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on Health Economics |
| By: | Parijat Maitra; Libertad González |
| Abstract: | We examine the impact of early elective birth timing on children's health and educational outcomes, focusing on cognitive development as measured by elementary school grades. We exploit a natural experiment in Spain: the abrupt termination of a generous child benefit at the end of 2010, which led to a sharp increase in elective deliveries during the final week of December. Children born during this spike had slightly shorter gestation periods and lower birth weights (within the normal range), and experienced a higher incidence of respiratory disorders during infancy. We find that the affected cohort of children had significantly lower academic performance at age seven (in second grade), suggesting large persistent effects on cognitive development. Our results provide causal evidence on the medium-term costs of early elective deliveries, and underscore the link between neonatal health and human capital. |
| Keywords: | birthweight, education, family benefits, health |
| JEL: | I2 I1 J13 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:bge:wpaper:1539 |
| By: | Banks, J.; French, E.; McCauley, J. |
| Abstract: | This paper examines the nature of long-term care for older adults with cognitive impairments in England1. Long-term care (LTC), which in England is commonly referred to as adult social care, is care that supports daily activities of living for older and disabled individuals to enhance their quality of life. This includes care services ranging from nursing home stays to home-based assistance with tasks like washing, dressing, and eating. For older people with cognitive impairment, such as dementia for example, there may be additional specialized care and support that is necessary. This paper shows that the high care needs of older individuals is largely attributable to those with cognitive impairments: approximately half of the total care costs of the age 65+ population in England are attributable to the 8.5% of individuals with cognitive limitations. |
| Date: | 2025–07–31 |
| URL: | https://d.repec.org/n?u=RePEc:cam:camdae:2583 |
| By: | Rong Fu (School of Commerce, Waseda University, and Waseda Institute of Social & Human Capital Studies (WISH)); Yunkyu Sohn (Department of Sociology, Seoul National University); Yichen Shen (School of Health Innovation, Kanagawa University of Human Services, and WISH); Haruko Noguchi (Faculty of Political Science and Economics, Waseda University, and WISH.) |
| Abstract: | Identifying causal effects of prenatal psychological stress on birth outcomes is challenging because stressful events typically bundle psychological stress with material disruptions. The 2011 Fukushima nuclear accident provides a unique setting to overcome this challenge: while physical radiation exposure was geographically limited and well-documented, fear of radiation spread nationwide. We exploit this geographic separation to examine how maternal anxiety independently affects fetal development. Using universal Japanese birth records linked to census data, combined with a novel Google Trends-based measure of radiation-specific anxiety, we employ three complementary identification strategies: population-level comparisons of in-utero exposed versus unexposed cohorts, within-family sibling analysis controlling for time-invariant family characteristics, and dose-response estimation exploiting geographic variation in anxiety intensity. Prenatal exposure to the accident increased preterm births by 16% and reduced birth weights by 22-26 grams. Birth outcomes exhibit a clear dose-response relationship with anxiety intensity: each standard deviation increase in radiation-specific fear corresponds to 4-5 gram birth weight reductions and 7% increases in preterm births. Effects are concentrated among socioeconomically disadvantaged mothers and during first-trimester exposure. Our findings demonstrate that invisible threats generate measurable intergenerational health impacts through psychological stress pathways, with implications for disaster preparedness and risk communication during contemporary crises from pandemics to climate change. |
| Keywords: | Prenatal Stress; Birth Outcomes; Nuclear Disasters; Google Trends; Fetal Origins |
| JEL: | Q54 J13 I14 I18 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:wap:wpaper:2527 |
| By: | Takumi Toyono (Waseda Institute of Social & Human Capital Studies (WISH), Waseda University); Haruko Noguchi (Faculty of Political Science and Economics, Waseda University; WISH;) |
