nep-hea New Economics Papers
on Health Economics
Issue of 2019‒02‒04
twenty-six papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. The Impact of the Affordable Care Act: Evidence from California's Hospital Sector By Mark Duggan; Atul Gupta; Emilie Jackson
  2. Urgent Care Centers and the Demand for Non-Emergent Emergency Department Visits By Lindsay Allen; Janet R. Cummings; Jason Hockenberry
  3. The Health of Disability Insurance Enrollees: An International Comparison By Enrica Croda; Jonathan Skinner; Laura Yasaitis
  4. How Many Life-Years Have New Drugs Saved? A 3-Way Fixed-Effects Analysis of 66 Diseases in 27 Countries, 2000-2013 By Frank R. Lichtenberg
  5. Does School Lunch Fill the “SNAP Gap” at the End of the Month? By Agustina Laurito; Amy Ellen Schwartz
  6. Works Councils and Workplace Health Promotion in Germany By Uwe Jirjahn; Jens Mohrenweiser; Stephen C. Smith
  7. The Role of Body Weight for Health, Earnings and Life Satisfaction By Hübler, Olaf
  8. The ‘healthy worker effect’: do healthy people climb the occupational ladder? By Costa-Font, Joan; Ljunge, Martin
  9. Econometric analysis of the effects of economic conditions on the health of newborns By van den Berg, Gerard J.; Paul, Alexander; Reinhold, Steffen
  10. Survival of the weakest? Culling evidence from the 1918 flu pandemic By Joël Floris; Laurent Kaiser; Harald Mayr; Kaspar Staub; Ulrich Woitek
  11. Mothers' Care: Reversing Early Childhood Health Shocks through Parental Investments By Cristina Bellés-Obrero; Antonio Cabrales; Sergi Jimenez-Martin; Judit Vall-Castello
  12. Universal preschool programs and long-term child outcomes: A systematic review By Dietrichson, Jens; Kristiansen, Ida Lykke; C. V. Nielsen, Bjørn
  13. The Impact of a Wartime Health Shock on the Postwar Socioeconomic Status and Mortality of Union Army Veterans and their Children By Dora Costa; Noelle Yetter; Heather DeSomer
  14. Public Preferences for Health Gains and Cures: A Discrete Choice Experiment By Hampson, G.; Mott, D. Devlin, N.; Shah, K.
  15. Redistribution in Whose Favor? Preferences with Regard to Nationality and Type of Beneficiaries By Neustadt, Ilja; Zweifel, Peter
  16. Time preferences and political regimes: Evidence from reunified Germany By Friehe, Tim; Pannenberg, Markus
  17. Changing Risk Preferences at Older Ages By James Banks; Elena Bassoli; Irene Mammi
  18. Sickness Absence and Relative Income By Laszlo Goerke
  19. The Association Between Restaurant Menu Label Use and Caloric Intake By Restrepo, Brandon; Minor, Travis; Peckham, Janet
  20. The dynamics of health care and growth: A model with physician in dual practice By Baris Alpaslan; King Yoong Lim; Yan Song
  21. The strange case of appropriate C-sections:DRG-tariff regulation, hospital ownership, and market concentration By Berta, P.;; Martini, G.;; Piacenza, M.;; Turati, G.;
  22. Tropical Storms and Mortality under Climate Change By Pugatch, Todd
  23. The Shattered “Iron Rice Bowl”— Intergenerational Effects of Economic Insecurity During Chinese State- Owned Enterprise Reform By Nancy Kong; Lars Osberg; Weina Zhou
  24. Urbanization and dietary change By Cockx, Lara; Colen, Liesbeth; De Weerdt, Joachim
  25. Does Performance Pay Increase Alcohol and Drug Use? By Colin Green; John Heywood
  26. Emigration and Alcohol Consumption among Migrant Household Members Staying Behind: Evidence from Kyrgyzstan By Paulone, Sara; Ivlevs, Artjoms

  1. By: Mark Duggan; Atul Gupta; Emilie Jackson
    Abstract: The Affordable Care Act (ACA) authorized the largest expansion of public health insurance in the U.S. since the mid-1960s. We exploit ACA-induced changes in the discontinuity in coverage at age 65 using a regression discontinuity based design to examine effects of the expansion on health insurance coverage, hospital use, and patient health. We then link these changes to effects on hospital finances. We show that a substantial share of the federally-funded Medicaid expansion substituted for existing locally-funded safety net programs. Despite this offset, the expansion produced a substantial increase in hospital revenue and profitability, with larger gains for government hospitals. On the benefits side, we do not detect significant improvements in patient health, although the expansion led to substantially greater hospital and emergency room use, and a reallocation of care from public to private and better-quality hospitals.
