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on Health Economics |
| By: | David Card; Ana Rute Cardoso; Pedro Luis Silva |
| Abstract: | In the depths of the 2010 financial crisis the Portuguese government enacted a series of reforms in its prescription drug reimbursement system. Over the next three years value added per pharmacist in retail pharmacies fell by a third, reflecting a rise in generic substitution and reductions in the markups allowed for prescription drugs. This massive shock led to pay cuts for incumbent pharmacists and the introduction of a two-tier pay system for new hires, with little or no reduction in the growth of employment. We use detailed longitudinal records from the Quadros de Pessoal data base, merged with information on collective bargaining settlements and firm financial records, to study the impacts of the reforms. We estimate that between 2009 and 2022 average wages of pharmacists fell by a third; most of this reduction was due to lower wages for newly entering cohorts. The implied responsiveness of wages to productivity is substantially above most estimates in the rent-sharing literature, arguably reflecting the strong attachment of workers to the sector and the steady inflow of newly graduating pharmacists. Stepping back, we then consider how wages of pharmacists have diverged relative to wages of other health care professionals in Portugal, and the decisions of recent college applicants to enter the profession. |
| JEL: | J3 J5 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35553 |
| By: | N. Meltem Daysal; Camille JH. Fredrickson; Ida L. Kristiansen; Mircea Trandafir; Jonathan Zhang |
| Abstract: | We estimate the causal impacts of GLP-1 treatment on labor market outcomes using linked Danish administrative data and a matched stacked difference-in-differences design. We compare patients who initiate GLP-1 treatment during the first two years of Semaglutide availability to observably similar patients who initiate four years later. We find that GLP-1 treatment reduces long-term sickness leave by 17.3%. We estimate total fiscal benefits of GLP-1 initiation of approximately 1.3–1.5% of annual labor income per employed individual. We do not detect statistically significant or economically meaningful impacts on income, labor force participation, or employment over four years. |
| JEL: | H51 I1 I12 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35475 |
| By: | Maurizia Di Buono; Sergio Galletta |
| Abstract: | Using linked Finnish administrative records and a staggered difference-in-differences design, we estimate how starting semaglutide (Ozempic) affects work capacity, measured by medically certified sickness absence. The first purchase is followed by persistent use and improved glycemic control, indicating that recorded purchases correspond to sustained and clinically active treatment. The reduction in sickness absence is near zero during months 0–5, becomes progressively larger thereafter, and is largest during months 12–18. Averaged over event months 0–18, sickness allowance receipt falls by 16.9 percent and compensated days by 14.3 percent relative to pre-treatment means. The decline in full-day sickness absence is not offset by greater reliance on unemployment or partial sickness benefits. The results show that semaglutide improves work capacity and can generate economic benefits beyond its direct effects on metabolic health. |
| Keywords: | semaglutide; GLP-1; blood glucose; sickness absence; social insurance; difference-indifferences; type 2 diabetes |
| JEL: | I12 I18 J21 J22 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:sap:wpaper:wp284 |
| By: | Trevor Fitzgerald; Atul Gupta; Stephen D. Schwab |
| Abstract: | Physicians in the U.S. military health care system are quasi-randomly assigned to combat deployments, leading to gaps of varying durations in their clinical practice. We leverage this unique setting to provide novel causal evidence on skill depreciation (forgetting) and learning-by-doing among physicians. We find robust evidence that readmission rates increase by 48% in the first two months after a surgeon returns from a deployment. However, surgeons return to baseline performance within 6 months of resuming practice. In contrast, obstetricians maintain elevated cesarean section rates for up to 9 months, implying a deeper change in clinical judgment. Finally, we interpret these patterns through the lens of a learning model and estimate learning-by-doing rates for surgeons and obstetricians. A doubling of recent procedure volume reduces readmission and C-section rates by 17% and 11% for surgeons and obstetricians, respectively. |
| JEL: | I10 J24 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35502 |
| By: | Christopher J. Ruhm |
