nep-hea New Economics Papers
on Health Economics
Issue of 2022‒11‒14
thirty-six papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Can Pollution Cause Poverty? The Effects of Pollution on Educational, Health and Economic Outcomes By Claudia Persico
  2. Does Maternal Depression Undermine Childhood Cognitive Development? Evidence from the Young Lives Survey in Peru By Bendini,Maria Magdalena; Dinarte Diaz,Lelys Ileana
  3. Texting Parents about Early Child Development : Behavioral Changes and Unintended Social Effects By Barrera,Oscar; Macours,Karen; Premand,Patrick; Vakis,Renos
  4. Is Longer Maternal Care Always Beneficial? The Impact of a Four-Year Paid Parental Leave By Bicakova, Alena; Kaliskova, Klara
  5. On the Doorstep of Adulthood: Empowering Economic and Fertility Choices of Young Women By Berge, Lars Ivar Oppedal; Bjorvatn, Kjetil; Makene, Fortunata; Sekei, Linda Helgesson; Somville, Vincent; Tungodden, Bertil
  6. The Effect of a Universal Preschool Programme on Long-Term Health Outcomes: Evidence from Spain By Laia Bosque-Mercader
  7. Maternity Leave By Regmi, Krishna; Wang, Le
  8. Mortality Effects of Healthcare Supply Shocks: Evidence Using Linked Deaths and Electronic Health Records By Engy Ziedan; Kosali I. Simon; Coady Wing
  9. One Country, Two Systems : Evidence on Retirement Patterns in China By Giles,John T.; Lei,Xiaoyan; Wang,Gewei; Wang,Yafeng; Zhao,Yaohui
  10. The health-Consumption Effects of Increasing Retirement Age Late in the Game By Eve Caroli; Catherine Pollak; Muriel Roger
  11. Economics of mental wellbeing: a prospective study estimating associated productivity costs due to sickness absence from the workplace in Denmark By Santini, Ziggi Ivan; Thygesen, Lau Caspar; Koyanagi, Ai; Stewart-Brown, Sarah; Meilstrup, Charlotte; Nielsen, Line; Olsen, Kim Rose; Birkjær, Michael; McDaid, David; Koushede, Vibeke; Ekholm, Ola
  12. Lost Mind, Lost Job? Unequal Effects of Corporate Downsizings on Employees By Böckerman, Petri; Haapanen, Mika; Johansson, Edvard
  13. Are Environmental Concerns Deterring People from Having Children? By Lockwood, Ben; Powdthavee, Nattavudh; Oswald, Andrew J.
  14. Vertical transmission of overweight: evidence from a sample of English adoptees By Costa-Font, Joan; Jofre-Bonet, Mireia; Le Grand, Julian
  15. Primary Health Care and Management of Noncommunicable Diseases in the Philippines By Ulep, Valerie Gilbert T.; Uy, Jhanna; Casas, Lyle Daryll D.
  16. Characterization of Ambient Air Quality in Selected Urban Areas in Uganda : A Low-Cost Approach By Lozano Gracia,Nancy; Bainomugisha,Engineer; Soppelsa,Maria Edisa; Okure,Deo
  17. Long-Term Impacts of Short Exposure to Conditional Cash Transfers in Adolescence : Evidence from the Philippines By Dervisevic,Ervin; Perova,Elizaveta; Sahay,Abhilasha
  18. Invisible or Mainstream ? Disability in Surveys and Censuses in Low- and Middle-Income Countries By Mitra,Sophie; Chen,Wei; Herve,Justine Francoise Marie; Pirozzi,Sophia; Yap,Jaclyn Lourdes Alcala
  19. Exploring the effectiveness of demand-side retail pharmaceutical expenditure reforms: cross-country evidence from weighted-average least squares estimation By Berger, Michael; Pock, Markus; Reiss, Miriam; Röhrling, Gerald; Czypionka, Thomas
  20. A Successful Replication of "Dust Pollution From the Sahara and African Infant Mortality" By Cook, Nikolai M.
  21. Children on the Move : Progressive Redistribution of Humanitarian Cash Transfers among Refugees By Ozler,Berk; Celik,Cigdem; Cunningham,Scott; Cuevas,Pablo Facundo; Parisotto,Luca
  22. Gender Violence, Enforcement, and Human Capital : Evidence from Women's Justice Centers in Peru By Sviatschi,Maria Micaela; Trako,Iva
  23. The Distribution of Effort : Physical Activity, Gender Roles, and Bargaining Power in an Agrarian Setting By Friedman,Jed; Gaddis,Isis; Kilic,Talip; Martuscelli,Antonio; Palacios-Lopez,Amparo; Zezza,Alberto
  24. Health-related activities of Big Tech By Retiene, Roman
  25. COVID-19 Pandemic and the Health and Well-being of Vulnerable People in Vietnam By Dang, Hai-Anh; Do, Minh N.N.
  26. The Causal Effects of Long-Term PM2.5 Exposure on COVID-19 in India By Yamada,Takahiro; Yamada,Hiroyuki; Mani,Muthukumara S.
  27. How to End the COVID-19 Pandemic by March 2022 By Agarwal,Ruchir; Reed,Tristan
  28. Large gender and age differences in hand disinfection behavior during the COVID-19 pandemic: Field data from Swiss retail stores By Frauke von Bieberstein; Anna-Corinna Kulle; Stefanie Schumacher
  29. Do differences in brute luck influence preferences for redistribution in favour of the environment and health? By Olivier Chanel; Pavitra Paul
  30. Earnings losses and the role of the welfare state during the COVID-19 pandemic: evidence from Sweden By Adermon, Adrian; Laun, Lisa; Lind, Patrik; Olsson, Martin; Sauermann, Jan; Sjögren , Anna
  31. Direct and Indirect Effects of Vaccines: Evidence from COVID-19 in Schools By Seth M. Freedman; Daniel W. Sacks; Kosali I. Simon; Coady Wing
  32. Calculating the Costs and Benefits of Advance Preparations for Future Pandemics By Rachel Glennerster; Christopher M. Snyder; Brandon Joel Tan
  33. The Coronavirus Pandemic and Food Security : Evidence from West Africa By Adjognon,Guigonan Serge; Bloem,Jeffrey R.; Sanoh,Aly
  34. Do Immigrants Push Natives towards Safer Jobs ? Exposure to COVID-19 in the European Union By Bossavie,Laurent Loic Yves; Garrote Sanchez,Daniel; Makovec,Mattia; Ozden,Caglar
  35. Does the COVID-19 Pandemic Disproportionately Affect the Poor? Evidence from a Six-Country Survey By Dang, Hai-Anh H.; Nguyen, Manh-Hung; Huynh, Toan L.D.
