Status and mortality: Is there a Whitehall effect in the United States?

The influential Whitehall studies found that top-ranking civil servants in Britain experienced lower mortality than civil servants below them in the organizational hierarchy due to differential exposure to workplace stress. I test for a Whitehall effect in the United States using a 1930 cohort of white-collar employees at a leading firm – General Electric (GE). All had access to a corporate health and welfare program during a critical period associated with the health transition. I measure status using position in the managerial hierarchy, attendance at prestigious management training camps and promotions, none of which is associated with a Whitehall-like rank-mortality gradient. Instead, senior managers and executives experienced a 3–5-year decrease in lifespan relative to those in lower levels, with the largest mortality penalty experienced by individuals in the second level of the hierarchy. I discuss generalizability and potential explanations for this reversal of the Whitehall phenomenon using additional data on the status and lifespan of top business executives and US senators.     

New perspectives on the contribution of sanitary investments to mortality decline in English cities, 1845–1909

Health improved in English cities in the last third of the nineteenth century, in tandem with substantial increases in public spending on water supplies and sanitation. However, previous efforts to measure the contribution of public expenditures to mortality improvements have been hampered by difficulties in quantifying public health investments and the lack of mortality data for specifically urban populations. We improve upon the existing evidence base by (1) creating measures of the stock of urban district sanitary capital, by type, on the basis of capital expenditure flows, rather than loan stocks; (2) using mortality and capital stock data that relate to the same administrative units (urban districts), and (3) studying the period 1880–1909 as well as the earlier period from 1845. The stock of sewerage capital was robustly related to improvements in all-cause mortality after 1880. The size of this effect varied with the extent of public investment in water supplies, suggesting complementarity between the two assets. For the period 1845–84, investments in water were associated with declines in infant and child mortality but the effect was much smaller and less precisely estimated in later decades. Our results suggest that improvements in water and sewerage targeted different transmission pathways for faecal–oral diseases.     

Urban mortality in Greece: Hermoupolis (1859–1940)

The paper examines mortality patterns in the city of Hermoupolis, on the Greek island of Syros, from 1859 to 1940. It produces important new insights into Mediterranean urban historical demography and is the first comprehensive study of urban mortality in Greece, utilising the largest and one of the longest time series at the individual level yet calculated from civil registration and census data. Abridged life tables were constructed for the first time for a Greek urban settlement, enabling the calculation of age-specific mortality rates and life expectancies. Hermoupolis experienced much higher mortality levels than the national average. The findings suggest that early childhood mortality started to decline rapidly from the late nineteenth century onwards, with declines in early adulthood and infancy following. The paper reinforces and confirms our limited knowledge about the timing of the mortality transition in Greece. It proposes that an urban penalty was clearly operating in the country even during the early twentieth century. Finally, this paper suggests that a combination of factors was responsible for the mortality decline in Hermoupolis, including wider access to water, which even when it was not clean enough to drink, nevertheless enabled improvements in personal hygiene among the residents of the city.     

Multi-population mortality projection: The augmented common factor model with structural breaks

Multi-population mortality forecasting has become an increasingly important area in actuarial science and demography, as a means to avoid long-run divergence in mortality projections. This paper aims to establish a unified state-space Bayesian framework to model, estimate, and forecast mortality rates in a multi-population context. In this regard, we reformulate the augmented common factor model to account for structural/trend changes in the mortality indexes. We conduct a Bayesian analysis to make inferences and generate forecasts so that process and parameter uncertainties can be considered simultaneously and appropriately. We illustrate the efficiency of our methodology through two case studies. Both point and probabilistic forecast evaluations are considered in the empirical analysis. The derived results support the fact that the incorporation of stochastic drifts mitigates the impact of the structural changes in the time indexes on mortality projections.     

