nep-hea New Economics Papers
on Health Economics
Issue of 2023‒11‒13
fifteen papers chosen by
Nicolas R. Ziebarth, Cornell University

  1. How to Curb Over-The-Counter Sales of Antibiotics? Evidence from a Field Experiment in Ethiopia By Maria Vittoria Levati; Ivan Soraperra; Saba Yifredew
  2. Temperature and the Timing of Work By Sam Cosaert; Adrián Nieto; Konstantinos Tatsiramos
  3. Graying and staying on the job: The welfare implications of employment protection for older workers By Morries, Todd; Dostie, Benoît
  4. The effect of reducing welfare access on employment, health, and children's long-run outcomes By Hicks, Jeffrey; Simard-Duplain, Gaëlle; Green, David A.; Warburton, William
  5. Strikes and gutters: biomarkers and anthropometric measures for predicting diagnosed diabetes mellitus in adults in low- and middle-income countries By Simmons, Sally Sonia
  6. From drought to distress: unpacking the mental health effects of water scarcity By Richard Freund
  7. Productivity and quality-adjusted life years: QALYs, PALYs and beyond By Hansen, Kristian S.; Moreno-Ternero, Juan D.; Østerdal, Lars P.
  8. The long-term impact of maternal leave duration on smoking behavior By Renner, Anna-Theresa; Shaikh, Mujaheed; Spitzer, Sonja
  9. The effect of a minor health shock on labour market outcomes: The case of concussions By Florian Fouquet; Lisa Meehan; Gail Pacheco; Alice Theadom
  10. Improving Breast Cancer Diagnosis Pathways in Quebec By Eleanor Corkum; Tiffanie Perrault; Erin C. Strumpf
  11. Lung Cancer in Argentina: A Modelling Study of Disease and Economic Burden By Andrea Alcaraz; Federico Rodriguez Cairoli; Carla Colaci; Constanza Silvestrini; Carolina Gabay; Natalia Espinola
  12. Bespoke scapegoats: Scientific advisory bodies and blame avoidance in the Covid-19 pandemic and beyond By Roger Koppl; Kira Pronin; Nick Cowen; Marta Podemska-Mikluch; Pablo Paniagua Prieto
  13. Media Information and People's Self-motivated Behaviour during the COVID-19 Pandemic By Mitomo, Hitoshi; Cheng, John W.; Kamplean, Artima; Seo, Yongkyoung
  14. Excess deaths of publicly employed educators in South Africa during the COVID-19 pandemic By Martin Gustafsson; Tsekere Maponya; Faith Kumalo; Mfela Mahlangu
  15. COVID-19 and mental health: natural experiments of the costs of lockdowns By Climent Quintana-Domeque; Jingya Zeng

  1. By: Maria Vittoria Levati (Department of Economics (University of Verona)); Ivan Soraperra (Department of Economics (University of Verona)); Saba Yifredew (Addis Ababa University)
    Abstract: In a randomized controlled trial among Addis Ababa's community pharmacies, we implement informational interventions to curb over-the-counter (OTC) antibiotic sales, which, especially in developing countries, contribute to the development of antimicrobial resistance (AMR). Our results show that one-time letters to pharmacists and a poster placed within the pharmacy premises significantly reduce OTC antibiotic sales in the short-run, with the poster's effect persisting five months later. We observe no significant impact on antibiotic prices. These findings highlight the potential of targeted informational interventions to tackle OTC antibiotic dispensing and mitigate the growing AMR threat.
    Keywords: Antimicrobial resistance, OTC antibiotics, Field experiment, Community pharmacies, Simulated patients
    JEL: C93 I12 I18 C21
    Date: 2023–10
  2. By: Sam Cosaert; Adrián Nieto; Konstantinos Tatsiramos
    Abstract: We leverage U.S. county-day temperature variation combined with daily time use data to examine the effect of temperature on the timing of work. We find that warmer (colder) temperatures increase (decrease) working time during the night and decrease (increase) working time in the morning. These effects are pronounced among workers with increased bargaining power, flexible work schedules, greater exposure to ambient temperature while at work, and fewer family-related constraints. Workers compensate for the shifts in the timing of work triggered by temperature fluctuations by adjusting their sleep time, without changing the timing of leisure and home production activities.
    Keywords: weather, time use, work schedule, labor supply, non-market activities, sleep
    JEL: J22 Q54 I31
    Date: 2023
  3. By: Morries, Todd; Dostie, Benoît
    Abstract: We study the welfare implications of employment protection for older workers, exploiting recent bans on mandatory retirement across Canadian provinces. Using linked employeremployee tax data, we show that the bans cause large and similar reductions in job separation rates and retirement hazards at age 65, with further reductions at higher ages. The effects vary substantially across industries and firms, and around two-fifths of the adjustments occur between ban announcement and implementation dates. We find no evidence that the demand for older workers falls, but the welfare effects are mediated by spillovers on savings behavior, workplace injuries, and spousal retirement timing.