| Abstract: | One way of examining how mental health has changed over time is to use information available in large national surveys. While these survey-based measures are valuable in principle, and have been widely employed in prior research, a number of challenges may limit their practical usefulness or require considerable care in their application. This study uses data on U.S. 18-64 year olds from five major household surveys over the period 1999-2019 to investigate three specific questions. First, do different measures or the same indicator from different data sets consistently show how mental distress has changed over time? Second, how does the performance of single-item measures compare to those of psychometrically validated screeners based on multiple questions? Third, what are the benefits or potential costs of using different functional forms of these measures? The answers to these questions are as follows: 1) the estimated trends vary, often dramatically, across measures and, for the same indicator, across data sets and, as a result, some proxies provide a misleading understanding of how mental health has changed over time; 2) the single-item measures do as well or better than those based on multiple questions; 3) no single functional form demonstrates clear superiority over the others. After demonstrating these points, lessons are elucidated for researchers attempting to use survey data to examine trends in mental health. |
| JEL: | I1 I10 I19 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35480 |
| By: | Bjorkegren, Evelina (Stockholm University); Bütikofer, Aline (Norwegian School of Economics); Conti, Gabriella (University College London); Palme, Marten (Stockholm University); Salvanes, Kjell (Norwegian School of Economics) |
| Abstract: | This study examines the long-term consequences of neonatal health using three birth measures — weight, length, and head circumference. Using linked Swedish and Norwegian population registers with follow-up into adulthood, we compare birth measures of singletons and twins, and find that different birth measures capture distinct aspects of fetal development with varying predictive validity across outcoms. Birth length emerges as the strongest predictor of health outcomes, consistent with its role as a cumulative indicator of skeletal growth throughout gestation. Birth weight retains stronger associations with cognitive and educational outcomes (grade point average [GPA], years of schooling). Head circumference shows weak and inconsistent associations across specifications. Using within-pair head circumference differences to classify twins as symmetrically versus asymmetrically growth restricted, we find that symmetric intrauterine growth restriction is associated with substantially worse long-term outcomes than asymmetric restriction. We also document significant intergenerational transmission of birth anthropometrics. Exclusive reliance on birth weight may obscure important information about early developmental insults. |
| Keywords: | birth weight, birth length, head circumference, twin studies, fetal origins, intrauterine growth restriction, linkage to administrative data |
| JEL: | I14 I12 J13 J24 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18897 |
| By: | Ian McCarthy; Seth Richards-Shubik |
| Abstract: | Buyers of complex goods and services often rely on the advice of expert intermediaries who are themselves imperfectly informed about the quality of the available options. How well do these intermediaries learn about that quality and act on it? We study this question in the setting of referrals from primary care physicians (PCPs) to specialists, using data on 4.5 million joint replacement surgeries for Medicare beneficiaries. We first document substantial heterogeneity in specialist quality and costs within geographic markets, and we present design-based evidence showing that PCPs adjust their referrals specifically based on the outcomes of their own patients. We then employ a structural learning model of PCP referral choices to quantify the losses from informational frictions and to simulate possible reallocations with improved information. Beyond learning, the model also accounts for limitations on possible reallocations due to habit persistence and capacity constraints. We find that about one-quarter of patients would be referred to a different specialist in the absence of informational frictions, with small but meaningful improvements in patient outcomes. |
| JEL: | D83 I11 I18 L15 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35486 |
| By: | Jimena S. Ferraro (Universidad de San Andrés); Raul A. Sosa (Universidad de San Andrés); Franco M. Vazquez (Universidad de San Andrés) |
| Abstract: | Cesarean rates differ sharply between private and public hospitals in Buenos Aires, even though payments do not vary with delivery mode in either sector. We argue this gap reflects organizational design rather than procedure prices. In the Buenos Aires metropolitan area, individualized private and team-based public maternity care coexist within the same labor market. Using ex ante preferences and medical records for low-risk first-time mothers, we document a preference margin and a timing margin. Stated preferences for cesarean predict scheduled procedures strongly in private hospitals and not at all in public ones. Elective cesareans in private hospitals cluster on boundary working days (the Monday or Friday adjacent to a weekend or holiday), and the intrapartum cesarean rate is about 13 percentage points higher on working than nonworking days in private hospitals, but indistinguishable from zero in public ones, a gradient that reflects selection induced by the timing margin. A simple model rationalizes both margins through the opportunity cost of physician time, internalized only when physicians are residual claimants of their own schedule. Organizational design, not procedure prices, is the primary lever behind the discretionary component of cesarean use. |