  36. The Evolving Socioeconomic Impacts of COVID-19 in Four African Countries By Furbush,Ann; Josephson,Anna Leigh; Kilic,Talip; Michler,Jeffrey David

  1. By: Claudia Persico
    Abstract: Although pollution is widespread, there is little evidence about how it might harm children’s long run outcomes. Using the detailed, geocoded data that follows national representative cohorts of children born to the National Longitudinal Survey of Youth respondents over time, I compare siblings who were gestating before versus after a Toxic Release Inventory site opened or closed within one mile of their home. I find that children who were exposed prenatally to industrial pollution have lower wages, are more likely to be in poverty as adults, have fewer years of completed education, and are less likely to graduate high school.
    JEL: I10 I14 Q53
    Date: 2022–10
  2. By: Bendini,Maria Magdalena; Dinarte Diaz,Lelys Ileana
    Abstract: This paper studies the effect of maternal depression on early childhood cognition in Peru. The identification strategy exploits variation in exposure to exogenous shocks during early life to instrument for maternal depression. The results suggest that maternal depression is detrimental to the child's vocabulary at age five. Although the effects fade out by age eight, early vocabulary gaps can undermine other development outcomes. The effects do not vary by maternal education, but they are significant only for children living in disadvantaged households. The presence of a partner worsens the effect of maternal depression on vocabulary development, and this effect is driven by households with partners who drink heavily.
    Keywords: Health Care Services Industry,Mental Health,Educational Sciences,Early Childhood Development,Nutrition,Early Child and Children's Health,Reproductive Health,Children and Youth
    Date: 2020–11–24
  3. By: Barrera,Oscar; Macours,Karen; Premand,Patrick; Vakis,Renos
    Abstract: Parenting interventions have the potential to improve early childhood development. Text messages are considered a promising channel to deliver parenting information at large scale. This paper tests whether sending text messages about parenting practices impacts early childhood development. Households in rural Nicaragua were randomly assigned to receive messages about nutrition, health, stimulation, or the home environment. The intervention led to significant changes in self-reported parenting practices. However, it did not translate into improvements in children's cognitive development. When local opinion leaders were randomly exposed to the same text message intervention, parental investments declined and children's outcomes deteriorated. Since interactions between parents and leaders about child development also decreased, the negative effects may have resulted from a crowding-out of some local leaders.
    Keywords: Social Protections&Assistance,Health Care Services Industry,Educational Sciences,Early Child and Children's Health,Early Childhood Development,Reproductive Health,Nutrition
    Date: 2020–12–09
  4. By: Bicakova, Alena (CERGE-EI); Kaliskova, Klara (CERGE-EI)
    Abstract: We study the impact of an extension of paid family leave from 3 to 4 years on child long- term outcomes. Using a difference-in-differences design and comparing the first-affected with the last-unaffected cohorts of children, we find that an additional year of maternal care at the age of 3, which primarily crowded out enrollment into public kindergartens, had an adverse effect for children of low-educated mothers on human capital investments and labor-market attachment in early adulthood. The affected children were 12 p.p. more likely not to be in education, employment, or training (NEET) at the age of 21-22. The impact on daughters was larger and driven by a lower probability of attending college and higher probability of home production. Sons of low-educated mothers, on the other hand, were less likely to be employed. The results suggest that exposure to formal childcare may be more beneficial than all-day maternal care at the age of 3, especially for children with a lower socio-economic background.
    Keywords: family leave, maternal care, subsidized childcare, child outcomes, human capital, labor-market attachment
    JEL: J13 J18 J21 J24
    Date: 2022–10
  5. By: Berge, Lars Ivar Oppedal (Department of Business and Management); Bjorvatn, Kjetil (Dept. of Economics, Norwegian School of Economics and Business Administration); Makene, Fortunata (Economic and Social Research Foundation); Sekei, Linda Helgesson (NIRAS); Somville, Vincent (Dept. of Economics, Norwegian School of Economics and Business Administration); Tungodden, Bertil (Dept. of Economics, Norwegian School of Economics and Business Administration)
    Abstract: We report from a large-scale randomized controlled trial of women empowerment in Tanzania investigating how two different empowerment strategies, economic empowerment and reproductive health empowerment, shape the economic and fertility choices of young women when they transition into adulthood. The analysis builds on a rich data set (survey, experimental, and medical data) collected over more than five years. The economic empowerment reduces poverty, while teenage pregnancy increases with both economic and reproductive health empowerment. The increase in fertility comes from a positive income effect and by women entering earlier into a relationship. We also provide evidence of the importance of social norms and labor market flexibility in explaining the income and relationship effects on fertility. The findings provide new insights on the economics of fertility, and show the importance of a comprehensive approach to women empowerment.
