay between parents’ insurance and their children’s aid, which implies that a number of intuitive conjectures are not always verified. For instance, while one would expect the deductible to be increasing in the child’s degree of altruism, this is unambiguously verified only under certain conditions. Given the ambiguity of some results, in the second part of the paper, we resort, more generally, to an empirical test of the relation between LTC insurance and children’s altruism using the data from the Health and Retirement Study (HRS). Our findings suggest that children’s altruism has a negative impact on parents’ LTC insurance purchases, even though some results also point to this relationship being more complex than one might think.
    Keywords: long-term care insurance, deductible theorem, alturism, family aid
    JEL: D64 I13 J14
    Date: 2018–04–06
  7. By: KLIMAVICIUTE Justina, (Université de Liège); PESTIEAU Pierre, (Université de Liège, CORE and Paris School of Economics); SCHOENMAECKERS Jérôme, (Université de Liège)
    Abstract: The aim of this paper is to analyze long-term care (LTC) insurance purchase decisions when parents expect to receive assistance from altruistic children. We first propose a simple theoretical model in which we show that the effect of children's altruism on parents' insurance decision is ambiguous and depends on a number of factors: the degree of substitutability between informal and formal care, the degree of parental altruism and the concavity of the utility functions. We then run an empirical test using data from the US, France, Spain, Germany and Israel. We find that the effect of children's altruism is negative in the US and Israel, but not significant in France, Germany and Spain, which possibly suggests that the different forces identified in the theoretical model are offsetting each other.
    Keywords: long-term care insurance, altruism, informal care
    JEL: D64 I13 J14
    Date: 2018–06–11
  8. By: Paolo Berta (Università di Milano Bicocca); Carla Guerriero (Università di Napoli Federico II); Rosella Levaggi (Università di Brescia)
    Abstract: We use 2009-14 data from patients hospital discharges to assess the effects of fiscal federalism on the quality of care provided to regional and extraregional patients in Lombardy. Empirical results suggest that even after controlling for hospital fixed effects, patients demographic and health characteristics, extraregional patients wait less compared to regional ones, stay longer in hospital and are associated with higher reimbursement costs. However, private and public hospitals with higher proportion of extraregional patients show a lower mortality and lower reimbursement costs. This result suggest that competition works because of the spillovers effects that the market for extraregional patients produces.
    Keywords: Hospital competition, patients mobility, mixed market, fiscal federalism
    JEL: H51 H77 D6 C70
    Date: 2018–09
  9. By: Osea Giuntella; Matthias Rieger; Lorenzo Rotunno
    Abstract: In this paper, we investigate the effects of trade in foods on obesity in Mexico. To do so, we match data on Mexican food imports from the U.S. with anthropometric and food expenditure data. Our findings suggest that exposure to food imports from the U.S. explains four percent of the rise in obesity prevalence among Mexican women between 1988 and 2012. Pro-obesity effects are more pronounced in areas receiving more unhealthy food imports. We also find that food imports may widen health disparities between education groups. By linking trade flows to obesity, the paper sheds light on an important channel through which globalisation may affect health.
    JEL: I10 I12
    Date: 2018–08
  10. By: Costa-Font, Joan (London School of Economics); de Miera Juarez, Belen Saenz (London School of Economics)
    Abstract: Although the rise in obesity and overweight is related to time constraints influencing health investments (e.g., exercise, shopping and cooking time, etc.), there is limited causal evidence to substantiate such claims. This paper estimates the causal effect of a change in working times on overweight and obesity drawing from evidence from the Aubrey reform implemented in the beginning of the past decade in France. We use longitudinal data from GAZEL (INSERM) 1997-2006 that contains detailed information about health indicators, including measures of height and weight. Taking the Alsace-Mosselle department as a control group and a difference-in-differences strategy, we estimate the effect of a differential reduction in working times on body weight. Our results show evidence of 0.7% increase in average BMI an 8pp increase in the probability of overweight among blue collars exposed to the reform. In contrast, we find no effect among white collar workers. The effects are robust to different specifications and placebo tests.
    Keywords: obesity, overweight, working times, difference-in-differences, blue collar, white collar, Body Mass Index
    JEL: I13 J81
    Date: 2018–07
  11. By: Braha, Kushtrim1mailto; Cupák, Andrej; Qineti, Artan; Pokrivčák, Ján; Rizov, Marian
    Abstract: We analyze the link between diet quality and health outcomes measured by body-mass index (BMI) in a sample of 8,900 Kosovar individuals utilizing household expenditure micro-data. Using a household model of health production we devise a two-stage empirical strategy to estimate the antecedents of diet diversity and its effect on BMI. Economic factors and demographic characteristics play an important role in the choice of more balanced diets. Results from the BMI analysis support the hypothesis that diet diversity is associated with optimal BMI and thus healthier status. One standard deviation increase in diet diversity leads to 2.3% increase in BMI of the underweight individuals and to 1.4% reduction in BMI of the obese individuals. The findings have important implications for food policies aiming at enhancing the public health in Kosovo.
