nep-hea New Economics Papers
on Health Economics
Issue of 2020‒12‒07
twenty-two papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Side effects of labor market policies By Caliendo, Marco; Mahlstedt, Robert; van den Berg, Gerard; Vikström, Johan
  2. Accident Externality of Driving: Evidence from the London Congestion Charge By Cheng Keat Tang; Jos van Ommeren
  3. Urban Air Pollution and Sick Leaves: Evidence From Social Security Data By Felix Holub; Laura Hospido; Ulrich J. Wagner
  4. Sterilization Policy with Incomplete Information in Peru: Does History Repeat Itself? By Jiménez, Bruno; Rendon, Silvio
  5. Does household income affect children’s outcomes? A systematic review of the evidence By Stewart, Kitty
  6. THE EFFECT OF HEALTH SHOCKS ON LABOUR MARKET OUTCOMES IN RUSSIA By Ekaterina A. Aleksandrova; Venera I. Bagranova; Christopher J. Gerry
  7. Drop Dead: Is Anchoring at 'Dead' a Theoretical Requirement in Health State Valuation? By Sampson, C.; Parkin, D.; Devlin, N.
  8. Chronic child poverty and health outcomes in South Africa using a multidimensional poverty measure By Marisa von Fintel; Ronelle Burger
  9. Sterilization Policy with Incomplete Information: Peru 1995-2000 By Rendon, Silvio
  10. The impact of cash transfers on subjective well-being and mental health in low- and middle- income countries: A systematic review and meta-analysis By McGuire, Joel; Kaiser, Caspar; Bach-Mortensen, Anders
  11. The Affordable Care Act and the COVID-19 Pandemic: A Regression Discontinuity Analysis By Rajashri Chakrabarti; Lindsay Meyerson; William Nober; Maxim L. Pinkovskiy
  12. Can a data driven obesity classification system identify those at risk of severe COVID-19 in the UK Biobank cohort study? By Clark, Stephen; Birkin, Mark; Lomax, Nik; Morris, Michelle
  13. Impact of the Covid-19 confinement measures on telework in Spain - A qualitative survey By Antonio Corral; Iñigo Isusi
  14. Does Contact Tracing Work? Quasi-Experimental Evidence from an Excel Error in England By Fetzer, Thiemo; Graeber, Thomas
  15. The Role of Schools in Transmission of the SARS-CoV-2 Virus: Quasi-Experimental Evidence from Germany By Clara von Bismarck-Osten; Kirill Borusyak; Uta Schönberg
  16. People Meet People: A Microlevel Approach to Predicting the Effect of Policies on the Spread of COVID-19 By Gabler, Janos; Raabe, Tobias; Röhrl, Klara
  17. Family Ties and the Pandemic: Some Evidence from Sars-CoV-2 By Luca Di Gialleonardo; Mauro Marè; Antonello Motroni; Francesco Porcelli
  18. Counting the Dead: COVID-19 and Mortality in Québec and British Columbia By Yann Décarie; Pierre-Carl Michaud
  19. Evaluating the effectiveness of policies against a pandemic By Alemán, Christian; Busch, Christopher; Ludwig, Alexander; Santaeulàlia-Llopis, Raül
  20. Revenge of the Experts: Will COVID-19 Renew or Diminish Public Trust in Science? By Eichengreen, Barry; Aksoy, Cevat Giray; Saka, Orkun
  21. Institutions and the uneven geography of the first wave of the COVID-19 pandemic By Rodríguez-Pose, Andrés; Burlina, Chiara
  22. Health and education concerns about returning to campus and online learning during the COVID-19 pandemic among US undergraduate STEM majors By Palmer, Lindsay; Pagoto, Sherry L.; Workman, Deja; Lewis, Kathrine A.; Rudin, Lauren R.; De Luna, Nina; Herrera, Valeria; Brown, Nathanial P.; Bibeau, Jessica; Arcangel, Kaylei

  1. By: Caliendo, Marco (University of Potsdam); Mahlstedt, Robert (University of Copenhagen); van den Berg, Gerard (University of Bristol); Vikström, Johan (IFAU - Institute for Evaluation of Labour Market and Education Policy)
    Abstract: Labor market policy tools such as training and sanctions are commonly used to help bring workers back to work. By analogy to medical treatments, the individual exposure to these tools may have side effects. We study effects on health using individual-level population registers on labor market events outcomes, drug prescriptions and sickness absence, comparing outcomes before and after exposure to training and sanctions. We find that training improves cardiovascular and mental health and lowers sickness absence. The results suggest that this is not due to improved employment prospects but rather to instantaneous features of participation such as, perhaps, the adoption of a more rigorous daily routine. Unemployment benefits sanctions cause a short-run deterioration of mental health, possibly due higher stress levels, but this tapers out quickly.