    Keywords: Women empowerment; Economic empowerment; Fertility; Poverty
    JEL: J13 J16
    Date: 2022–10–27
  6. By: Laia Bosque-Mercader
    Abstract: Early childhood education programmes are expected to improve child conditions including educational attainment, labour, and health outcomes. This study evaluates the effect of a Spanish universal preschool programme, which implied a large-scale expansion of full-time high-quality public preschool for three-year-olds in 1991, on long-term health. Using a difference-in-differences approach, I exploit the timing of the policy and the differential initial speed of implementation of public preschool expansion across regions. I compare long-term health of cohorts aged three before to those aged three after the start of the policy residing in regions with varying initial implementation intensity of the programme. The results show that the policy does not affect long-term health outcomes and use of healthcare services, except for two outcomes. A greater initial intensity in public preschool expansion by 10 percentage points decreases the likelihood of being diagnosed with asthma by 2.1 percentage points, but hospitalisation rates increase by 2.7%. The findings indicate that the effect on asthma is larger for men, hospitalisation rates are higher for pregnant women, and disadvantaged children benefit the most in terms of a lower probability of taking medicines and being diagnosed with asthma and mental health disorders.
    Date: 2022–10
  7. By: Regmi, Krishna; Wang, Le
    Abstract: Supporting working mothers to balance their work and childcare responsibilities is a central objective of maternal and parental leave policies. Nearly all countries offer some forms of maternity and family leave programs for childbearing on a national basis. This chapter reviews various types of leave policies available for working mothers (or parents) across countries and whether and how the policies affect women's labor market outcomes, their own and children's health, and child development. The leave policies can also influence women's fertility choices, as well as household specialization and husbands' labor supply. Recent studies also note the potential impacts on employers and coworkers of mothers who are on leave. One message that this chapter draws from the vast literature - with diverse and, in some instances, contradictory findings - is that policy debates should not center around whether or not governments should offer paid leave; rather they should focus on how to design more efficient or optimal leave programs. This chapter discusses some preliminary lessons for designing a leave program.
    Keywords: maternity leave,parental leave,gender role,birth outcomes,breastfeeding,infant health,children's outcomes,mothers' health,labor supply,fertility,divorce
    JEL: H31 I12 I18 J21 J22 J16 J71 J78 J22 J12 J13 J38 J83 J88 K36
    Date: 2022
  8. By: Engy Ziedan; Kosali I. Simon; Coady Wing
    Abstract: The contraction in health care consumption at the start of the pandemic provides insight into central economic questions of waste and productivity in the U.S. health care system. Using linked mortality and Electronic Medical Records, we compare people who had outpatient appointments scheduled for dates in 30 day periods immediately before and after the Covid-19 emergency declaration. Appointment cancellation rates were 77% higher for people with appointments in the shutdown period. Intent to treat estimates imply that having a scheduled appointment date right after the emergency declaration increased one-year mortality rates by 4 deaths per 10,000. Instrumental variable estimates suggest that a cancelled appointment increased one-year mortality by 29.7 deaths per 10,000 among compliers, implying that a 10% increase in health care appointments reduces mortality rates by 2.9%. The mortality effects are rooted in two mechanisms: a complier sub-population with high marginal benefits from care, and a cascade of delayed or missed follow-up care that lasted for about 3 months. Healthcare spending accounted for 19.7% of U.S. GDP in 2021, and controlling health spending is a major policy objective. Our results quantify health tradeoffs from cutting every-day non-emergency visits, illustrating the importance of cost-control efforts that differentiate between medical care with the largest and smallest benefits for patient health.
    JEL: I0 I11
    Date: 2022–10
  9. By: Giles,John T.; Lei,Xiaoyan; Wang,Gewei; Wang,Yafeng; Zhao,Yaohui
    Abstract: This paper documents the patterns and correlates of retirement in China using a nationally representative survey, the China Health and Retirement Longitudinal Study. After documenting stark differences in retirement ages between urban and rural residents, the paper shows that China's urban residents retire earlier than workers in many Organisation for Economic Co-operation and Development countries and that rural residents continue to work until advanced ages. Differences in access to generous pensions and economic resources explain much of the urban-rural difference in retirement rates. Fending off the fiscal pressures resulting from rapid population aging will require encouraging longer working lives among more highly educated and skilled workers living in China's urban areas. The paper suggests that reducing disincentives created by China's employee pension system, improving health status, providing childcare, and elder care support may all facilitate longer working lives. Given spouse preferences for joint retirement, creating incentives for women to retire later may facilitate longer working lives for men and women.
    Keywords: Pensions&Retirement Systems,Health Care Services Industry,Labor Markets,Educational Sciences,Adolescent Health
    Date: 2021–05–06
  10. By: Eve Caroli (LEDa - Université Paris Dauphine - PSL and IZA); Catherine Pollak (DRESS and LEDa - Université Paris Dauphine - PSL); Muriel Roger (Centre d'Economie de la Sorbonne - Université Paris 1 Panthéon-Sorbonne and LIEPP)
    Abstract: Using the differentiated increase in retirement age across cohorts introduced by the 2010 French pension reform, we estimate the health-consumption effects of a 4-month increase in retirement age. We focus on individuals who were close to retirement age but not retired yet by the time the reform was passed. Using administrative data on individual sick-leave claims and non-hospital health-care expenses, we show that the probability of having at least one sickness absence increases for all treated groups, while the duration of sick leaves remains unchanged. Delaying retirement does not increase the probability of seeing a GP, except for men in the younger cohorts. In contrast, it raises the probability of having a visit with a specialist physician for all individuals, except men in the older cohorts. Delaying retirement also increases the probability of seeing a physiotherapist among women from the older cohorts. Overall, it increases health expense claims, in particular in the lower part of the expenditure distribution
    Keywords: pension reform; retirement age; health; health-care consumption
    JEL: I10 J14 J18 J26
    Date: 2022–10
  11. By: Santini, Ziggi Ivan; Thygesen, Lau Caspar; Koyanagi, Ai; Stewart-Brown, Sarah; Meilstrup, Charlotte; Nielsen, Line; Olsen, Kim Rose; Birkjær, Michael; McDaid, David; Koushede, Vibeke; Ekholm, Ola
    Abstract: Background Few studies have assessed associations between mental wellbeing (MWB) and productivity loss using nationally-representative longitudinal data. The objective of the study was to determine how different levels of MWB are associated with future productivity loss due to sickness absence. Methods Data stem from a Danish nationally representative panel study of 1,959 employed adults (aged 16-64 years old) conducted in 2019 and 2020, which was linked to Danish register data. The validated Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) was used to assess MWB in 2019. The outcome was days absent from work due to sickness in 2020. Linear regression models were used to predict sickness absence in 2020 while adjusting for sickness absence in 2019, sociodemographics and health status, including psychiatric morbidity. Productivity costs were estimated using the human capital approach (HCA) and friction cost approach (FCA). Results Each point increase in MWB was significantly associated with fewer sick days and, by extension, lower productivity loss (reported in the order HCA/FCA). As compared to low MWB, moderate MWB was associated with $-1,614/$-1,271 per person, while high MWB was associated with $-2,351/$-1,779 per person. Extrapolated to the Danish population (2.7M employed adults aged 16-64), moderate MWB (67.3% of the population) was associated with lower productivity costs amounting to $-2.9bn/$-2.3bn, while high MWB (20.4% of the population) was associated with lower costs amounting to $-1.3bn/$-0.9bn. Conclusions Higher levels of MWB are associated with considerably less productivity loss. Substantial reductions in productivity loss could potentially be achieved by promoting higher levels of MWB in the population workforce.