| Keywords: | cesarean section, physici anagency, organizational design, birth timing, maternity care, mixed health systems. |
| JEL: | I11 I18 L23 J22 J44 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:sad:wpaper:184 |
| By: | Panle Jia Barwick; Anran Li; Tianli Xia; Shizhe Yu |
| Abstract: | The No Surprises Act (NSA) capped patients' liability for surprise bills and established federal final-offer arbitration for insurer–provider payment disputes. Linking arbitration records to the national longitudinal provider-insurer network panel and plan design data in the ACA marketplace, we find that the NSA reduced provider network participation in the specialties and states most affected by the reform, contrary to the standard prediction that removing balance billing makes network participation more attractive. The decline is consistent with arbitration strengthening providers' outside option: arbitration is high-volume and provider-favorable, with awards well above the statutory benchmark; and network participation declines after provider groups' first favorable arbitration outcomes. Suggestive evidence indicates that insurers more exposed to arbitration raise premiums. These results reveal an unintended consequence of the NSA: the law's direct consumer protections may be accompanied by narrower networks and higher premiums. |
| JEL: | D82 I1 I11 I13 I18 L10 L14 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35717 |
| By: | Lawrence Jin; Donald S. Kenkel; Alan D. Mathios; Grace N. Phillips; Revathy Suryanarayana; Hua Wang |
| Abstract: | With the growth of sales of e-cigarettes and other alternative nicotine products, governments face the new challenge of crafting public health messages that provide information to consumers about these less risky but not risk-free products. Bayesian learning serves as the theoretical framework for our analysis of how smokers form their perceptions of the risks of e-cigarettes based on the risks of smoking. This paper consists of two parts. First, we conduct a cross-country descriptive analysis of government messaging and smokers’ perceptions of e-cigarette risks. We study a diverse group of eight countries: Australia, China, Indonesia, Japan, Malaysia, Sweden, the U.K. and the U.S. We find that public health messages range widely across the countries. In online cross-country surveys of adult smokers, on average perceptions of e-cigarette risks are associated with their perceptions of the risk of smoking and with their countries’ messaging. Notably, in all eight countries many smokers incorrectly believe that e-cigarettes are relatively more harmful than smoking and over-estimate the absolute risks of e-cigarettes. In the second part of our study, we report the results of online randomized experiments that compare the effects of different e-cigarette risk messaging about an outbreak of lung injuries (given the acronym EVALI). The U.K. public health message about the low risk of e-cigarettes relative to smoking reduced smokers’ incorrect risk perceptions, while the U.S. public health message increased incorrect risk perceptions. |
| JEL: | I12 I18 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35724 |
| By: | Peter Haan (DIW Berlin, FU Berlin, Berlin School of Economics); Julia Schmieder (Otto von Guericke University Magdeburg, RFBerlin); Izabela Wnuk-Soares (RFBerlin, DIW Berlin) |
| Abstract: | We study how immigration affects prices through changes in labor supply. Using policy-driven increases in immigration to Germany and administrative data covering the universe of nursing homes, we find that one additional foreign-born woman per 100 residents reduces nursing-home care prices by 2.6 percent. The price effects are concentrated in more competitive markets. Examining potential mechanisms, we find that immigration lowers labor costs as nursing homes shift toward lower-paid foreign-born workers. We find no evidence of declines in inspection-based measures of quality or of scale effects. Finally, immigration increases the use of informal care, potentially strengthening competitive pressure from the broader care market. |
| Keywords: | immigration; labor supply; prices; nursing homes; |
| JEL: | J61 F22 J30 |
| Date: | 2026–09–09 |
| URL: | https://d.repec.org/n?u=RePEc:rco:dpaper:585 |
| By: | Costa-Font, Joan; Saenz De Miera Juarez, Belen |
| Abstract: | We examine the impact of a statutory reduction in working time (WTR) on overweight and obesity among white- and blue-collar workers in a large French firm. The firm implemented a 35-hour workweek one year prior to the national reform in all regions except Alsace–Moselle, where statutory WTR were smaller and working-time norms differ. We find that the WTR had heterogeneous effects across workers. Among blue-collar employees, the reform increased the likelihood of being overweight by 6.7 percentage points and reduced obesity by 2.6 percentage point. Heterogeneity by baseline BMI indicates that the increase in overweight among blue-collar workers is driven by individuals initially of normal weight. In contrast, among white-collar workers, individuals who were overweight or obese at baseline exhibit significant reductions in overweight. Overall, the results suggest that the effects of WTR vary systematically with the level of occupational sedentariness. |
