The Siren Song of Cicadas: Early-Life Pesticide Exposure and Later-Life Male Mortality

This paper studies the long-term effects of in-utero and early-life exposure to pesticide use on adulthood and old-age longevity. We use the cyclical emergence of cicadas in the eastern half of the United States as a shock that raises the pesticide use among tree crop growing farmlands. We implement a difference-in-difference framework and employ Social Security Administration death records over the years 1975-2005 linked to the complete count 1940 census. We find that males born in top-quartile tree-crop counties and exposed to a cicada event during fetal development and early-life live roughly 2.2 months shorted lives; those with direct farm exposure face a reduction of nearly a year. We provide empirical evidence to examine mortality selection before adulthood, endogenous fertility, and differential data linkage rates. Additional analyses suggests that reductions in education and income during adulthood are potential mechanisms of impact. Our findings add to our understanding of the relevance of early-life insults for old-age health and mortality.

Parenting Promotes Social Mobility Within and Across Generations

This paper compares early childhood enrichment programs that promote social mobility for disadvantaged children within and across generations. Instead of conducting a standard meta-analysis, we present a harmonized primary data analysis of programs that shape current policy. Our analysis is a template for rigorous syntheses and comparisons across programs. We analyze new long-run life-cycle data collected for iconic programs when participants are middle-aged and their children are in their twenties. The iconic programs are omnibus in nature and offer many services to children and their parents. We compare them with relatively low-cost more focused home-visiting programs. Successful interventions target both children and their caregivers. They engage caregivers and improve the home lives of children. They permanently boost cognitive and non-cognitive skills. Participants in programs that enrich home environments grow up with better skills, jobs, earnings, marital stability, and health, as well as reduced participation in crime. Long-run monetized gains are substantially greater than program costs for the iconic programs. We investigate the mechanisms promoting successful family lives for participants and report intergenerational effects on their children. A study of focused home-visiting programs that target parents enables us to isolate a crucial component of successful programs: they activate and promote parenting skills of child caregivers. The home-visiting programs we analyze produce outcomes comparable to those of the iconic omnibus programs. National implementation of the programs with long-run follow up that we analyze would substantially shrink the overall US Black-White earnings gap.

Advancing towards a worldwide healthcare system in the post-COVID-19 era: benefits and barriers to international collaboration in healthcare

The COVID-19 pandemic has exposed serious shortcomings in healthcare systems around the world. Shortages of staff, equipment and access to healthcare have created major obstacles for facilities when managing public health emergencies. The pandemic has resulted in a decrease in healthcare revenue, layoffs and furloughs of staff members, as well as decreased funding for public health programs. Global variations in response to the pandemic have resulted in varying death rates and economic damage, underscoring the necessity for a coordinated global health response. This editorial examines both the advantages and drawbacks of international healthcare collaboration when responding to pandemics, with an aim of building a comprehensive global healthcare system.

Unconditional Cash and Family Investments in Infants: Evidence from a Large-Scale Cash Transfer Experiment in the U.S

Economists have limited causal evidence on how families receiving unconditional income would spend those funds. We examine financial and time investments in infants among families living in poverty from a large-scale, multi-site randomized controlled study of monthly unconditional cash. We find increased spending on child-specific goods and mothers' early-learning activities with their infants. The marginal propensity to consume child-focused items from the cash transfer exceeded that from other income, consistent with the behavioral cues in the design. We find no statistically detectable offsets in household earnings or impacts on pre-registered outcomes related to expenditures, labor supply, childcare or subjective well-being.

Cost-effectiveness analysis of bimekizumab for the treatment of active psoriatic arthritis in Sweden

AIMS

To evaluate the cost-effectiveness of bimekizumab, an inhibitor of IL-17F and IL-17A, against biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARD) for psoriatic arthritis (PsA) from the Swedish healthcare system perspective.

MATERIALS AND METHODS

A Markov model was developed to simulate the clinical pathway of biologic [b] DMARD-naïve or tumor necrosis factor inhibitor experienced [TNFi-exp] PsA patients over a lifetime horizon. Treatment response was incorporated as achievement of the American College of Rheumatology 50% (ACR50) and Psoriasis Area and Severity Index 75% (PASI75) response, and changes in the Health Assessment Questionnaire-Disability Index (HAQ-DI) score. The efficacy of bimekizumab was obtained from the BE OPTIMAL (bDMARD-naïve) and BE COMPLETE (TNFi-experienced) trials while a network meta-analysis (NMA) informed the efficacy of the comparators. Resource use and drug costs were obtained from published studies and databases of drug retail prices in Sweden. A willingness-to-pay threshold of €50,000 per quality-adjusted life year (QALY) was applied.

RESULTS

In bDMARD-naïve patients, bimekizumab achieved greater QALYs (14.08) than with all comparators except infliximab (14.22), dominated guselkumab every 4 and 8 weeks, ixekizumab, secukinumab 300 mg, ustekinumab 45 mg and 90 mg, and was cost-effective against risankizumab, tofacitinib, upadacitinib and TNFis, except adalimumab biosimilar. In TNFi-experienced patients, bimekizumab led to greater QALYs (13.56) than all comparators except certolizumab pegol (13.84), and dominated ixekizumab and secukinumab 300 mg while being cost-effective against all other IL-17A-, IL-23- and JAK inhibitors.