    Keywords: health economics; productivity; absenteeism; mental health; mental wellbeing
    JEL: J1
    Date: 2022–12–01
  12. By: Böckerman, Petri (Labour Institute for Economic Research); Haapanen, Mika (Jyväskylä University School of Business and Economics); Johansson, Edvard (Abo Akademi University)
    Abstract: We analyze whether employees with diagnosed mental health disorders have a higher probability of being laid off during corporate downsizing. Our analysis is based on nationwide administrative data on all private sector firms and their employees in Finland over the period 2005–2017. We focus on firms with at least 20 employees that lay off at least 20% of their total workforce between two consecutive years. We estimate whether those who have been laid off have more diagnosed mental health disorders before downsizing happens than those who have not been laid off. In our baseline specification, controlling for a rich set of employee characteristics, we find that having had any mental health disorder diagnosis in the three years that preceded the downsizing increases the probability that an employee is laid off by 6 percentage points. The results highlight that those with underlying mental health disorders are more vulnerable to losing their jobs, even in the event of a mass layoff.
    Keywords: unemployment, health, mental heath, job displacement, corporate downsizing, mass layoff
    JEL: I10 I12 J64
    Date: 2022–10
  13. By: Lockwood, Ben (University of Warwick); Powdthavee, Nattavudh (University of Warwick); Oswald, Andrew J. (University of Warwick)
    Abstract: Are 'green' environmental concerns -- about climate change, biodiversity, pollution -- deterring today's citizens from having children? This paper, which we believe to be the first of its kind, reports preliminary evidence consistent with that increasingly discussed hypothesis. Our study has a simple longitudinal design. It follows through time a random sample of thousands of initially childless men and women in the UK. Those individuals who are committed to a green lifestyle are found to be less likely to go on to have offspring. Later analysis adjusts statistically for a large set of potential confounders, including age, education, marital status, mental health, life satisfaction, optimism, and physical health. Because there might be unobservable reasons why those who are pro-environmental may be less likely to want a child, and to try to ensure that the finding cannot be explained by selection and omitted variables, the paper explores Oster's (2019) bounds test. The paper's final estimated effect-size is substantial: a person entirely unconcerned about environmental behaviour is found to be approximately 60% more likely to go on to have a child when compared to a deeply committed environmentalist.
    Keywords: fertility, child-bearing, climate change, environment, green
    JEL: J1 Q50
    Date: 2022–10
  14. By: Costa-Font, Joan; Jofre-Bonet, Mireia; Le Grand, Julian
    Abstract: Vertical influences can significantly shape children overweight by affecting both genetics and the environment children are exposed to. This paper examines the vertical (parental) transmission of child overweight drawing upon a fifteen year sample of English adults and their children, both adopted and biological, for which we can retrieve clinical measures height and weight. We find that, when both parents are overweight, children exhibit an increased likelihood of overweight, irrespective of whether they are adopted or biological children. When both parents are obese as opposed to overweight the picture is different. We find that the likelihood of child overweight increases by 16.7 percentage points among natural (non-adopted) children but only by 4.5 percentage points among adopted children. This suggests that the transmission of overweight when both parents are obese is not merely genetic, and what has been called vertical or parental transmission plays a non-negligible role. Our findings are validated by are a battery of robustness checks.
    Keywords: vertical transmission; cultural transmission; overweight; children; adopted children; biological children; biological paretns; Body Mass Index; sample selection
    JEL: I18 D13
    Date: 2020–12–01
  15. By: Ulep, Valerie Gilbert T.; Uy, Jhanna; Casas, Lyle Daryll D.
    Abstract: As the Philippines adopts major reforms under the Universal Health Care Act and embarks on an integrated and primary healthcare-oriented system, it is critical to assess its readiness to manage noncommunicable diseases (NCDs), the leading disease burden in the country. This study assesses the readiness of the primary healthcare system to handle NCDs, in the context of governance, financing, service delivery, human resources, and information and communications technology. It identifies challenges in the availability, quality, and equity of the health system, which hamper the provision of comprehensive and continuous healthcare services in local communities.
    Keywords: noncommunicable diseases; health systems; primary healthcare
    Date: 2021
  16. By: Lozano Gracia,Nancy; Bainomugisha,Engineer; Soppelsa,Maria Edisa; Okure,Deo
    Abstract: Many cities and urban centers around the world experience high air pollution episodes attributable to increased anthropogenic alterations of natural environmental systems. World Health Organization estimates indicate strong exceedances of prescribed limits in developing countries. However, the evidence on local pollution measures is limited for such cities and Uganda is no exception. Informed by the practical realities of air quality monitoring, this paper employs a low-cost approach using passive and active monitors to obtain characterization of pollution levels based on particulate matter 2.5, nitrogen dioxide, and ozone over a six-month period (starting in December 2018) for selected urban centers in three of the four macro-regions in Uganda. This is the first attempt to comprehensively assess pollution levels at a near-national level in Uganda. A combination of distributed stationary monitors and mobile monitors installed on motorcycle taxis (boda-boda) was employed in selected parishes to obtain spatiotemporal variations in the pollutant concentrations. The results suggest that seasonal particulate levels heavily depend on precipitation patterns with a strong inverse relation, which further corroborates the need for longer monitoring periods to reflect actual seasonal variations. Informed by the observed level of data completeness and quality in all the monitoring scenarios, the paper highlights the practicability and potential of a low-cost approach to air quality monitoring and the potential to use this information to inform citizens.