    JEL: H51 I13 L33
    Date: 2019–01
  2. By: Lindsay Allen; Janet R. Cummings; Jason Hockenberry
    Abstract: Urgent care centers (UCCs) are a cost-efficient substitute to the emergency department (ED) for non-emergent conditions, but no study has identified their impact on ED demand. We address this gap using a novel strategy that exploits daily UCC operating times in a differencing framework. After UCCs close each day, local non-emergent ED visits increase by 1.43 percent (over the adjusted mean rate of 70.58 percent) in areas with multiple UCCs. This effect occurs only among the privately insured population, the target customers of UCCs. Our results suggest that UCCs are successfully substituting for EDs in the treatment of non-emergent conditions.
    JEL: I11
    Date: 2019–01
  3. By: Enrica Croda (Department of Economics, University Of Venice Cà Foscari); Jonathan Skinner (Dartmouth College, Hanover); Laura Yasaitis (Leonard David Institute, University of Pennsylvania)
    Abstract: Rising costs of disability insurance (DI) programs are putting increased strain on central government budgets, yet little is known about how well countries target those in the poorest health. In this paper, we use the SHARE and HRS surveys to measure the average health of people aged 50-64 receiving DI, and the effectiveness of the DI safety net in covering those in poor health. The U.S. and Denmark appear successful at targeting benefits, with France and Belgium less so. These measures can also be used over time to evaluate country-level policy changes.
    Keywords: Health, Disability Insurance, Europe, US, SHARE, HRS
    JEL: H55 J14 J J26
    Date: 2018
  4. By: Frank R. Lichtenberg
    Abstract: We analyze the role that the launch of new drugs has played in reducing the number of years of life lost (YLL) before 3 different ages (85, 70, and 55) due to 66 diseases in 27 countries. We estimate 2-way fixed-effects models of the rate of decline of the disease- and country-specific age-standardized YLL rate. The models control for the average decline in the YLL rate in each country and from each disease. One additional drug launch 0-11 years before year t is estimated to have reduced the pre-age-85 YLL rate (YLL85) in year t by 3.0%, and one additional drug launch 12 or more years before year t is estimated to have reduced YLL85 by 5.5%. (A drug’s utilization peaks 8-10 years after it was launched.) Controlling for the number of drugs previously launched, YLL rates are unrelated to the number of drug classes previously launched. The estimates imply that, if no new drugs had been launched after 1981, YLL85 in 2013 would have been 2.16 times as high as it actually was. We estimate that pharmaceutical expenditure per life-year saved before age 85 in 2013 by post-1981 drugs was $2837. This amount is about 8% of per capita GDP, indicating that post-1981 drugs launched were very cost–effective, overall. But the fact that an intervention is cost-effective does not necessarily mean that it is “affordable.”
    JEL: I1 J11 O30
    Date: 2019–01
  5. By: Agustina Laurito; Amy Ellen Schwartz
    Abstract: This paper examines the relationship between the timing of SNAP benefit payments and participation in school lunch and breakfast using the National Household Food Acquisition and Purchase Survey (FoodAPS). An event study approach examines participation over the five-day window before and after the SNAP payment. We find that school lunch participation decreases 17 to 23 percentage points immediately after the SNAP payment among 11-18 year olds while breakfast drops 19 to 36 percentage points. The decline begins the day prior to payment. We find no effects for 5-10 year olds. Models examining participation over the full SNAP month using individual fixed effects yield similar findings. Among teenagers, participation in school lunch and breakfast decline in the first two weeks of the SNAP month, increasing afterwards. Non-school meals show the opposite pattern. Overall, results indicate SNAP households rely more on school lunch and breakfast toward the end of the SNAP month. Adolescents substitute away from school meals to non-subsidized meal options earlier in the SNAP benefit cycle.
