nep-hea New Economics Papers
on Health Economics
Issue of 2022‒02‒14
34 papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Effect of health insurance in India: a randomized controlled trial By Anup Malani; Phoebe Holtzman; Kosuke Imai; Cynthia Kinnan; Morgen Miller; Shailender Swaminathan; Alessandra Voena; Bartosz Woda; Gabriella Conti
  2. School health programs: education, health, and welfare dependency of young adults By Signe A. Abrahamsen; Rita Ginja; Julie Riise
  3. School selectivity, peers, and mental health By Aline Bütikofer; Rita Ginja; Fanny Landaud; Katrine Loken
  4. Breastfeeding and child development By Emla Fitzsimons; Marcos Vera-Hernandez
  5. Exposure in utero to Adverse Events and Health Late-in-life:Evidence from China By Wang, J.; Alessi, R.; Angelini, V.
  6. The Long-Term Effects of In-Utero Exposure to Rubella By Irene Mosca; Anne Nolan
  7. The economic costs of child maltreatment in UK By Gabriella Conti; Elena Pizzo; Stephen Morris; Mariya Melnychuk
  8. Does Grandparenting Pay off for the Next Generations? Intergenerational Effects of Grandparental Care By Mara Barschkett; C. Katharina Spieß; Elena Ziege
  9. Fear and Economic Behavior By Andersson, Lina
  10. Early Retirement of Employees in Demanding Jobs: Evidence from a German Pension Reform By Johannes Geyer; Svenja Lorenz; Thomas Zwick; Mona Bruns
  11. The Effects of an Increase in the Retirement Age on Health: Evidence from Administrative Data By Mara Barschkett; Johannes Geyer; Peter Haan; Anna Hammerschmid
  12. The impact of working conditions on mental health: novel evidence from the UK By Michele Belloni; Ludovico Carrino; Elena Meschi
  13. Why do couples and singles save during retirement? By Mariacristina De Nardi; Eric French; John Bailey Jones; Rory McGee
  14. Well-Informed Choices? Effects of Information Interventions in Primary Care on Care Quality By Anell, Anders; Dietrichson, Jens; Ellegård, Lina Maria; Kjellsson, Gustav
  15. The Impact of Income Inequality on Mortality: A Replication Study of Leigh & Jencks (Journal of Health Economics, 2007) By Weilun Wu
  16. Learnings from the Assessments of Entrectinib and Larotrectinib: Health Technology Assessment Challenges Associated with Tumour-Agnostic Therapies By Brogaard, N.; Abdul-Ghani, R.; Bayle, A.; Henderson, N.; Bréant, A,; Steuten, L.
  17. The impact of a malaria elimination initiative on school outcomes: Evidence from Southern Mozambique By Cirera, Laia; Castelló, Judit Vall; Brew, Joe; Saúte, Francisco; Sicuri, Elisa
  18. Worth your weight: experimental evidence on the benefits of obesity in low-income countries By Elisa Macchi
  19. Video-based behavioral change communication to change consumption patterns: Experimental evidence from urban Ethiopia By Abate, Gashaw Tadesse; Baye, Kaleab; de Brauw, Alan; Hirvonen, Kalle; Wolle, Abdulazize
  20. Changing Patterns of Son Preference and Fertility in Pakistan By Rashid Javed; Mazhar Mughal
  21. Effectiveness of Covid-19 vaccination in Poland By Karol Madoñ; Piotr Lewandowski
  22. Mental Health Consequences of Working from Home during the Pandemic By Kim, Jun Hyung; Koh, Yu Kyung; Park, Jinseong
  23. Vulnerable to the Virus: Globally-Oriented Manufacturing Firms at Risk From the Spread of COVID-19 By SA Quimbo; CT Latinazo; JW Peabody
  24. Why reducing relative deprivation but not reducing income inequality might bring down COVID-19 infections By Stark, Oded
  25. God is in the rain: The impact of rainfall-induced early social distancing on COVID-19 outbreaks. By Shenoy, Ajay; Sharma, Bhavyaa; Xu, Guanghong; Kapoor, Rolly; Rho, Haedong Aiden; Sangha, Kinpritma
  26. Can white elephants kill? Unintended consequences of infrastructure development in Peru By Antonella Bancalari
  27. A game-theoretic analysis of childhood vaccination behavior: Nash versus Kant By Philippe de Donder; Humberto Llavador; Stefan Penczynski; John Roemer; Roberto Vélez
  28. The politicized pandemic: Ideological polarization and the behavioral response to COVID-19 By Gianluca Grimalda; Fabrice Murtin; David Pipke; Louis Putterman; Matthias Sutter
  29. COVID-19 incidence and the timing of quarantine measures and travel restrictions: A cross-country analysis By Marjorie C. Pajaron
  30. The dietary impact of the COVID-19 pandemic By Martin O'Connell; Kate Smith; Rebekah Stroud
  31. Emerging infectious diseases and the economy: climate change, natural world preservation, and containment policies By William Brock; Anastasios Xepapadeas
  32. Crowdsourcing interventions to promote uptake of COVID-19 booster vaccines By Robert Böhm; Cornelia Betsch; Yana Litovsky; Philipp Sprengholz; Noel T. Brewer; Gretchen Chapman; Julie Leask; George Leowenstein; Martha Scherzer; Cass R. Sunstein; Michael Kirchler
  33. Preparing for a pandemic: spending dynamics and panic buying during the COVID-19 first wave By Martin O'Connell; Áureo de Paula; Kate Smith
  34. Shutdown policies and conflict worldwide By Nicolas Berman; Mathieu Couttenier; Nathalie Monnet; Rohit Ticku

  1. By: Anup Malani (Institute for Fiscal Studies); Phoebe Holtzman (Institute for Fiscal Studies); Kosuke Imai (Institute for Fiscal Studies); Cynthia Kinnan (Institute for Fiscal Studies); Morgen Miller (Institute for Fiscal Studies); Shailender Swaminathan (Institute for Fiscal Studies); Alessandra Voena (Institute for Fiscal Studies and University of Chicago); Bartosz Woda (Institute for Fiscal Studies); Gabriella Conti (Institute for Fiscal Studies and University College London)
    Abstract: We report on a large randomized controlled trial of hospital insurance for above-poverty-line Indian households. Households were assigned to free insurance, sale of insurance, sale plus cash transfer, or control. To estimate spillovers, the fraction of households offered insurance varied across villages. The opportunity to purchase insurance led to 59.91% uptake and access to free insurance to 78.71% uptake. Access increased insurance utilization. Positive spillover effects on utilization suggest learning from peers. Many beneficiaries were unable to use insurance, demonstrating hurdles to expanding access via insurance. Across a range of health measures, we estimate no significant impacts on health.