    Keywords: Unemployment; health; sickness; prescriptions; mental health; drugs; training; depression; cardiovascular disease; sanctions
    JEL: H51 I12 I18 J68
    Date: 2020–11–17
  2. By: Cheng Keat Tang (Nanyang Technological University); Jos van Ommeren (Vrije Universiteit Amsterdam)
    Abstract: This paper estimates the marginal accident externality of driving in Central London by exploiting variation in traffic flow induced by the London Congestion Charge Zone using an instrumental variable approach. The charge attributed to a 9.4% reduction in traffic flow, which resulted in a less than proportional 6.0% and 7.6% decrease in accidents and slight injuries, and a 6.5% increase in serious injuries/fatalities. Our preferred estimates indicate that the accident, slight injuries, and serious injuries/fatalities rate elasticities with respect to traffic flow are -0.36, -0.19 and -1.65 respectively. These estimates imply that the marginal external benefit of road safety from an additional kilometre driven is approximately £ 0.16. The marginal accident externality is positive, as the marginal driver along congested roads decreases the risk and severity of traffic collisions for other road users by slowing others down and increasing awareness.
    Keywords: Accidents, Injuries, Fatalities, Congestion Charge, Externalities
    JEL: H23 I18 R41 R48
    Date: 2020–11–24
  3. By: Felix Holub; Laura Hospido; Ulrich J. Wagner
    Abstract: We estimate the causal impact of air pollution on the incidence of sick leaves in a representative panel of employees affiliated to the Spanish social security system. Using over 100 million worker-by-week observations from the period 2005-2014, we estimate the relationship between the share of days an individual is on sick leave in a given week and exposure to particulate matter (PM10) at the place of residence, controlling for weather, individual effects, and a wide range of time-by-location controls. We exploit quasi-experimental variation in PM10 that is due to Sahara dust advection in order to instrument for local PM10 concentrations. We estimate that the causal effect of PM10 on sick leaves is positive and varies with respect to worker and job characteristics. The effect is stronger for workers with pre-existing medical conditions, and weaker for workers with low job security. Our estimates are instrumental for quantifying air pollution damages due to changes in labor supply. We estimate that improved ambient air quality in urban Spain between 2005 and 2014 saved at least €503 million in foregone production by reducing worker absence by more than 5.55 million days.
    Keywords: air pollution, health, sickness insurance, labor supply
    JEL: I12 I13 Q51 Q53
    Date: 2020–11
  4. By: Jiménez, Bruno (Universidad de Piura); Rendon, Silvio (Independent Researcher)
    Abstract: We contrast the socio-demographic profiles and degree of information received by women that were sterilized with women that used other contraceptive methods. We use data from the 2016 round of the Demographic and Health Survey (DHS) for Peru and compare these profiles with those of the 2000s, which contain the effects of the massive non-voluntary sterilizations executed in Peru in the late 1990s. From 2000 to 2016 there is a reduction from 17% to 10% in the use of sterilization as a contraceptive method. There is also an important socio-demographic change in the incidence of sterilization, from women who are indigenous, from the highlands, and without electricity toward women who are non-indigenous, literate, coastal and who have electricity at home. There is not only no improvement in the information received by users of contraceptive methods with respect to the 1990s, but there is even a worsening: the percentage of sterilized women that received complete information dropped from 35% in 2000 to 34% in 2016. Moreover, the information provided for sterilizations continues to be poorer than for other, non-terminal, methods. We also estimate that providing incomplete information about the sterilization procedure increases the probability of sterilization in 7 percent points.