    JEL: I38 J18
    Date: 2019–01
  6. By: Uwe Jirjahn; Jens Mohrenweiser; Stephen C. Smith
    Abstract: From a theoretical viewpoint, there can be market failures resulting in an underprovision of occupational health and safety. Works councils may help mitigate these failures. Using establishment data from Germany, our empirical analysis confirms that the incidence of a works council is significantly associated with an increased likelihood that the establishment provides more workplace health promotion than required by law. This result also holds in a recursive bivariate probit regression accounting for the possible endogeneity of works council incidence. Furthermore, analyzing potentially moderating factors such as collective bargaining coverage, industry, type of ownership, multi-establishment status and product market competition, we find a positive association between works councils and workplace health promotion for the various types of establishments examined. Finally, we go beyond the mere incidence of workplace health promotion and show that works councils are positively associated with a series of different measures of workplace health promotion.
    Keywords: Non-union employee representation, works council, occupational health and safety, workplace health promotion
    JEL: I18 J28 J50 J81
    Date: 2019
  7. By: Hübler, Olaf (Leibniz University of Hannover)
    Abstract: Based on the German Socio-Economic Panel, the influence of the body mass index on health, earnings and satisfaction is analysed by gender. Basic results are: health worsens, income declines and satisfaction is poorer with higher body mass index. If control variables are added, estimates are split by gender and different effects of over- and underweight people are determined, the health estimates show nonlinear effects but the direction of action is unchanged. Effects on earnings differ. Underweight women earn more and overweight less than others. For normal-weight men the income is on average higher than for over- and underweight men. This is also confirmed for self-employed persons. The pattern for employees is equal to the total sample. No effects on life satisfaction can be found except for underweight men. They reveal less satisfaction. Only in the public sector the sign of the coefficient changes. The results for eastern Germany are different with respect to satisfaction. Overweight women are less satisfied than others while this is not confirmed for underweight men from eastern Germany. When interdependencies are taken into account and matching procedures are applied, the outcome matches to that of independent and unmatched estimates. However, no clear-cut disadvantage in income of underweight men can be found. Stable coefficients result for the health estimates while satisfaction results fluctuate. Underweight women and especially underweight men tend to less happiness. For overweight men the influence is ambiguous but more speaks in favour of a less level of satisfaction. Overweight women seem to be happier.
    Keywords: over- and underweight, health, income, satisfaction, gender, self-confidence, wage earners vs. self-employed, private vs. public sector, Eastern vs. Western Germany, interdependencies, matching
    JEL: I15 I31 J16 J31
    Date: 2019–01
  8. By: Costa-Font, Joan; Ljunge, Martin
    Abstract: The association between occupational status and health has been taken to reveal the presence of health inequalities shaped by occupational status. However, that interpretation assumes no influence of health status in explaining occupational standing. This paper documents evidence of non-negligible returns to occupation status on health (which we refer as ‘healthy worker effect’). We use a unique empirical strategy that addressed reverse causality, namely an instrumental variable strategy using the variation in average health in the migrant’s country of origin, a health measure plausibly not determined by the migrant’s occupational status. Our findings suggest that health status exerts significant effects on occupational status in several dimensions; having a supervising role, worker autonomy, and worker influence. The effect size of health is larger than that of an upper secondary education.
    Keywords: occupational status; self-reported health; immigrants; work autonomy; supervising role
    JEL: I18 J5
    Date: 2018–02–01
  9. By: van den Berg, Gerard J. (IFAU - Institute for Evaluation of Labour Market and Education Policy); Paul, Alexander (Aarhus University, and TrygFonden’s Centre); Reinhold, Steffen (Germany and Max Planck Institute for Social Law and Social Policy (MEA))
    Abstract: We examine whether economic downturns are beneficial to health outcomes of newborn infants in developed countries. For this we use merged populationwide registers on health and economic and demographic variables, including the national medical birth register and intergenerational link registers from Sweden covering 1992–2004. We take a rigorous econometric approach that exploits regional variation in unemployment and compares babies born to the same parents so as to deal with possible selective fertility based on labor market conditions. We find that downturns are beneficial; an increase in the unemployment rate during pregnancy reduces the probability of having a birth weight less than 1,500 grams or of dying within 28 days of birth. Effects are larger in low socio-economic status households. Health improvements cannot be attributed to the parents’ own employment status. Instead, the results suggest a pathway through air pollution.