    Date: 2021–12–07
  2. By: Signe A. Abrahamsen (Institute for Fiscal Studies); Rita Ginja (Institute for Fiscal Studies and University of Bergen); Julie Riise (Institute for Fiscal Studies)
    Abstract: This paper provides new evidence that preventive health care services delivered at schools and provided at a relatively low cost have positive and lasting impacts. We use variation from a 1999-reform in Norway that induced substantial differences in the avail-ability of health professionals across municipalities and cohorts. In municipalities with one fewer school nurse per 1,000 school-age children before the reform there was an increase in the availability of nurses of 35% from the pre- to the post-reform period, attributed to the policy change. The reform reduced teenage pregnancies and increased college attendance for girls. It also reduced the take-up of welfare benefits by ages 26 and 30 and increased the planned use of primary and specialist health care services at ages 25-35, without impacts on emergency room admissions. The reform also improved the health of newborns of affected new mothers and reduced the likelihood of miscarriages.
    Date: 2021–07–08
  3. By: Aline Bütikofer (Institute for Fiscal Studies); Rita Ginja (Institute for Fiscal Studies and University of Bergen); Fanny Landaud (Institute for Fiscal Studies); Katrine Loken (Institute for Fiscal Studies and University of Bergen)
    Abstract: Although many students suffer from anxiety and depression, and often identify school pressure and concerns about their futures as the main reasons for their worries, little is known about the consequences of a selective school environment on students’ mental health. Using a regression discontinuity analysis in the largest Norwegian cities, we show that eligibility to enroll in a more selective high school increases the probability of enrollment in higher education and decreases the probability of diagnosis or treatment of psychological problems. We provide suggestive evidence that changes in both teacher and peers’ characteristics are likely drivers of these effects.
    Date: 2021–10–08
  4. By: Emla Fitzsimons (Institute for Fiscal Studies and University College London); Marcos Vera-Hernandez (Institute for Fiscal Studies and University College London)
    Abstract: We show that children who are born at or just before the weekend are less likely to be breastfed, owing to poorer breastfeeding support services in hospitals at weekends. We use this variation to estimate the effect of breastfeeding on children’s development in the first five years of life, for a sample of births of low educated mothers. We find large effects of breastfeeding on children’s cognitive development but no effects on health or non-cognitive development during the period of childhood we consider. Regarding mechanisms, we study how breastfeeding affects parental investments and the quality of the mother-child relationship.
    Date: 2021–10–25
  5. By: Wang, J.; Alessi, R.; Angelini, V.
    Abstract: This paper estimates the effect of in utero exposure to adverse events on late life diabetes, cardiovascular disease risks and cognition deficiency. We merge data on the regional violence during the Cultural Revolution and the excessive death rates during the Chinese Great Famine with data from the China Health and Retirement Longitudinal Study (CHARLS)survey. Results show that female babies who were exposed in utero to the famine have higher diabetes risks, while male babies who were exposed to the Cultural Revolution are shown to have lower cognitive abilities.