    Keywords: health policy, fertility, sterilization, family planning, development
    JEL: J13 I15 J16
    Date: 2020–11
  5. By: Stewart, Kitty
    Abstract: There is abundant evidence that children in low income households do less well than their peers on a range of developmental outcomes. However, there is continuing uncertainty about how far money itself matters, and how far associations simply reflect other, unobserved, differences between richer and poorer families. The authors conducted a systematic review of studies using methods that lend themselves to causal interpretation. To be included, studies had to use Randomised Controlled Trials, quasi-experiments or fixed effect-style techniques on longitudinal data. The results lend strong support to the hypothesis that household income has a positive causal effect on children’s outcomes, including cognitive and social- behavioural development and early childhood health, particularly in households with low income to begin with. There is also clear evidence of a positive causal effect of income on ‘intermediate outcomes’ that are important for children’s development, including maternal mental health, parenting and the home environment. The review also makes a methodological contribution, identifying that effects tend to be larger in experimental and quasi-experimental studies than in fixed effect approaches. This finding has implications for our ability to generalise from observational studies.
    Keywords: poverty; family income; child development; child outcomes; maternal depression; casual estimates; forthcoming
    JEL: N0
    Date: 2020–11–04
  6. By: Ekaterina A. Aleksandrova (National Research University Higher School of Economics); Venera I. Bagranova (National Research University Higher School of Economics); Christopher J. Gerry (National Research University Higher School of Economics)
    Abstract: This paper provides evidence for the effects of health shocks measured by any negative change in self-assessed health (SAH) status on employment, personal income, and wages in the Russian population. We employ the average treatment effect on the treated (ATET) estimator combined with propensity score and nearest neighbour matching and data from Russian Longitudinal Monitoring Survey-HSE (RLMS-HSE) for 2000–2018. We find that adverse health shocks are associated with a reduction in the probability of remaining employed by 2%, and losses of income and wages of 17% and 11%, respectively. For men the consequences of health shocks are more drastic. Severe health shocks that are measured as a drop in SAH by two or more levels are associated with greater losses: respondents aged 30–45 years old lose approximately 60% of their monthly income for severe shocks, and those aged 46–72 lose 35–45% of their wages and 9–10% in the probability of remaining employed.
    Keywords: health shock, labour market outcomes, matching, difference-in-difference, Russia
    JEL: C23 I12 J60
    Date: 2020
  7. By: Sampson, C.; Parkin, D.; Devlin, N.
    Abstract: By convention, values for generic 'preference-based' measures, such as the EQ-5D, are anchored at 1 = full health and 0 = dead. This paper challenges the assumption that anchoring health state values at 'dead = 0' is a necessary condition for values to be used in quality-adjusted life year (QALY) estimation. The authors consider five propositions, using narrative review of the literature and conceptual explication of the problem - - anchoring at 'dead' is not required by theories of scale measurement and utility; - calculating QALY gains does not require a distinction between states better than and worse than dead; - cost-effectiveness analysis does not require that 'dead' has a value relative to health states; - using 'dead' as an anchor causes problems that make studies difficult to conduct and their results difficult to interpret; and - there are alternative states to 'dead' that exhibit favourable properties for anchoring. There is support for each proposition. Anchoring health state values at dead was an arbitrary choice made early in the development of health state valuation methods. The use of dead as an anchor is unnecessary and undesirable because of the methodological and conceptual issues it causes. The authors conclude that, in valuing health states, researchers should 'drop dead'.
    Keywords: Measuring and Valuing Outcomes
    JEL: I1
    Date: 2020–11–01
  8. By: Marisa von Fintel (Department of Economics, Research on Socio-Economic Policy (ReSEP), Stellenbosch University); Ronelle Burger (Department of Economics, Research on Socio-Economic Policy (ReSEP), Stellenbosch University)
    Abstract: In this paper, we examine the differences in health outcomes between children residing in poor and non-poor households. In order to identify household poverty, we make use of the framework of multidimensional poverty as introduced by Alkire and Foster (2011). In our sample, we follow all children (defined as individuals aged 18 years or younger) over the period 2012- 2017, using the last three waves of the National Income Dynamics Study (NIDS). We find great disparities in health and well-being among children depending on the classification of the household as being poor or non-poor. In addition, children residing in households which are chronically poor (i.e. are observed to remain in poverty over time) have worse health outcomes than children residing in households which move in and out of poverty, pointing towards the negative effects of poverty traps. Finally, we rely on the previous work conducted by Wagstaff et al (2004) to explore some of the causes of child health inequalities in South Africa, including maternal education, water and sanitation and social norms (which includes the prevalence of female-headed households and the decision-making power of women in the household).
