Every Monday our authors provide a round-up of the latest peer-reviewed journal publications. We cover all issues of major health economics journals as well as some other notable releases. If you’d like to write one of our weekly journal round-ups, get in touch.
I know we keep saying that health economists haven’t been much of a presence in COVID-related policy discussions, but these round-ups are testament to the fact that there is no shortage of economics research on the topic. The latest issue of E&HB is no exception. One article focuses on mental health and reports on an analysis that is very similar to one that I highlighted in last week’s round-up. The authors looked at Google searches to show that mitigation policies in the US were associated with more searches relating to isolation and worry and fewer searches for antidepressants and suicide. I’m looking forward to the bibliometric study that analyses the extent of duplicated effort in COVID-related research. Who will get there first?
Another study in this issue uses Google data, but in this case it’s location data not search data. The analysis compares mobility levels in the US and Europe and shows that people in the US were less responsive to stay-at-home orders. Reductions in visits to grocery stores and pharmacies were smaller in most US states than in most European countries. The time spent at home changed very little in the US. Finally on COVID, there is a study using data on supermarket sales in Spain. The analysis included 12 food products with data stratified by three age groups. People in the younger age groups stockpiled in response to lockdown and reductions in sales were associated with the local number of new cases.
This issue also includes several other studies on infectious diseases that are relevant to COVID. Setting aside hare-brained schemes of sunlight injections, there is good clinical evidence for the effectiveness of Vitamin D in protecting against respiratory infections. A study in this issue looks at levels of sunlight and influenza incidence in the US over a period of ten years. The researchers found a strong association, especially in 2009 when there was an early flu season. The take-home message is to get outside in late summer and early Autumn.
A couple of studies examined inequalities in relation to epidemics. One article reports on racial inequalities in the US during the HIV/AIDS epidemic. The researchers show that lifespan disparity for black people (compared with whites) increased between 1980 and 1990 in six states and that this can be mostly attributed to HIV/AIDS. Delving deeper into history is a study of inequalities during epidemics in a Spanish town during the late 18th and early 19th centuries. Yellow fever was the disease du jour. Through census data and municipal records, the authors were able to identify some social inequalities in mortality and in the ability to escape yellow fever.
I’ve recently taken more of an interest in infant health and nutrition, since starting some work in this context (i.e. this project). This issue includes quite a few studies on the determinants of health in early life.
Several studies explored variation in the characteristics of the external environment during pregnancy and early life. One analysis looked at the impact of deforestation on infant mortality in Indonesia. It’s a more interesting research question than it may at first seem. The expected impact is ambiguous, with deforestation likely associated with economic activity (positive) and air pollution (negative). The analysis uses changes in forest protections as a source of variation and finds that protected forest loss is positively associated with infant survival rates, except for first-borns. The author’s explanation is that malaria is the mechanism, being associated with both deforestation and infection in first-time mothers. Also from Indonesia is an analysis of the impact of drinking water and sanitation. Rates of childhood stunting and cognitive outcomes are improved by better sanitation.
Another study sought to identify the determinants of growth in infancy in 38 low and middle income countries between 1990 and 2016. The authors focus on the merits of their Bayesian distributional regression methodology in taking the analysis beyond the conditional mean. The findings help to identify regions within countries where improvements have been particularly slow.
Early life outcomes can have long-term effects, as demonstrated by a study of exposure to the German food crisis in the mid-1940s. By the time people were aged 60-70, they were more likely to be diagnosed with a range of common chronic conditions. Another study looks at childhood obesity in Italy, combining two household surveys to identify within-family peer effects. The presence of other overweight children in the household is a stronger predictor of obesity than overweight adults. Finally, a study of perinatal care for Chinese Americans reveals that girls tend to be born in poorer health and receive higher levels of care, which the authors attribute to a preference for sons.
Other topics covered in this issue are the impact of retirement on health, causes of regional variation in diabetes across Europe, Medicaid coverage and use of nicotine replacement therapy, an analysis of Philadelphia’s beverage tax, and a study of HPV vaccination and sexual behaviour in Brazil.
