Showing papers by "Marc Suhrcke published in 2011"

Judging nudging: can nudging improve population health?

Abstract: Nudging has captured the imagination of the public, researchers, and policy makers as a way of changing human behaviour, with both the UK and US governments embracing it. Theresa Marteau and colleagues ask whether the concept stands up to scientific scrutiny

A Cross-Sectional Study of the Microeconomic Impact of Cardiovascular Disease Hospitalization in Four Low- and Middle-Income Countries

Abstract: Objective: To estimate individual and household economic impact of cardiovascular disease (CVD) in selected low- and middle-income countries (LMIC). Background: Empirical evidence on the microeconomic consequences of CVD in LMIC is scarce. Methods and Findings: We surveyed 1,657 recently hospitalized CVD patients (66% male; mean age 55.8 years) from Argentina, China, India, and Tanzania to evaluate the microeconomic and functional/productivity impact of CVD hospitalization. Respondents were stratified into three income groups. Median out-of-pocket expenditures for CVD treatment over 15 month follow-up ranged from 354 international dollars (2007 INT$, Tanzania, low-income) to INT$2,917 (India, high-income). Catastrophic health spending (CHS) was present in .50% of respondents in China, India, and Tanzania. Distress financing (DF) and lost income were more common in low-income respondents. After adjustment, lack of health insurance was associated with CHS in Argentina (OR 4.73 [2.56, 8.76], India (OR 3.93 [2.23, 6.90], and Tanzania (OR 3.68 [1.86, 7.26] with a marginal association in China (OR 2.05 [0.82, 5.11]). These economic effects were accompanied by substantial decreases in individual functional health and productivity. Conclusions: Individuals in selected LMIC bear significant financial burdens following CVD hospitalization, yet with substantial variation across and within countries. Lack of insurance may drive much of the financial stress of CVD in LMIC patients and their families.

The impact of health and health behaviours on educational outcomes in high-income countries: a review of the evidence.

Abstract: While the importance of education is widely appreciated as a public policy priority in industrialized countries and cross-country comparative rankings of educational performance typically provoke major national debates, comparably little attention, outside of health, is paid to the impact of child and adolescent health on education. Part of the reason could be the perception that child health is but a by-product of education rather than a factor that could determine educational outcomes. This report casts doubt on this perception by critically examining the evidence on the effect of health on education in industrialized countries. Based on seemingly under-recognized evidence, our overall finding is that there is reason to believe health does have an impact on education. This finding should serve as a basis for raising the profile of child health in the public policy debate, and by illustrating the potential for mutual gains, it should help stimulate cross-sectoral collaboration between the health and education sectors. Education and health are known to be highly correlated – that is, more education indicates better health and vice versa – but the actual mechanisms driving this correlation are unknown. The effect of health on education has been well researched in developing countries, as has the effect of education on health in both developing and industrialized countries. Such imbalance could signal lack of attention not only in research but also in the public policy debate. While children in developing countries face more serious health challenges than those in industrialized ones, the potentially relevant effect of health on their educations (and perhaps on labour force participation) cannot be ruled out. The analytical framework we used to guide our research posits a path leading from health behaviours (e.g. smoking) and health conditions (e.g. asthma) to educational attainment (level of education) and educational performance (e.g. grades). We searched literature in the fields of health, socioeconomic research, and education and ultimately narrowed our selected publications to 53, all of them based in countries belonging to the Organisation for Economic Co-operation and Development. Based on the evidence reviewed, some of our more important findings are the following. • Overall child health status positively affects educational performance and attainment. For example, one study found that very good or better health in childhood was linked to a third of a year more in school; another concluded that the probability of sickness significantly affected academic success: sickness before age 21 decreased education on average by 1.4 years. • The evidence indicates that the negative effect on educational outcomes of smoking or poor nutrition is greater than that of alcohol consumption or drug use. • Initial research has found a significant positive impact of physical exercise on academic performance. • Obesity and overweight are associated negatively with educational outcomes. • Sleeping disorders can hinder academic performance. • Particularly under-researched, especially considering their growing significance, is the effect of anxiety and depression on educational outcomes. • Asthma on average has not been shown to affect school performance. • The preponderance of research was based in the United States of America, but overall this field has grown markedly since 2001, including in Europe. • From a methodological perspective it is important to note that several papers undertake serious efforts to tackle the challenge of proving causality in the relationship.

