Income Inequality and Mortality: A Norwegian Perspective*

While Norway has experienced income growth accompanied by a large decline in mortality during the past several decades, little is known about the distribution of these improvements in longevity across the income distribution. Using municipality‐level income and mortality data, we show that the stark income gradient in infant mortality across municipalities in the 1950s mostly closed in the late 1960s. However, the income gradient in mortality for older age categories across municipalities persisted until 2010 and only flattened thereafter. Further, the infant mortality gap between rich and poor Norwegian families based on individual‐level data persisted several decades longer than the gap between rich and poor municipalities and only finally closed in the early 21st century.     

Gender and Age Differences in Socio‐economic Inequalities in Total and Avoidable Mortality in Portugal: A Trend Analysis*

The purpose of this paper is to analyse how socio‐economic inequalities in mortality (total and avoidable) evolved in Portugal from the 1990s onwards by looking at differences by gender, age group, poverty and cause of death. Results show that mortality in younger age groups is decreasing faster in the most deprived municipalities. Yet, avoidable deaths do not follow this pattern, particularly with respect to treatable mortality amenable to the health care services. Although total and avoidable mortality are decreasing across all age groups and both genders, decreases in treatable deaths during and after the 2011–14 economic crisis slowed down among the young, with a sharpening of socio‐economic inequalities in avoidable mortality among adults and the elderly. This provides evidence that, in some respects, focusing programmes on those living in poor circumstances has been successful over time. However, the impact of the Great Recession on health care services might have contributed to a significant increase in some treatable causes of death associated with these services.     

Sovereign credit ratings during the COVID-19 pandemic

Using 603 sovereign rating actions by the three leading global rating agencies between January 2020 and March 2021, this paper shows that the severity of sovereign ratings actions is not directly affected by the intensity of the COVID-19 health crisis (proxied by case and mortality rates) but through a mechanism of its negative economic repercussions such as the economic outlook of a country and governments' response to the health crisis. Contrary to expectations, credit rating agencies pursued mostly a business-as-usual approach and reviewed sovereign ratings when they were due for regulatory purposes rather than in response to the rapid developments of the pandemic. Despite their limited reaction to the ongoing pandemic, sovereign rating news from S&P and Moody's still conveyed price-relevant information to the bond markets.     

Communicating with the public during health crises: experts' experiences and opinions

Governments and health agencies worldwide are planning for a potential influenza pandemic. Their plans acknowledge the importance of public communication during an outbreak and include related guidelines and strategies. Emerging infectious disease (EID) communication is a new addition to the literature, drawing on health promotion communication, crisis communication and environmental/technological risk communication. This paper adds to the literature, exploring the notion of ‘effective communication during health crises' by reporting on interviews with 22 public health officials, scientists and communications professionals responsible for communicating with the public. When analyzed in the context of the risk communication literature, the interviews reveal several considerations for health risk communicators. First, given the important role that mass media will play in an EID outbreak, there is an urgent need for public health to build partnerships with journalists based on an understanding of the two parties' unique societal roles. Second, seemingly practical communications considerations – such as how certain to be about information before sharing it and whether to engage in two‐way communication with the public – have ethical dimensions that deserve attention. Third, there are unique challenges associated with communicating uncertainty, which would benefit from an exploration of the role of trust in health crisis communication.     

Risk communication and social media during food safety crises: a study of stakeholders’ opinions in Ireland