    Keywords: Economic conditions; Health of newborns
    JEL: I14
    Date: 2018–12–05
  10. By: Joël Floris; Laurent Kaiser; Harald Mayr; Kaspar Staub; Ulrich Woitek
    Abstract: When a negative shock affects a cohort in utero, two things may happen: first, the population suffers detrimental consequences in later life; and second, some will die as a consequence of the shock, either in utero or early in life. The latter effect, often referred to as culling, may induce a bias in estimates of later life outcomes. When the health shock disproportionately affects a positively selected subpopulation, the long-term effects are overestimated. The 1918 flu pandemic was plausibly more harmful to mothers of high socioeconomic status, as a suppressed immune system in mothers of low socioeconomic status may have been protective against the most severe consequences of infection. Using historical birth records from the city of Bern, Switzerland, we assess this concern empirically and document that a careful consideration of culling is paramount for the evaluation of the 1918 flu pandemic and other fetal health shocks.
    Keywords: Fetal origins hypothesis, 1918 flu pandemic, culling, survivorship bias
    JEL: I10 I15 I18 N34 J24
    Date: 2019–01
  11. By: Cristina Bellés-Obrero; Antonio Cabrales; Sergi Jimenez-Martin; Judit Vall-Castello
    Abstract: We explore the effects of a child labor regulation that changed the legal working age from 14 to 16 over the health of their offspring. We show that the reform was detrimental for the health of the son’s of affected parents at delivery. Yet, in the medium run, the effects of the reform are insignificant for both male and female children. The sons of treated mothers are perceived as still having worse health at older ages, even if their objective health status has recovered. These boys are also more likely to have private health insurance, which suggests more concerned mothers.
    Keywords: minimum working age, education, child health, gender
    JEL: J81 I25 I12 J13
    Date: 2019
  12. By: Dietrichson, Jens (VIVE – The Danish Center for Social Science Research); Kristiansen, Ida Lykke (University of Copenhagen); C. V. Nielsen, Bjørn (VIVE – The Danish Center for Social Science Research)
    Abstract: What are the long-term effects of universal preschool programs on child outcomes? We review 26 studies using natural experiments to estimate the effects of universal preschool programs for children aged 0-6 years on child outcomes measured from third grade to adulthood. Studies comparing preschool with parental, family, or other informal modes of care show mixed effects on test scores, and on measures related to health, well-being, and behavior. However, all estimates for outcomes related to adequate primary and secondary school progression, years of schooling, highest degree completed, employment, and earnings indicate beneficial average effects of universal preschool programs. Three of the included studies calculate benefits-to-costs ratios and find ratios clearly above one. Universal preschool tends to be more beneficial for children with low socioeconomic status, and there are not consistently different effects for boys or girls. Only three studies compare two alternative types of universal preschool programs in terms of long-term outcomes.
    Keywords: universal preschool; long-term effects; child outcomes; systematic review
    JEL: I00 I20 I24 I38 J24 Z18
    Date: 2018–11–23
  13. By: Dora Costa; Noelle Yetter; Heather DeSomer
    Abstract: We investigate when and how health shocks reverberate across the life cycle and down to descendants by examining the impact of war wounds on the socioeconomic status and older age mortality of US Civil War (1861-5) veterans and of their adult children. Younger veterans who had been wounded in the war left the farm sector, becoming laborers. Consistent with human capital and job matching models, older wounded men were unlikely to switch sectors and experienced wealth declines. Fathers' severe wartime wounds affected daughters', but not sons', socioeconomic status. Daughters were shorter-lived if their fathers were older at the end of the war and had been severely wounded compared to daughters of fathers not severely wounded or younger when severely wounded. We suspect that early life conditions disproportionately affected daughters. Our findings illuminate the long reach of disability in a manual labor economy.
