Social interactions and the contemporaneous determinants of individuals’ weight

Obesity and overweight are central issues in the public health debate in most developed countries. In this debate, some of the socio-economic determinants of obesity and overweight are still relatively unexplored. This paper presents an empirical examination of the possible influence of social interactions on contemporaneous obesity and (over)underweight. A joint estimation model for obesity and self-image is applied to a sample for Spain taken from the European Union household panel for 1998. The results suggest that obesity might be in part a social phenomenon connected to individuals’ social life.     

Determinants of obesity in Brazil: the effects of trade liberalization and socio-economic variables

This article aims to evaluate a possible relation between increased Brazilian trade openness and increasing observed rates of overweight and obesity during the last 25 years. We develop an economic model where formal trade barriers are eliminated, and resulting sociocultural outcomes such as the adoption of westernized lifestyle in traditional non-western countries prevails, which could imply a health externality. In order to empirically analyse the influence of trade flows on overweight and obesity in Brazil, a balanced fixed-effects panel model has been estimated. Data for the 26 Brazilian states plus the Federal District are run for 1988/1989, 2002 and 2008. We found that an increase in trade openness leads to an increase in overweight and obesity ratios in Brazil. Hence results seem to point that there is a health externality in Brazil due to trade liberalization. However, more consistent evidence may be necessary to convince politicians and policymakers that any interference will be necessary to correct this externality.     

Does the ban on trans-fats improve public health? In search of the optimal policy response

This paper examines the contribution of the regulatory ban on trans-fats and voluntary trans-fat regulation to public health outcomes for a sample of 39 countries in the period 1990–2015. To this end, we exploit within-country variation in trans-fat legislation to estimate the impact of the trans fat ban on cardiovascular mortality and obesity rates. Our difference-in-difference estimates indicate modest and beneficial effects of the trans-fats ban in reducing cardiovascular mortality and obesity rate. We find that the ban on trans fats tends to decrease the mortality rate attributed to cardiovascular diseases while the effects on the obesity rates are significant, especially among children and adolescent age group. By contrast, voluntary regulation of trans fats and demand-driven regulatory strategies are generally not associated with a marked drop in the obesity rate. By controlling for country-specific time trends, we show that the estimated mortality- and obesity-related impact of the ban is not driven by pre-existing trends, and does not affect non-cardiovascular mortality rate.

     

Aggregation bias-correcting approach to the health–income relationship: Life expectancy and GDP per capita in 148 countries, 1970–2010

A large amount of data consisting of 148 countries for the years 1970 to 2010 is analysed in the context of the health–income relationship. The literature suggests that the biased income–health effect obtained with macro data can be a result of the aggregation of individual concave income functions on average health. This aggregation problem is analysed in detail, and a bias-correcting method is proposed to overcome it. The results with new model alternatives show that they correct the income effects on average health in the right direction; that is, they produce smaller parameter estimates than biased models. Augmenting the results with the quantile regression approach, which is sensitive to health differences between countries, indicates that the poorest countries’ income gradient is still much larger than that of rich countries. However, the median life expectancy effect of the log of GDP per capita across the countries decreased during the sample decennials. The results for income inequality measured with the Gini coefficient indicate that the effects of inequality on health are still significant in the poorest countries but non-significant among rich countries after the year 2000. We argue that the proposed bias-correcting method retains the interest in macro health modelling and offers new model alternatives in other contexts.     

The relationship between childhood obesity and food insecurity: a nonparametric analysis

Childhood obesity and food insecurity are major public health concerns in the United States and other developed countries. Research on the relationship between the two has provided mixed results across a variety of data sets and empirical methods. Common throughout this research, however, is the use of parametric frameworks for empirical analyses. This study moves beyond parametric methods by examining the relationship between childhood obesity and food insecurity among low-income children with nonparametric regression techniques. We examine data from the Child Development Supplement (CDS) of the Panel Study of Income Dynamics (PSID), a nationally representative data set from the US. Consistent with recent work, our parametric analyses indicate that there is no statistically significant relationship between childhood obesity and food insecurity. In contrast, our nonparametric results indicate that the probability of being obese varies markedly with the level of food insecurity being experienced by the child. Moreover, this relationship differs across relevant subgroups including those defined by gender, race/ethnicity and income. Fully understanding the relationship between childhood obesity and food insecurity has significant policy implications.     