    Keywords: Food Consumption/Nutrition/Food Safety
    Date: 2017–08–28
  12. By: Jeffrey E. Harris; Mariana Gerstenblüth; Patricia Triunfo
    Abstract: We asked 97 cigarette smokers to make a series of 12 binary choices between experimental cigarette packages with varying warnings and background colors. Each smoker had to decide which of the two packages contained cigarettes less risky for his health. We tested whether the smokers, confronted with warnings that were repugnant and threatening to many of them, could still make choices that adhered to the standard axioms of rational choice. We supplemented our observations on smokers’ choices with data on their eye movements. We find that participants universally made choices consistent with a complete, transitive preference ordering. We find little evidence of inconsistent choices violating the weak axiom of revealed preference. In a majority of smokers, we find strong evidence of the use of a lexicographic decision rule to assess the riskiness of a cigarette package. These smokers first ranked the two packages solely on the basis of their warnings. Only when the two packages had the same warning did they rank the packages on the basis of their color. The data on eye tracking strongly confirmed the lexicographic nature of the underlying decision rule. Our study represents an entirely different angle of inquiry into the question of rational addiction.
    JEL: D12 D83 D87 D91 I12 M31
    Date: 2018–08
  13. By: René Petilliot
    Abstract: This paper provides the first empirical analysis of the (short-term) welfare consequences of an alcohol ban. Using subjective well-being data to proxy individual welfare, I apply a regression discontinuity design where the date of the implementation of the ban in the German federal state of Baden-Wuerttemberg functions as discontinuity. I find that the ban reduces life satisfaction of the total population and the subpopulation of drinkers, while life satisfaction of nondrinkers is unaffected. My findings are well in line with the rational addiction model perspective.
    Keywords: Alcohol ban, Well-being, Life satisfaction, Welfare, Addiction, Regression discontinuity design
    JEL: D04 D60 H30 I31
    Date: 2018
  14. By: Libertad González Luna; Ana Rodríguez-González
    Abstract: We analyze the evolution of inequality in mortality in Spain during 1990-2014. We focus on age-specific mortality and consider inequality across narrowly defined geographical areas, ranked by average socioeconomic status. We find substantial decreases in mortality over the past 25 years for all age groups, which were particularly pronounced for men, resulting in a sizeable reduction in the gender gap in mortality. Inequality in mortality also decreased during this period, including during the recent recession, so that by the 2010’s mortality presents a flat socioeconomic gradient for most age groups. Compared to the US and Canada, decreases in mortality have been larger in Spain, and inequality is the lowest of the three countries. We find essentially no change in inequality among the elderly, in contrast to the increase found in the US.
    Keywords: Mortality, inequality, health
    JEL: J11 I14
    Date: 2018–08
  15. By: Furtado, Isabela Brandão; Mattos, Enlinson
    Abstract: This paper estimates the effects of birth weight on health and educational outcomes for Brazil using a twin fixed effect approach. The recent literature, mainly based on data from developed countries, has provided evidence that health at birth is a critical factor for outcomes related to health and to cognition. Using a matching of administrative records of birth and school enrollment we aim to provide this type of evidence for Brazil. The main finding is that birth weight matters. For instance, there is evidence that a 10% increase in weight is associated with a 0.6% increase in Apgar, a score for health at birth. In the educational dimension, the findings suggest that a 10% increase in birth weight is associated with a 6% increase in the chances of completing high school by the age of 17 and with a 3.6% decrease in the probability of repeating a grade. Furthermore, estimates provide evidence that parents tend to reinforce, rather than compensate, the negative effects of adverse initial health conditions. Larger effects are found for the infants with low birth weight, limited access to basic health care services, lower maternal education and enrolled at schools of lower socioeconomic status.