    Keywords: Poverty measurement, poverty dynamics, health inequality, children, South Africa
    JEL: I14 I31 I32
    Date: 2020
  9. By: Rendon, Silvio (Independent Researcher)
    Abstract: In this research I investigate what percentage of female sterilizations performed in Peru from 1993 to 2000 were done providing adequate information to their users for a free decision about their adoption. I use data from ENDES/DHS 2000, which contains detailed information about contraceptive methods adopted in those years, with especial emphasis on sterilizations. I make a descriptive analysis, a projection of total sterilizations, and an estimation of the probability that a woman be sterilized. I find a large use of sterilizations as a contraceptive method between 1995 and 1997: more than 36% of women that used a contraceptive method were sterilized. I also find that a large percentage of women were not adequately informed about sterilizations: only 35% of sterilized women was given complete information, that is, that they will have no more children, about side effects, what to do about them, and that there were alternative contraceptive methods. With additional data from MINSA I calculate that 211,000 sterilized women did not receive complete information from 1993 to 2000, of which 25,000 sterilized women did not receive information that the sterilization implied not being able to have more children. I also estimated that not receiving complete information increased the probability that a women is sterilized in 10 percentage points.
    Keywords: health policy, fertility, sterilization, family planning, development
    JEL: J13 I15 J16
    Date: 2020–11
  10. By: McGuire, Joel; Kaiser, Caspar (University of Oxford); Bach-Mortensen, Anders
    Abstract: Background: A large body of evidence evaluates the impact of cash transfers (CTs) on physical health and economic indicators. A growing amount of research on CTs contains measures of subjective well- being (SWB) and mental health (MH) but no attempt has been made to systematically synthesize this work. Methods/design: We undertook a systematic review and meta-analysis of RCTs and quasi- experimental studies, including peer-reviewed publications and grey literature (e.g. reports, pre-prints, and working papers), conducted over the period 2000-2020, examining the impact of CTs on self- reported SWB and MH outcomes. Results: Two authors (JM and CK) double-screened 1,147 records of potentially relevant studies, finding 38 studies suitable for inclusion in our meta-analysis, covering 100 outcomes and a total sample of n=114,274 individuals. The average effect size (Cohen’s d) of 38 CT studies on our composite outcome of MH and SWB is 0.10 standard deviations (SDs) (95% CI: 0.8, 0.13) for an average time until follow-up of two years. However, there is a substantial amount of heterogeneity in the estimated effects (I-squared = 64% and 95% Prediction interval: 0.0021, 0.215). CT value, both in absolute terms and relative to previous income, are significant predictors of the effect size. We find only weak evidence that the impact diminishes over time. Four randomized controlled trials in our sample were designed to identify the spillover effects of CTs on the SWB and MH outcomes of non-recipients. Two found negative spillovers but the average effect is not statistically significant and is close to zero. Discussion: Cash transfers significantly increase MH and SWB in low- and middle-income countries. More research on the long run (5+ years) effects is needed, as well as further analysis of the community and household spillover effects of cash transfers on MH and SWB outcomes. We encourage the inclusion of MH and SWB metrics in impact evaluations of interventions to enable the assessment of their relative cost-effectiveness at improving lives compared to cash transfers.
