Hurting
Public health expenditures, taxation, and growth
Bebonchu Atems
Health Economics, forthcoming
Abstract:
This note studies the empirical link between public health expenditures and growth using a dynamic panel data model and U.S. state‐level data over the period 1963-2015. We find a positive relationship between public health expenditures and growth, even after controlling for the offsetting impacts of the requisite taxation and the government budget constraint.
Weathering, Drugs, and Whack-a-Mole: Fundamental and Proximate Causes of Widening Educational Inequity in U.S. Life Expectancy by Sex and Race, 1990-2015
Arline Geronimus et al.
Journal of Health and Social Behavior, June 2019, Pages 222-239
Abstract:
Discussion of growing inequity in U.S. life expectancy increasingly focuses on the popularized narrative that it is driven by a surge of “deaths of despair.” Does this narrative fit the empirical evidence? Using census and Vital Statistics data, we apply life-table methods to calculate cause-specific years of life lost between ages 25 and 84 by sex and educational rank for non-Hispanic blacks and whites in 1990 and 2015. Drug overdoses do contribute importantly to widening inequity for whites, especially men, but trivially for blacks. The contribution of suicide to growing inequity is unremarkable. Cardiovascular disease, non-lung cancers, and other internal causes are key to explaining growing life expectancy inequity. Results underline the speculative nature of attempts to attribute trends in life-expectancy inequity to an epidemic of despair. They call for continued investigation of the possible weathering effects of tenacious high-effort coping with chronic stressors on the health of marginalized populations.
Do Stricter Immunization Laws Improve Coverage? Evidence from the Repeal of Non-medical Exemptions for School Mandated Vaccines
Chelsea Richwine, Avi Dor & Ali Moghtaderi
NBER Working Paper, May 2019
Abstract:
Nonmedical exemptions are widely shown to be associated with outbreaks of vaccine-preventable disease. In response to a recent measles outbreak in 2015, California acted to increase immunization coverage by removing all nonmedical exemptions effective in 2016. Employing a unique dataset of county-level vaccination and exemption rates at Kindergarten entry, we exploit the recent policy change in California to estimate the impact of the repeal of nonmedical exemptions on immunization coverage for school-mandated vaccines. Relative to a diverse group of control states, our findings indicate that vaccination coverage increased for all required vaccines following the repeal, ranging from 2.5% for MMR to 5% for Polio. We also find a significant 3.4 percentage-point decline in nonmedical exemptions, accompanied by a 2.1 percentage-point increase in medical exemptions in counties that previously had high rates of nonmedical waivers. Our findings indicate that the repeal of nonmedical exemptions in California was only partially effective in improving vaccination coverage, and may have led parents to substitute between medical and nonmedical exemptions, leading to a net decline in total exemptions of just 1 percentage-point.
The politics hypothesis and racial disparities in infants’ health in the United States
Javier Rodriguez
SSM - Population Health, forthcoming
Abstract:
We propose the politics hypothesis - i.e., the hypothesis that political forces comprise either a powerful predecessor of the social determinants of health or are essential social determinants of health themselves. We examine the hypothesis that political actors like presidents, their ideology, and institutions like the political parties they represent shape overall and race-specific health outcomes. Using census and Vital Statistics data among many other sources, we apply both theory- and data-driven statistical methods to assess the role of the president's party and the president's political ideology as predictors of overall and race-specific infant mortality in the United States, 1965-2010. We find that, net of trend, Republican presidencies and socially-conservative ideology of U.S. presidents are strongly associated with slower declines of infant mortality rates, overall and for white and black infants, compared to Democratic and socially-liberal presidents in the U.S. About half (46%) of the white-black infant mortality gap, about 20,000 additional infant deaths, and most if not all the infant mortality rate gap between the U.S. and the rest of the developed world, can be attributed to the 28 years of Republican administrations during the study period. These findings are consistent with the politicization of public health and the conceptualization of politics as a powerful predecessor, in the causal chain, of the social determinants of health. Understanding the political ideological and institutional contexts in which health policies and healthcare and welfare programs are implemented, as well as how governments construct culture and social psychology, provide a more comprehensive framework for understanding and improving population patterns of disease, mortality, and entrenched racial disparities in health in the U.S.
