Do wealth shocks affect health? New evidence from the housing boom

We exploit wealth shocks arising from housing wealth gains to examine the relationship between wealth and health. In UK household panel data positive housing wealth gains lower the likelihood of home owners exhibiting a range of non-chronic health conditions with no effect on renters. For owners housing wealth gains change health behaviours: increasing use of private health care, reducing hours of work (especially for women) and increasing time dedicated to exercise. Housing wealth gains, unlike income gains, do not increase risky health behaviours such as smoking and drinking. Furthermore, house prices highly pro-cyclical. The positive health effects of housing wealth gains on home owner health over the business cycle offset the negative health effects of labour market conditions and work intensity

The response to nutritional labels:Evidence from a quasi-experiment

This paper evaluates a UK policy that aimed to improve dietary information provision by introducing nutrition labelling on retailers’ store-brand products. Exploiting the differential timing of the introduction of Front-of-Pack nutrition labels as a quasi-experiment, our findings suggest that labelling led to a reduction in the quantity purchased of labelled store-brand foods, and an improvement in their nutritional composition. More specifically, we find that households reduced the total monthly calories from labelled store-brand foods by 588 kcal, saturated fats by 14 g, sugars by 7 g, and sodium by 0.8 mg

An analysis of households' credit markets in Ethiopia and Malawi.

The aim of this thesis is to analyse formal and informal credit in Ethiopia and Malawi. As credit markets in developing economies are dominated by informal institutions, the analysis of the interaction between formal and informal institutions is crucial to understanding how welfare improvements can be achieved. The thesis begins with an explanation of the motives for demanding credit. It then focuses on analysing the existence, diffusion and persistence of informal nance in developing economies. Much research on this topic remains hamstrung by the quality and availability of data and by the lack of empirical models, constraining the meaningful identification of the characteristics of the localities where informal institutions operate. The central idea of the first essay is to develop an empirical model that explains the determinants of participation in informal credit arrangements. We adopt an endogenous switching regression model of access to informal credit where the availability of a particular type of informal arrangement varies across clusters in rural Ethiopia. This strategy allows for taking into account substitutability between sources as well as household and cluster socioeconomic characteristics. The second essay exploits the idea that banks can crowd out informal borrowing in Malawi by creating microfinance institutions that acquire information in innovative ways. We adopt propensity score matching and find that the creation of a specific microfinance programme reduces informal borrowing. The third essay uses the credit limit variable to test liquidity constraints and the spillover hypotheses in Malawi. A ten percent increase in the informal credit line increases households' demand for informal credit by more than nine percent. We also find that a 10 percent increase in the credit limit of a microfinance programme reduces the informal demand by four percent, partly explaining the coexistence of formal and informal credit institutions

The effect of cash transfers on mental health – New evidence from South Africa

Background Mental health and poverty are strongly interlinked. There is a gap in the literature on the effects of poverty alleviation programmes on mental health. We aim to fill this gap by studying the effect of an exogenous income shock generated by the Child Support Grant, South Africa’s largest Unconditional Cash Transfer (UCT) programme, on mental health. Methods We use biennial data on 10,925 individuals from the National Income Dynamics Study between 2008 and 2014. We exploit the programme’s eligibility criteria to estimate instrumental variable Fixed Effects models. Results We find that receiving the Child Support Grant improves adult mental health by 0.822 points (on a 0–30 scale), 4.1% of the sample mean. Conclusion Our findings show that UCT programmes have strong mental health benefits for the poor adult population

Does Patient Health Behaviour respond to Doctor Effort?

Incentive pay systems have been introduced in public sectors such as education and health care. In these sectors the output (education or health respectively) depends on the actions of different agents and it is unclear what the effects of such incentive systems are on the behaviour of untargeted agents. In this study we focus on patient health, modelled as a joint product of patient effort (through lifestyle and behaviour) and doctor effort (through diagnosis and treatment). Patient response to doctor effort is shown to be a priori ambiguous and depends on the degree of complementarity or substitution between doctor and patient effort. We build an empirical model to estimate the effect of doctors’ treatment effort on patient behaviour. To address the endogeneity of doctor effort we exploit a change in payments to doctors in the U.K. that led to incentive changes that varied by practice, depending on their prior performance levels. We use panel data on the physical activity, drinking and smoking behaviours of over 2,000 cardiovascular disease patients aged over 50 in England and link these data to their primary care practice performance data. Our results indicate that primary care practices increased the proportion of patients with controlled disease from 76% to 83% in response to the payment change. Patients responded by reducing the frequency of drinking alcohol and their cigarette consumption, suggesting that patient efforts are complements to doctor effort. Understanding such complementarities has implications for assessing the design and effectiveness of pay-for-performance schemes which encourage higher doctor effort

Protecting Adolescents in Low- And Middle-Income Countries from Interpersonal Violence (PRO YOUTH TRIAL):Study Protocol for a Cluster Randomized Controlled Trial of the Strengthening Families Programme 10-14 (“Familias Fuertes”) in Panama

Background Interpersonal violence can significantly reduce adolescents’ opportunities for becoming happy and healthy adults. Central America is the most violent region in the world and it is estimated that adolescents are involved in 82% of all homicides in this region. Family skills training programmes have been designed to prevent interpersonal violence in adolescents. Several studies in high-income countries suggest they are effective. However, there are no published trials assessing effectiveness of these programmes in low- and middle-income countries (LMIC). The aim of this study is to test the effectiveness of the Strengthening Families Programme 10–14 (SFP 10–14 or “Familias Fuertes”) in Panama, a LMIC in Central America. An embedded process evaluation will examine the extent to which the intervention is delivered as intended, variation across trial sites, influences on implementation and intervention-context interactions. Cost-effectiveness will also be assessed. Methods This is a cluster randomised controlled trial. The 28 townships with the highest homicide rates in Panama will be randomly allocated to implementation of SFP 10–14 alongside services-as-usual or to services-as-usual only. Approximately 30 families will be recruited in each township, a total sample of 840 families. Families will be assessed at baseline, approximately eight weeks after baseline (i.e. post intervention), six months and 12 months after. The primary outcome measure will be the parent reported externalising subscale of the Child Behaviour Checklist at T3 (i.e., which is approximately 12 months after baseline). For the process evaluation, recruitment, attendance, fidelity and receipt will be measured. Qualitative interviews with facilitators, trainers, parents and adolescents will explore barriers/facilitators to implementation and intervention receipt. For the cost-effectiveness analysis, service use information will be gathered from parents and adolescents with a three-month recall period. Costs and consequences associated with implementation of the intervention will be identified. Discussion This trial will be the first to evaluate SFP 10–14 in a LMIC. Results have the potential to guide public policies for the prevention of interpersonal violence in Central America and beyond

Is treatment "intensity" associated with healthier lifestyle choices?:An application of the dose response function

Healthy lifestyle choices and doctor consultations can be substitutes or complements in the health production function. In this paper we consider the relation between the number of doctor consultations and the frequency of patient physical activity. We use a novel application of the Dose-Response Function model proposed by Hirano and Imbens (2004) to deal with treatment endogeneity under the no unmeasured confounding assumption. Our application takes account of unobserved heterogeneity and uses dynamic non-linear models for the treatment and outcome variables of interest. Using seven waves of the British Household Panel Survey, we find that higher treatment intensity and frequency of physical activity are inversely related. We show that accounting for both treatment selection and unobserved heterogeneity halves the size of this relationship. An additional doctor consultation is associated with a 0.5 percentage point reduction in the probability of undertaking vigorous physical activity. Our results hold for a sub-sample visiting the doctor for health check-ups, and are shown to be robust using instrumental variables