    Date: 2020–11–13
  11. By: Rajashri Chakrabarti; Lindsay Meyerson; William Nober; Maxim L. Pinkovskiy
    Abstract: Did Medicaid expansion under the Affordable Care Act affect the course of the COVID-19 pandemic? We answer this question using a regression discontinuity design for counties near the borders of states that expanded Medicaid with states that did not. Relevant covariates change continuously across the Medicaid expansion frontier. We find that 1) health insurance changes discontinuously at the frontier, 2) COVID-19 cases do not change discontinuously at the frontier but the precision of this estimate is low, 3) COVID-19 deaths do not change discontinuously at the frontier and the confidence intervals exclude large declines in deaths in Medicaid expansion areas, 4) smart thermometer readings of fever rates from Kinsa, Inc. do not change discontinuously at the frontier, and 5) COVID-19-related doctor visits discontinuously increase in Medicaid expansion areas.
    Keywords: Affordable Care Act; COVID-19; Medicaid; regression discontinuity
    JEL: C21 I13 I18
    Date: 2020–11–01
  12. By: Clark, Stephen; Birkin, Mark; Lomax, Nik; Morris, Michelle
    Abstract: In this short communication we demonstrate how an individual level classification built using a Whole Systems approach to an understanding of obesity can be used to profile individual’s exposure, treatment and mortality for COVID-19. The cohort is the UK Biobank and the information on COVID-19 test outcomes, hospitalisations and mortality are provided as part of this research initiative. We find that the cohort profiles accurately against the understood heightened risk factors for COVID-19, namely age, gender, ethnicity, obesity and deprivation. This confidence in these data then allows us to profile the participants in each of the classification clusters for these COVID-19 outcomes. We see that there is a large degree of differentiation between the classes. The article finishes by highlighting how this classification can help in prioritising care, treatments and vaccine delivery.
    Date: 2020–11–13
  13. By: Antonio Corral (IKEI Research & Consultancy); Iñigo Isusi (IKEI Research & Consultancy)
    Abstract: The spread of the COVID-19 pandemic and the associated home confinement measures in March 2020 urged many Spanish companies and their workers to "improvise" a teleworking practice for which not much previous experience was available. The qualitative survey results show that a large proportion of Spanish workers have accepted telework in relatively good terms, where a majority of them would be ready to telework more in the future if a balanced combination with physical presence at the workplace could be managed. Notwithstanding this, the research also identified some particularly conflictive issues related to conciliation (difficult to manage when all day at home), worktime (sometimes extended and problematic to stop) and occupational health, both physical (MSD related) and psychosocial (feelings of isolation).
    Keywords: Telework, COVID-19, Confinement, Spain, Work organisation, Job quality, Work-life
    Date: 2020–11
  14. By: Fetzer, Thiemo (University of Warwick, CAGE, CESifo and CEPR); Graeber, Thomas (Harvard Business School, CESifo and IZA)
    Abstract: Contact tracing has been a central pillar of the public health response to the COVID-19 pandemic. Yet, contact tracing measures face substantive challenges in practice and well-identified evidence about their effectiveness remains scarce. This paper exploits quasi-random variation in COVID-19 contact tracing. Between September 25 and October 2, 2020, a total of 15,841 COVID-19 cases in England (around 15 to 20% of all cases) were not immediately referred to the contact tracing system due to a data processing error. Case information was truncated from an Excel spreadsheet after the row limit had been reached, which was discovered on October 3. There is substantial variation in the degree to which different parts of England areas were exposed – by chance – to delayed referrals of COVID-19 cases to to the contact tracing system. We show that more affected areas subsequently experienced a drastic rise in new COVID-19 infections and deaths alongside an increase in the positivity rate and the number of test performed, as well as a decline in the performance of the contact tracing system. Conservative estimates suggest that the failure of timely contact tracing due to the data glitch is associated with more than 125,000 additional infections and over 1,500 additional COVID-19 related deaths. Our findings provide strong quasi-experimental evidence for the effectiveness of contact tracing.
    Keywords: Health ; Coronavirus JEL codes: I31 ; Z18
    Date: 2020
  15. By: Clara von Bismarck-Osten (University College London); Kirill Borusyak (University College London and CEPR); Uta Schönberg (University College London, CReAM, IAB and RWI)
    Abstract: This paper considers the role of school closures in the spread of the SARS-CoV-2 virus. To isolate the impact of the closures from other containment measures and identify a causal effect, we exploit variation in the start and end dates of the summer school and fall holiday across the 16 federal states in Germany. Leveraging a difference-in-differences design with staggered adoption, we show that neither the summer closures nor the closures in the fall have had any significant containing effect on the spread of SARS-CoV-2 among children or any spill-over effect on older generations. We also do not find any evidence that the return to school at full capacity after the summer holidays increased infections among children or adults. Instead, we find the number of children infected increased during the last weeks of the summer holiday and decreased in the first weeks after schools reopen, a pattern we attribute to travel returnees and increased testing.