    Keywords: early life conditions; chinese great famine; cultural revolution; diabetes; cardiovascular disease; cognition;
    JEL: I10 J11 J14
    Date: 2022–01
  6. By: Irene Mosca (Department of Economics, Finance and Accounting, Maynooth University.); Anne Nolan (Economic and Social Research Institute, Dublin. Department of Economics Trinity College)
    Abstract: A large body of research in economics and other disciplines considers the role of early-life circumstances in shaping later-life outcomes. The foetal origins hypothesis establishes that certain health conditions in later adulthood can be linked to in-utero development. In this paper, we contribute to the evidence on the foetal origins hypothesis by examining the later-life impact of a rubella outbreak that occurred in Ireland in 1956. Rubella is a contagious viral disease that displays mild symptoms and is generally inconsequential in childhood or adulthood. However, a rubella infection in early pregnancy poses a significant risk of damage to the foetus. Matching the outcomes of individuals born in 1955 to 1958 who are in the 2016 Irish Census to the county-level rubella incidence rate that was prevailing when respondents were in utero, we find that a 1% increase in the rubella incidence rate when in utero is associated with a 0.03% to 0.17% increase in the probability of having lower levels of educational attainment, being in poor health and having a disability in later life
    Keywords: in-utero; rubella; Ireland; later-life health
    JEL: I10 I18 J13
    Date: 2022
  7. By: Gabriella Conti (Institute for Fiscal Studies and University College London); Elena Pizzo (Institute for Fiscal Studies); Stephen Morris (Institute for Fiscal Studies); Mariya Melnychuk (Institute for Fiscal Studies)
    Abstract: Child maltreatment is a major public health problem with significant consequences for individual victims and for society. In this paper we quantify for the first time the economic costs of fatal and non-fatal child maltreatment in the UK in relation to several short-, medium- and long-term outcomes ranging from physical and mental health problems, to labour market outcomes and welfare use. We combine novel regression analysis of rich data from the National Child Development Study and the English Longitudinal Study of Ageing with secondary evidence to produce an incidence-based estimate of the lifetime costs of child maltreatment from a societal perspective. The discounted average lifetime incidence cost of non-fatal child maltreatment by a primary caregiver is estimated at £89,390 (95% uncertainty interval £44,896 to £145,508); the largest contributors to this are costs from social care, short-term health and long-term labour market outcomes. The discounted lifetime cost per death from child maltreatment is estimated at £940,758, comprising health care and lost productivity costs. Our estimates provide the first comprehensive benchmark to quantify the costs of child maltreatment in the UK and the benefits of interventions aimed at reducing or preventing it.
    Date: 2021–07–27
  8. By: Mara Barschkett; C. Katharina Spieß; Elena Ziege
    Abstract: Grandparents act as the third largest caregiver after parental care and daycare in Germany, as in many Western societies. Adopting a double-generation perspective, we investigate the causal impact of this care mode on children's health, socio-emotional behavior, and school outcomes, as well as parental well-being. Based on representative German panel data sets, and exploiting arguably exogenous variations in geographical distance to grandparents, we analyze age-specific effects, taking into account counterfactual care modes. Our results suggest null or negative effects on children's outcomes: If children three years and older are in full-time daycare or school and, in addition, cared for by grandparents, they have more health and socio-emotional problems, in particular conduct problems. In contrast, our results point to positive effects on parental satisfaction with the childcare situation and leisure. The effects for mothers correspond to an increase of 11 percent in satisfaction with the childcare situation and 14 percent in satisfaction with leisure, compared to the mean, although the results differ by child age. While the increase in paternal satisfaction with the childcare situation is, at 21 percent, even higher, we do not find an effect on paternal satisfaction with leisure.
    Keywords: grandparental childcare, socio-emotional outcomes, cognitive outcomes, parental well-being, instrumental variable
    JEL: D1 I21 I31 J13 J14
    Date: 2021
  9. By: Andersson, Lina (Department of Economics, School of Business, Economics and Law, Göteborg University)
    Abstract: Fear is an important factor in decision-making under risk and uncertainty. Psychology research suggests that fear influences one’s risk attitude and fear may have important consequences for decisions concerning for example investments, crime, conflicts, and politics. I model strategic interactions between players who can be in either a neutral or a fearful state of mind. A player’s state of mind determines his or her utility function. The two main assumptions are that (i) fear is triggered by an increase in the probability or cost of negative outcomes and (ii) a player in the fearful state is more risk averse. A player’s beliefs over the probability and cost of negative outcomes determine how the player transitions between the states of mind. I use psychological game theory to analyze the role of fear in three applications, a robbery game, a bank run game, and a public health intervention.
    Keywords: emotions; fear; risk aversion; psychological game theory
    JEL: C72 D01 D91
    Date: 2022–02
  10. By: Johannes Geyer; Svenja Lorenz; Thomas Zwick; Mona Bruns
    Abstract: Early retirement options are usually targeted at employees at risk of not reaching their regular retirement age in employment. An important at-risk group comprises employees who have worked in demanding jobs for many years. This group may be particularly negatively affected by the abolition of early retirement options. To measure differences in labor market reactions of employees in low- and high-demand jobs, we exploit the quasi-natural experiment of a cohort-specific pension reform that increased the early retirement age for women from 60 to 63 years. Based on a large administrative dataset, we use a regression-discontinuity approach to estimate the labor market reactions. Surprisingly, we find the same relative employment increase of about 25% for treated women who were exposed to low and to high job demand. For older women in demanding jobs, we do not find substitution effects into unemployment, partial retirement, disability pension, or inactivity. Eligibility for the pension for women required high labor market attachment; thus, we argue that this eligibility rule induced the positive selection of healthy workers into early retirement. We propose alternative policies that protect workers exposed to high job demand better against the negative consequences of being unable to reach their statutory retirement age in employment.