Health and Income Variation – A Panel Data Study on the Developed and Less Developed Economies

In this paper, human capital in the form of ‘health status’ is introduced into a neoclassical economic growth model as one of the main factors differentiating rich and poor countries. Various panel data models are used to examine how health and other growth factors affect average income in different countries. Our main empirical finding indicates that a one-year increase in life expectancy (the health status measure) raises GDP per capita by 0.5–0.9%. Based on this result, a baseline health status can be established to help poor countries achieve a targeted economic growth rate.     

Public health infrastructure and growth: Ways to improve the inferior equilibrium under multiple equilibria

This paper develops an endogenous growth model in which public health infrastructure, specified as a stock, plays an important role in economic growth. A notable feature of the model is that it employs a non-separable utility function for consumption, leisure, and the level of public health. In addition, increasing the level of health infrastructure contributes to the production of goods through labor augmentation. With these settings, our model is found to have a unique equilibrium or multiple equilibria, depending on the magnitude of the intertemporal elasticity of substitution. For the case of multiple equilibria, we numerically study the ways to avoid the low-growth state in developing countries. From this, we identify two feasible policy implications. The results indicate that public health infrastructure has a vital role in the development policies of low-income countries. Lastly, we show that there are two possibilities in regard to the local dynamics of the model.     

Transition welfare gaps: One closed,another to follow?

Respondents from post‐communist countries have been found to systematically report lower levels of happiness and self‐rated health. While the first welfare gap in happiness has closed recently, the second transition gap in self‐perceived health only started to close. Specifically, this paper shows that treating all transition countries as a homogeneous group may be misleading and therefore divides 28 transition countries into three groups. As a result, in the most recent 2016 round of the ‘Life in Transition’ survey, transition countries in Southern Europe are no longer found to be different from non‐transition nations in terms of their self‐rated health. Although the gap in self‐perceived health for transition nations in Eastern Europe is present in a basic model, it becomes less statistically and economically significant when subjective beliefs and macro‐level variables are added. Countries from the former Soviet Union and Mongolia remain the only group in which respondents report 16.5%–29.1% lower probability of ‘Good’ or ‘Very Good’ health compared to other transition and non‐transition countries. Controlling for communist party membership, ideological beliefs and macro‐level variables somewhat reduces the gap for the former Soviet Union and Mongolia but it remains significant in multiple robustness checks. Although the gap in self‐rated health now applies to only one group of transition countries, it remains an important empirical puzzle with far‐reaching implications for health policy, demand for healthcare and the process of transition.     

New panel results on cointegration of international health expenditure and GDP

This article tests for existence of cointegration between health expenditure and GDP using data from 25 OECD countries for the period 19607ndash;1997. The empirical modelling is based on a heterogeneous bivariate vector error correction panel model that allows for trending data as well as intercepts and trends in the cointegrating relations. Univariate country-by-country and panel unit root tests generally fail to reject the null of a unit root in the health expenditure and GDP variables. Country-by-country results based on the Johansen multivariate likelihood-based inference indicate somewhat mixed results on country-specific cointegration with a rank of one found for 12 countries and a rank of zero for the remaining 13 countries. Application of a new panel test for cointegration rank with higher power than the individual tests indicates that health expenditure and GDP are cointegrated around linear trends.     