How many articles is too many for one issue of a journal? 28 seems like a lot. No wonder it’s hard to keep up. But we need space for the papers on COVID, I suppose! This issue of SS&M has three papers on COVID, all using data from the US, with two econometric studies relying on variation between states, and one experimental study.
The impact of the pandemic on income shocks and mental health are likely to be long-lasting, and are the subject of one study in this issue. Using data from a large household survey, the authors show that anxiety and depression co-occurs with income shocks. This association is reduced in states with more generous social support. Another study shows that the impact of corruption is to reduce compliance with social distancing, adding to a growing evidence base on the importance of trust and social capital during the pandemic. Finally, an experimental study (n=1,451) explores how the pandemic might have increased xenophobia and prejudice by testing alternative ways of framing the disease. It quantifies the obvious, showing how specifying the disease as ‘Chinese’ is associated with negative beliefs about Asian Americans. Interestingly, the result is magnified by drawing attention to the economic impact of the disease, but not by an emphasis on the severity of the health impact.
A couple of other papers address questions relating to mental health. One study explores well-being for students during the transition to college. The analysis uses online survey data from 5,509 first-year students at one American university. On average, anxiety and depression increased from the pre-enrolment period through to the spring. The study identifies some of the groups most likely to experience chronic stressors, relating to relationships, finances, or discrimination, which predict poorer outcomes. Self-compassion was an important protective factor overall, but didn’t eliminate the impact of chronic stressors. The other article on mental health explores the impact of structural racism in the US. The authors use data on depression-related visits to emergency departments across US states, and model how these vary when police murder Black Americans1. As if we needed any more reason to confront this issue, the study provides a public health angle to the shame, with visits per 100,000 African Americans increasing by 11% in the three months following a police murder.
This issue also includes a few papers on health inequalities. There’s a study by a fellow blogger, reporting on a choice experiment to understand inequality aversion in the UK. Participants were asked about trade-offs between health-improving and inequality-reducing interventions, focussing on how the trade-offs were labelled. The findings show that people were more averse to inequality associated with socioeconomic groups than with neutral labelling, which is in part explained by perceptions of non-health inequalities. The other studies on inequalities address a modelling framework for intersectional inequalities, and the importance of early life conditions in understanding the causes of socioeconomic inequalities.
Quite a few articles in this issue are on the topic of food and nutrition. A spatial analysis of fast food and obesity in China, and a related commentary, highlight the importance of fast food restaurant density in determining weight status. Similarly, a study of the changing food environment in New Zealand shows that the distance to fast food outlets and supermarkets has reduced in recent years, especially in more deprived areas.
A longitudinal study looks at the socioeconomic determinants of obesity in Chinese adults. The analysis finds little in the way of causal effects in either direction. This lends support to the ‘indirect selection’ hypothesis that some third factors explain the correlation between socioeconomic status and obesity. Also from Asia is an analysis of households with stunted children and overweight mothers, whereby both undernutrition and overnutrition are present. Data from 11 countries reveals that household-level factors are more important than macroeconomic factors in predicting the presence of these paradoxical households. The authors’ explanation is an increase in the consumption of high-energy low-nutrient foods. Finally, a short paper considers nutrition and nudges on social media.
And there are many other topics covered in this issue, including long-term care in the UK and the Netherlands, clinical guideline implementation, interpreter-mediated consultations, health and safety at work, chronic illness and employment in middle-income countries, migration and cancer risk, and infant sleep practices.
One of the things I like about reading social science beyond economics is that researchers more often tackle politically controversial topics. There are several studies relating to abortion, on whether a foetus feels pain, the impact of abortion denial, and abortion stigma. There are also studies on HIV stigma, and on women who use drugs in Ukraine. Other politically charged topics covered in this issue include health ‘responsibilisation’ and the institutional identity of hospitals.
1 Fuck the police. Black lives matter.