    Keywords: Pension reform, job demand, early retirement, quasi-experimental variation
    JEL: J14 J18 J22 J26 H31
    Date: 2021
  11. By: Mara Barschkett; Johannes Geyer; Peter Haan; Anna Hammerschmid
    Abstract: This study analyzes the causal effect of an increase in the retirement age on health. We exploit a sizable cohort-specific pension reform for women using two complementary empirical approaches - a Regression Discontinuity Design and a Difference-in- Differences approach. The analysis is based on official records covering all individuals insured by the public health system in Germany and including all certified diagnoses by practitioners. This enables us to gain a detailed understanding of the multi-dimensionality in these health effects. The empirical findings reflect the multidimensionality but allow for deriving two broader conclusions. We provide evidence that the increase in the retirement age negatively affects health outcomes as the prevalence of several diagnoses, e.g., mental health, musculoskeletal diseases, and obesity, increases. In contrast, we do not find support for an improvement in health related to a prolonged working life since there is no significant evidence for a reduction in the prevalence of any health outcome we consider. These findings hold for both identification strategies, are robust to sensitivity checks, and do not change when correcting for multiple hypothesis testing.
    Keywords: Germany, Retirement, Pension reform, Health, ICD-10, Regression Discontinuity Design, Difference-in-Differences
    JEL: I10 I12 I18 J14 J18 J26
    Date: 2021
  12. By: Michele Belloni; Ludovico Carrino; Elena Meschi
    Abstract: This paper investigates the causal impact of working conditions on mental health in the UK, combining new comprehensive longitudinal data on working conditions from the European Working Condition Survey with microdata from the UK Household Longitudinal Survey (Understanding Society). Our empirical strategy accounts for the endogenous sorting of individuals into occupations by including individual fixed effects. It addresses the potential endogeneity of occupational change over time by focusing only on individuals who remain in the same occupation (same ISCO), exploiting the variation in working conditions within each occupation over time. This variation, determined primarily by general macroeconomic conditions, is likely to be exogenous from the individual point of view. Our results indicate that improvements in working conditions have a beneficial, statistically significant, and clinically meaningful impact on depressive symptoms for women. A one standard deviation increase in the skills and discretion index reduces depression score by 2.84 points, which corresponds to approximately 20% of the GHQ score standard deviation, while a one standard deviation increase in working time quality reduces depression score by 0.97 points. The results differ by age: improvements in skills and discretion benefit younger workers (through increases in decision latitude and training) and older workers (through higher cognitive roles), as do improvements in working time quality; changes in work intensity and physical environment affect only younger and older workers, respectively. Each aspect of job quality impacts different dimensions of mental health. Specifically, skills and discretion primarily affect the loss of confidence and anxiety; working time quality impacts anxiety and social dysfunction; work intensity affects the feeling of social dysfunction among young female workers. Finally, we show that improvements in levels of job control (higher skills and discretion) and job demand (lower intensity) lead to greater health benefits, especially for occupations that are inherently characterised by higher job strain.
    Keywords: mental health, working conditions, job demand, job control.
    JEL: I1 J24 J28 J81
    Date: 2022–01
  13. By: Mariacristina De Nardi (Institute for Fiscal Studies and University of Minnesota and Federal Reserve Bank of Minneapolis); Eric French (Institute for Fiscal Studies and University College London and University of Cambridge); John Bailey Jones (Institute for Fiscal Studies); Rory McGee (Institute for Fiscal Studies and University of Western Ontario)
    Abstract: While the savings of retired singles tend to fall with age, those of retired couples tend to rise. We estimate a rich model of retired singles and couples with bequest motives and uncertain longevity and medical expenses. Our estimates imply that while medical expenses are an important driver of the savings of middle-income singles, bequest motives matter for couples and high-income singles, and generate transfers to non-spousal heirs whenever a household mem-ber dies. The interaction of medical expenses and bequest motives is a crucial determinant of savings for all retirees. Hence, to understand savings, it is important to model household structure, medical expenses, and bequest motives.
    Date: 2021–05–28
  14. By: Anell, Anders (Department of Business Administration, Lund University); Dietrichson, Jens (VIVE - The Danish Center for Social Science Research); Ellegård, Lina Maria (Department of Economics, Lund University); Kjellsson, Gustav (Department of Economics, University of Gothenburg)
    Abstract: Market frictions, such as imperfect information or hassle costs, may reduce benefits from market incentives in healthcare settings. We use data from two randomised policy interventions in a Swedish region, which improved the access to provider information and reduced the switching costs of one percent of the adult population and of a sample of new residents. We examine the effects of the interventions on a large number of clinical process quality measures, access to care, and adverse health events, measured at the individual level. We find no significant effect of the interventions on any of the quality measures.
    Keywords: Market frictions; Field experiment; Care quality; Primary care; Sweden
    JEL: D89 I11
    Date: 2022–02–02
  15. By: Weilun Wu (University of Canterbury)
    Abstract: This study replicates Leigh and Jencks’ (2007) analysis of the relationship between income inequality and mortality. Using L&J’s preferred specification, I am able to closely reproduce their original findings after reconstructing their data from original sources. When I use multiple imputation instead of their method of linear interpolation, I largely confirm their results. When I extend their data from 2003 to 2018, I again do not find a significant relationship between income inequality and mortality. As a result, I conclude that my replication exercise confirms L&J’s results, providing even stronger evidence for the view that income inequality is not adversely related to mortality.