    Keywords: Pollution Management&Control,Air Quality&Clean Air,Brown Issues and Health,Health Care Services Industry,Intelligent Transport Systems,Social Risk Management,Disaster Management,Hazard Risk Management
    Date: 2021–01–20
  17. By: Dervisevic,Ervin; Perova,Elizaveta; Sahay,Abhilasha
    Abstract: This paper evaluates the long-term impacts of the national conditional cash transfer program in the Philippines on beneficiaries who were exposed to it during a relatively short but potentially critical period of transitioning from adolescence to adulthood. The paper estimates the impacts of the Pantawid Pamilyang Pilipino Program on men and women who were enrolled in the program for up to 1.5 years when they were between ages 12.5 and 14 and are currently in their early twenties. The analysis finds evidence of impacts on marriage and fertility for women: participation in the program is associated with delay in marriage and the first birth of approximately one year and six months, respectively. No impacts are found on educational or labor market outcomes or proxies for economic welfare. Further, there is no strong and consistent evidence of changes in empowerment or gender norms.
    Keywords: Gender and Development,Access of Poor to Social Services,Economic Assistance,Services&Transfers to Poor,Disability,Educational Sciences,Rural Labor Markets,Labor Markets,Health Care Services Industry
    Date: 2021–04–09
  18. By: Mitra,Sophie; Chen,Wei; Herve,Justine Francoise Marie; Pirozzi,Sophia; Yap,Jaclyn Lourdes Alcala
    Abstract: This paper examines to what extent household surveys and censuses in low- and middle-income countries include disability questions and the types of questions under use. A pool of 734 data sets and 1,297 data set-years from 133 low- and middle-income countries from 2009 to 2018 were screened for disability questions, which were classified by type of questions: Washington Group short set of questions, other functional difficulty questions, activities of daily living, broad activity limitation, general disability, and other disability questions. Only 31 percent of the data sets under review had at least one disability-related question and 15 percent of the datasets of low- and middle-income countries have functional difficulty questions that meet international standards, whether the Washington Group short set or other functional difficulty questions. The most commonly found disability question is the general question “Do you have a disability?” which does not produce meaningful and internationally comparable data. The adoption of functional difficulty questions such as the Washington Group short set in national censuses and surveys and in international surveys is needed to monitor the implementation of the 2030 Agenda for Sustainable Development as well as the Convention on the Rights of Persons with Disabilities.
    Keywords: Disability,Health Care Services Industry,Public Health Promotion,Disease Control&Prevention,Labor&Employment Law
    Date: 2021–04–13
  19. By: Berger, Michael; Pock, Markus; Reiss, Miriam; Röhrling, Gerald; Czypionka, Thomas
    Abstract: Increasing expenditures on retail pharmaceuticals bring a critical challenge to the financial stability of healthcare systems worldwide. Policy makers have reacted by introducing a range of measures to control the growth of public pharmaceutical expenditure (PPE). Using panel data on European and non-European OECD member countries from 1990 to 2015, we evaluate the effectiveness of six types of demand-side expenditure control measures including physician-level behaviour measures, system-level price-control measures and substitution measures, alongside a proxy for cost-sharing and add a new dimension to the existing empirical evidence hitherto based on national-level and meta-studies. We use the weighted-average least squares regression framework adapted for estimation with panel-corrected standard errors. Our empirical analysis suggests that direct patient cost-sharing and some—but not all—demand-side measures successfully dampened PPE growth in the past. Cost-sharing schemes stand out as a powerful mechanism to curb PPE growth, but bear a high risk of adverse effects. Other demand-side measures are more limited in effect, though may be more equitable. Due to limitations inherent in the study approach and the data, the results are only explorative.
    Keywords: health expenditure; panel data models; pharmaceutical policy; public pharmaceutical expenditure; weighted-average least squares
    JEL: J1
    Date: 2022
  20. By: Cook, Nikolai M.
    Abstract: This analysis is an independent replication of Heft-Neal et al. (2020).1 The original authors (HBBVB) provide evidence that particulate matter air pollution increases infant mortality in 30 African nations between 2000 and 2015. They provide three effect estimates. Using ordinary least squares, a 10 μg/m3 increase in PM2.5 exposure results in an estimated 8.6% increase in infant mortality. Using dust in the Bod'el'e depression as an instrumental variable, the same exposure increases infant mortality by 23.6%. Using rainfall in the Bod'el'e depression, the same exposure increases infant mortality by 24.3%. Using similar data and independently developed procedures I find corresponding estimates of 3.4%, 31.0%, and 29.7%.
    Date: 2022
  21. By: Ozler,Berk; Celik,Cigdem; Cunningham,Scott; Cuevas,Pablo Facundo; Parisotto,Luca
    Abstract: This paper evaluates the impact of the Emergency Social Safety Net (ESSN) in Turkey, the largest cash transfer program for international refugees in the world. The paper provides prima facie evidence that the program quickly caused substantial changes in household size and composition, with a net movement of primarily school-age children from larger ineligible households to smaller eligible ones. A sharp decline in inequality is observed in the entire study population: the Gini index declined by four percentage points (or 15 percent) within six months of program rollout, and the poverty headcount at the $3.20/day international poverty line declined by more than 50 percent after one year. ESSN caused a moderate increase in the diversity and frequency of food consumption among eligible households, and although there was no statistically significant effect on overall school enrollment, there were meaningful gains among the most vulnerable beneficiary households. To strike the right balance between transfer size and coverage, key parameters in the design of any cash transfer program, policy makers should consider the possibility that refugee populations may respond to their eligibility status by altering their household structure and living arrangements.