    JEL: I12 J24 N12
    Date: 2019–01
  14. By: Hampson, G.; Mott, D. Devlin, N.; Shah, K.
    Abstract: Whether or not society values curative therapies more highly (or less highly) than the sum of the iterative improvements that might come from conventional therapy has been highlighted as an important area for research. The aim of this research was thus to explore society's preferences across curative and non-curative therapies and large and small health gains, via a discrete choice experiment. We find that respondents value health gains highly but do not appear to place additional value on the treatment being a "cure" per se. However, we use a very specific definition of a cure (treatments that restore patients to normal life expectancy and full quality of life), and therefore suggest that our results are taken with caution. Treatments that offer sizeable health gains, but do not necessarily restore health to that of a 'healthy' individual, would no doubt be of significant social value given the preferences of our respondents for larger health gains. This reflects the benefits offered by some advanced therapy medicinal products, which have the potential to result in substantial health benefits but may not entirely restore patients to the health of a disease-free individual. This study was funded by the Association of the British Pharmaceutical Industry.
    Keywords: Measuring and valuing outcomes
    JEL: I1
    Date: 2019–01–01
  15. By: Neustadt, Ilja; Zweifel, Peter
    Abstract: In this paper, we elicit preferences for the allocation of income redistribution to different uses through a Discrete Choice Experiment performed with a representative sample of Swiss citizens. The total desired amount of income redistribution is estimated as a share of disposable income. Further, we estimate marginal willingness-to-pay values for recipients' nationalities (Swiss, citizens of western European countries, citizens of other countries) as well as their types (old-age pensioners, people with ill health, the unemployed, working poor, and families with children). Swiss citizens are found to have a positive willingness to pay for a reallocation of social expenditure in favor of themselves or Western European citizens to the detriment of citizens of other countries, who are perceived to be culturally distant.
    Keywords: Income redistribution, preferences, willingness to pay, discrete choice experiments, conjoint analysis, social status, immigration debate, insurance motive.
    JEL: C35 C93 D63 H29
    Date: 2018–11–21
  16. By: Friehe, Tim; Pannenberg, Markus
    Abstract: We use the separation and later reunification of Germany after World War II to show that a political regime shapes time preferences of its residents. Using two identification strategies, we find that former residents of the German Democratic Republic exhibit a significantly less pronounced present bias when compared to former residents of the Fed- eral Republic of Germany, whereas measures of patience are statistically indistinguishable. Interpreting the years spent under the regime as a proxy for treatment intensity yields consistent results. Moreover, we present evidence showing that present bias predicts choices in the domains of health, finance, and education, thereby illustrating lasting repercussions of a regime's in uence on time preferences.
    Keywords: Time preferences,Political regime,Germany,Natural experiment,SOEP
    JEL: D02 D12
    Date: 2019
  17. By: James Banks (Institute for Fiscal Studies and University of Manchester); Elena Bassoli (Department of Economics, University Of Venice Cà Foscari); Irene Mammi (Department of Economics, University Of Venice Cà Foscari)
    Abstract: This paper investigates risk preference at older ages in 14 European countries. Older individuals report greater risk aversion. Using the longitudinal nature of the data we are able to show this relationship between risk preferences and age is not due to cohort effects or selective mortality. We also show, however, that on average roughly forty percent of this overall age effect is actually due to life events such as retirement, health shocks and widowhood or marital change that occur increasingly as individuals age. These life events are a particularly important explanation of the age `effect' for women and for the age group 50-64.
    Keywords: Risk attitude, ageing, health status, life-related events, SHARE
    JEL: D90 D91 D81
    Date: 2019
  18. By: Laszlo Goerke (Institute for Labour Law and Industrial Relations in the European Union IAAEU), Trier University)
    Abstract: We analyse labour supply and absence from work choices, assuming that individual preferences exhibit relative consumption concerns. We show that contractual hours and the length of absence periods may vary equally with the strength of positional considerations. In this case, positional concerns do not affect their difference, i.e. overall or effective working time. Moreover, the nature and intensity of relative consumption effects influence the impact of sick pay and of true illness periods on contractual work hours and absence behaviour. Consequently, the profitability of employing individuals also varies with the strength of their positional concerns.