    Keywords: Income Inequality, Health, Mortality, Multiple Imputation
    JEL: I12 N30
    Date: 2022–02–01
  16. By: Brogaard, N.; Abdul-Ghani, R.; Bayle, A.; Henderson, N.; Bréant, A,; Steuten, L.
    Abstract: A paradigm shift is occurring in cancer care with the introduction of tumour-agnostic therapies, for which the indication is defined by the molecular signature of the tumour rather than by its location. Several agents have already gained regulatory approval, including pembrolizumab for solid tumours with high microsatellite instability (MSI-H) or high tumour mutational burden (TMB-H), and larotrectinib and entrectinib for neurotrophic tyrosine receptor kinase (NTRK) fusion-positive solid tumours, and many other emerging molecules are set to enter the market over the next decade. For healthcare systems, one of the biggest challenges lies in the clinical and economic assessment of these therapies, and subsequent decisions regarding reimbursement. As head-to-head data and comparative analyses remain a challenge for tumour-agnostic therapies, clinical evidence provided at the time of regulatory or reimbursement dossier submissions may include indirect comparisons to real-world data (RWD), or intrapatient analyses. In addition, testing costs and value need to be considered, given the need for broad genomic profiling platforms to facilitate patient identification and matching to novel treatments. The evaluation framework of each country's health technology assessment (HTA) agency determines how these challenges are currently addressed. This report provides an analysis of HTA agency assessments and reimbursement decisions for entrectinib and larotrectinib across England, Germany, France, Canada, Denmark, Sweden and Scotland. Overall, 13 reimbursement decisions (six for entrectinib, seven for larotrectinib) with publicly accessible documents were analysed to understand the assessment outcomes and what evidence may have influenced them.
    Keywords: Economics of Health Technology Assessment
    JEL: I1
    Date: 2022–01–01
  17. By: Cirera, Laia; Castelló, Judit Vall; Brew, Joe; Saúte, Francisco; Sicuri, Elisa
    Abstract: Despite the significant improvements achieved over the last ten years, primary education attainment in Mozambique is still low. Potential reasons acting from the demand perspective include ill health, among other factors. In Mozambique, ill health is still largely linked to malaria, which is a leading cause of outpatient contacts, hospital admissions and death, particularly among under-five and school-aged children. Despite this, in Mozambique and more generally, in malaria endemic countries, the identification and measurement of how improved malaria indicators may contribute to better school outcomes remains largely unknown. In particular, there is a low understanding of the extent to which better health translates immediately into school indicators, such as absenteeism and grades. In this study, we exploit the first year of a malaria elimination initiative implemented in Magude district (Southern Mozambique) that started in 2015, as a quasi-experiment to estimate the impact of malaria on selected primary school outcomes. While malaria was not eliminated, its incidence drastically dropped. We use as control a neighbouring district (Manhiça) with similar socio-economic and epidemiological characteristics. By employing a difference-in-differences (DiD) approach, we examine whether the positive health shock translated into improved school outcomes. Using information from school registers, we generated a dataset on school attendance and grades for 9,848 primary-school students from 9 schools (4 in the treated district and 5 in the control district). In our main specification, a repeated cross-section analysis, we find that the elimination initiative led to a 28% decrease in school absenteeism and a 2% increase in students’ grades. Our results are robust across different specifications, including a panel DiD individual fixed effects estimate on a sub-sample of students. These findings provide evidence on the negative impact of malaria on primary education attainment and suggest remarkable economic benefits consequent to its elimination.
    Keywords: difference-in-differences; human capital; Malaria; Mozambique; primary education
    JEL: N0
    Date: 2022–01
  18. By: Elisa Macchi
    Abstract: I study the economic value of obesity—a seemingly inconsequential but unhealthy status symbol in poor countries. Randomizing decision-makers in Kampala, Uganda to view weight-manipulated portraits, I make four findings. First, obesity is perceived as a reliable signal of wealth rather than beauty and health. Second, being obese facilitates access to credit: in a real-stakes experiment involving loan officers, the obesity premium is comparable to raising borrower self-reported earnings by 60%. Third, asymmetric information drives this premium, which drops significantly when more financial information is provided. Fourth, obesity benefits and wealth-signaling value are commonly overestimated, raising the cost of healthy behaviors.
    Keywords: Obesity, status, asymmetric information
    JEL: I10 O10 Z13
    Date: 2022–01
  19. By: Abate, Gashaw Tadesse; Baye, Kaleab; de Brauw, Alan; Hirvonen, Kalle; Wolle, Abdulazize
    Abstract: Poor diet quality has been widely identified as a primary reason for malnutrition and the increasing burden of non-communicable diseases in low- and middle-income countries. Low consumption of fruits and vegetables contributes to poor diet quality, and one factor leading to low fruit and vegetable consumption is limited consumer awareness of the health and nutrition benefits of consumption. In this study, we experimentally assess a method of increasing consumer awareness, specifically, through showing households two different versions of a video embedded with messages about increasing fruit and vegetable consumption. The first video included just the basic recommended consumption behavior messages, while the second video also explained why and how fruit and vegetable consumption could improve health and nutrition outcomes. Even four months after viewing the video, average household consumption of fruits and vegetables increased by about 10 percent in both treatment groups relative to the control group, both in kilocalorie and consumption expenditure terms. The videos were developed to eventually show on national TV, suggesting that embedding dietary BCC messages in popular media can have positive impacts on diet quality at scale.