LIMITATIONS

An NMA informed the comparative effectiveness estimates. Given gaps in evidence of disease management and indirect costs specific to HAQ-DI scores, and sequential clinical trial evidence in PsA, non-PsA cost data from similar joint conditions were used, and one line of active treatment followed by best supportive care was assumed.

CONCLUSIONS

Bimekizumab was cost-effective against most available treatments for PsA in Sweden, irrespective of prior TNFi exposure.

The impact of the COVID-19 recession on Mexican households: evidence from employment and time use for men, women, and children

This study examines changes in labor supply, income, and time allocation during the COVID-19 pandemic in Mexico. Using an event-study design, we show that the COVID-19 recession had severe negative consequences for Mexican households. In the first month of the pandemic, employment declined by 17 percentage points. Men recovered their employment faster than women, where men's employment approaches original levels by 2021Q2. Women, on the other hand, experienced persistent employment losses. Within-household, men also increased their time spent on household chores while neither gender (persistently) increased their time caring for others. Instead, children reduced their time spent on schoolwork by 25%.

Who Works Less When a Parent Needs Long-Term Care? Gender Disparities in Labor Market Effects in Mexico

We use longitudinal data from the Mexican Health and Aging Study to analyze the effect of having a parent in need of long-term care on labor supply of men and women aged 50-64 in Mexico. After accounting for both individual and time fixed effects, we find that parents' need of long-term care is associated with both a significant drop in the likelihood of working (by 2.42 percentage points), and a reduction in the number of hours worked (by 7.3%) among women who remain employed. In contrast, we find no effect on the labor supply of men. In a context of rapid population aging, the increase in the need of long-term care risks to hinder the efforts to reduce gender imbalances in the labor market.

Does younger age at marriage affect divorce? Evidence from Johnson's Executive Order 11241

Before President Johnson's Executive Order 11241 in August 1965, married men received lower draft priority for military service. As the Vietnam War escalated in the summer of 1965, anecdotal evidence suggests draft-eligible men sought marriage to lower their likelihood of serving. This paper quantifies the effects of these Vietnam-era policies on marriage and finds that they significantly reduced the age at first marriage and altered the choice of spouse. However, younger marriages induced by the war were less likely to result in divorce 15 years later. Evidence also suggests that these younger marriages had little effect on long-term outcomes.

Redistributive effects of different pension systems when longevity varies by socioeconomic status

We propose a general analytical framework to model the redistributive features of alternative pension systems when individuals face ex ante differences in mortality. Differences in life expectancy between high and low socioeconomic groups are often large and have widened recently in many countries. Such longevity gaps affect the actuarial fairness and progressivity of public pension systems. However, behavioral responses to longevity and policy complicate analysis of possible reforms. Here we consider how various pension systems would perform in an OLG setting with heterogeneous longevity and ability. We evaluate redistributive effects of three Notional Defined Contribution plans and three Defined Benefit plans, calibrated on the US case. Compared to a benchmark non-redistributive plan that accounts for differences in mortality, US Social Security reduces regressivity from longevity differences, but would require group-specific life tables to achieve progressivity. Moreover, without separate life tables, despite apparent accounting gains, lower income groups would suffer welfare losses and higher income groups would enjoy welfare gains through indirect effects of pension systems on labor supply.

Leaving Money on the Table? Suboptimal Enrollment in the New Social Pension Program in China

China's recently implemented New Rural Pension Scheme (NRPS), the largest social pension program in the world, was designed to provide financial protection for its rural population and reduce economic inequities. Yet the impact of this program is mitigated if those eligible fail to enroll. This paper examines the extent to which pension-eligible individuals, and their families, make optimal pension decisions. Families are involved in the NRPS decisions because, in most cases, adult children need to enroll as a prerequisite of their parents' receipt of benefits. We examine the decisions of both those eligible for pension benefits (i.e. over 60 years old) and their adult children. We use the rural sample of the 2012 China Family Panel Study to study determinants of the decision to enroll in NRPS, premiums paid, and time taken to enroll. We find evidence of low and suboptimal pension enrollment by eligible individuals and their families. Suboptimal enrollment takes various forms including failure to switch from the dominated default pension program to NRPS and evidence that families do not make mutually beneficial intra-family decisions. For the older cohort, few individual and family characteristics are significant in enrollment decisions, but village characteristics play an important role. For the younger cohort, more individual-level characteristics are significant, including own and children's education. Village characteristics are important but not as much as for the older cohort. Our finding of suboptimal enrollment is important as it highlights the need for policies to improve enrollment. This paper provides needed information on the extent of the factors relating to suboptimal enrollment.

Care choices in Europe: To Each According to His or Her Needs?