    Keywords: Disability,Economic Assistance,Services&Transfers to Poor,Access of Poor to Social Services,Health Care Services Industry,Educational Sciences,Inequality
    Date: 2020–11–06
  22. By: Sviatschi,Maria Micaela; Trako,Iva
    Abstract: In many developing countries, access to justice remains unequal, especially for women. What are the implications of this inequality for gender-based violence and investment in children? This paper provides evidence from Peru’s women’s justice centers (WJCs), which are specialized institutions that provide police, medical, and legal services to reduce gender-based violence. Examining the gradual rollout of WJCs across districts and villages, the study finds that the opening of a center reduces the incidence of gender-based violence, as measured by domestic violence, female deaths due to aggression, and hospitalizations due to mental health, by about 10 percent. This decrease in women’s exposure to violence has intergenerational effects: WJCs substantially increase human capital investments in children, raising enrollment, attendance, and test scores. The evidence suggests that these results are driven by an increase in enforcement against gender violence. After a WJC opens, there is an increase in reporting and prosecutions of gender-specific crimes.
    Keywords: Social Conflict and Violence,Gender and Development,Social Cohesion,Judicial System Reform
    Date: 2021–04–12
  23. By: Friedman,Jed; Gaddis,Isis; Kilic,Talip; Martuscelli,Antonio; Palacios-Lopez,Amparo; Zezza,Alberto
    Abstract: The disutility of work, often summarily described as effort, is a primal component of economic models of worker and consumer behavior. However, empirical applications that measure effort, especially those that assess the distribution of effort across known populations, are historically scarce. This paper explores intra-household differences in physical activity in a rural agrarian setting. Physical activity is captured via wearable accelerometers that provide a proxy for physical effort expended per unit of time. In the study setting of agricultural households in Malawi, men devote significantly more time to sedentary activities than women (38 minutes per day), but also spend more time on moderate-to-vigorous activities (16 minutes). Using standardized energy expenditure as a summary measure for physical effort, women exert marginally higher levels of physical effort than men. However, gender differences in effort among married partners are strongly associated with intra-household differences in bargaining power, with significantly larger husband-wife effort gaps alongside larger differences in age and individual land ownership as well as whether the couple lives as part of a polygamous union. Physical activity -- a proxy for physical effort, an understudied dimension of wellbeing -- exhibits an unequal distribution across gender in this population.
    Keywords: Gender and Development,Energy and Environment,Energy Demand,Energy and Mining,Inequality,Health Care Services Industry,Hydrology
    Date: 2021–04–19
  24. By: Retiene, Roman
    Abstract: While the German health sector has often been criticised for its slow uptake of novel digital products, other health systems have been significantly faster in adopting these products. In the course of this development, Big Tech companies have entered these health systems, particularly in the United States and the United Kingdom. But also in Germany, the involvement of Big Tech companies has become increasingly relevant in recent years. Among these Big Tech companies are the “Big Four” (i.e. Alphabet, Apple, Meta and Amazon) but also companies like Palantir and Oracle which have reinforced their activities in the health sector without much attention of the broader public. In this paper, these health-related activities of Big Tech are described in detail. Also providers of electronic health records and hospital information systems like Epic Systems and Cerner and German companies like the Deutsche Telekom and SAP are taken into account. All in all, fourteen companies are covered and their activities are divided into six categories to facilitate an overview and reveal the different focuses of the companies.
    Keywords: Big Tech, health data, eHealth
    JEL: I11 L00 L86 O30 O31 O33 O34
    Date: 2022–10–19
  25. By: Dang, Hai-Anh (World Bank); Do, Minh N.N. (National Economics University Vietnam)
    Abstract: Despite a sizable population and modest status as a low middle-income country, Vietnam has recorded a low COVID-19 fatality rate that rivals those of richer countries with far larger spending on health. We offer an early review of the emerging literatures in public health and economics on the pandemic effects in Vietnam, with a specific focus on vulnerable population groups. Our review suggests that vulnerable workers were at more health risks than the general population. The pandemic reduced household income, increased the poverty rate, and worsened wage equality. It increased the proportion of below-minimum wage workers by 2.5 percentage points (i.e., 32 percent increase). While government policy responses were generally regarded as effective, the public support for these responses was essential for this success, particularly where there were stronger public participation in the political process. Our review also indicates the need for a social protection database to identify the poor and the informal workers to further enhance targeting efforts. Finally, we suggest future directions for research in the Vietnamese context.
    Keywords: COVID-19, health, vulnerable households, poverty, inequality, Vietnam
    JEL: E24 I1 I30 J21 O12
    Date: 2022–10
  26. By: Yamada,Takahiro; Yamada,Hiroyuki; Mani,Muthukumara S.
    Abstract: This study investigates the causal effects of long-term particulate matter 2.5 exposure on COVID-19 deaths, fatality rates, and cases in India by using an instrumental variables approach based on thermal inversion episodes. The estimation results indicate that a 1 percent increase in long-term exposure to particulate matter 2.5 leads to an increase in COVID-19 deaths by 5.7 percentage points and an increase in the COVID-19 fatality rate by 0.027 percentage point, but this exposure is not necessarily correlated with COVID-19 cases. People with underlying health conditions such as respiratory illness caused by exposure to air pollution might have a higher risk of death following SARS-CoV-2 infection. This finding might also apply to other countries where high levels of air pollution are a critical issue for development and public health.