| Keywords: | overweight;obesity;statutory working times;difference-in-differences;blue collar;white collar;Body Mass Index |
| JEL: | I12 J22 J28 |
| Date: | 2026–08–24 |
| URL: | https://d.repec.org/n?u=RePEc:ehl:lserod:140426 |
| By: | Fan, Junwei (University of Glasgow); Montoya-Blandon, Santiago (University of Glasgow); Proto, Eugenio (University of Glasgow) |
| Abstract: | We examine how social comparison within endogenously formed peer networks affects different measures of young adult mental health. Using over 2 million smartphone-based communication records from the NetHealth Study, we construct objective social networks among university students and estimate a structural model in which individuals choose their peers and mental health depends on the income of chosen peers. When networks are treated as exogenous, higher average peer income predicts better mental health; once network formation is modelled endogenously, the relationship reverses: exposure to higher-income peers significantly worsens depressive symptoms. Income gaps harm mental health in both directions, consistent with inequality aversion rather than relative deprivation. The reversal survives extending binary links to message-weighted networks, and counterfactual exercises show that policies reducing the volume of messages exchanged with peers improve mental health, increasingly so with the size of the reduction, though the effect of targeted reductions depends on which ties are attenuated. Ignoring endogenous peer selection can thus yield qualitatively misleading conclusions about peer effects on mental health. |
| Keywords: | social networks, relative status, mental health, network formation |
| JEL: | D63 D85 D91 I14 I31 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:iza:izadps:dp18899 |
| By: | Hamid Noghanibehambari; Jason Fletcher |
| Abstract: | Many previous studies have used cross-cohort comparisons and a focus on in utero exposure to document the lingering effects of the 1918 influenza pandemic on survivors’ outcomes later in life. A subset has examined impacts on old-age health and mortality, finding mixed results. This paper contributes to the literature by extending the analysis to evaluate early-life and childhood exposure to the pandemic on old-age longevity along with a set of candidate mechanisms. We employ Social Security Administration death records linked to the full-count 1940 census and employ event-study and difference-in-difference regressions to compare longevity of cohorts with different age-at-exposure who were born in cities with high versus low exposure based on 1918 influenza-related mortality. Our treatment-on-treated calculations suggest that cohorts with age-at-exposure of 3-8 and 9-11 experience 6.4 and 11.2 months reductions in old age longevity; importantly, we note that these cohorts are often used as “controls” in the broader literature. While our main analysis focuses on males due to data constraints, supplementary results suggest smaller and less precise effects for females. An analysis of census data suggests reductions in health, education and socioeconomic scores as potential mechanisms. |
| JEL: | I1 J10 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35471 |
| By: | Karen Mulligan; Drishti Baid; Jason N. Doctor; Darius N. Lakdawalla |
| Abstract: | Health technology assessment bodies and policymakers have grappled with the issue of whose preferences – the general healthy population or the patient population – should be incorporated into traditional cost-effectiveness analysis. This debate arises because healthy individuals and patients often value the same health state differently, and cost-effectiveness will undervalue health-related quality of life (HRQoL) for individuals with chronic illness or disability because it cannot account for adaptation. Prospect theory (PT) provides a framework that permits adaptation since it assumes individuals evaluate outcomes relative to a reference point. We estimate utility over HRQoL in a PT framework in a nationally representative U.S. population and compare directly with utility estimates in an EU framework from the same population. Consistent with previous studies in the monetary and health domains, we find evidence of probability weighting bias and loss aversion over health. Using the PT utility estimates, we demonstrate how PT can be incorporated into healthcare value assessment and present the resulting implications for medical decision making. |
| JEL: | D9 I1 I3 |
| Date: | 2026–08 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35666 |
| By: | Hyeran Chung; Haena Lee; Sita Slavov |
| Abstract: | Health shocks are a major driver of retirement. However, the existing literature on this topic tends not to consider the marital context in which retirements occur. Using the 1992-2022 Health and Retirement Study and staggered difference-in-differences methods, we investigate how spousal health shocks impact retirement transitions. We also investigate whether these effects differ by gender and health insurance status. We consider multiple definitions of health shocks, including self-reported health declines, additional diagnoses, hospitalizations, increases in out-of-pocket medical spending, and functional deterioration. Our results suggest that the probability of retirement increases by 1.2 to 1.3 percentage points (12 to 13 percent) after a spouse’s new health condition diagnosis or hospitalization. These retirements tend to occur earlier than anticipated. They also tend to be concentrated among women and respondents with employment-based health plans that include retiree coverage for their spouse. |
