Air pollution and procyclical mortality: Evidence from China

There is growing evidence that in developed countries, mortality rises (falls) in economic booms (busts). However, little is known about the cyclical pattern of mortality in developing countries. Using China's city-year data, we find that the total mortality in China also exhibits procyclical fluctuations. In exploring the mechanisms, we find that air pollution is one of the reasons for procyclical fluctuations in total mortality. Specifically, economic booms lead to severe air pollution, worsening human health and thus increasing death rates. Moreover, we find that changes in lifestyles may not be an important reason for procyclical mortality in China.     

Health Expenditures and Health Outcomes in Africa*

Abstract: This paper provides econometric evidence linking African countries’ per capita total as well as government health expenditures and per capita income to two health outcomes: infant mortality and under‐five mortality. This relationship is examined using data from 47 African countries between 1999 and 2004. Health expenditures have a statistically significant negative effect on infant and under‐five mortality rates. The magnitude of our elasticity estimates are in consonance to those reported in the literature. For African countries, our results imply that total health expenditures (as well as the public component) are certainly important contributors to health outcomes. In addition, we find that both infant and under‐five mortality are positively and significantly associated with sub‐Saharan Africa. The reverse is true for North Africa. While ethnolinguistic fractionalization and HIV prevalence positively and significantly affect the health outcomes, higher numbers of physicians and female literacy significantly reduce these health outcomes. These results have important implications for attaining the targets envisioned by the Millennium Development Goals. The data implications are also discussed.     

A survey of cross-sectional and time-series literature on factors affecting child welfare

This paper reviews the literature on the socio-economic determinants of child welfare. Cross-sectional evidence is first analysed. The relevant literature is subdivided into four groups of studies depending on the main factors influencing child welfare: demographic; related to family circumstances; related to health care and sanitation; and economic. The very few time-series studies on this subject are then examined. While the existing literature does not allow definitive conclusions to be drawn on the predominance or relative importance of these four sets of factors, this paper identifies three related research areas for which particularly severe gaps seem to emerge and for which additional investigation appears necessary. These are: over-time studies, studies for low-income, high-mortality countries of Africa, for middle-income countries and for high-income, high-mortality countries, and studies measuring impact on the basis of indicators of welfare other than infant mortality rates.     

Are smokers too optimistic about their health status: Ex ante perception versus ex post observation

As the world has moved toward the era of non-communicable diseases, whether the individuals are in a capable position to accurately evaluate their own health status has an important implication on disease prevention in particularly and population health outcome in general. In this paper, we address four important questions surrounding the accuracy of health perception: (1) to what extent that individuals can make an accurate evaluation on their own health status; (2) what are the major factors influencing health misperception if any; (3) what are the causal directions between health behavior and health perception; and (4) whether individuals can learn and update their self-evaluation on health status over time and whether such learning is productive in that it mitigates the health misperception. Specifically, we use a longitudinal data set obtained from Taiwan that covers six waves of survey over about twenty-year period to compare the ex ante subjective perception on health and the ex post mortality hazards. Our results suggest that over one third of the survey respondents are not performing well in the evaluation of their own health status. We also find that smokers are more likely to have an optimistic bias on their own health assessment as compared to nonsmokers. After controlling for the simultaneous causality problem, we find a causal effect of individuals' misperceptions on continuing smoking, but not vice versa. In addition, our results show that individuals update their subjective perception on health over time through the learning from personal health shocks and the provision of public information on smoking hazards. Although the learning process tends to be overshooting among smokers, it is beneficial to mitigate the optimistic bias. We also find the evidence that personal health shock has a stronger impact on updating behavior than public information, indicating that personal experience is a more effective channel through which to correct the bias in health perception, compared to the provision of public information, such as anti-smoking campaign.     