Child survival and contraception choice: Theory and evidence

This paper asks whether increases in child survival bring down fertility and incentivize couples to switch from traditional to modern methods of contraception. Our parsimonious model predicts the answer in each case is, yes. We test these connections using household-level Demographic and Health Surveys from recent fertility transitions using arguably exogenous variation in child survival at the regional level. We find a 1% increase in ambient child survival leads to a fertility drop of 1.2%. The same raises the chance of switching to modern birth control (and sticking to it) by 0.4%. Our finding supports the notion that prevailing rates of child survival influence the effectiveness of family planning programs that promote modern contraceptive use.     

More long-term care for better healthcare and vice versa: investigating the mortality effects of interactions between these public sectors

Public healthcare (HC) and long-term care (LTC) sectors coexist in several OECD countries. Economic interactions between these two sectors have been found to occur even in the absence of formal integrated care arrangements. We investigate whether and how interactions between the HC and LTC sectors impact mortality. We analyse data on English local authorities in 2014–15 and employ a sequence of cross-sectional econometric specifications based on instrumental variables to identify the effect that LTC expenditure has on mortality through its interactions with HC services, and vice versa. Our findings suggest that any effect of LTC expenditure on mortality is likely to run through the HC sector by allowing the latter to reallocate resources from less to more effective services. A 10 per cent increase in LTC expenditure per user can indirectly save, on average, about three lives per million individuals. In addition, on top of the known HC direct mortality effects, we find that investing an extra £42 million in the HC sector – equivalent to a 10 per cent increase in HC expenditure per capita for the average local authority – can decrease the use of LTC services, producing around £7.8 million of savings. These can generate mortality effects if invested in services having an impact on mortality.     

Short-term effects on Unionid mussel density and distribution before and after low-head dam removal in northern New York

Unionid mussel populations have declined in many environments, particularly those that were altered by human activities such as dam construction and removal. The Fort Covington Dam blocked the Salmon River in northern New York upriver of its confluence with a smaller tributary, the Little Salmon River. This dam was removed in 2009. My study compared the mean ranked density of mussels in both rivers for the pre-removal period (2005–2008) to the post-removal period (2009–2012) with special attention to Lampsilis cariosa and Margaritifera margaritifera. Systematic sampling was used at six riffles and double sampling at four glides divided between the Salmon and Little Salmon rivers from 2005 through 2012. The Little Salmon River served as a control. Mean ranked adult mussel density was not significantly different between the two rivers in the pre-removal period but was significantly greater in the Little Salmon River after dam removal. Living mussels of 13 species were collected dominated by Elliptio complanata. Dam removal did not affect sediment sorting, porosity, water chemistry, or mussel species distribution. Rapid dewatering of the reservoir led to stranding and death of mussels in the reservoir and in the adjacent ponds. Increased water velocity, exacerbated by rain, mobilized sediment that buried a potentially large mussel bed downstream of the dam where Lampsilis cardium and L. cariosa were abundant, which showed little recovery by 2013.     

Ethnic-specific infant care practices and infant mortality in late Imperial Russia

The Russian Empire had the highest infant mortality rate in Europe at the beginning of the twentieth century. Using a variety of official statistical sources and qualitative evidence, this paper documents uniquely high infant mortality among ethnic Russians. In contrast, among other ethnic groups of the empire, infant mortality rates did not exceed those of the European countries by much. The evidence suggests that the explanation for the Russian infant mortality pattern was ethnic-specific infant care practices, such as the early introduction of solid food, which increased the incidence of lethal gastrointestinal diseases. Our findings highlight the importance of traditional infant feeding practices in mortality in pre-industrial societies.     

Does paid family leave save infant lives? Evidence from California's paid family leave program

Paid family leave (PFL) aims to help working parents balance their careers and family responsibilities while also improving the well-being of infants. Using linked U.S. birth and infant death data with a difference-in-differences framework, I find that a 6-week PFL in California reduced the post-neonatal mortality rate by 0.135- that is, it saved approximately 339 infant lives. There were fewer deaths from health-related causes and larger effects for infants with married mothers and for infant boys. Additional checks and placebo examinations indicate that the observed effect is not due to contemporaneous shocks but rather is causal.