Social media is a particular communication platform which has witnessed an exponential growth in use and influence in recent years, democratising the communication process, and offering risk communicators a way of putting into practice those principles which are advocated to be at the core of risk management and communication. However, little is known about stakeholders’ willingness to embrace this new form of communication in a food crisis. The current study presented an exploratory investigation of the opinions of Irish stakeholders on the position of risk communication in a crisis, with a particular focus on understanding what application social media may have. In-depth one-to-one interviews were carried out with key stakeholders holding frontline positions in managing and communicating about risk in the food sector in Ireland. The stakeholders identified risk communication as a central activity in a food safety crisis, driven by an obligation to protect both consumer health and the reputation of the Irish food sector. Stakeholders relied primarily on risk communication to disseminate information in a crisis so to educate and inform the public on a risk and to prevent confusion and alarmism; most did not explicitly value two-way risk communication in a crisis. The ability to effectively manage future crises may depend on stakeholders’ willingness to adapt to the changing communication landscape, namely – their willingness to adopt social media and use it effectively. The findings indicate that the stakeholders interviewed are appreciative of the need to engage with social media in times of a food safety crisis. However, most valued social media as a one-way channel to help spread a message and there was little reference to the interactive nature of this medium. Implications for integrating social media into crisis risk communication strategies are discussed.     

COVID-19 and Ethnic Inequalities in England and Wales*

The economic and public health crisis created by the COVID-19 pandemic has exposed existing inequalities between ethnic groups in England and Wales, as well as creating new ones. We draw on current mortality and case data, alongside pre-crisis labour force data, to investigate the relative vulnerability of different ethnic groups to adverse health and economic impacts. After accounting for differences in population structure and regional concentration, we show that most minority groups suffered excess mortality compared with the white British majority group. Differences in underlying health conditions such as diabetes may play a role; so too may occupational exposure to the virus, given the very different labour market profiles of ethnic groups. Distinctive patterns of occupational concentration also highlight the vulnerability of some groups to the economic consequences of social distancing measures, with Bangladeshi and Pakistani men particularly likely to be employed in occupations directly affected by the UK's ‘lockdown’. We show that differences in household structures and inequalities in access to savings mean that a number of minority groups are also less able to weather short-term shocks to their income. Documenting these immediate consequences of the crisis reveals the potential for inequalities to become entrenched in the longer term.     

A new method for early detection of mass concern about public health issues

During a public health crisis, risk communication professionals and other risk managers need timely and reliable information about the public reaction as soon as possible in order to effectively carry out their responsibilities. Based on a data-set of microblog news posts, this article presents a method that can forecast to what extent news about a public health issue will be disseminated. The study makes advances in rapidly tracking citizens’ reaction towards public health issues by monitoring news media on microblog sites. The findings show that the proposed method can detect early on the intensity of social reaction on a public health issue as well as provide alert signals. The method can also complement existing risk detection systems and help in the design of other powerful risk analytics tools.     

Do Macroeconomic Crises Always Slow Human Capital Accumulation?

The impact of macroeconomic crises on the investments made byparents in the human capital of their children is a questionof considerable policy importance. Analysis of the effects ofthe profound 1988–92 macroeconomic crisis in Peru on theschooling and employment decisions of school-age children inurban areas finds no effect on attendance rates but a significantdecline in the fraction of children who are both employed andattend school. It also finds significantly higher mean educationalattainment for children exposed to the crisis than for thosewho were not. These findings may be related: Children who arenot employed have more time available and may therefore putmore effort into school.     

The evolution of death rates and life expectancy in Denmark

From 1835 to date Denmark has experienced an increase in life expectancy at birth of about 40 years for both sexes. Over the course of the last 170 years, life expectancy at birth has increased from 40 to 80 years for women and from 36 to 76 years for men, and it continues to rise. Using a new methodology, we show that about half of the total historic increase can be attributed to the sharp decline in infant and young age death rates up to 1950. However, life expectancy gains from 1950 to date can be primarily attributed to improvements in the age-specific death rates for the age group from 50 to 80, although there is also a noticeable contribution from the further decline in infant mortality over this period. With age-specific death rates up to age 60 now at a very low absolute level, substantial future life expectancy improvements must necessarily arise from improvements in age-specific death rates for ages 60 and above. Using the developed methodology, we quantify the impact of further reductions in age-specific mortality. Despite being one of countries with the highest life expectancy at the beginning of the 20th century, and despite the spectacular historic increase in life expectancy since then, Denmark is, in fact, lagging behind compared to many other countries, notably the other Nordic countries. The main reason is an alarming excess mortality for cause-specific death rates related to ischaemic heart diseases and, in particular, a number of cancer diseases. Age-specific death rates continue to improve in most countries, and a likely scenario is that in the future Denmark will experience improvement rates at the international level or perhaps even higher as a result of a catch-up effect.     