    Keywords: employment protection, retirement, welfare, active and passive savings responses, health effects, spousal spillovers
    JEL: J26 J78 H55
    Date: 2023
  4. By: Hicks, Jeffrey; Simard-Duplain, Gaëlle; Green, David A.; Warburton, William
    Abstract: Welfare caseloads in North America halved following reforms in the 1990s and 2000s. We study how this shift affected families by linking Canadian welfare records to tax returns, medical spending, educational attainment, and crime data. We find substantial and heterogeneous employment responses that increased average income despite reduced transfers. We find zero effects on aggregate health expenditures, but mothers saw reduced preventative care and increased mental health treatment, consistent with the transition to employment elevating time pressure and stress. We find no effect on teenagers' education and criminal charges as young adults but do find evidence of intergenerational welfare transmission.
    JEL: H23 H31 I14 I24 I38 J62
    Date: 2023
  5. By: Simmons, Sally Sonia
    Abstract: Background: The management of diabetes necessitates the requirement of reliable health indices, specifically biomarkers and anthropometric measures, to detect the presence or absence of the disease. Nevertheless, limited robust empirical evidence exists regarding the optimal metrics for predicting diabetes in adults, particularly within low- and middle-income countries. This study investigates objective and subjective indices for screening diabetes in these countries. Methods: Data for this study was sourced from surveys conducted among adults (aged 18 years and above) in seventeen (17) countries. Self-reported diabetes status, fifty-four biomarkers, and twenty-six core and twenty-eight estimated anthropometric indices, including weight, waist circumference, body mass index, glycaemic triglycerides, and fasting blood glucose, were utilised to construct lasso regression models. Results: The study revealed variances in diabetes prediction outcomes across different countries. Central adiposity measures, fasting plasma glucose and glycaemic triglycerides demonstrated superior predictive capabilities for diabetes when compared to body mass index. Furthermore, fasting plasma or blood glucose, serving as a biomarker, emerged as the most accurate predictor of diabetes. Conclusions: These findings offer critical insights into both general and context-specific tools for diabetes screening. The study proposes that fasting plasma glucose and central adiposity indices should be considered as routine screening tools for diabetes, both in policy interventions and clinical practice. By identifying adults with or at higher risk of developing diabetes and implementing appropriate interventions, these screening tools possess the potential to mitigate diabetes-related complications in low- and middle-income countries.
    Keywords: anthropometric indices; biomarkers; diabetes; low- and middle-Income Countries; This work was supported by the London School of Economics and Political Science (LSE) Postgraduate Studies Fund.; REF fund
    JEL: J1
    Date: 2023–08–29
  6. By: Richard Freund
    Abstract: I provide quasi-experimental evidence of the effect of drought exposure on young adults’ experiences of anxiety and depression by leveraging a natural experiment: the 2021 drought in Ethiopia. My analysis applies a difference-in-differences strategy and couples 40 years of rainfall data with longitudinal data on mental health. I find that exposure to below long-run average rainfall increases in the probability of experiencing at least mild anxiety and depression by 0.35 and 0.29 standard deviations, respectively. These effects are strongest among those who grew up in the poorest households and those with low childhood reading ability. The impact on depression is also pronounced among those with low self-esteem. Additional evidence on mechanisms suggests the mental health effects may partly be explained by the drought’s impact on food insecurity, inflation, and perceived household poverty.
    Keywords: mental health , drought , climate change , anxiety , Ethiopia , depression
    Date: 2023
  7. By: Hansen, Kristian S. (National Research Centre for the Working Environment (NFA)); Moreno-Ternero, Juan D. (Department of Economics, Universidad Pablo de Olavide); Østerdal, Lars P. (Department of Economics, Copenhagen Business School)
    Abstract: We develop a general framework for the evaluation of health and productivity of a population of individuals. In such a framework, we characterize Productivity-and-Quality-Adjusted Life Years evaluation functions, which range from the classical Quality-Adjusted Life Years (QALYs) to its polar Productivity-Adjusted Life Years (PALYs). Our frame-work and characterization results provide a new normative basis for the economic evalu-ation of health care or occupational health and safety policies.