Do the Chinese “Keep up with the Jones”?: Implications of peer effects,growing economic disparities and relative deprivation on health outcomes among older adults in China

What are the health effects of unequal economic growth? What are the health consequences of ‘keeping up with the Jones’? Many developed countries (e.g., US and Japan) have experienced significant income growth between 1950s and 2000s but population survey shows that on average the population is not growing more satisfied with life. Theories that attempt to respond to these findings hypothesize that as income grows, people may spend more on conspicuous consumption because they compare themselves with others in their peer groups and care about their position in socio-economic distributions relative to others. Indeed, public health studies have found a relationship between income inequality and adult health outcomes in developed countries. Specifically, there seems to be a correlation between social hierarchy and mortality, as well as a correlation between social hierarchy and morbidity.China is a prime study site due to its growing spatial inequalities in the past decade. Though China has been committed to economic reform, different regions and cities have encountered very disparate rates of development and growth. In this paper, we utilize a set of panel data collected in China (China Health and Nutrition Survey 1989–2004) to examine the effects of peer groups, relative deprivation, and income disparities on individual health outcomes such as the probability of high waist circumference, body mass index categories, probability of hypertension, nutritional intake as well as health behavior such as smoking. We use a combination of multi-level mixed effects modeling as well as factor analysis to examine these effects and find significant and differential effects of income quartiles, peer groups, relative deprivation, and Gini coefficient on health.     

Poor health as a precursor to consumer debt distress in South Africa

While it is well documented that severe consumer indebtedness can lead to mental and physical health problems including unhealthy coping mechanisms, the pathways from poor health to financial strain is still an understudied area. Using the National Income Dynamics Study (NIDS) data, this study examines the relationship between poor health and debt distress while controlling for the possible endogeneity between these two conditions and some health-related variables. The results indicate that poor health significantly increases the probability of financial strain. Insofar as poor health is associated with catastrophic healthcare costs and income deprivation, for instance through inability to work, other factors affecting health such as socioeconomic status and insurance might shape the contours of consumers’ debt performances in the face of health risk. Ultimately, health may be creating a vicious circle in which poor health affects the capacity to earn income and accumulate assets, which limits access to quality healthcare.     

On the pro-trade effects of immigrants

This paper investigates the causal effect of immigration on trade flows using Italian panel data at the province level. We exploit the exceptional characteristics of the Italian data (the fine geographical disaggregation, the very high number of countries of origin of immigrants, the high heterogeneity of social and economic characteristics of Italian provinces, and the absence of cultural or historical ties with the countries where immigrants come from) coupled with the use of a wide set of fixed effects and an ‘instrument’ based on immigrants’ enclaves. We find that immigrants have a significant positive effect on both exports and imports, but much larger for the latter. The pro-trade effects of immigrants tend to decline in space, and even turn negative when large ethnic communities are located too far away from a specific province (via a trade-diversion effect). Moreover, while our data show inter-ethnic spillovers for exports, we find no evidence that networks between different ethnicities affect provinces’ imports. Finally, we provide evidence of a substantial heterogeneity in the effects of immigrants: the impact on trade tends to be larger for immigrants coming from low-income countries, for earlier waves of immigrants, and for least advanced provinces (Southern Italy).     

Child survival in East Africa: The impact of preventive health care

Since the mid-1980s or earlier, several East African countries have experienced constant or rising child mortality rates concurrent with social and biomedical improvements of the “Child Survival Revolution”. This study examines whether preventive primary health care enhanced early child survival in the late 1980s and early 1990s in five East African countries. Child mortality rates were considerably lower than they would have been in the absence of specific immunizations, access to safe drinking water, fertility regulation, and frequent antenatal care visits. There was, however, substantial missed opportunity for mortality decline as a result of insufficient use of preventive measures. In particular, universal immunization across these countries could have reduced rates of mortality under age two by as much as one-third. Continued pursuit of the goals of the World Summit for Children appears essential to offset macroeconomic and growing epidemiological constraints to child survival in the region.     