The effects of health aid on child health promotion in developing countries: cross-country evidence

Although epidemiological knowledge in relation to child health has improved in the last few decades, around 3 million children die each year in developing countries from preventable diseases. The international development community views increased immunization coverage for children as an important step in eliminating or reducing these deaths. Many developing countries have very limited resources to tackle major health problems and have to rely on external finance. This article examines the impact of foreign aid devoted to the health sector on child health promotion in developing countries. Two proxies for child health promotion are used: (a) immunization against measles and (b) immunization against Diphtheria–Pertussis–Tetanus (DPT). A range of model specifications and panel data econometric techniques are applied to data covering the period 1990 to 2005. This article finds a positive and statistically significant link between health aid and the measures of child health promotion.     

Modeling the clinical and economic implications of obesity using microsimulation

Abstract

Objectives:

The obesity epidemic has raised considerable public health concerns, but there are few validated longitudinal simulation models examining the human and economic cost of obesity. This paper describes a microsimulation model as a comprehensive tool to understand the relationship between body weight, health, and economic outcomes.     

The relationship between smoking,quitting smoking and obesity in Australia: a seemingly unrelated probit approach

Smoking and obesity are two leading causes of preventable death. Further understanding of the relationship between these two risk factors can assist in reducing avoidable morbidity and mortality. This study investigates the empirical association between obesity and the propensity to smoke and to quit smoking, using a Seemingly Unrelated (SUR) probit approach that takes into consideration the potential for reverse causality and unobserved heterogeneity. Using Australian health survey data, this article demonstrates the usefulness of the SUR probit approach in generating information on the relationship between unobserved factors influencing both smoking behaviour and obesity, and in providing estimates of the conditional probabilities of each risk factor. Results suggest the two risk factors are not independent. The presence, size and direction of correlation between the unobserved factors are found to vary by smoking behaviour and by gender. Estimates of conditional probabilities demonstrate smokers have a lower probability of obesity, particularly among females, and ex-smokers have a higher probability of obesity, particularly among males. These findings suggest that health policies targeted at one risk factor may have unintended implications for the other.     

Food security and health status in the United States

Food security is defined as access by all times to enough food for an active, healthy life. This paper explores the relationships between food security and women's self-evaluated health status. A theoretical model is developed which suggests that our primary interests can be served by estimating health and food security production functions. We find that food security has a significant influence on a woman's self-evaluated health status. However, the exact manifestations are difficult to quantify; they may be psychological or physiolgical. The most food-insecure women tend to be poor and less educated. Tobacco use, lack of physical exercise and obesity also weigh heavily good health status.     

TELEVISION VIEWING, FAST-FOOD CONSUMPTION, AND CHILDREN'S OBESITY

Childhood obesity is rising in Taiwan and is becoming a major public health issue. This article examines the effect of children's TV viewing and fast-food consumption on childhood obesity. Using a nationwide survey data in Taiwan and a two-step estimation procedure, our results show that TV viewing hours and fast-food consumption are correlated. After controlling for the endogeneity, we find these two activities positively contribute to children's body weight and the increased risk of being overweight. Results suggest that public health/childhood obesity programs should educate parents of the critical influence of TV viewing and fast-food consumption on childhood obesity. The government can also encourage the fast-food industry to develop and sell healthier foods for children and provide point of sale nutritional information of these products . ( JEL I12, I18)     

Public–private mix of health expenditure: A political economy and quantitative analysis

This paper constructs a simple model to examine decisions on public and private health spending under majority voting. In the model, agents with heterogeneous incomes choose how much to consume and spend on health care and vote for public health expenditure. The health status of an agent is determined by a CES composite of public and private health expenditure. The existence and uniqueness of the voting equilibrium are established. A quantitative exercise reveals the importance of the relative effectiveness of public and private health expenditure and their substitutability in determining the public‐private mix of health expenditure and in accounting for the observed differences across a sample of 22 advanced democratic countries.     

ENDOGENOUS HEALTH CARE, LIFE EXPECTANCY AND ECONOMIC GROWTH

We study the endogenous relationship between health care, life expectancy and output in a neoclassical growth model. Although health care directly diverts resources away from goods production, it prolongs life expectancy, which in turn leads to higher savings and, hence, capital formation through a private annuity market. We show that savings and health care are complements in equilibrium, with both rising with economic development. Our model is therefore consistent with several observed stylized development patterns across countries. Moreover, through the longevity-enhancing channel, health care and health production technology are found by simulation to be growth and welfare promoting.     