    Keywords: absence, labour supply, positional concerns, relative consumption, sick pay
    JEL: D H I J J
    Date: 2018–12
  19. By: Restrepo, Brandon; Minor, Travis; Peckham, Janet
    Abstract: This study uses survey data to analyze the association between restaurant menu label use and total and source-specific daily caloric intakes among U.S. adults age 20 and older who saw nutrition information on a menu the last time they visited a fast-food or sit-down restaurant. Findings show that survey respondents who report seeing and using restaurant menu labels consume significantly fewer total calories per day than do respondents who report seeing the labels but not using them. Fast-food and sit-down restaurant menu label uses are both significantly associated with lower total daily caloric intake, and the associations are estimated to be of similar magnitudes. Findings also suggest that the total daily calorie consumption difference between restaurant menu label users and nonusers may be partly attributable to restaurant menu label users’ lower intake of calories from restaurants that post nutrition information on menus. Taken together, these results suggest that nutrition information on restaurant menus may be helping some consumers to align their food orders according to their demand for lower calories which, in turn, is also helping them to keep their total daily caloric intake lower relative to consumers who see but do not use the information.
    Keywords: Food Consumption/Nutrition/Food Safety
  20. By: Baris Alpaslan; King Yoong Lim; Yan Song
    Abstract: We present a growth model with micro-foundations of a mixed health care system and physician dual-practice, to analyze for welfare-optimal government financing strategy for a mixed health system in developing countries. Calibrating the model for Indonesia, we find that a government subsidy to private health care is both growth- and welfare-enhancing, whereas it is more effective for the government to invest in health infrastructure instead of a public-sector “rewarding” policy in raising government physicians’ wage if its goal is to improve physician effort in public practice. Indeed, for the “rewarding” policy, a dynamic trade-off in growth is found, which is not previously documented in the literature. We also find the model to produce two regimes with different welfare-optimal health financing (a “normal” regime and a low public-sector congestion regime). In the former, welfare-optimal health financing strategy appears to be promoting private health subsidy at the expense of public-sector physician wages. In the latter, the opposite is welfare-optimal.
    Keywords: Dual Practice, Economic Growth, Health Care Financing, Welfare
    JEL: H51 I11 I15 O41
    Date: 2019–01
  21. By: Berta, P.;; Martini, G.;; Piacenza, M.;; Turati, G.;
    Abstract: The aim of this paper is to discuss how different types of hospitals respond to large financial incentives for vaginal deliveries and to financial disincentives for C-sections. We focus on a public health care system based on the quasi–market model. We theoretically and empirically evaluate a government policy equalizing the tariff for C-section and vaginal deliveries at a level such that hospitals face monetary disincentives for C-section and monetary incentives for vaginal deliveries. We first theoretically show that hospital ownership matters insofar different types of hospitals are characterized by different ethical preferences; but ownership interacts with market concentration. We then consider the case-study of Lombardy in Italy. We exploit spatial variation in the presence of for-profit, not-for-profit and public hospitals and in the market concentration at the local level to evaluate the relationship between ownership and the probability of C-section. Our empirical results strongly suggest that competitive pressures from alternative providers tend to homogenize behaviors. However, in local monopolies, we do observe less C-section from private for-profit hospitals than from public and private non-profit hospitals especially when they are medically appropriate.
    Keywords: public; for-profit and nonprofit hospital; market for birth deliveries; tariff regulation; c-sections;
    JEL: I11 I18 L22 L33 D21 D22
    Date: 2019–01
  22. By: Pugatch, Todd
    Abstract: Extreme weather induced by climate change can have major consequences for human health. In this study, I quantify the effect of tropical storm frequency and severity on mortality using objective meteorological data and the universe of vital statistics records from a large developing country, Mexico. Using a measure of storm exposure that accounts for both windspeed dispersion and population density along the storm track, I project changes in past storm-related mortality under various scenarios of continued climate change, while holding population and income at current levels. I find that storm-related deaths would have risen under most climate change scenarios considered, with increases of as much as 52% or declines of as much as 10%, depending on the interplay between increasing storm severity and decreased frequency.