Place-Based Drivers of Mortality: Evidence from Migration
Amy Finkelstein, Matthew Gentzkow & Heidi Williams
NBER Working Paper, June 2019
Abstract:
We estimate the effect of current location on elderly mortality by analyzing outcomes of movers in the Medicare population. We control for movers' origin locations as well as a rich vector of pre-move health measures. We also develop a novel strategy to adjust for remaining unobservables, based on the assumption that the relative importance of observables and unobservables correlated with movers' destinations is the same as the relative importance of those correlated with movers' origins. We estimate substantial effects of current location. Moving from a 10th to a 90th percentile location would increase life expectancy at age 65 by 1.1 years, and equalizing location effects would reduce cross-sectional variation in life expectancy by 15 percent. Places with favorable life expectancy effects tend to have higher quality and quantity of health care, less extreme climates, lower crime rates, and higher socioeconomic status.
Caveats in science-based news stories communicate caution without lowering interest
Lewis Bott et al.
Journal of Experimental Psychology: Applied, forthcoming
Abstract:
Science stories in the media are strongly linked to changes in health-related behavior. Science writers (including journalists, press officers, and researchers) must therefore frame their stories to communicate scientific caution without disrupting coherence and disengaging the reader. In this study we investigate whether caveats (“Further research is needed to validate the results”) satisfy this dual requirement. In four experiments participants read news reports with and without caveats. In Experiments 1 to 3, participants judged how cautious or confident researchers were, and how interesting or comprehensible they found the reports. News reports with caveats were judged as more cautious that those without, but levels of reader interest and comprehensibility were unaffected. In a fourth experiment, we created a mock newsroom and recruited journalism students to make judgments about which press releases should be published. Here, neither caveats nor the introduction of qualifying expressions in headlines had an effect on judgments of newsworthiness, consistent with Experiments 1 to 3. The reasons participants gave for rejecting a press release rarely referred to the caveat. Our results therefore suggest that science writers should include caveats in news reporting and that they can do so without fear of disengaging their readers or losing news uptake.
Comparison of Cancer Burden and Nonprofit Organization Funding Reveals Disparities in Funding Across Cancer Types
Suneel Kamath, Sheetal Kircher & Al Benson
Journal of the National Comprehensive Cancer Network, July 2019
Background: Nonprofit organizations (NPOs) in oncology are vital for patient advocacy and funding research for rare cancers, young investigators, and innovative projects. However, some cancers may be underfunded relative to their burden. This study examined the alignment of cancer burden by histology with NPO funding for each histology.
Patients and Methods: This nationwide, cross-sectional study conducted from October 2017 through February 2018 included all oncology NPOs with >$5 million in annual revenue. Total revenue from NPOs supporting individual cancer types with the incidence, mortality, and person-years of life lost (PYLL) for each cancer type was compared using scatter plots and Pearson correlation coefficients. Correlation of expenditure types (eg, fundraising, patient education) with revenue was assessed using Pearson correlation coefficients. Effect of disease association with a stigmatized behavior (eg, lung cancer and smoking) was evaluated using descriptive statistics.
Results: A total of 119 cancer-related NPOs were included, generating approximately $6 billion in annual revenue in 2015. Cancers with the largest revenue were breast cancer ($460 million; 33.2%), leukemia ($201 million; 14.5%), pediatric cancers ($177 million; 12.8%), and lymphoma ($145 million; 10.5%). Breast cancer, leukemia, lymphoma, and pediatric cancers were all well funded compared with their incidence, mortality, and PYLL. Gastrointestinal (colorectal, pancreas, and hepatobiliary), gynecologic (ovarian, cervical, and endometrial), brain, and lung cancers were poorly funded in all 3 metrics. All cancers associated with a stigmatized behavior were poorly funded in at least 2 metrics. Increased spending on fundraising, administrative costs, patient education, and treatment was highly correlated with increased revenue (Pearson correlation coefficients all >0.92).