Investor attention and global market returns during the COVID-19 crisis

The financial market response to the COVID-19 pandemic provides the first example of a market crash instigated by a health crisis. As such, the crisis provides a unique setting in which to examine the market response to changes in investor attention. We utilise Google search volume (GSV) as a proxy for investor attention. GSV for the “coronavirus” keyword increases markedly from late-February and peaks in mid-March before declining substantially. Our results are broadly consistent with Da, Engelberg, and Gao (2015), indicating that GSV is primarily a proxy for the attention of retail investors and confirming that investor attention negatively influences global stock returns during this crisis period. A rise in the number of internet searches during the COVID-19 crisis induces a faster rate of information flow into financial markets and so is also associated with higher volatility. The identified relationships are economically and statistically significant even after controlling for the number of COVID-19 cases and macroeconomic effects. Increases in GSV have less impact on government bond yields where the limited role of GSV is likely due to lower participation of retail investors. The results suggest that, rather than searching for information on potential stocks to buy (Barber & Odean, 2008), retail investors are searching for information to resolve uncertainty about household FEARS (Da et al., 2015) during the COVID-19 crisis.     

The British 2001 Foot and Mouth crisis: a comparative study of public risk perceptions,trust and beliefs about government policy in two communities

This mixed methodology study examines public attitudes to risk and its management during the 2001 Foot and Mouth Disease (FMD) epidemic in Britain. A quantitative survey and qualitative focus groups were conducted to examine how two communities (Norwich and Bude) responded to the crisis. People were more concerned about a broad range of indirect consequences than about the direct (health) impacts of the disease, especially about the effects on the livelihood and future of rural economies. Moreover, people detected a complex of causes underlying the emergence of FMD, which suggests that the outbreak of FMD was considered a system failure, rather than something that could be blamed on one specific cause or actor. In general, people appeared to be critical about governmental handling of the FMD epidemic. Although there was some support for the government policy of slaughtering infected animals, the government was widely criticized for the way they carried out their policies. Only minor differences between the two communities Norwich and Bude were found. In particular, differences were found related to the government handling of the disease, reflected most notably in people's trust judgements. It is argued that these were the result of contextual differences in local experience, and debate on the crisis, in the two communities.     

What health care cost crisis?

Managed care has inherent limitations that, perhaps out of desperation for some degree of control of health care costs, we tend to disregard. A better understanding of the "crisis" and a host of new strategies become apparent when we separately consider the health care elements and cost elements of the crisis. Managed care is essentially palliative in that it eases symptoms without curing conditions. While this is not a call for the abandonment of managed care, it is a warning that our efforts will prove futile if we do not also address other fundamental elements of impaired health.     

Immediate Annuity Pricing in the Presence of Unobserved Heterogeneity

Abstract

One of the acknowledged difficulties with pricing immediate annuities is that underwriting the annuitantis life is the exception rather than the rule. In the absence of underwriting, the price paid for a life-contingent annuity is the same for all sales at a given age. This exposes the market (insurance company and potential policyholder alike) to antiselection. The insurance company worries that only the healthiest people choose a life-contingent annuity and therefore adjust mortality accordingly. The potential policyholders worry that they are not being compensated for their relatively poor health and choose not to purchase what would otherwise be a very beneficial product.

This paper develops a model of underlying, unobserved health. Health is a state variable that follows a first-order Markov process. An individual reaches the state “death” either by accident from any health state or by progressively declining health state. Health state is one-dimensional, in the sense that health can either “improve” or “deteriorate” by moving farther from or close to the “death” state, respectively. The probability of death in a given year is a function of health state, not of age. Therefore, in this model a person is exactly as old as he or she feels.