    Keywords: Health; productivity; QALYs; PALYs; axioms
    JEL: D63 I10 J24
    Date: 2023–10–23
  8. By: Renner, Anna-Theresa; Shaikh, Mujaheed; Spitzer, Sonja
    Abstract: Maternal leave policies aim at protecting the health of new mothers. However, the impact of such policies on precursors of health, such as smoking behavior, is both theoretically and empirically understudied. We investigate the effect of maternal leave duration on the long-term smoking behavior of mothers across 14 European countries by combining survey data on health behaviors with retrospective information on birth and employment histories, and link these with maternity and parental leave policies between 1960 and 2010. To identify the causal impact of maternal leave duration, we exploit between and within country variation in mothers’ exposure to statutory leave duration policies in an instrumental variable framework. We find that a one-month increase in maternal leave duration increases the probability that a woman smokes in the long run by 2.3 percentage points. Similarly, a one-month increase in leave duration increases the lifetime duration of smoking by 13 months. We document non-linearity in this effect for the first time, showing that shorter leave durations have a protective effect, while very long maternal leave promotes harmful health behavior. Suggestive evidence shows lack of financial support from spouse around childbirth as a mediator of the observed effects, while employment and other socio-demographic characteristics play no role.
    Keywords: risky health behavior, maternity leave, parental leave policies, SHARE, instrumental variables
    JEL: I12 J13 J22
    Date: 2023–09
  9. By: Florian Fouquet (LEMNA, Nantes Université & GAINS, Le Mans Université); Lisa Meehan (NZ Work Research Institute, Auckland University of Technology); Gail Pacheco (NZ Work Research Institute, Auckland University of Technology); Alice Theadom (Traumatic Brain Injury Network, Auckland University of Technology)
    Abstract: The literature on health shocks finds that minor injuries have only a short-term impact on labour market outcomes. However, mild traumatic brain injuries (mTBIs, commonly referred to as concussions) may be different as the medical literature highlights that they can have long-term health and cognitive effects. We use administrative data on all medically-diagnosed mTBIs in New Zealand linked to monthly tax records to examine the labour market effects of suffering a mTBI up to four years after the injury. We use a comparison group of those who suffer a mTBI but at a later date to overcome potential endogeneity issues, and employ a doubly-robust difference-in-differences method. We find that suffering a mTBI has negative effects on both employment and earnings. Rather than dissipating over time, these negative effects grow, representing a decrease in employment rate of 20 percentage points and earning losses of about a third after 48 months. Our results highlight the need for timely diagnosis and treatment to mitigate the effect of mTBIs on individuals’ labour market outcomes to reduce economic and social costs.
    Keywords: : health shock, mild traumatic brain injury, labour market outcomes
    JEL: I10 I14 J01 J31
    Date: 2023–10
  10. By: Eleanor Corkum; Tiffanie Perrault; Erin C. Strumpf
    Abstract: In 2022, Canada saw nearly 28, 900 new cases of breast cancer, making it the most prevalent cancer among women and the second most common across the entire Canadian population, following lung cancer. Delays in diagnosis can significantly worsen the condition and amplify existing inequalities. Despite Quebec setting a 17-day investigation timeframe after an abnormal mammography result back in 1999, the CEO of the Quebec Breast Cancer Foundation bemoaned in October 2021 that the actual delay could sometimes extend up to 17 weeks. Drawing from scientific literature on cancer care, government reports, and expert interviews, this document delves into Quebec's diagnostic capabilities and performance. The authors compare breast cancer diagnostic innovations in Quebec with those in Alberta and Ontario, where diagnostic delays are comparatively shorter. They present practical strategies to accelerate and streamline the breast cancer diagnostic process, guiding readers toward essential resources for deeper insights. The authors recommend integrating high-risk individuals into Quebec's organized screening program, customizing the screening process, modernizing available imaging technologies and genetic tests, and enhancing communication methods.
    Keywords: cancer, health, public health, breast cancer, screening, healthcare performance, diagnosis,
    Date: 2023–10–25
  11. By: Andrea Alcaraz; Federico Rodriguez Cairoli; Carla Colaci; Constanza Silvestrini; Carolina Gabay; Natalia Espinola
    Abstract: Objectives: Lung cancer remains a significant global public health challenge and is still one of the leading cause of cancer-related death in Argentina. This study aims to assess the disease and economic burden of lung cancer in the country. Study design: Burden of disease study Methods. A mathematical model was developed to estimate the disease burden and direct medical cost attributable to lung cancer. Epidemiological parameters were obtained from local statistics, the Global Cancer Observatory, the Global Burden of Disease databases, and a literature review. Direct medical costs were estimated through micro-costing. Costs were expressed in US dollars (US$), April 2023 (1 US$ =216.38 argentine pesos). A second-order Monte Carlo simulation was performed to estimate the uncertainty. Results: Considering approximately 10, 000 deaths, 12, 000 incident cases, and 14, 000 5-year prevalent cases, the economic burden of lung cancer in Argentina in 2023 was estimated to be US$ 556.20 million (396.96 -718.20), approximately 1.4% of the total healthcare expenditure for the country. The cost increased with a higher stage of the disease and the main driver was the drug acquisition (80%). 179, 046 Disability-adjusted life years could be attributable to lung cancer representing the 10% of the total cancer. Conclusion: The disease and economic burden of lung cancer in Argentina implies a high cost for the health system and would represent 19% of the previously estimated economic burden for 29 cancers in Argentina.