    Keywords: Brown Issues and Health,Pollution Management&Control,Air Quality&Clean Air,Health Care Services Industry,Law and Justice Institutions
    Date: 2021–02–10
  27. By: Agarwal,Ruchir; Reed,Tristan
    Abstract: How can the world reach herd immunity against COVID-19 before the second anniversary of the pandemic, or March 2022? A study of vaccine demand and supply answers this question. A target of vaccinating 60 percent of the population in each country by March 2022 is likely sufficient to achieve worldwide herd immunity under a baseline scenario with limited mutation. Achieving this target appears feasible given stated production capacity of vaccine manufacturers and the pace of current and historical vaccination campaigns. Considering existing pre-purchase contracts for vaccines, achieving this target requires addressing a procurement gap of just 350 million vaccine courses in low- and middle-income countries. Immediate additional donor funding of about $4 billion or in-kind donations of excess orders by high-income countries would be sufficient to close this gap. There are additional challenges along the path to achieving world-wide herd immunity---including supply chain issues, trade restrictions, vaccine delivery, and mutations. Overall however, this analysis suggests multilateral action now can bring an end to the acute phase of the pandemic early next year.
    Keywords: Immunizations,Reproductive Health,Disease Control&Prevention,Early Child and Children's Health,Public Health Promotion,Business Cycles and Stabilization Policies,Pulp&Paper Industry,Plastics&Rubber Industry,General Manufacturing,Construction Industry,Textiles, Apparel&Leather Industry,Food&Beverage Industry,Common Carriers Industry,International Trade and Trade Rules
    Date: 2021–04–15
  28. By: Frauke von Bieberstein; Anna-Corinna Kulle; Stefanie Schumacher
    Abstract: Hand hygiene is one of the key low-cost measures proposed by the World Health Organization (WHO) to contain the spread of COVID-19. In a field study conducted during the pandemic in June and July 2020 in Switzerland, we captured the hand disinfection behavior of customers in five stores of a large retail chain (n = 8,245). The study reveals considerable differences with respect to gender and age: Women were 8.3 percentage points more likely to disinfect their hands compared to men. With respect to age, we identified a steep increase across age groups, with people age 60 years and older disinfecting their hands significantly more often than younger adults (>+16.7 percentage points) and youth (>+ 31.7 percentage points). A validation study conducted in December 2020 (n = 1,918) confirmed the gender and age differences at a later point in the pandemic. In sum, the differences between gender and age groups are substantial and should be considered in the design of protective measures to ensure clean and safe hands.
    Date: 2022–10
  29. By: Olivier Chanel (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Pavitra Paul (CSH - Centre de sciences humaines de New Delhi - MEAE - Ministère de l'Europe et des Affaires étrangères - CNRS - Centre National de la Recherche Scientifique)
    Abstract: Redistributive justice is based on the premise that it is unfair for people to be better or worse off relative to others simply because of their fortune or misfortune. It assumes equal opportunities arising from four factors: social circumstances, effort, option luck and brute luck. This paper seeks to investigate how differences in perceived brute luck influence individual preferences for redistribution in favour of two public policies: "health intervention" and "environmental actions". These policies are viewed somewhat differently: the environment is considered a pure "public good" and health, more as a "private good" with a strong public good element. Consequently, potential self-serving biases inherent in the preferences for redistributive policies are expected to differ, more likely favouring health than the environment. The perceived degree of brute luck may capture such a difference—those perceiving themselves as luckiest should be less amenable to redistribution in favour of health than the unluckiest. Data from the three waves (2000, 2006 and 2008) of a French population survey are used to examine this self-serving bias. A Generalised Ordered Logit (GOL) model is found to be statistically more relevant compared to other logistic regression models (multinomial and ordered). We find that a perceived low degree of brute luck is significantly associated with a decreased preference of redistributive environmental policies but the reverse is true for redistributive health policies, i.e., association with an increased preference. Assuming that all inequalities due to differing luck are unjust, this empirical validation gives redistributive justice grounds for equalisation policies regarding health.
    Keywords: Economics,Health humanities
    Date: 2022–09
  30. By: Adermon, Adrian (IFAU - Institute for Evaluation of Labour Market and Education Policy); Laun, Lisa (IFAU - Institute for Evaluation of Labour Market and Education Policy); Lind, Patrik (IFAU - Institute for Evaluation of Labour Market and Education Policy); Olsson, Martin (IFN); Sauermann, Jan (IFAU - Institute for Evaluation of Labour Market and Education Policy); Sjögren , Anna (IFAU - Institute for Evaluation of Labour Market and Education Policy)
    Abstract: Many governments introduced temporary adjustments to counter the economic and health consequences of the COVID-19 pandemic. We study the importance of already existing government transfers and pandemic measures to mitigate individual income losses during the pandemic in Sweden using a difference-in-differences approach and population-wide data on monthly earnings and government transfer payments. We find that labor earnings dropped by 2.7 percent in 2020. Existing transfers and pandemic measures reduced earnings losses to 1.5 percent. These average effects mask considerable differences in income losses, which were, by and large, evened out by existing transfers and pandemic measures.
    Keywords: COVID-19; income inequality; government transfers; short-time work
    JEL: C23 D31 E24 H12 H20
    Date: 2022–10–27
  31. By: Seth M. Freedman; Daniel W. Sacks; Kosali I. Simon; Coady Wing
    Abstract: Vaccines influence the course of pandemics both directly, by protecting the vaccinated, and indirectly, by reducing transmission to the unvaccinated, a key externality. Estimating direct effects is challenging because of selective vaccine take-up; estimating indirect effects also poses difficulty as it requires exogenous variation in peer vaccination status. We overcome these challenges using unique microdata from Indiana together with a natural experiment. To identify direct effects, we use federal age-based vaccine eligibility rules by which seventh graders were eligible in Fall 2021 but sixth graders and younger were not. To identify indirect effects, we compare sixth graders in middle schools (whose older schoolmates are vaccine eligible) to sixth graders in elementary schools (whose schoolmates are ineligible). This variation in difference-in-differences designs leads to large estimates of direct effects: vaccination reduces COVID-19 incidence by 80 percent. But our estimates of indirect effects are small and statistically insignificant: despite a 20 percentage point increase in vaccination rates across all grades, we find essentially no difference in COVID-19 incidence between sixth graders in middle schools and sixth graders in elementary schools. A complementary identification strategy also finds small indirect effects from vaccinated grade-mates. This evidence from real-world settings matches clinical evidence forCOVID-19 vaccines’ benefits for the vaccinated, and provides new evidence that clinical trials were unable to examine, on indirect effects. Prior work on the influenza and pertussis vaccines has found substantial externalities, thus our findings suggest that prior evidence on one disease and its vaccine need not generalize to others.