| Abstract: | As natural disasters increase in frequency and severity globally and populations age rapidly, understanding how disasters affect informal care systems becomes critical for policy design in aging societies. This study examines the causal impact of disaster exposure on informal caregiving burdens and caregiver health, exploiting spatial variation in seismic intensity from the 2011 Great East Japan Earthquake. Using difference-in-differences estimation applied to unique longitudinal survey data linked to administrative records, we provide the first empirical evidence distinguishing impacts across the intensive margin (existing caregivers) and extensive margin (new caregivers) — a theoretically important distinction grounded in household production theory that prior disaster-caregiving research has overlooked. We find that a 12 percentage point increase in the proportion of destroyed or damaged houses increases weekly care time by 8.5 hours (45.9% increase) among existing caregivers and raises care provision likelihood by 2.3 percentage points (19.5% increase) among new caregivers. Mental health deteriorates exclusively among new caregivers, with effects concentrated among female and less-educated caregivers. Two key mechanisms drive these effects: disrupted formal at-home care services, with an estimated elasticity of informal-to-formal care substitution near unity, and reduced employment among new caregivers. Our findings reveal substantial hidden welfare costs beyond standard disaster impact assessments and demonstrate that optimal policy responses must account for fundamental differences in household adjustment mechanisms across margins. The results have broad relevance for disaster preparedness planning in aging economies worldwide. |
| Keywords: | natural disaster, informal caregiving, caregiver health, intensive and extensive margins, long-term care |
| JEL: | I10 J14 Q54 |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:wap:wpaper:2528 |
| By: | Chihaya, Guilherme Kenji; Mitchell, Jeffrey |
| Abstract: | In 2015, the Swedish police released a list of urban neighborhoods that it deemed ‘vulnerable’ (utsatta områden) with the intended purpose of reducing crime in those areas. We argue that this highly publicized list is a case of Spatial Marking, which refers to the institutionalization of positive or negative perceptions of a place via the enactment of a place-based intervention. Spatial marking leads to formal and informal rules dictating the differential treatment of communities largely based on racial composition, and should therefore be conceptualized as a structural determinant of health. In the case of the Swedish police list, we argue Spatial Marking amounts to the criminalization of entire neighborhoods, whose residents are subject to stigma and increased police interventions which should negatively impact the health of the people that live there. We assess this possibility with geo-located register data using a staggered difference in differences design to estimate the effect of being added to the police list across 9 health outcomes. Our results show that both the number of overdoses, babies born with low birth weights, and babies born out of pregnancies without adequate prenatal care increased as a result of being added to the police list. We find no evidence that of meaningful changes in the number of suicides, violent deaths, violent hospitalizations, or rates in mental health prescriptions. The analyses highlight how policing and criminalization, institutionalized through Spatial Marking can contribute to inequalities in health. |
| Date: | 2025–12–01 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:jxphb_v1 |
| By: | Nobre, Francisco; Kitsos, Tasos; Tranos, Emmanouil; Donegani, Chiara Paola |
| Abstract: | We focus on the relationship between exposure to gambling shops and gambling-related harms. Gambling is now a public health concern, but its economic geography and associated harms are underexplored. We propose a framework that combines proximity and density, use data on gambling shops matched with surveys and measure the impact of gamblogenic environments on problem gambling using probit models and coarsened exact matching. Living closer to and in high densities of gambling shops, increases the likelihood of gambling and being a problematic gambler. The spatial distribution of gambling venues matters and calls for targeted interventions to mitigate harms. |
| Date: | 2025–12–01 |
| URL: | https://d.repec.org/n?u=RePEc:osf:socarx:uj6y8_v1 |
| By: | Yamey, Gavin; Bharali, Ipchita; Ogbuoji, Osondu |