    Date: 2018–08
  16. By: Saha, Sanjib (Department of Clinical Sciences, Lund University, Sweden); Gerdtham, Ulf-G. (Department of Economics, Lund University); Toresson, Håkan (Department of Clinical Science, Lund University, Sweden); Minthon, Lennart (Department of Clinical Science, Lund University, Sweden); Jarl, Johan (Department of Clinical Science, Lund University, Sweden)
    Abstract: OBJECTIVE: The objective is to systematically review the literature on economic evaluations of screening interventions for early diagnosis of dementia disorders. METHODS: A systematic search of published economic evaluation studies in English was conducted using specified key words in relevant databased and websites. Data extracted included methods and empirical evidence (costs, effects, incremental cost-effectiveness ratio) and we assessed if the conclusions made in terms of cost-effectiveness were supported by the reported evidence. The included studies were also assessed for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS: Fourteen studies were identified and broadly fell into two groups: screening without biomarkers and screening using biomarkers. There was a considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives as well as types of biomarkers used. The sensitivity and specificity of screening instruments are one of the important aspects in estimating the cost-effectiveness of the interventions. Cost-effectiveness of non-biomarker based interventions cannot be judged due to lack of information. The biomarkers based screening have the potential to be cost-effective but their effectiveness has to be established first. CONCLUSION: More economic evaluations studies as well as good quality effectiveness studies are required in screening strategies before these can be implemented in the clinical practice.
    Keywords: Dementia; Screening; Early diagnostic; Economic evaluation
    JEL: H43 I10 I18
    Date: 2018–08–15
  17. By: Bloom, David E. (Harvard University); Khoury, Alexander (Harvard University); Srinivasan, V. (Stanford University)
    Abstract: Background: Recently developed direct-acting antiviral (DAA) treatments for HCV have been groundbreaking for their high efficacy across disease genotypes and lack of severe side effects. This study uses a cost-of-illness (COI) approach to estimate the net value conferred by one of these novel drug combinations, sofosbuvir and velpatasvir (SOF/VEL), recently licensed for generic manufacture in India. Methodology: This study considers COI from lifetime earnings lost due to disability and premature death from HCV infection. Risk of death and disability in future years is calculated using a Markov state-transition model with parameters determined from the literature. The future earnings of sampled patients are predicted using an empirical earnings model with coefficients determined from India Human Development Survey data. Costs to both the patient and secondarily infected individuals are considered. Results: Curing individuals diagnosed with chronic HCV in India would preserve 36,83,290 INR in earnings per person. For non-cirrhotic (NC) and compensated cirrhotic (CC) individuals, the expected benefits associated with prevented secondary infections are worth between 1% and 40% of the value of benefits conferred to the diagnosed individual (depending on sex and extent of liver damage). Treating decompensated cirrhotic (DC) individuals with DAAs alone offers minimal earnings benefits because these individuals will likely remain disabled and unable to work without liver transplantation. Expected net benefits of treatment are substantial for NC and CC patients (ranging from 5,98,003 INR for NC women to 1,05,25,504 INR for CC men). The cost of treatment for DC individuals exceeds the expected earnings benefits. Conclusion: For average NC and CC individuals, the benefits of increased future productivity far outweigh the cost of treatment with SOF/VEL. Increased earnings are not sufficient to fully offset cost of treatment for DC individuals but treatment may still be justified on the basis of the intrinsic value of health improvements and other treatment benefits.
    Date: 2018–04
  18. By: Michael Woolcock (Center for International Development at Harvard University)
    Abstract: In rich and poor countries alike, a core challenge is building the state’s capability for policy implementation. Delivering high-quality public health and health care – affordably, reliably, at scale, for all – exemplifies this challenge, since doing so requires deftly integrating refined technical skills (surgery), broad logistics management (supply chains, facilities maintenance), adaptive problem solving (curative care) and resolving ideological differences (who pays? who provides?), even as the prevailing health problems themselves only become more diverse, complex and expensive as countries become more prosperous. The current state of state capability in developing countries, however, is demonstrably alarming, with the strains and demands only likely to intensify in the coming decades. Prevailing ‘best practice’ strategies for building implementation capability – copying and scaling putative successes from abroad – are too often part of the problem, while individual training (‘capacity building’) and technological upgrades (e.g., new management information systems) remain necessary but deeply insufficient. An alternative approach is outlined, one centered on building implementation capability by working iteratively to solve problems nominated and prioritized by local actors.
    Keywords: Policy Implementation, State Capability, Public Health, Subnational Variation
    Date: 2018–02
  19. By: Fletcher, Jason M. (University of Wisconsin-Madison)
    Abstract: This paper provides new evidence of the impacts of early life exposure to the 1918 pandemic on old-age mortality by analyzing data from the National Longitudinal Mortality Study (n ~ 220,000). The specifications used year and quarter of birth indicators to assess the effects of timing of pandemic exposure and used Cox proportional hazard models for all-cause mortality outcomes. The findings suggest evidence of excess all-cause mortality for cohorts born during 1918 and mixed evidence for cohorts born in 1917 and 1919. Therefore, contrary to some existing research, the results suggest no consistent evidence of the importance of specific windows of exposure by gestation period.