    Date: 2023–10
  12. By: Roger Koppl; Kira Pronin; Nick Cowen; Marta Podemska-Mikluch; Pablo Paniagua Prieto
    Abstract: Scholars have not asked why so many governments created ad hoc scientific advisory bodies (ahSABs) to address the Covid-19 pandemic instead of relying on existing public health infrastructure. We address this neglected question with an exploratory study of the US, UK, Sweden, Italy, Poland, and Uganda. Drawing on our case studies and the blame-avoidance literature, we find that ahSABs are created to excuse unpopular policies and take the blame should things go wrong. Thus, membership typically represents a narrow range of perspectives. An ahSAB is a good scapegoat because it does little to reduce government discretion and has limited ability to deflect blame back to government. Our explanation of our deviant case of Sweden, that did not create and ahSAB, reinforces our general principles. We draw the policy inference that ahSAB membership should be vetted by the legislature to ensure broad membership.
    Date: 2023–10
  13. By: Mitomo, Hitoshi; Cheng, John W.; Kamplean, Artima; Seo, Yongkyoung
    Abstract: This paper quantitatively examines the impact of media information on people's self-motivated behaviour during the COVID-19 pandemic. Using a framework based Extended Parallel Process Model and data collected from Japan in 2021 (n=2660), it is found that fear appeals of COVID-19 from television news increase people's perceived threat of COVID-19 infection and perceived efficacy of COVID-19 prevention measures. These perceptions mediate the effects of the fear appeals on people's intention to follow voluntarily COVID-19 prevention measures requested by the Japanese government. The results also show that while hard news and soft news programmes have similar effects, hard news appears to have stronger effects on the fear appeals than that of soft news.
    Date: 2023
  14. By: Martin Gustafsson (ReSEP, Stellenbosch University, and Department of Basic Education); Tsekere Maponya (Department of Basic Education); Faith Kumalo (Department of Basic Education); Mfela Mahlangu (Department of Basic Education)
    Abstract: An excess deaths method used by South Africa’s national authority for schools to understand mortality among publicly employed educators during the COVID-10 pandemic is explained. While pandemic-related deaths in the population were clearly under-reported in South Africa and elsewhere, an initial bottom-up reporting system for the schooling sector resulted in a slight over-reporting of these deaths, probably because schools did not separate out deaths that were likely to have occurred in the absence of the pandemic. Given the importance of understanding teacher mortality in a context of difficult negotiations around the full or partial closure of schools, a more accurate approach was sought, using payroll data, which include information on when an employee dies. It is concluded that the pandemic resulted in the deaths of around 3, 500 educators. It is moreover found that the prioritisation of educators in the national vaccination programme reduced mortality for educators in the third and fourth waves of the pandemic. It is estimated that some 870 additional educator deaths would have occurred if vaccinations for educators had not been brought forward. Educator excess deaths during pandemic were clearly concentrated above age 40. The fact that educators at the secondary-level appear to have experienced similar levels of mortality to primary-level educators, despite epidemiological evidence pointing to learners in secondary schools being more likely to infect others, would be in line with the World Health Organization position that the infection of educators was not primarily by learners. A multivariate model finds that black African and coloured educators, and educators in the two provinces Eastern Cape and Northern Cape, experienced particularly high mortality rates.
    Keywords: COVID-19, teachers, excess deaths, South Africa
    JEL: C13 I21 J11
    Date: 2023
  15. By: Climent Quintana-Domeque (Department of Economics, University of Exeter); Jingya Zeng (Department of Economics, University of Exeter)
    Abstract: The COVID-19 pandemic has profoundly impacted the world, affecting not only physical health and the economy but also mental well-being. This chapter provides an investigation of the causal link between lockdown measures - a significant public health intervention - and mental health. Our examination begins with an overview of the mental health landscape across various countries prior to the COVID-19 pandemic. We then summarize key insights from a range of surveys, reviews, and meta-analyses concerning the pandemic's effect on mental health. Further, we delve into a detailed analysis of three noteworthy studies that employ natural experiments to investigate the effects of lockdowns on mental health in different countries. Despite their differing research designs, these studies converge on the conclusion that lockdowns have had a detrimental impact on mental health. The intensity of this effect, however, varies among different population groups. This suggests that lockdown measures have affected certain segments of the population more profoundly than others.
    Keywords: COVID-19, mental distress, natural experiments
    JEL: I1 J1
    Date: 2023–10–18

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