| Abstract: | The year 2000 marked the start of a period of sustained growth in the amount of annual health aid, but that era is now over. This year, several donors made large cuts in their official development assistance (ODA) for health, accompanied by other shocks to the global health system. While the impact of these aid cuts on public health in recipient countries has received widespread political, advocacy, and media attention, much less attention has been paid to how these declines could affect donors. This lack of attention is probably because there has been surprisingly little empirical research on the benefits of health ODA to donors, so the benefits are poorly understood. In this paper, we therefore set out to examine the research evidence on the impact of health ODA on both recipients and donors. We use the term "mutual interest health ODA" to denote health ODA that has benefits for both recipients and donors. We found evidence that health ODA could mutually benefit recipients and donors and categorized these benefits into (i) health benefits and health-related economic benefits; (ii) economic benefits unrelated to health; and (iii) political benefits. While there is an important ongoing role for health ODA, the rapid changes in global health assistance-including the sharp decline in funding levels-is sparking important discussions about what this role should be and how health ODA should best be targeted. Our review of what the empirical evidence shows on mutual interest health ODA could help to inform these discussions, assisting donor governments in quantifying the value of their health aid investments and helping to shape health aid portfolios in an era of rising fiscal pressures. |
| Keywords: | official development assistance, development assistance for health, health aid, mutual benefits, donor country benefits, recipient country benefits, aid effectiveness |
| JEL: | F35 I10 I15 O19 H87 D64 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:ifwkwp:333886 |
| By: | Srinivas Goli; Nandeen Bhattacharyya; Shalem Balla; Harchand Ram |
| Abstract: | This study analyses the adverse impact of different types of conflicts on child mortality and its mechanisms across a large group of countries. Our analysis pools data from multiple countries and time-points, to provide robust evidence on the relationship between conflict and child health. Geo-referenced data on different types of conflict are linked with the unit level information from Demographic Health Survey datasets, to construct a unique database of 943139 pre-school age children across 52 developing countries over the period 1993-2018. Our analysis exploits the within-country differences in children’s exposure to conflict from in utero to age 5, to estimate its association with mortality outcomes. Our baseline estimate shows the association between conflict exposure and childhood mortality where we found excess mortality in children exposed to conflict. The Cox proportional hazard regression model estimates show that even after controlling for an extensive array of socio-economic and demographic characteristics time and entity-fixed effects, conflict exposure is associated with excess child mortality, across all our measures of conflict. Additional analyses show that probability of dying in the childhood increases with increasing the intensity of exposure to conflict events. Proximate mechanisms explaining excess mortality in children exposed to conflict include poor maternal health outcomes (ANC and Institutional delivery care), child health outcomes (height-for-age and weight-for-age z-scores), and immunization status. These findings are robust across alternative measures of conflict, and sub-samples. Our main findings sustain even after controlling for unobserved heterogeneity and migration history. |
| Keywords: | child mortality, child nutrition, conflict, immunization, maternal health care, multi-country analysis |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:hic:wpaper:446 |
| By: | Dorothee Weiffen; Ghassan Baliki; Tilman Brück; Mariami Marsagishvili |
| Abstract: | Natural disasters, violent conflict and other adverse shocks severely disrupt food systems, causing or exacerbating food insecurity among many communities worldwide. This study examines the impact and mechanisms of an integrated home garden intervention on food security in South Sudan, a context severely affected by conflict, forced displacement, recurrent severe flooding, the COVID-19 pandemic and institutional fragility, where, at baseline, only 29% of households had adequate food consumption. Using a quasi-experimental design with three waves of panel data from 772 households over two years, we find that the intervention increased food security as measured through the Food Consumption Score by 33% after two years (4.4 points, 90% CI [2.8, 6.1], p < 0.01) while significant impacts were absent after one year. Improved nutritional knowledge, increased market-oriented production and, most notably, asset ownership explain 56% of this impact. Our findings demonstrate that home garden interventions are an effective policy tool to improve food access as well as broader resilience-building, supporting economic stabilization and livelihood recovery for highly vulnerable communities in crisis-affected contexts. Given their relatively low cost and high adaptability, home garden interventions merit consideration as a scalable response to persistent food insecurity in crisis settings. |