    Keywords: Covid Economics, School Closures, Public Health
    JEL: I10 I18 I28
    Date: 2020–11
  16. By: Gabler, Janos (IZA); Raabe, Tobias (quantilope); Röhrl, Klara (University of Bonn)
    Abstract: Governments worldwide are adopting nuanced policy measures to reduce the number of Covid-19 cases with minimal social and economic costs. Epidemiological models have a hard time predicting the effects of such fine grained policies. We propose a novel simulation-based model to address this shortcoming. We build on state-of-the-art agent-based simulation models but replace the way contacts between susceptible and infected people take place. Firstly, we allow for heterogeneity in the types of contacts (e.g. recurrent or random) and in the infectiousness of each contact type. Secondly, we strictly separate the number of contacts from the probabilities that a contact leads to an infection. The number of contacts changes with social distancing policies, the infection probabilities remain invariant. This allows us to model many types of fine grained policies that cannot easily be incorporated into other models. To validate our model, we show that it can accurately predict the effect of the German November lockdown even if no similar policy has been observed in the time series that were used to estimate the model parameters.
    Keywords: COVID-19, agent based simulation model, public health measures
    JEL: C63 I18
    Date: 2020–11
  17. By: Luca Di Gialleonardo (Mefop, Rome, Italy); Mauro Marè (Tuscia and Luiss University, Italy); Antonello Motroni (Mefop, Rome, Italy); Francesco Porcelli (University of Bari)
    Abstract: This paper provides an empirical analysis of the relationship between the strength of family ties and the spread of Sars-CoV-2. The dataset is constructed for a cross-section of 63 countries combining different data sources, to cover seven dimensions: the spread of the virus, family ties, trust and religion, policies implemented to stop the outbreak, status of the economy, geography, demography. We observe a robust positive relationship between family ties and the contagion rate across the world; in particular, the attitude of parents towards the wellbeing for their children is the main force that drives the positive correlation with the contagion. Instead, the respect toward parents (the variable love-parents) seems to be a component of the family ties which negatively correlates with the diffusion of Sars-CoV-2, leading to the final quadratic relationship between the overall family ties strength and the spread of the virus. As conclusive evidence, we observe that the death rate, as well as the recovery rate, are not affected by the strength of family ties and other social capital variables. What matters, in this case, are structural variables like GPD, number of hospital beds per capita, life expectance, median age and geographical location.
    Keywords: Family Ties, Sars-CoV-2, social capital, pandemic
    JEL: A13 I12 I18
    Date: 2020–11
  18. By: Yann Décarie; Pierre-Carl Michaud
    Abstract: The first wave of the pandemic has led to excess mortality across the globe. Canada was no exception. But, the experience of provinces has been very different, and the objective of this paper is to investigate these differences focusing on two extreme cases. We contrast the mortality experience of British Columbia with that of Québec to understand how large differences in mortality during the pandemic emerged across these two provinces. We find that most of the differences can be found in excess mortality in institutions (nursing homes) and that both travel restrictions, differences in how deaths are recorded, differences in the seasonality of the flu or differences in how the pandemic spread across different economic segments of the population cannot explain these differences. We also document that the reported death toll from COVID is larger than excess mortality in Quebec, by about 30%, due to lower mortality from other causes of death, in particular malignant tumors, heart disease and respiratory problems.