The impact of economic crises on communicable disease transmission and control: a systematic review of the evidence.

Abstract: There is concern among public health professionals that the current economic downturn, initiated by the financial crisis that started in 2007, could precipitate the transmission of infectious diseases while also limiting capacity for control. Although studies have reviewed the potential effects of economic downturns on overall health, to our knowledge such an analysis has yet to be done focusing on infectious diseases. We performed a systematic literature review of studies examining changes in infectious disease burden subsequent to periods of crisis. The review identified 230 studies of which 37 met our inclusion criteria. Of these, 30 found evidence of worse infectious disease outcomes during recession, often resulting from higher rates of infectious contact under poorer living circumstances, worsened access to therapy, or poorer retention in treatment. The remaining studies found either reductions in infectious disease or no significant effect. Using the paradigm of the "SIR" (susceptible-infected-recovered) model of infectious disease transmission, we examined the implications of these findings for infectious disease transmission and control. Key susceptible groups include infants and the elderly. We identified certain high-risk groups, including migrants, homeless persons, and prison populations, as particularly vulnerable conduits of epidemics during situations of economic duress. We also observed that the long-term impacts of crises on infectious disease are not inevitable: considerable evidence suggests that the magnitude of effect depends critically on budgetary responses by governments. Like other emergencies and natural disasters, preparedness for financial crises should include consideration of consequences for communicable disease control.

Chronic diseases and labor market outcomes in Egypt

Abstract: By causing a sizeable reduction in employment 6 percent and labor supply 19 percent, chronic diseases are responsible for a major efficiency loss in the Egyptian economy. Furthermore the impact of chronic diseases on the labor market is not uniformly distributed. The older and the less educated suffer a larger drop in the probability of being employed and in their supply of working hours. The authors estimate the reduced form equations of individual employment status, labor supply and the usual wage equation. They control for unobserved ability and individual preferences by means of a within-siblings estimator. Measurement errors in our self-reported health variable have been accounted for.

The influence of social capital on health in eight former Soviet countries: why does it differ?

Abstract: Background Previous research has identified the role of social capital in explaining variations in health in the countries of the former Soviet Union. This study explores whether the benefits of social capital vary among these countries and why. Methods The impact of micro social capital (trust, membership and social isolation) on individual health was estimated in each of eight former Soviet republics using instrumental variables to overcome methodological hazards such as endogeneity and reverse causality. Interactions with institutional variables (voice and accountability, effectiveness of the legal system, informal economy) and social protection variables (employment protection, old age and disability benefits, sickness and health benefits) were examined. Results Most social capital indicators, in most countries, are associated with better health but the magnitude and significance of the impact differ between countries. Some of this variation can be explained by interacting social capital indicators with measures of institutional quality, with membership of organisations bringing greater benefit for health in countries where civil liberties are stronger, whereas social isolation has more adverse consequences where there is a large informal economy. A lesser amount is explained by the interaction of social capital indicators with selected measures of social protection. Conclusion When considering interventions to improve social capital as a means of improving population health, it seems advisable to take into account the influence of macrocontextual variables, in order not to overstate or understate the likely impact of the intervention.

Health inequalities in Europe: new insights from European Labour Force Surveys

Abstract: Background Socio-economic inequalities in health have become a major public health concern in Europe. The measurement of health inequalities over time and across countries does, however, remain a challenge. Previous European evidence found that health inequalities have been increasing in most countries, with greatly varying degrees. Methods The authors use the European Labour Force Survey (ELFS), with its unprecedented coverage of years and countries, as a potential complementary source for the measurement of health inequality. The ELFS provides information on sickness absence or reduced labour supply attributable to ill health. After constructing four separate and one overall health indicator, the authors compute health inequality indices for all countries and years, and analyse their trends. The authors also examine the sensitivity of the health inequality measures to different proxies of socio-economic status and. Results Health inequalities in the working age population have been increasing for several countries, but also decreasing in about as many countries, while they remained stable in a minority of countries. These results are not too sensitive to the various proxies for socio-economic status we employ, but they are sensitive to the specific health indicator from which the inequality index is derived. Conclusions While not without its problems, the ELFS may offer a useful additional and hitherto unexploited resource for the measurement of socio-economic inequalities in health across European countries and over time. Future research should try to understand how and why health inequality trends differ between different surveys as much as they appear to do in light of the present findings.