    Keywords: ETHIOPIA; EAST AFRICA; AFRICA SOUTH OF SAHARA; AFRICA; diet; fruit; vegetables; urban areas; malnutrition; consumer education; nutrition education; videos; behavior change communication; diet quality
    Date: 2021
  20. By: Rashid Javed (Université de Pau); Mazhar Mughal (Pau Business School)
    Abstract: Using data from two representative Demographic and Health Surveys, we examine the change in son preference over the past three decades and its effects on Pakistani women's fertility. We analyse a number of indicators and employ different empirical methods to come up with strong and persistent evidence for both the revealed and stated preference for sons. This disproportionate preference for boys is visible in increasing desired sex ratio and worsening sex ratio at last birth. Reliance over differential birth-stopping has significantly increased over time as couples are more likely to stop childbearing once the desired number of boys is achieved.
    Keywords: Son preference,Fertility,parity progression,Pakistan D13
    Date: 2021–12–25
  21. By: Karol Madoñ; Piotr Lewandowski
    Abstract: COVID-19 vaccines have proven highly effective in protecting against serious disease and death. Yet despite their introduction, Poland’s COVID-19 mortality rate remains high. This results from Poland’s lower vaccination rate compared to other EU countries – especially among people aged 70 or more who are at the highest risk from COVID-19.Vaccinating people aged 70+ is a much more effective method of lowering COVID-19 mortality rates than vaccinating people of working age. Increasing vaccination rates in the former age group would noticeably lower COVID-19 mortality in Poland. However, this would require an intensification of support efforts on a local level, including providing the elderly with comprehensive assistance in the vaccination process.
    Keywords: covid-19, pandemic, vaccination
    Date: 2022–01
  22. By: Kim, Jun Hyung; Koh, Yu Kyung; Park, Jinseong
    Abstract: This paper examines the effects of working from home on mental health, with particular attention to the role of home environments. Using unique real time survey data from South Korea collected during the COVID-19 pandemic, we find that working from home negatively affects the mental health of workers, with greater effects on women and those who are primarily responsible for housework while also maintaining market work. Surprisingly, workers who live with children in the household do not suffer from the negative effects of working from home. Our findings suggest that family-work interaction may be an important factor in the optimal design of working from home.
    Keywords: Working from home,home working,remote work,COVID-19,mental health,subjective well-being
    JEL: D13 L23 L84 M11 M54
    Date: 2022
  23. By: SA Quimbo (House of Repsesentatives, Batasan Complex, Constitution Hills, Quezon City); CT Latinazo (House of Repsesentatives, Batasan Complex, Constitution Hills, Quezon City); JW Peabody (QURE Healthcare, UCSF and UCLA)
    Abstract: COVID-19 risk assessment is multi-faceted. The highly infectious nature of the virus in a naïve population, the high case fatality rate and health system over-burdening each need to be considered in developing a strategy to control the spread of the virus and mitigate its health and economic consequences. This note provides a framework for classifying LGUs by degree of risk and identifies policy options for each risk scenario. It urges the Department of Health (DOH) to: (i) re-assess risk levels of local government units (LGUs), (ii) undertake a 100 percent identification of place of residence of all COVID-19 confirmed cases and 100 percent reporting of number of isolation beds and ventilators by all hospitals, and (iii) develop and immediately implement a COVID-specific disease surveillance protocol, including mass testing, contact tracing, and quarantine. Careful and diligent implementation of these protocols will allow a gradual yet cautious and informed re-opening of the economy.
    Keywords: COVID-19; Philippines; risk-assessment
    Date: 2020–04
  24. By: Stark, Oded
    Abstract: We examine an assumed link between reducing inequality in income distribution, namely reducing the Gini coefficient on one hand, and improving public health in general and lowering the incidence and severity of COVID-19 in particular on the other hand. The Gini coefficient can be shown to consist of two components, one of which is (a measure of) relative deprivation, which was found to cause social stress that harms public health. Because a component is not the whole, the lowering of inequality in the income distribution by means of reducing the Gini coefficient does not necessarily result in lowering relative deprivation. Specifically, we show that a policy of reducing income inequality aimed at improving public health might not be effective - even when, in the process, no-one’s income is reduced, or all incomes increase.
    Keywords: Health Economics and Policy, Public Economics
    Date: 2022–01–31
  25. By: Shenoy, Ajay; Sharma, Bhavyaa; Xu, Guanghong; Kapoor, Rolly; Rho, Haedong Aiden; Sangha, Kinpritma
    Abstract: We measure the benefit to society created by preventing COVID-19 deaths through a marginal increase in early social distancing. We exploit county-level rainfall on the last weekend before statewide lockdown in the early phase of the pandemic. After controlling for historical rainfall, temperature, and state fixed-effects, current rainfall is a plausibly exogenous instrument for social distancing. A one percent decrease in the population leaving home on the weekend before lockdown creates an average of 132 dollars of benefit per county resident within 2 weeks. The impacts of earlier distancing compound over time and mainly arise from lowering the risk of a major outbreak, yielding large but unevenly distributed social benefit.
    Keywords: COVID-19, Coronavirus, Rainfall, Social distancing, Prevention, coronavirus, social distancing, rainfall, Health Policy & Services, Public Health and Health Services, Applied Economics, Econometrics
    Date: 2021–12–09
  26. By: Antonella Bancalari (Institute for Fiscal Studies and University of St. Andrews)
    Abstract: It is widely accepted that investing in public infrastructure promotes economic development. However, there is little awareness of the prevalence of unfinished infrastructure projects and their consequences. In this paper, I study the effect of unfinished sewerage infrastructure on early-life mortality in Peru. I compile several sources of administrative panel data for 1,400 districts spanning 2005–2015, and I rely on the budgetary plans and timing of expenditure for 6,000 projects to measure unfinished projects and those completed in a given district. I document that mid-construction abandonment and delays are highly prevalent. I exploit geographical features and partisan alignment to instrument for project implementation. Surprisingly, I find that unfinished sewerage projects increased early-life mortality, driven by lack of water availability, water-borne diseases and accidents. I also show that while unfinished projects pose hazards to the population, completed sewerage projects decrease early-life mortality, in line with public health studies in advanced economies during the previous centuries.