    Keywords: tropical storms,tropical cyclones,hurricanes,natural disasters,human mortality,human health,climate change,developing countries,Latin America,Mexico
    JEL: I15 J10 O13
    Date: 2019
  23. By: Nancy Kong; Lars Osberg; Weina Zhou (Department of Economics, Dalhousie University)
    Abstract: Reform of the Chinese state-owned enterprise (SOE) sector in the late 1990s produced massive layoffs (34 million employees) and marked the end of the “iron rice bowl” guarantee of employment security. An expanding international literature has documented the adverse health impacts of economic insecurity on adults but has usually neglected children. This paper uses the natural experiment of SOE reform in China to explore the causal relationship between increased parental economic insecurity and children’s BMI Z-score. Using provincial and year-level layoff rates and income loss from the layoffs, we estimate a generalized differences-in-differences model with individual fixed effects and year fixed effects. For a medium-built 10-year-old boy, a 10%-point increase in expected parental economic loss from layoff (largest treatment effect) implies a gain of 4 kg. The counterfactual analysis suggests a 4.5%-point increase in overweight rate due to the reform. The weight gain persists for boys whose parents kept their jobs, indicating the importance of anxiety about potential losses, as well as the experience of actual loss. Quantile regressions suggest that boys who were relatively overweight were more severely affected by parental economic insecurity. Girls are not significantly affected. Accounting for intergenerational effects therefore increases the estimated public health costs of greater economic insecurity.
    Date: 2018–01–01
  24. By: Cockx, Lara; Colen, Liesbeth; De Weerdt, Joachim
    Abstract: Sub-Saharan Africa still evokes images of undernourished children in poor farming villages. And indeed, this is a region where one in every three children under 5 is stunted in their growth and in danger of irreversible physical and cognitive damage. As recently as 2017, parts of South-Sudan, Somalia and Nigeria experienced episodes of famine. However, the region is changing rapidly. While still mostly rural today, sub-Saharan Africa is the fastest urbanizing region in the world. The share of population living in urban areas rose from less than 15% in 1960 to nearly 39% in 2015 and is projected to reach 58% by 2050. At the same time the total population in Africa is growing, making for an even more impressive increase. As can be seen on the infographic below, the absolute number of people living in urban areas in Africa will almost triple over the next 30 years. This shift toward urban living is often put forward as an explanation for changing diets in the region. That is, traditional African staple foods such as maize, sorghum, cassava and pulses are increasingly complemented with and substituted by more processed food items, often with higher levels of sugar and fat. As such, urbanization is commonly linked to increasing rates of overweight and obesity. While undernutrition remains a major public health problem in sub-Saharan Africa, 39% of adult women in Africa were estimated to be overweight and sub-Saharan Africa was home to 6.4 million overweight children in 2017.
    Keywords: Sub-Saharan Africa; food
    Date: 2019–01
  25. By: Colin Green (Department of Economics, Norwegian University of Science and Technology); John Heywood (Department of Economics, University of Wisconsin-Milwaukee)
    Abstract: Using a panel of young workers, we show cross-sectional evidence of greater alcohol and illicit drug use among those paid performance pay. Recognizing that this likely reflects worker sorting, we first control for risk and ability proxies. We then control for worker fixed effects and finally for worker-employer match fixed effects. These estimates continue to indicate that the risk of substance use increases when workers are moved to performance pay. While robustness tests examine heterogeneous responses, our evidence fits conjectures that stress and effort increase with performance pay as does the spillover coping mechanism of alcohol and drug use.
    Keywords: Performance Pay; Alcohol; Drugs; Sorting
    JEL: I12 J33
    Date: 2018–12–21
  26. By: Paulone, Sara (University of Siena); Ivlevs, Artjoms (University of the West of England, Bristol)
    Abstract: Despite the growth of alcohol consumption and international migration in many developing countries, the links between the two remain underexplored. We study the relationship between emigration of household members, receiving remittances (migrant monetary transfers), and alcohol consumption of migrant household members staying behind in Kyrgyzstan, a poor post-socialist country that has recently witnessed both large-scale emigration and a rise in alcohol-related health problems. Using a large longitudinal survey, we find that, among the ethnic majority (Kyrgyz), an increase in migrant remittances is associated with a higher likelihood and frequency of consuming alcohol, as well as an increase in the consumption of beer. Among ethnic Russians, the emigration of family members who do not send remittances back home is associated with an increased likelihood and frequency of alcohol consumption. We discuss possible mechanisms through which emigration and remittances may affect the alcohol consumption of those staying behind, including the relaxation of budget constraints and psychological distress. Overall, our findings suggest that the emigration of household members contribute to a greater alcohol consumption among those staying behind, and highlight the role of remittances and cultural background in understanding the nuances in this relationship.
    Keywords: emigration, alcoholism, Kyrgyzstan, Central Asia, monetary remittances, social remittances
    JEL: F22 F24 J61 I12
    Date: 2019–01

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