| JEL: | D13 D15 I10 J14 J26 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35477 |
| By: | Hamid Noghanibehambari; David Slusky; Erdal Tekin; Hoa Vu |
| Abstract: | We examine whether expanded legal access to the contraceptive pill for minors generated health benefits for subsequent generations. We use data from the restricted-use Natality files from 1970-2020, linking mothers to the level of access to the pill in their state and year of birth and the extent to which their mothers could access the pill as minors. Our results show that children whose mothers were born after expanded access to the pill as minors had better birth outcomes, with gains concentrated among Black families. Among affected births, legalization increased birth weight by 12-16 grams and reduced incidence of low birth weight by 2.7-3.4 percent. These magnitudes have economic significance, corresponding to approximately $113.8–$115.3 million in medical cost savings, measured in 2025 dollars, for the 2000 Black birth cohort alone. Our mechanism analysis points to a postponement of early childbearing by the generation directly affected by legal access to the pill as minors whose daughters subsequently attained higher levels of education, used more prenatal care, and had longer birth spacing. Taken together, our results suggest that reproductive health policy can generate multigenerational benefits and contribute to reductions in racial disparities in early-life health. |
| JEL: | H75 I12 I18 J13 J16 J18 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35722 |
| By: | Maria Dieci; Paul Gertler; Jonathan T. Kolstad; Carlos Paramo |
| Abstract: | Unnecessary treatment reflects a gap between what patients believe about their health and their true condition; people often seek and consume care for diseases they suspect, but do not know that actually have. The value a patient places on testing therefore depends on their priors about being sick, and when those beliefs are biased, the resulting testing rate might be sub-optimal and leave welfare on the table. We study diagnosis-contingent incentive contracts, which tie treatment incentives to diagnostic results. For malaria, the contract subsidizes rapid diagnostic tests (RDTs) and antimalarials (ACTs) only for patients who test positive. In a cluster-randomized experiment across 140 Kenyan pharmacies, both patient subsidies and provider incentives roughly tripled testing and sharply reduced unnecessary ACT purchases among test-negative patients, working through distinct channels: patient subsidies through lower prices, provider incentives through information and advice. A model of patient choice implies these contracts raise social welfare well above their cost. Estimating the model structurally, we find that because patients substantially overestimate their infection risk, loading incentives onto diagnosis-contingent treatment discounts delivers four times the welfare gains of free testing programs. |
| JEL: | I11 O15 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35543 |
| By: | Agar Brugiavini; Ludovico Carrino; Gloria Moroni; Rinaldo Naci; Giacomo Pasini |
| Abstract: | This chapter examines the incidence and economic burden of cognitive impairment among older individuals in Italy within the long-term care (LTC) system. Using SHARE Wave 9 data (2022), cognitive impairment is measured through standardized memory and numeracy tests, classifying 8.6% of individuals aged 65+ as cognitively impaired. Cognitive decline rises sharply with age and is strongly associated with higher care needs, particularly intensive formal care. While both physically and cognitively impaired individuals rely heavily on informal care, cognitively impaired individuals receive substantially more hours of care. Total LTC costs amount to $35.3 billion (1.66% of GDP), with cognitively impaired individuals accounting for the largest share of expenditures. Informal care represents a greater financial burden than formal care across all groups. The findings highlight significant unmet care needs and underscore the urgent necessity of policy reforms and healthy ageing strategies to ensure LTC sustainability. |
| JEL: | D10 I13 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35441 |
| By: | Gabriel Facundes Monteiro; Edson R. Severnini |
| Abstract: | Transportation is a major source of greenhouse gas and air pollution emissions worldwide, with most automobile pollution coming from vehicles older than 10 years. Yet, many policies discourage the removal of older vehicles from the fleet, with potential consequences for pollution and public health. This paper examines an equity-motivated anti-scrappage policy in Brazil using a border-pair design that exploits state variation in the age thresholds for vehicle ownership tax exemptions. Using municipality-level vehicle registration data from 2013-2020, we find that lower exemption age thresholds increase the average fleet age by up to one year, as they encourage owners to retain vehicles until they qualify for tax exemptions. Using fleet- and satellite-based estimates of pollution and administrative health data, we show that these policies increase on-road CO2 emissions per capita by up to 23% and PM2.5 concentrations by 4%, while deteriorating infant health outcomes. Leveraging state reforms that raised exemption ages, we find evidence that incumbents face greater electoral penalties wherever a greater share of the vehicle fleet re-enters the tax base, consistent with a “political environmental trap.” Within an MVPF framework, we find that lowering the exemption age by five years generates a net welfare loss of $0.78 for every $1 of forgone government revenue. |