Parental income and child health in Japan

Previous studies have consistently found evidence of an income gradient in health among children in various countries, and studies in Anglo-Saxon countries have found that this gradient increases with child age. Using nationally representative individual-level data, I examine the association between child health and parental income in Japan. Japan has a child poverty rate that is similar to the rate of many countries that have been studied previously, but Japan outperforms those countries on most health indicators. I find that an income gradient exists in child health in Japan, but that it is limited to specific health measures and symptoms, and that it is weaker overall in that respect than the gradient found in other countries or among Japanese adults. Moreover, I find no evidence that the gradient increases with child age. The fact that children in low-income families have relatively modest and non-accumulating health disadvantages may contribute to the overall health of the Japanese population. Nevertheless, there is a statistically significant negative association between parental income and the incidences of asthma, hearing problems, and dental symptoms in children, implying that future efforts to improve the health of underprivileged children should focus on the prevention and control of these diseases.     

Social inequalities in famine mortality in the manorial system of the tsarist Russian province of Livland in the mid-1840s

By relying on longitudinal data on two rural parishes in the Russian Baltic province of Livland, the article analyses two questions concerning famine's short-run effects on mortality in a manorial system: (1) whether there is evidence of a social gradient in mortality during the famine of 1844–6 and (2) whether the manors could protect the peasants against the hardships. The analysis reveals that neither the status of a farmer peasant nor the landlord saved the local inhabitants from an increased risk of dying during the famine of 1844–6. The conventional assumptions about the protective effect of the higher socio-economic status or type of manor against subsistence crisis found very little support in the study.     

Does New Rural Pension Scheme decrease elderly labor supply? Evidence from CHARLS

This paper examines the effect of the New Rural Pension Scheme (NRPS) on the labor supply behavior of the elderly in rural China. Using pooled data from two waves of the China Health and Retirement Longitudinal Survey (CHARLS) and an analytical framework of combination of regression discontinuity design and difference in difference method (RD-DiD), we find no evidence that pension receipt from the NRPS program does significantly induce the elderly to withdraw from the labor market. The heterogeneous effects by health status indicate that pension recipient slightly decreases the probability of labor force participation for those individuals with chronic diseases; however, the effect is not statistically significant. The empirical findings suggest that the introduction of the NRPS program does not improve the welfare effect of the originally targeted elder individuals with illness.     

Wealth data quality in the National Income Dynamics Study Wave 2

This paper examines the quality of data on household assets, liabilities and net worth in the South African National Income Dynamics Study (NIDS) Wave 2. The NIDS is the first nationally representative survey on household wealth in South Africa. The cross-sectionally weighted data are found to be fit for use in terms of the univariate distributions of net worth, assets and liabilities, but population totals are probably underestimated due to the presence of missing wealth data in Phase 2 of Wave 2 that is not taken into account in the weights. When compared with national accounts estimates of household net worth, there is an apparent inversion of the estimated totals of financial assets versus non-financial assets. Further research is required into why this is so. We find that the NIDS wealth module is a suitable instrument for the analysis of household wealth.     

The Impact of Cannabis Use on Health

Summary Chronic daily cannabis use has been shown to have long term harmful health effects, which in turn is expected to reduce labour market productivity. The evidence is less clear on the health impact of less frequent consumption, which is the more typical mode of use, and previous empirical studies fail to find robust evidence of an adverse impact of these modes of use on labour market productivity. This paper attempts to shed some light on this issue by directly estimating the impact of cannabis consumption in the past week and past year on health status using information on prime age individuals living in Australia. We find that cannabis use does reduce self-assessed health status, with the effect of weekly use being of a similar magnitude as smoking cigarettes daily. Moreover, we find evidence of a dose-response relationship in the health impact of cannabis use, with annual use having roughly half the impact of weekly use.Helpful comments on an earlier draft were received from Jan van Ours, Rosalie Pacula, two anonymous referees and participants at the 81st Annual Conference of the Western Economic Association International.     