    JEL: I0 I28
    Date: 2022–10
  32. By: Rachel Glennerster; Christopher M. Snyder; Brandon Joel Tan
    Abstract: The Covid-19 pandemic is estimated to have caused over 7 million deaths and reduced economic output by over $13 trillion to date. While vaccines were developed and deployed with unprecedented speed, pre-pandemic investments could have accelerated their widespread introduction, saving millions of lives and trillions of dollars. Combining estimates of the frequency and intensity of pandemics with estimates of mortality, economic-output, and human-capital losses from pandemics of varying severities, we calculate expected global losses from pandemics of over $800 billion annually. According to our model, spending $60 billion up front to expand production capacity for vaccines and supply-chain inputs and $5 billion every year thereafter would be sufficient to ensure production capacity to vaccinate 70% of the global population against a new virus within six months, generating an expected net present value (NPV) of over $400 billion. A proportionate advance-investment program undertaken by the United States alone would generate an expected NPV of $47 billion ($141 per capita).
    JEL: H44 I15 I18 L65
    Date: 2022–10
  33. By: Adjognon,Guigonan Serge; Bloem,Jeffrey R.; Sanoh,Aly
    Abstract: This paper documents some of the first estimates of the effect of the coronavirus pandemic on food security in a low- and middle-income country context. It combines nationally representative pre- pandemic household survey data with follow-up phone survey data from Mali and exploits sub- national variation in the intensity of pandemic-related disruptions between urban and rural areas. These disruptions stem from both government policies aiming to slow the spread of the virus and also individual behavior motivated by fear of contracting the virus. The paper finds evidence of increasing food insecurity in Mali associated with the pandemic. Difference-in-difference estimates show that moderate food insecurity increased by about 8 percentage points -- a 33 percent increase -- in urban areas compared with rural areas in Mali. The estimates are substantially larger than existing predictions of the average effect of the pandemic on food security globally and therefore highlights the critical importance of understanding effect heterogeneity.
    Keywords: Food Security,Nutrition,Health Care Services Industry,Inequality,Transport Services
    Date: 2020–11–11
  34. By: Bossavie,Laurent Loic Yves; Garrote Sanchez,Daniel; Makovec,Mattia; Ozden,Caglar
    Abstract: This paper assesses the impact of immigration to Western Europe on the exposure of native-born workers to economic and health risks created by the COVID-19 pandemic. Using various measures of occupational risks, it first shows that immigrant workers, especially those coming from lower-income member countries of the European Union or from outside the European Union, are more exposed to the negative income shocks relative to the natives. The paper then examines whether immigration has an impact on the exposure of natives to COVID-19-related risks in Western Europe. A Bartik-type shift share instrument is used to control for potential unobservable factors that would lead migrants to self-select into more vulnerable occupations across regions and bias the results. The results of the instrumental variable estimates indicate that the presence of immigrant workers had a causal impact in reducing the exposure of natives to COVID-19-related economic and health risks in European regions. Estimated effects are stronger for high-skilled native workers than for low-skilled natives and for women relative to men. The paper does not find any significant effect of immigration on wages and employment, which indicates that the effects are mostly driven by a reallocation from less safe jobs to safer jobs.
    Keywords: Labor Markets,Indigenous Peoples Law,Indigenous Peoples,Indigenous Communities,Health Care Services Industry,Human Migrations&Resettlements,International Migration,Migration and Development
    Date: 2020–12–16
  35. By: Dang, Hai-Anh H.; Nguyen, Manh-Hung; Huynh, Toan L.D.
    Abstract: The COVID-19 pandemic has wrought havocs on economies around the world. Yet, much needs to be learnt on the distributional impacts of the pandemic. We contribute new theoretical and empirical evidence on the distributional impacts of the pandemic on different income groups in a multi-country setting. Analyzing rich individual-level data from a six-country survey, we find that while the outbreak has no impacts on household income losses, it results in a 63-percent reduction in the expected own labor income for the second-poorest income quintile. The impacts of the pandemic are most noticeable in terms of savings, with all the four poorer income quintiles suffering reduced savings ranging between 5 and 7 percent compared to the richest income quintile. The poor are also less likely to change their behaviors, both in terms of immediate prevention measures against COVID-19 and healthy activities. We also find countries to exhibit heterogeneous impacts. The United Kingdom has the least household income loss and expected labor income loss, and the most savings. Japanese are least likely to adapt behavioral changes, but Chinese, Italians, and South Koreans wash their hands and wear a mask more often than Americans.
    Keywords: COVID-19; poverty; income quintiles; behavior changes
    JEL: D00 H00 I1 I3 O1
    Date: 2022–10–11
  36. By: Furbush,Ann; Josephson,Anna Leigh; Kilic,Talip; Michler,Jeffrey David
    Abstract: The paper provides evidence on the evolving socioeconomic impacts of the COVID-19 pandemic among households in Ethiopia, Malawi, Nigeria, and Uganda. The data allow estimating the immediate economic impacts of the pandemic, beginning in April 2020, and tracking how the situation evolved through September 2020. Although households have started to see recovery in income, business revenues, and food security, the gains have been relatively modest. Additionally, households have received very little outside assistance and their ability to cope with shocks remains limited. School closures have created a vacuum in education delivery and school-aged children have struggled to receive education services remotely.
    Keywords: Educational Sciences,Access of Poor to Social Services,Economic Assistance,Disability,Services&Transfers to Poor,Pharmaceuticals&Pharmacoeconomics,Pharmaceuticals Industry,Leprosy,Avian Flu,Communicable Diseases,Cholera
    Date: 2021–03–01

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.