    Date: 2020–09–28
  27. By: Philippe de Donder (TSE - Toulouse School of Economics - UT1 - Université Toulouse 1 Capitole - Université Fédérale Toulouse Midi-Pyrénées - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement); Humberto Llavador (UPF - Universitat Pompeu Fabra [Barcelona]); Stefan Penczynski (UEA - University of East Anglia [Norwich]); John Roemer (Yale University [New Haven]); Roberto Vélez (Centro Estudios Espinosa Yglesias)
    Abstract: Whether or not to vaccinate one's child is a decision that a parent may approach in several ways. The vaccination game, in which parents must choose whether to vaccinate a child against a disease, is one with positive externalities (herd immunity). In some societies, not vaccinating is an increasingly prevalent behavior, due to deleterious side effects that parents believe may accompany vaccination. The standard game-theoretic approach assumes that parents make decisions according to the Nash behavioral protocol, which is individualistic and non-cooperative. Because of the positive externality that each child's vaccination generates for others, the Nash equilibrium suffers from a free-rider problem. However, in more solidaristic societies, parents may behave cooperatively –they may optimize according to the Kantian protocol, in which the equilibrium is efficient. We test, on a sample of six countries, whether childhood vaccination behavior conforms better to the individualistic or cooperative protocol. In order to do so, we conduct surveys of parents in these countries, to ascertain the distribution of beliefs concerning the subjective probability and severity of deleterious side effects of vaccination. We show that in all the countries of our sample the Kant model dominates the Nash model. We conjecture that, due to the free-rider problem inherent in the Nash equilibrium, a social norm has evolved, quite generally, inducing parents to vaccinate with higher probability than they would in the noncooperative solution. Kantian equilibrium offers one precise version of such a social norm.
    Keywords: Kantian equilibrium,Nash equilibrium,Vaccination,Social norm
    Date: 2021–12–29
  28. By: Gianluca Grimalda (Kiel Institute for the World Economy; Centre for Global Cooperation Research, University of Duisburg-Essen; Jaume I University); Fabrice Murtin (Organization for Economic Co-Operation and Development (OECD)); David Pipke (Kiel Institute for the World Economy); Louis Putterman (Brown University); Matthias Sutter (Max Planck Institute for Research on Collective Goods, University of Cologne, University of Innsbruck, IZA, and CESifo)
    Abstract: We investigate the relationship between political attitudes and prosociality in a survey of a representative sample of the U.S. population during the first summer of the COVID-19 pandemic. We find that an experimental measure of prosociality correlates positively with adherence to protective behaviors. Liberal political ideology predicts higher levels of protective behavior than conservative ideology, independently of the differences in prosociality across the two groups. Differences between liberals and conservatives are up to 4.4 times smaller in their behavior than in judging the government’s crisis management. This result suggests that U.S. Americans are more polarized on ideological than behavioral grounds.
    Keywords: Polarization, Ideology, Trust in politicians, COVID-19, Prosociality, Health behavior, Worries
    JEL: D01 D72 D91 I12 I18 H11 H12
    Date: 2022–01–20
  29. By: Marjorie C. Pajaron (School of Economics, University of the Philippines Diliman)
    Abstract: Recent data on COVID-19 would suggest that no country is inured to the adverse effects of this disease. Although experts somehow agree on the virulence of the COVID-19 virus (SARS-CoV-2), it is puzzling why some countries have experienced the full brunt of the virus while others appear to have been totally spared. This paper examines one possible reason for the seemingly capricious nature of this virus. We compare the timing of the government response (travel restrictions and social distancing measures) of the ten ASEAN member countries and the incidence of COVID-19. Our preliminary results suggest that countries that responded relatively late (Indonesia, Philippines, Malaysia, and Thailand), when the local human-to-human transmission was already intense, have experienced a relatively high incidence of COVID-19 with the exception of Singapore and Cambodia. Further and more rigorous (regression) analysis is planned, conditional on data availability.
    Keywords: COVID-19; Cross-country analysis; ASEAN
    JEL: H12 I15 I18
    Date: 2020–06
  30. By: Martin O'Connell (Institute for Fiscal Studies and University of Wisconsin); Kate Smith (Institute for Fiscal Studies and Institute for Fiscal Studies); Rebekah Stroud (Institute for Fiscal Studies and Institute for Fiscal Studies)
    Abstract: The COVID-19 pandemic has led to significant changes in where people work, eat and socialise. We use novel data on the food and non-alcoholic drink purchases from stores, takeaways, restaurants and other outlets to quantify the impact of the pandemic on the diets of a large, representative panel of British households. We find that a substantial and persistent increase in calories consumed at home more than offset reductions in calories eaten out. By May 2020 (towards the end of the UK’s first national lockdown), total calories were, on average, 15% above normal levels, and they remained higher than normal for the rest of 2020. All socioeconomic groups increased their calorie purchases, with the largest rises for the highest SES households and the smallest for retired ones. Our findings suggest that the COVID-19 pandemic and the associated changes in people’s lifestyles have exacerbated the challenges of improving population diet and reducing obesity levels.