I first demonstrate that a multistate, ageless Markov model can match the mortality patterns in the common annuity mortality tables. The model is extended to consider several types of mortality improvements: permanent through decreasing probability of deteriorating health, temporary through improved distribution of initial health state, and plateau through the effects of past health improvements.

I then construct an economic model of optimal policyholder behavior, assuming that the policyholder either knows his or her health state or has some limited information. the value of mortality risk transfer through purchasing a life-contingent annuity is estimated for each health state under various risk-aversion parameters. Given the economic model for optimal purchasing of annuities, the value of underwriting (limited information about policyholder health state) is demonstrated.     

COVID-19 and Inequalities*

This paper brings together evidence from various data sources and the most recent studies to describe what we know so far about the impacts of the COVID-19 crisis on inequalities across several key domains of life, including employment and ability to earn, family life and health. We show how these new fissures interact with existing inequalities along various key dimensions, including socio-economic status, education, age, gender, ethnicity and geography. We find that the deep underlying inequalities and policy challenges that we already had are crucial in understanding the complex impacts of the pandemic itself and our response to it, and that the crisis does in itself have the potential to exacerbate some of these pre-existing inequalities fairly directly. Moreover, it seems likely that the current crisis will leave legacies that will impact inequalities in the long term. These possibilities are not all disequalising, but many are.     

Inequality in Mortality: Updated Estimates for the United States,Canada and France*

This study provides comparisons of inequalities in mortality between the United States, Canada and France using the most recent available data. The period between 2010 and 2018 saw increases in mortality and in inequality in mortality for most age and gender groups in the United States. The main exceptions were children under 5 and adults over 65. In contrast, Canada saw a further flattening of mortality gradients in most groups, as well as further declines in overall mortality. The sole exception was Canadian women over 80 years old, who saw small increases in mortality rates. France saw continuing improvements in mortality rates in all groups. Both Canada and France have distributions of mortality that are much more equal than those in the United States, demonstrating the importance of public policy in the achievement of equality in health.     

Risk and crisis communication narratives in response to rapidly emerging diseases

The uncertainty inherent in crises can create a narrative space that is often filled by multiple interpretations about both what is happening and what steps should be taken to resolve the crisis. As more information becomes known, these competing crisis narratives gradually merge into a dominant narrative about the crisis, lessons learned from it, and recommendations for the future. This case study examines the swine industry’s response to the Porcine Epidemic Diarrhea virus (PEDv) outbreak. The virus spread rapidly throughout the industry and, in a matter of months, had killed approximately 10% of the U.S. swine population. This analysis examines the crisis communication that ensued during that time. More specifically, 13 specialists representing the National Pork Board, American Association of Swine Veterinarians, veterinarians highly active in treating PEDv, university extension agents, and academic researchers were interviewed for this study. A narrative analysis of the interview content revealed that communication efforts made by swine industry leaders successfully shifted the PEDv story from that of competing narratives to a dominant narrative that helped resolve the crisis efficiently. This success is attributed, in part, to effective use of all available industry resources for both conducting research and sharing information rapidly through pre-established communication networks and widely read resources. Results of this narrative analysis reveal a key recommendation that maybe generalizable to similar crisis events. That is, an effective crisis narrative should focus not only on what protective actions to take, but also on a clear explanation regarding the nature of the crisis. Moreover, such explanations must be translated intelligibly to diverse non-scientific publics and provide a compelling rationale for why the recommended actions are vital.     

