Wereldoorlog en theologie

Rectorale oratie Vrije Universiteit 194

Verdienste of genade?

Rectorale oratie Vrije Universiteit 195

Structured Early Consultation with the Occupational Physician Reduces Sickness Absence Among Office Workers at High Risk for Long-Term Sickness Absence: a Randomized Controlled Trial

Objective To examine the efficacy of structured early consultation among employees at high risk for future long-term sickness absence, in the prevention and/or reduction of sickness absence. The focus of the experiment was the timing of the intervention, that is, treatment before sickness absence actually occurs. Methods In the current prospective randomized controlled trial (RCT), employees at high risk for long-term sickness absence were selected based on responses to a 34-item screening questionnaire including demographic, workplace, health and psychosocial factors associated with long-term sickness absence (>28 days). A total of 299 subjects at risk for future long-term sickness absence were randomized in an experimental group (n = 147) or in a control group (n = 152). Subjects in the experimental group received a structured early consult with their occupational physician (OP), in some cases followed by targeted intervention. The control group received care as usual. Sickness absence was assessed objectively through record linkage with the company registers on sickness absence over a 1 year follow-up period. Results Modified intention-to-treat analysis revealed substantial and statistically significant differences (p = 0.007) in total sickness absence duration over 1 year follow-up between the experimental (mean 18.98; SD 29.50) and control group (mean 31.13; SD 55.47). Per-protocol analysis additionally showed that the proportion of long-term sickness absence spells (>28 days) over 1 year follow-up was significantly (p = 0.048) lower in the experimental (9.1%) versus control group (18.3%). Conclusions Structured early consultation with the OP among employees at high risk for future long-term sickness absence is successful in reducing total sickness absence

Prediction of Long-Term Sickness Absence Among Employees with Depressive Complaints

Introduction To study the properties of a screening instrument in predicting long-term sickness absence among employees with depressive complaints. Methods Employees at high risk of future sickness absence were selected by the screening instrument Balansmeter (BM). Depressive complaints were assessed with the depression scale of the Hospital Anxiety and Depression Scale. The total study population consisted of 7,401 employees. Sickness absence was assessed objectively and analyzed at 12 and 18 months of follow-up using company registers on certified sick leave. Results The relative risk (RR) for long-term sickness absence, for employees at high risk versus not at high risk, was 3.26 (95% CI 2.54–4.22) in men and 2.55 (1.98–3.35) in women, when the BM was applied in the total study population. The RR of long-term sickness absence of employees with depressive complaints compared with employees without depressive complaints was 3.13 (2.41–4.09) in men and 2.45 (2.00–3.00) in women. The RR of long-term sickness absence for the BM applied in employees with depressive complaints was 5.23 in men and 3.87 in women. When the BM with a cut-off point with a higher sensitivity was applied in employees with depressive complaints, the RR for long-term sickness absence was 4.88 in men and 3.80 in women. Conclusions The screening instrument Balansmeter is able to predict long-term sickness absence within employees with depressive complaints. The total prediction of long-term sickness absence proved better in employees with depressive complaints compared with employees of a general working population

Environmental and energy economics in low-income countries

Low-income countries are expected to contribute almost all of the growth in global energy demand over the coming decades. A large body of research spanning several decades has generated a deep understanding of energy economics in the U.S.—but policy makers have little rigorous evidence about what optimal energy policy may look like in a setting where policy makers face pressures to simultaneously reduce poverty, stem growing inequality, and stimulate economic growth, while also protecting the environment. Second-best policy for correcting environmental externalities may look different in settings with frictions that are common in developing settings, such as credit constraints, the cognitive stress of poverty, and weak institutions.Energy generation in low-income countries often generates large negative health consequences. But reliable energy has also facilitated higher levels of economic welfare than ever before: energy powers hospitals, schools, homes, transport for billions, and other industries that have enabled higher qualities of life and longer life expectancies. How can the billions of people who currently have no or low-quality access to electricity reach higher, safer, and healthier standards of living, while also minimizing the potential damages of environmental changes? And how can this be done given the political pressures, credit constraints, corruption, and other market failures that are common in low-income contexts? Motivated by the broader goal of reducing poverty and increasing welfare among the poor, my research attempts to inform policies that reduce poverty while protecting individuals against the environmental damages that have often accompanied economic growth through industrialization in the past two centuries. In the first chapter, coauthored with Joshua Dean, we explore the roles of credit constraints and inattention in the under-adoption of high-return technologies. We study this question in the case of energy efficient cookstoves in Nairobi. Using a randomized field experiment with 1,000 households, we estimate a 300% average annual rate of return to investing in this technology, or $120 per year in fuel savings—around one month of income. Despite this, adoption rates are low: eliciting preferences using an incentive-compatible Becker-DeGroot-Marschak mechanism, we find that average willingness-to-pay (WTP) is only$12. Households would need to have a discount factor of 0.88 per week to rationalize this. To investigate what drives this puzzling pattern, we cross-randomize access to credit with two interventions designed to increase attention to the costs and benefits of adoption. Our first main finding is that credit doubles WTP and closes the energy efficiency gap over the period of the loan. Second, credit works in part through psychological mechanisms: around one-third of the total impact of credit is caused by inattention to loan payments. We find no evidence of inattention to energy savings. These findings have implications for second-best regulation of pollution externalities using subsidies versus taxes. These results contribute to the debate on the efficacy of taxation versus technology subsidies in correcting environmental externalities: in low-income contexts, where credit constraints are common, Pigovian taxation alone may not be the optimal policy. Private benefits and avoided environmental damages generate average welfare gains of $600 for each stove adopted and used for two years. A subsidy would have a marginal value of public funds of$19 per $1 spent. Low- and middle-income countries will propel global energy demand in coming decades, increasing costs for the poor and straining energy systems, and credit constraints will exacerbate deadweight loss by limiting the adoption of energy efficient technologies. We show that technology subsidies correct environmental externalities more efficiently than Pigovian taxation alone in these settings.In the second chapter I study how temperature affects household energy demand in low-income countries. I use 132,375,282 hourly electricity consumption observations from 5,975 households in South Africa to estimate the causal effects of short-term temperature changes on household electricity consumption. The estimates flexibly identify a constant log-linear temperature response—for every 1C increase in temperature, electricity consumption decreases by 4.1% among temperatures below the heating threshold but increases by 8.1% among temperatures above the cooling threshold. This relationship is driven more strongly by seasonal than hourly temperature changes. Holding all else constant, a 3.25C increase in temperatures would reduce electricity consumption by 1,093.4 kWh (6.2%) per year per household. Widespread use of electric heating due to limited residential gas heating infrastructure likely drives this. These results point to important regional heterogeneity in how temperature increases may affect household energy demand in the coming decades.In the third chapter, coauthored with Eric Hsu, Oliver Kim, Edward Miguel, Felipe Vial, and Catherine Wolfram, we study how political favoritism shapes the provision of public goods. We study the implementation of Kenya’s Last Mile Connectivity Project, a large-scale program to connect all households in Kenya to electricity. Using administrative construction data and voting data from the 2013 and 2017 presidential elections, we find evidence that sites in wards that voted for the current president in 2013 are more likely to be included in the program, and that construction at these sites proceeds on average more quickly than those that voted for the opposition---a pattern consistent with clientelistic behavior around the election cycle. To account for unobservables that may threaten identification, we repeat our analysis using only adjacent electoral wards, where unobservable characteristics are less likely to differ, and find similar results