Gesundheitsökonomische Methoden in der Prävention

Abstract: Die methodischen Grundlagen der gesundheitsokonomischen Evaluation sind weitgehend definiert und vereinheitlicht. Einige Besonderheiten bestehen jedoch bei der Evaluation von Primarpravention und Gesundheitsforderung (gegenuber medizinischen Interventionen). In dem vorliegenden Beitrag werden die spezifischen Anforderungen an die Evaluation von Praventionsprogrammen diskutiert: (1) Aus welcher Perspektive soll Pravention evaluiert werden? (2) Wie und in welchem Umfang sollen die Kosten von gewonnenen Lebensjahren durch Pravention in gesundheitsokonomischen Evaluationen berucksichtigt werden? (3) Soll der Zeitaufwand von Individuen fur Praventionsaktivitaten in den Praventionskosten abgebildet werden? (4) Welche Effekte von Pravention sind aus gesundheitsokonomischer Perspektive relevant? (5) Sollen Auswirkungen auf die Verteilung von Gesundheit ausgewiesen werden, und wenn ja, wie konnen sie berucksichtigt werden?

Chronic Diseases and Labor Market Outcomes in Egypt

Abstract: By causing a sizeable reduction in employment 6 percent and labor supply 19 percent, chronic diseases are responsible for a major efficiency loss in the Egyptian economy. Furthermore the impact of chronic diseases on the labor market is not uniformly distributed. The older and the less educated suffer a larger drop in the probability of being employed and in their supply of working hours. The authors estimate the reduced form equations of individual employment status, labor supply and the usual wage equation. They control for unobserved ability and individual preferences by means of a within-siblings estimator. Measurement errors in our self-reported health variable have been accounted for.

The influence of social capital on health in Eight Former Soviet Countries: why does it differ?

Abstract: Background: Previous research has identified the role of social capital in explaining variations in health in the countries of the former Soviet Union. We explore whether the benefits of social capital vary among these countries and why. Methods: We estimate the impact of micro social capital (trust, membership and social isolation) on individual health in each of eight former Soviet republics using instrumental variables to overcome methodological hazards such as endogeneity and reverse causality. We examine interactions with institutional variables (voice and accountability; effectiveness of the legal system; informal economy) and social protection variables (employment protection; old age and disability benefits; sickness and health benefits). Results: Most social capital indicators, in most countries, are associated with better health but the magnitude and significance of the impact differ between countries. Some of this variation can be explained by interacting social capital indicators with measures of institutional quality, with membership of organisations bringing greater benefit for health in countries where civil liberties are stronger, whereas social isolation has more adverse consequences where there is a large informal economy. A lesser amount is explained by the interaction of social capital indicators with selected measures of social protection. Conclusion: When considering interventions to improve social capital as a means of improving population health, it seems advisable to take into account the influence of macro contextual variables, in order not to over- or understate the likely impact of the intervention.

From social capital to health - and back

Abstract: We assess the causal relationship between health and social capital, measured by generalized trust, both at the individual and the community level. The paper contributes to the literature in two ways: it tackles the problems of endogeneity and reverse causation between social capital and health by estimating a simultaneous equation model, and it explicitly accounts for mis-reporting in self reported trust. The relationship is tested using data from the first four waves of the European Social Survey for 26 European countries, supplemented by regional data from the Eurostat. Our estimates show that a causal and positive relationship between selfperceived health and social capital does exist and that it acts in both directions. In addition, the magnitude of the structural coefficients suggests that individual social capital is a strong determinant of health, while community level social capital plays a considerably smaller role in determining health.