    Keywords: Excess Mortality,COVID-19,Nursing Homes,Cause of Death,
    JEL: I18 J11
    Date: 2020–11–17
  19. By: Alemán, Christian; Busch, Christopher; Ludwig, Alexander; Santaeulàlia-Llopis, Raül
    Abstract: We develop a novel empirical approach to identify the effectiveness of policies against a pandemic. The essence of our approach is the insight that epidemic dynamics are best tracked over stages, rather than over time. We use a normalization procedure that makes the pre-policy paths of the epidemic identical across regions. The procedure uncovers regional variation in the stage of the epidemic at the time of policy implementation. This variation delivers clean identification of the policy effect based on the epidemic path of a leading region that serves as a counterfactual for other regions. We apply our method to evaluate the effectiveness of the nationwide stay-home policy enacted in Spain against the Covid-19 pandemic. We find that the policy saved 15.9% of lives relative to the number of deaths that would have occurred had it not been for the policy intervention. Its effectiveness evolves with the epidemic and is larger when implemented at earlier stages.
    Keywords: Macroeconomics,Pandemic,Stages,Covid-19,Stay-Home,Policy Effects,Identification
    JEL: E01 E22 E25
    Date: 2020
  20. By: Eichengreen, Barry (University of California, Berkeley); Aksoy, Cevat Giray (European Bank for Reconstruction and Development); Saka, Orkun (University of Sussex)
    Abstract: It is sometimes said that an effect of the COVID-19 pandemic will be heightened appreciation of the importance of scientific research and expertise. We test this hypothesis by examining how exposure to previous epidemics affected trust in science and scientists. Building on the "impressionable years hypothesis" that attitudes are durably formed during the ages 18 to 25, we focus on individuals exposed to epidemics in their country of residence at this particular stage of the life course. Combining data from a 2018 Wellcome Trust survey of more than 75,000 individuals in 138 countries with data on global epidemics since 1970, we show that such exposure has no impact on views of science as an endeavor but that it significantly reduces trust in scientists and in the benefits of their work. We also illustrate that the decline in trust is driven by the individuals with little previous training in science subjects. Finally, our evidence suggests that epidemic-induced distrust translates into lower compliance with health-related policies in the form of negative views towards vaccines and lower rates of child vaccination.
    Keywords: impressionable years, scientists, trust, epidemics, COVID-19
    JEL: D83 F50 I19
    Date: 2020–11
  21. By: Rodríguez-Pose, Andrés; Burlina, Chiara
    Abstract: This paper examines the uneven geography of COVID-19-related excess mortality during the first wave of the pandemic in Europe, before assessing the factors behind the geographical differences in impact. The analysis of 206 regions across 23 European countries reveals a distinct COVID-19 geography. Excess deaths were concentrated in a limited number of regions —expected deaths exceeded 20% in just 16 regions— with more than 40% of the regions considered experiencing no excess mortality during the first six months of 2020. Highly connected regions, in colder and dryer climates, with high air pollution levels, and relatively poorly endowed health systems witnessed the highest incidence of excess mortality. Institutional factors also played an important role. The first wave hit regions with a combination of weak and declining formal institutional quality and fragile informal institutions hardest. Low and declining national government effectiveness, together with a limited capacity to reach out across societal divides, and a frequent tendency to meet with friends and family were powerful drivers of regional excess mortality.
    Keywords: Covid-19; pandemic; institutions; regions; Europe; coronavirus
    JEL: H75 R58
    Date: 2020–11
  22. By: Palmer, Lindsay; Pagoto, Sherry L.; Workman, Deja; Lewis, Kathrine A.; Rudin, Lauren R.; De Luna, Nina; Herrera, Valeria; Brown, Nathanial P.; Bibeau, Jessica; Arcangel, Kaylei
    Abstract: Undergraduates majoring in STEM at US universities/colleges completed an online survey in July 2020 and answered open-ended questions about their concerns about returning to campus and about learning online from home in Fall 2020. Students’ concerns about returning to campus included student noncompliance with university COVID-19 prevention guidelines, infection risk, poor instructional quality, inadequate university plans for preventing/handling outbreaks, negative impacts on social interactions, and transportation/commuting. Concerns about online learning from home included difficulty focusing on schoolwork, lack of hands-on/experiential learning, negative impacts on social interactions, family/home environment, concerns that online learning wastes time/money, and inadequate technology/Internet access. Universities should address student concerns and provide resources to overcome barriers to effective learning.
    Date: 2020–11–20

This nep-hea issue is ©2020 by Nicolas R. Ziebarth. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.