Public financing of health expenditures,insurance, and health outcomes

The effects of public financing of health expenditures, insurance coverage and other factors on health outcomes are examined within health production models estimated using 1960–1992 data across 20 OECD countries. Mortality rates are found to depend on the mix of health care expenditures and the type of health insurance coverage. Increases in the publicly financed share of health expenditures are associated with increases in mortality rates. Increases in inpatient and ambulatory insurance coverage are associated with reduced mortality. The effects of GDP, health expenditures and age structure on mortality are similar to those in previous studies. Tobacco use, alcohol use, fat consumption, female labour force participation, and education levels are also significantly related to overall mortality rates. Increases in income inequality are associated with lower mortality rates, suggesting that the negative relationship between inequality and health outcomes suggested by some previous studies does not remain when a more complete model is estimated. The result that increases in public financing increase mortality rates is robust to a number of changes in specifications and samples. Thus, as countries increase the level of their health expenditures, they may want to avoid increasing the proportion of their expenditures that are publicly financed.     

How a race to the bottom can make you fat

This article measures the effect of fiscal competition on obesity rates in the United States through education and health spending. We hypothesize that fiscal competition to attract firms results in lower business tax revenues and higher public infrastructure spending which crowds out education and health spending leading to an increase in obesity rates. We empirically test this hypothesis. We find that there is significant fiscal competition to attract firms. Next, we show that when business tax revenues are lowered and public infrastructure spending favouring businesses increased, public health and education spending declines and obesity rates significantly increase. Thus, fiscal competition significantly contributes to obesity rates through the education and health spending channel.     

Where can obesity management policy make the largest impact? Evaluating sub-populations through a microsimulation approach

Background: There is a critical need to focus limited resources on sub-groups of patients with obesity where we expect the largest return on investment. This paper identifies patient sub-groups where an investment may result in larger positive economic and health outcomes.

Methods: The baseline population with obesity was derived from a public survey database and divided into sub-populations defined by demographics and disease status. In 2016, a validated model was used to simulate the incidence of diabetes, absenteeism, and direct medical cost in five care settings. Research findings were derived from the difference in population outcomes with and without weight loss over 15 years. Modeled weight loss scenarios included initial 5% or 12% reduction in body mass index followed by a gradual weight regain. Additional simulations were conducted to show alternative outcomes from different time courses and maintenance scenarios.

Results: Univariate analyses showed that age 45–64, pre-diabetes, female, or obesity class III are independently predictive of larger savings. After considering the correlation between these factors, multivariate analyses projected young females with obesity class I as the optimal sub-group to control obesity-related medical expenditures. In contrast, the population aged 20–35 with obesity class III will yield the best health outcomes. Also, the sub-group aged 45–54 with obesity class I will produce the biggest productivity improvement. Each additional year of weight loss maintained showed increased financial benefits.

Conclusions: This paper studied the heterogeneity between many sub-populations affected by obesity and recommended different priorities for decision-makers in economic, productivity, and health realms.     

Decomposing differences in health and inequality using quasi-objective health indices

People in Canada and the United States often make claims regarding whose country has a better health system. Several researchers have attempted to address this question by analysing subjective health measures in the two countries, thus assuming a common definition of ‘good’ health. Using data from the Joint Canada/US Survey of Health, which provides rich and comparable health information for the two countries, I generate two quasi-objective health indices and show that Canadians and Americans define ‘good’ health differently. After controlling for cross-country reporting heterogeneity, health differences between Americans and Canadians are eliminated for intermediate health statuses, while health differences at the tails of the health distribution lead to slightly better average population health in Canada. With respect to health inequality, my results show that income and education gradients increase steeply with poor health in both countries. Hence, considering differences along the health distribution is crucial when assessing population health or health inequality.