| Keywords: | conflict, displacement, food security, home garden intervention, humanitarian assistance, polycrisis, resilience |
| JEL: | I31 O12 Q15 Q54 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:hic:wpaper:448 |
| By: | Jirjahn, Uwe; Ottenbacher, Martha |
| Abstract: | Using representative data from Germany, this study compares the role of the Big Five personality traits in the sex life of single and partnered individuals. While extraversion has a positive influence on the sex life of both single and partnered individuals, the influence is much stronger for singles. By contrast, the positive role of conscientiousness in sexual fulfillment is stronger for partnered than for single individuals. Openness to experience and agreeableness play a positive role only in the sex life of partnered individuals. Neuroticism has a detrimental impact on people's sex life with the impact being stronger for singles than for partnered individuals. The empirical findings fit our theoretical considerations. Personality traits play different roles in the sex life of single and partnered individuals as the sexual relationships of these individuals are characterized by different time horizons. |
| Keywords: | Big Five Personality Traits, Casual Sex, Singlehood, Romantic Relationship, Sexual Well-Being, Frequency of Intercourse, Family Economics |
| JEL: | D91 I31 J10 J12 |
| Date: | 2025 |
| URL: | https://d.repec.org/n?u=RePEc:zbw:glodps:1698 |
| By: | Dylan A Mordaunt |
| Abstract: | Health economic evaluations are sensitive to the choice of analytical perspective (e.g., health system vs. societal). While guidelines often recommend specific perspectives, the uncertainty associated with this choice - and the potential decision discordance it creates - is rarely quantified. We present vop_poc_nz, a Python package that implements a framework for Distributional Cost-Effectiveness Analysis (DCEA) and operationalizes the quantification of perspective uncertainty through the Value of Perspective (VoP) metric. The package provides tools for Markov modeling, probabilistic sensitivity analysis, value of information analysis, and equity impact assessment. Unlike existing tools that treat perspective as a fixed input, vop_poc_nz allows for the simultaneous evaluation of multiple perspectives. This enables decision-makers to estimate the opportunity cost of perspective misalignment. We demonstrate the package's capabilities using case studies from Aotearoa New Zealand. |
| Date: | 2025–12 |
| URL: | https://d.repec.org/n?u=RePEc:arx:papers:2512.03596 |
| By: | Herten Crabb, Asha; Yadanar, Yadanar; Wenham, Clare |
| Abstract: | The COVID-19 pandemic momentarily elevated care work - applauded on doorsteps and deemed “essential” by governments - yet this rhetorical visibility stood in stark contrast to its persistent structural invisibility. In the UK, women disproportionately shouldered the burden of social reproduction as healthcare workers, childcare providers, and unpaid carers, all while facing heightened job insecurity, domestic violence, and mental health strain. These patterns, mirrored globally, were exacerbated by policy responses that largely failed to recognise or support unpaid care. Feminist scholars have long shown how health crises, from HIV/AIDS to Ebola, reinforce gendered divisions of labour and marginalise unpaid care, acknowledging it only when instrumental to crisis management. This paper explores how that pattern was reproduced in the UK’s pandemic response, shaped by a decade of austerity and a residual model of care governance. Yet care policy across the UK is not uniform. Drawing on feminist political economy and critical policy analysis, this study compares how the four UK administrations - England, Scotland, Wales, and Northern Ireland - approached unpaid care across four domains of childcare, adult care, workplace flexibility, and public recognition between January 2020 and December 2021. The analysis, based on publicly available policy documents, reveals significant divergence: while Westminster leaned on unpaid care with minimal support, devolved administrations enacted modest redistributive measures. This paper contributes to feminist political economy by mapping how unpaid care was simultaneously essential and expendable in crisis governance, revealing the spatial, institutional, and ideological logics that shape how care is valued, and by whom, in moments of crisis. |
| Keywords: | unpaid care; devolved governance; social reproduction; COVID-19 |
| JEL: | N0 |
| Date: | 2025–12–03 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:130130 |