    Date: 2021–07–01
  31. By: William Brock; Anastasios Xepapadeas
    Abstract: Scientific evidence suggests that anthropogenic impacts on the environment such as land use changes and climate change promote the emergence of infectious diseases in humans. We develop a two-region epidemic-economic (epi-econ) model which unifies short-run disease containment policies with long-run policies which could control the drivers and the severity of infectious diseases. We structure our paper by linking a susceptible-infected-susceptible (SIS) model with an economic model which includes land use choices for agriculture and climate change. In the SIS model the contact number depends on short-run containment policies (e.g., lockdown, social distancing, vaccination), and the long-run policies affecting land use and the preservation of the natural world, and climate change. Utility in each region is determined by a composite consumption good produced by labor, land devoted to agriculture, and energy. Climate change and land use changes which reduce the natural world have an additional cost in terms of infectious disease since they might increase the contact number in the long run. We provide a deterministic solution as a benchmark and we compare it with outcomes derived under ambiguity associated with important parameters of the epi-econ model and ambiguity aversion.
    Keywords: infectious diseases, SIS model, natural world, climate change, containment policy, Nash equilibrium
    JEL: I18 Q54 D81
    Date: 2022–01–29
  32. By: Robert Böhm; Cornelia Betsch; Yana Litovsky; Philipp Sprengholz; Noel T. Brewer; Gretchen Chapman; Julie Leask; George Leowenstein; Martha Scherzer; Cass R. Sunstein; Michael Kirchler
    Abstract: We apply a novel crowdsourcing approach to provide rapid insights on the most promising interventions to promote uptake of COVID-19 booster vaccines. In the first stage, international experts proposed 46 unique interventions. To reduce noise and potential bias, in the second stage, experts and representative general population samples from the UK and the US rated the proposed interventions on several criteria, including expected effectiveness and acceptability. Sanctions were evaluated as potentially most effective but least accepted. Interventions that received the most positive evaluations regarding both effectiveness and acceptability across evaluation groups were a day off after getting vaccinated, financial incentives, tax benefits, benefit campaigns, and mobile vaccination teams. The results provide useful insights to help governments in their decision which interventions to implement.
    Keywords: booster vaccination, COVID-19, interventions
    Date: 2022–03
  33. By: Martin O'Connell (Institute for Fiscal Studies and University of Wisconsin); Áureo de Paula (Institute for Fiscal Studies and University College London); Kate Smith (Institute for Fiscal Studies and Institute for Fiscal Studies)
    Abstract: We study consumer spending dynamics during the first infection wave of the COVID-19 pandemic using household scanner data covering fast-moving consumer goods in the United Kingdom. We document a large spike in spending for storable products, such as food staples and household supplies, in the days before lockdown. Demand increases were concentrated in 30 of 138 product categories, e.g. soap, soup, canned goods and dried pasta. Households in all socioeconomic groups exhibit unusually high demand pre-lockdown, but there is a clear gradient, with the largest demand spikes for wealthier households. Although stories of people purchasing extreme amounts received a lot of attention, higher aggregate demand was mainly driven by more households than usual choosing to buy storable products, with only small increases in average quantities bought on a given trip. Temporary limits on the number of units per transaction, introduced following the demand spike, are therefore unlikely to lead to the avoidance of stock-outs. Given rapidly increasing case numbers in the ongoing second wave, and the spectre of further national lockdowns, our work provides timely evidence for preparing for a future demand spike.
    Date: 2020–10–15
  34. By: Nicolas Berman (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique - AMU - Aix Marseille Université, CEPR - Center for Economic Policy Research - CEPR); Mathieu Couttenier (CEPR - Center for Economic Policy Research - CEPR, GATE - Health System Analysis Laboratory - Université de Lyon); Nathalie Monnet (Institut de hautes études internationales et du développement - Graduate Institute of International and Development Studies [Geneva, Switzerland]); Rohit Ticku (Economics Department [European University Institute] - EUI - European University Institute)
    Abstract: We provide evidence on the link between the policy response to the SARS CoV-2 pandemic and conflicts worldwide. We combine daily information on conflict events and government policy responses to limit the spread of SARS CoV-2 to study how demonstrations and violent events vary following shutdown policies. We use the staggered implementation of restriction policies across countries to identify the dynamic effects in an event study framework. Our results show that imposing a nation-wide shutdown is associated with a reduction in the number of demonstrations, which suggests that public demonstrations are hampered by the rising cost of participation. However, the reduction is short-lived, as the number of demonstrations are back to their pre-restriction levels in two months. In contrast, we observe that the purported increase in mobilization or coordination costs, following the imposition of restrictions, is not followed by a drop of violent events that involve organized armed groups. Instead, we find that the number of events, on average, increases slightly following the implementation of the restriction policies. The rise in violent events is most prominent in poorer countries, with higher levels of polarization, and in authoritarian countries. We discuss the potential channels underlying this heterogeneity.
    Keywords: SARS CoV-2,Conflict,Violence,Mobility
    Date: 2022

This nep-hea issue is ©2022 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.