Health and the welfare of U.S. business

Business leaders continue to blame the skyrocketing cost of health care for jeopardizing the global competitiveness of U.S. industries, and they continue to turn to Washington for the solution. Yet after a study of 16 countries, Wharton researchers David Brailer and R. Lawrence Van Horn have discovered that health care costs do not directly hinder U.S. competitiveness. Their conclusion: there is indeed a health care crisis in the United States as well as a competitiveness crisis. But the two are unrelated, and confusing them makes it difficult to solve either one. The real problem, according to the authors, is the hands-off approach that employers typically adopt when it comes to health care. No matter how Washington responds to the health care crisis, employers must explore their own role in ensuring the health of their work force. And they must realize that their role can be a strategic one. Instead of containing costs by fine-tuning benefits packages, companies can control costs and improve health care delivery by treating health care like any other crucial component of production. Brailer and Van Horn propose three strategies for managing health care delivery: First, companies must intervene in the supply side of the health care market. This may mean creating a clinic alone or with other companies, or joining with other companies to procure health care. Second, companies need to translate corporate health benefits into the most cost-effective set of services at the local level. Finally, companies must encourage and educate employees to participate in decisions regarding health care delivery.(ABSTRACT TRUNCATED AT 250 WORDS)     

COVID-19, government interventions and emerging capital markets performance

In this study, we explore the impact of government intervention to contain the spread of COVID-19 in emerging countries on the performance of their leading stock indices. We retrieved data on the performance of 25 international capital market indices included in the MSCI Emerging Markets Index and data about the closures, economic, and health measures imposed in each country examined. Overall, our findings show that government restrictions are associated with negative market returns, possibly due to the anticipated adverse effect to the economy. The adverse effect is more evident when closures are imposed. The market response to economic stimulus is mild but varies depending on the type of intervention imposed, much as with the health measures. Public campaigns may raise public awareness about COVID-19, but they can also increase the public’s fear of the pandemic, reflected in the negative response in capital markets. The results are essential for understanding the trends and fluctuations in emerging markets during this current crisis and for preparing for crises in the future.     

Reducing the Incidence of Low Birth Weight in Low-Income Countries Has Substantial Economic Benefits

Reducing the incidence of low birth weight not only lowers infantmortality rates but also has multiple benefits over the lifecycle. This study estimates the economic benefits of reducingthe incidence of low birth weight in low-income countries, boththrough lower mortality rates and medical costs and throughincreased learning and productivity. The estimated economicbenefits, under plausible assumptions, are fairly substantial,at about $510 per infant moved from a low-birth-weight status.The estimated gains are primarily from increases in labor productivity(partially through more education) and secondarily from avoidingcosts due to infant illness and death. Thus there may be manyinterventions to reduce the incidence of low birth weight thatare warranted purely on the grounds of saving resources or increasingproductivity.      

Covid-19, corporate survival and public policy: The role of accounting information and regulation in the wake of a systemic crisis

The economic crisis triggered by the Covid-19 pandemic prompted governments to issue several relief mechanisms to hold up companies and workers. This study analyzes how accounting information and regulation can support policymakers in the wake of a systemic crisis. Based on an accounting-based framework and readily available data from financial statements, it forecasts the impact of the crisis in terms of losses, equity depletion, and corporate defaults, absent government intervention. Next, it quantifies the costs and effects of five relief mechanisms in alleviating the risk of generalized corporate bankruptcies. The effects of the health pandemic and relief mechanisms on profitability and equity shortfalls are estimated for a sample of 586,076 privately held Italian firms. The findings indicate that the number of companies facing bankruptcy risk would increase from 65,463 (11% of the population) in 2019 to 153,681 (26%) in 2020, absent any government intervention. Altogether, these firms employ 1.4 million employees and have a total exposure to the financial industry equal to €68 billion in loans. Next, we assess the effects of relief mechanisms introduced by the Italian government to support corporations, whose aggregate costs reach €49.33 billion in 2020, and find that the interventions ‘rescue’ about 43,000 firms otherwise in default. Finally, the study adds to the debate on the role of accounting regulation in the wake of a systemic crisis by (a) discussing the effects of temporary changes to accounting rules on the informativeness and transparency of financial statements, and (b) suggesting alternative ways to modify accounting rules to safeguard corporate survival without compromising the informativeness of financial statements once the crisis reaches a halt.