    Keywords: early conditions, in utero, 1918 influenza pandemic, mortality
    JEL: I14
    Date: 2018–07
  20. By: Roland Hodler; Anna Bruderle
    Abstract: Oil spills can lead to irreversible environmental degradation and pose hazards to human health. We are the first to study the causal effects of onshore oil spills on neonatal and infant mortality rates. We use spatial data from the Nigerian Oil Spill Monitor and the Demographic and Health Surveys, and rely on the comparison of siblings conceived before and after nearby oil spills. We find that nearby oil spills double the neonatal mortality rate. These effects are fairly uniform across locations and socio-economic backgrounds. We also provide some evidence for negative health effects of nearby oil spills on surviving children.
    Keywords: oil spills, Nigeria, infant mortality, child health
    JEL: I10 I18 J13 Q53
    Date: 2017
  21. By: Anja Tolonen
    Abstract: Does industrial development change gender norms? This is the first paper to causally Anja Texplore the local effects of a continent-wide exogenous expansion of a modern industry on gender norms. The identification strategy relies on plausibly exogenous temporal and spatial variation in gold mining in Africa. The establishment of an industrial-scale mine changes local gender norms: justification of domestic violence decreases by 19%, women have better access to healthcare, and are 31% more likely to work in the service sector. The effects happen alongside rapid economic growth. The findings are robust to assumptions about trends, distance, and migration, and withstand a spatial randomization test. The results show that entrenched gender norms can change rapidly in the presence of economic development.
    Keywords: gender norms, female empowerment, local industrial development, gold minig=ng
    JEL: O12 O13 J16
    Date: 2018
  22. By: Mark E. McGovern
    Abstract: 200 million children globally are not meeting their growth potential, and as a result will suffer the consequences in terms of future outcomes. I examine the effects of birth weight on child health and growth using information from 66 countries. I account for missing data and measurement error using instrumental variables, and adopt an identification strategy based on siblings and twins. I find a consistent effect of birth weight on mortality risk, stunting, wasting, and coughing, with some evidence for fever, diarrhoea and anaemia. Bounds analysis indicates that coefficients may be substantially underestimated due to mortality selection. Improving the pre-natal environment is likely to be important for helping children reach their full potential.
    Keywords: Birth Weight; Child Health; Mortality Selection
    JEL: I12 O15 J13
    Date: 2018–09
  23. By: Geruso, Michael (University of Texas at Austin); Spears, Dean (University of Texas at Austin)
    Abstract: We study how extreme weather exposure impacts infant survival in the developing world. Our analysis overcomes the absence of vital registration systems in many poor countries by extracting birth histories from household surveys. Studying 53 developing countries that span five continents, we find impacts of hot days on infant morality that are an order of magnitude larger than corresponding estimates from rich country studies, with humidity playing an important role. The size and implied geographic distribution of harms documented here have the potential to significantly alter assessments of optimal climate policy.
    Keywords: heat, humidity, mortality, neonatal mortality, development, climate damages
    JEL: J1 J13 I15 Q54 Q56 O15
    Date: 2018–07
  24. By: Ariell Zimran
    Abstract: I study the impact of transportation on health in the rural US, 1820–1847. Measuring health by average stature and using within-county panel analysis and a straight-line instrument, I find that greater transportation linkage, as measured by market access, in a cohort's county-year of birth had an adverse impact on its health. A one-standard deviation increase in market access reduced average stature by 0.10 to 0.29 inches. These results explain 26 to 65 percent of the decline in average stature in the study period. I find evidence that transportation affected health by increasing population density, leading to a worse epidemiological environment.
    JEL: I15 N31 N71 O18
    Date: 2018–08
  25. By: Giammarco Daniele; Sulagna Mookerjee; Denni Tommasi
    Abstract: Street-food safety is a public health concern in several developing countries. We investigate whether improvements in food safety can be achieved by providing information to vendors in the form of a training. Among randomly assigned groups of street-food vendors in urban Kolkata, India, we find large improvements in knowledge and awareness, but little changes in their observed behaviors. We provide suggestive evidence that a combination of both lack of demand for food safety and perceived high costs of hygiene practices for vendors, are likely to drive the results. We conclude that information is not the key constraint in this context
    Keywords: Food Safety, Public Health, Street-Food, Hawkers, Trainings, RCT, Informal Sector
    Date: 2018–07

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