Effects of quantity of education on health: A regression discontinuity design approach based on the Chinese Cultural Revolution

In this paper, we exploit the negative educational shock caused by the Chinese Cultural Revolution to apply a regression discontinuity method in identifying the causal effects of education on health. While we find that better education reduces the probability of having poor self-assessed health and disabilities, we do not find statistically significant effects of education on the probability of having poor physical functioning status or uncomfortable body pains in the previous four weeks. Moreover, we find an interesting result that better education increases the probability of having chronic diseases. While most existing studies only identify the effect of education at a particular level, one contribution of our paper is that it provides estimates much closer to the population average effect. Moreover, our results imply that the underlying mechanism behind the effect of education on health might be different in developing countries from that in developed countries.     

What Have Remittances Done to Development? Evidence from the Caribbean Community and Common Market

This paper analyzes the long-run impact of remittances on socio-economic development in the Caribbean Community and Common Market (CARICOM) between 1970 and 2013. We find that remittances have improved the health indicators, reducing infant and child mortality, and food deficit and improving life expectancy, and sanitation and water sources, especially in the rural areas. However, remittance inflows have no significant impact on education and communication infrastructure. Neither do they contribute to any demographic changes.     

Determinants of fertility in developing countries

The contribution of agricultural modernization to changes in fertility in developing countries was examined. A model for the determinants of both fertility and infant mortality--hypothesized to be positively related--was specified and applied to cross-sectional data for 75 developing countries for the year 1971. The infant mortality rate, productivity per unit of labor and land, and density of population for agricultural land were highly correlated with the crude birth rate. The only other exogenous variables highly correlated with each other were productivity per unit of labor and infant mortality, and productivity per unit of land and population density for agricultural areas. The coefficient of population density of agricultural areas suggested a negative impact of density on fertility. The infant mortality rate, productivity per unit of land and labor, and density of population of agricultural areas explained 85% of the intercountry variation in fertility. The infant mortality rate, productivity of land, and productivity of labor were of descending order of importance in determining the crude birth rates in the countries analyzed. 68% of the intercountry variation in infant mortality was explained by fertility, adult literacy, per capita energy consumption, gini-coefficient of income distribution, population per hospital bed, and protein supply. Adult literacy, crude birth rates, population per hospital bed, per capita energy consumption, per capita protein supply, and gini-coefficient of income distribution were of descending order of importance in determining infant mortality rates. All of the variables that affected infant mortality directly affected fertility indirectly; conversely, all the variables that affected fertility directly affected infant mortality indirectly. Overall, these results confirm that agricultural modernization does exert an effect on fertility. The task in developing countries is to break the vicious cycle of infant mortality and fertility. This can be achieved both through family planning programs and the diffusion of health programs to lower infant mortality.     

The health capacity to work at older ages in urban China

Tapping into the older workforce is a potential economic solution to population aging, but its feasibility depends on the health capacity to work among older people. Existing estimations in OECD countries involve establishing the relationship between work and health on a younger cohort, extrapolating the relationship to older individuals, and deriving the excess health capacity as the difference between predicted and actual employment rates. However, benchmarking on the younger cohort is sub-optimal because the observable retirement-health relationship changes with age. The dual nature of the Chinese social security system provides us with a relatively neat benchmark, allowing us to estimate the excess health capacity among urban workers benchmarking on rural residents in the same age range. Using the China Health and Retirement Longitudinal Study, this choice, combined with other fine-tuning, yields significantly lower but still substantial excess capacity among older urban workers than benchmarking against younger cohorts. Altogether, among urban Chinese aged 45–69, 31.2 million extra workers can potentially be added to the workforce.     

PURCHASING POWER PARITY WITH RANK TESTS FOR NONLINEAR COINTEGRATION IN AFRICAN COUNTRIES

This study applies nonlinear cointegration to assess exchange rates with the corresponding relative prices and aggregate price levels for 20 African countries. We find that a nonparametric rank test has higher power than parametric testing procedures; a true data‐generating process of exchange rate is in fact a stationary nonlinear process. We examine the validity of purchasing power parity (PPP) from the nonparametric nonlinear point of view and provide robust evidence that clearly indicates PPP holds true for these countries. Hence, the long‐run African countries exchange rate adjustments are in equilibrium with the relevant fundamentals as suggested by the PPP hypothesis in a nonlinear way.