| JEL: | H23 I18 Q53 Q56 Q58 |
| Date: | 2026–09 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35713 |
| By: | Gaia Bagnasco; Pieter Bakx; Stijn Coremans; Bram Wouterse |
| Abstract: | We analyze the association between cognitive impairments and long-term care use in the 65+ population in the Netherlands. For this, we use data from the Lifelines Cohort Study that are linked to administrative records available through Statistics Netherlands. We find that, among those with cognitive impairments, long-term care use is concentrated in a subgroup: 42% of those with cognitive impairments do not use any long-term care. At the same time, individuals with cognitive impairments who use long-term care have high expenditures, in particular when living in nursing homes. Further analyses reveal that many individuals with cognitive impairments report functional limitations and that cognitive impairment is associated with long-term care use above and beyond these impairments. These findings highlight the importance of taking cognitive impairments into account when seeking to explain the determinants of long-term care use in research and when tailoring long-term care programs to the needs of the elderly when considering policy reforms. |
| JEL: | I10 |
| Date: | 2026–07 |
| URL: | https://d.repec.org/n?u=RePEc:nbr:nberwo:35538 |
| By: | Arlette Simo Fotso (INED - Institut national d'études démographiques, CEPED - Centre Population et Développement - INED - Institut national d'études démographiques - IRD - Institut de Recherche pour le Développement - UPD5 - Université Paris Descartes - Paris 5); Jacob Martin (INED - Institut national d'études démographiques); Florian Bonnet (INED - Institut national d'études démographiques) |
| Abstract: | The World Health Organization estimates that that the highest prevalence of disability among individuals below age 60 is observed in sub-Saharan Africa. Yet, knowledge of disability remains limited in the region, which is partly due to the lack of robust and comparable measurements of disability. In Sub-Saharan Africa, sub-national and comparable estimates of disability prevalence are limited. This paper aims to use comparable sources of data to estimate and construct an atlas of sub-regional disability prevalence. We take data from the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys which use the Washington Group on Disability Statistics short set of questions, which is designed to be a 'culturally neutral' disability screening tool. The questionnaire assesses limitations across six functional. We have data for a total of 26 Sub-Saharan African countries which were collected between 2016 and 2022. We aim to estimate the age-specific prevalence of functional limitation in the population aged 18-49 at the second subnational administrative division level in each country. Given the instability of direct estimates at the subnational level, we use recently developed small area estimation techniques that borrow strength over age and space. From our estimates we compute age standardized prevalences of limitation to facilitate comparison between regions and countries. Preliminary results show large heterogeneity between and within countries, but the amount of within-country differences varies from country to country. Overall, we found 682 subnational entities with age standardized disability prevalence significantly above 2.5%, 233 above 5%, and 31 above 10%. |
| Date: | 2026–06–03 |
| URL: | https://d.repec.org/n?u=RePEc:hal:journl:hal-05716140 |
| By: | OECD |
| Abstract: | This paper examines the main drivers of homelessness and housing exclusion by bringing together evidence from the academic literature on homelessness and cross-national data on past housing difficulties. Research confirms that homelessness is a complex, multifaceted phenomenon shaped by the interaction of structural, systemic and individual factors. Poverty and adverse economic conditions emerge as fundamental drivers, alongside housing market pressures in some country contexts. Family conflict and relationship breakdown represent persistent pathways into homelessness, while health conditions tend to increase vulnerability rather than act as sole triggers. Survey evidence highlights that less visible forms of “hidden homelessness, ” particularly temporary stays with family and friends, are more widespread than rough sleeping or shelter stays, but remain under-researched. The paper identifies remaining knowledge gaps, including limited geographic coverage and a high prevalence of unspecified causes, underscoring the need for improved data that can inform more targeted and preventative public policies. |
| JEL: | I38 R21 R31 D31 J68 |
| Date: | 2026–09–11 |
| URL: | https://d.repec.org/n?u=RePEc:oec:elsaab:336-en |