Conclusions: NPO funding by cancer type is not proportionate with individual cancer burden on society. Disease stigma negatively impacts funding. A significant need exists to increase awareness and funding for many undersupported but common and highly lethal cancers.
Reducing Obesity by Taxing Soft Drinks: Tax Salience and Firms’ Strategic Responses
Hualu Zheng, Lu Huang & William Ross
Journal of Public Policy & Marketing, July 2019, Pages 297-315
Abstract:
In the fight against obesity, governments have pursued various policies to increase soda prices in the hope of discouraging consumption. Previous studies examining the efficacy of taxing sodas have generalized sales taxes to other taxes and assumed that imposing a tax is as salient as imposing a direct price hike. In this research, the authors recognize that most consumers do not pay much attention to how taxes differ in application. Thus, the authors disassociate the effects of sales taxes from the effects of direct price increases on soda demand, estimate pass-through rates of excise taxes in the soda market, and compare the efficacy of the two types of tax at three tax levels. They find that, for all three tax levels, imposing an excise tax on sodas drives much steeper declines in overall demand than a sales tax does. The findings suggest that failing to distinguish between tax types leads to a biased estimation of the effect of taxes on soda consumption. This research provides important implications to help policy makers adopt the most applicable tax instrument to battle obesity.
A hypothesis linking the energy demand of the brain to obesity risk
Christopher Kuzawa & Clancy Blair
Proceedings of the National Academy of Sciences, 2 July 2019, Pages 13266-13275
Abstract:
The causes of obesity are complex and multifactorial. We propose that one unconsidered but likely important factor is the energetic demand of brain development, which could constrain energy available for body growth and other functions, including fat deposition. Humans are leanest during early childhood and regain body fat in later childhood. Children reaching this adiposity rebound (AR) early are at risk for adult obesity. In aggregate data, the developing brain consumes a lifetime peak of 66% of resting energy expenditure in the years preceding the AR, and brain energy use is inversely related to body weight gain from infancy until puberty. Building on this finding, we hypothesize that individual variation in childhood brain energy expenditure will help explain variation in the timing of the AR and subsequent obesity risk. The idea that brain energetics constrain fat deposition is consistent with evidence that genes that elevate BMI are expressed in the brain and mediate a trade-off between the size of brain structures and BMI. Variability in energy expended on brain development and function could also help explain widely documented inverse relationships between the BMI and cognitive abilities. We estimate that variability in brain energetics could explain the weight differential separating children at the 50th and 70th BMI-for-age centiles immediately before the AR. Our model proposes a role for brain energetics as a driver of variation within a population’s BMI distribution and suggests that educational interventions that boost global brain energy use during childhood could help reduce the burden of obesity.
The development of executive function in early childhood is inversely related to change in body mass index: Evidence for an energetic tradeoff?
Clancy Blair, Christopher Kuzawa & Michael Willoughby
Developmental Science, forthcoming
Abstract:
A well‐established literature demonstrates executive function (EF) deficits in obese children and adults relative to healthy weight comparisons. EF deficits in obesity are associated with overeating and impulsive consumption of high calorie foods leading to excess weight gain and to problems with metabolic regulation and low‐grade inflammation that detrimentally affect the structure and function of prefrontal cortex. Here, we test a complementary explanation for the relation between EF and body mass index (BMI) grounded in the energy demand of the developing brain. Recent work shows that the brain accounts for a lifetime peak of 66% of resting metabolic rate in childhood and that developmental changes in brain energetics and normative changes in body weight gain are closely inversely related. This finding suggests a trade‐off in early childhood between energy used to support brain development versus energy used to support physical growth and fat deposition. To test this theorized energetic trade‐off, we analyzed data from a large longitudinal sample (N = 1,292) and found that change in EF from age 3 to 5 years, as a proxy for brain development in energetically costly prefrontal cortex, is inversely related to change in BMI from age 2 to 5 years. Greater linear decline in BMI predicted greater linear increase in EF. We interpret this finding as tentative support for a brain-body energetic trade‐off in early childhood with implications for lifetime obesity risk.