Growing long-term care (LTC) needs represent a major challenge for our aging societies. Understanding how utilization patterns of different types of care are influenced by LTC policies or changes in the population composition such as age patterns or health can provide helpful insight on how to adequately prepare for this situation. To this aim, this paper explores how individuals choose between different forms of LTC. We exploit variation between countries as well as between individuals within countries using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE). Using nonlinear decomposition techniques, we break down the difference in utilization rates between countries into differences based on observed sociodemographic and need-related characteristics and differences in the impacts of these characteristics, which allows us to identify the drivers behind differences in the formal-informal care mix. Our results show that a substantial fraction of the observed country differences can be explained by differences in impacts. We argue that this is a result of the different incentives provided by the different LTC systems.

Pilot study assessing the direct medical cost of treating patients with cancer in Kenya; findings and implications for the future

BACKGROUND

Currently the majority of cancer deaths occur in low- and middle-income countries, where there are appreciable funding concerns. In Kenya, most patients currently pay out of pocket for treatment, and those who are insured are generally not covered for the full costs of treatment. This places a considerable burden on households if family members develop cancer. However, the actual cost of cancer treatment in Kenya is unknown. Such an analysis is essential to better allocate resources as Kenya strives towards universal healthcare.

OBJECTIVES

To evaluate the economic burden of treating cancer patients.

METHOD

Descriptive cross-sectional cost of illness study in the leading teaching and referral hospital in Kenya, with data collected from the hospital files of sampled adult patients for treatment during 2016.

RESULTS

In total, 412 patient files were reviewed, of which 63.4% (n = 261) were female and 36.6% (n = 151) male. The cost of cancer care is highly dependent on the modality. Most reviewed patients had surgery, chemotherapy and palliative care. The cost of cancer therapy varied with the type of cancer. Patients on chemotherapy alone cost an average of KES 138,207 (USD 1364.3); while those treated with surgery cost an average of KES 128,207 (1265.6), and those on radiotherapy KES 119,036 (1175.1). Some patients had a combination of all three, costing, on average, KES 333,462 (3291.8) per patient during the year.

CONCLUSION

The cost of cancer treatment in Kenya depends on the type of cancer, the modality, cost of medicines and the type of inpatient admission. The greatest contributors are currently the cost of medicines and inpatient admissions. This pilot study can inform future initiatives among the government as well as private and public insurance companies to increase available resources, and better allocate available resources, to more effectively treat patients with cancer in Kenya. The authors will be monitoring developments and conducting further research.

Gun prevalence and suicide

In light of the ongoing debate over tighter firearm regulations, this paper considers the relationship between gun prevalence and suicide. I exploit a reform in Switzerland that reduced the prevalence of military-issued guns in private households. In Switzerland, military service is compulsory for men, and military-issued guns account for nearly half of the total number of firearms available. The results show that the firearm suicide rate decreases by 9% for a reduction in gun prevalence of 1000 guns per 100,000 inhabitants. The elasticity of gun suicides with respect to firearm prevalence is +0.48, but converges towards zero for low levels of gun prevalence. The overall suicide rate is negatively and significantly related to firearm prevalence, which indicates that non-gun methods of suicide are not perfect replacements for firearms.

The Effect of Leisure-Time Physical Activity on Obesity, Diabetes, High BP and Heart Disease Among Canadians: Evidence from 2000/2001 to 2005/2006

Although studies have looked at the effect of physical activity on obesity and other health outcomes, the causal nature of this relationship remains unclear. We fill this gap by investigating the impact of leisure-time physical activity (LTPA) and work-related physical activity (WRPA) on obesity and chronic conditions in Canadians aged 18-75 using instrumental variable and recursive bivariate probit approaches. Average local temperatures surrounding the respondents' interview month are used as a novel instrument to help identify the causal relationship between LTPA and health outcomes. We find that an active level of LTPA (i.e., walking ≥1 h/day) reduces the probability of obesity by five percentage points, which increases to 11 percentage points if also combined with some WRPA. WRPA exhibits a negative effect on the probability of obesity and chronic conditions.

Publication selection and the income elasticity of the value of a statistical life

Estimates of the value of a statistical life (VSL) establish the price government agencies use to value fatality risks. Transferring these valuations to other populations often utilizes the income elasticity of the VSL, which typically draw on estimates from meta-analyses. Using a data set consisting of 101 estimates of the income elasticity of VSL from 14 previously reported meta-analyses, we find that after accounting for potential publication bias the income elasticity of value of a statistical life is clearly and robustly inelastic, with a value of approximately 0.25-0.63. There is also clear evidence of the importance of controlling for levels of risk, differential publication selection bias, and the greater income sensitivity of VSL from stated preference surveys.

Immigration to the United States: Recent Trends and Future Prospects

Almost 13 per cent of the American population is foreign born, and if the children of the foreign born are included, about 1 in 4 Americans can be counted as part of the recent immigrant community. Although there is lingering prejudice and popular fears of immigrants, there is growing evidence that, on balance, immigrants make a positive contribution to the American economy and society. There is little evidence that immigrants have an adverse impact on the wages and employment of native born Americans. Moreover, immigrants and their children are disproportionately represented in a broad variety of scientific and cultural fields.