Drinking under Communism: Why do Alcohol Consumption Habits in Eastern Europe Differ from the West in the Long-Run?

This paper looks into possible explanations for differences between Eastern and Western Europe alcohol consumption behaviour even twenty years after the collapse of the Soviet regime. It suggests these differences can be viewed as an expression of cultural habits. We explore different ways of defining exposure to the communist regime: using number of years a person spent under the regime and also a dummy indicator for spending formative years (18-25) in it. We find both to be strong factors in explaining alcohol consumption behaviour. We consider differences in frequency of alcohol consumption and binge drinking using European Health Interview Survey (EHIS) micro data from Eurostat. Estimations are run with ordered probit model for men and women separately. Evidence suggests a statistically significant effect of experiencing communist regimes, which is larger for women’s alcohol consumption frequency than for men’s. It is also the most important factor in explaining more frequent male binge drinking. These effects hold after controlling for socio-economic, country level and time characteristics. This suggests the attitudes towards alcohol consumption could be more permissive in the Eastern Bloc countries

Unemployment and well-being of Europeans across the life cycle: The role of countries’ macroeconomic situation

Unemployment impairs individuals’ well-being and health and there is some empirical evidence showing that macroeconomic conditions can moderate these effects. This paper goes a step further and investigates differences in how macroeconomic indicators of European countries’ economic situation relate to individual subjective health and well-being, and also moderate the relationship between individual labour market exclusion and these outcomes across age groups: young individuals (aged 15-29), prime working age adults (aged 30-49, base category) and pre-retirement age adults (aged 50-64). We used two different macroeconomic indicators to define macroeconomic situation: country-level unemployment rate (UR) and gross domestic product (GDP). Both indicators were disaggregated into long-term economic trend and business cycle shocks using Hodrick-Prescott filtering to allow distinguishing between expected and unexpected change in macroeconomic circumstances. We used the European Social Survey (ESS) individual-level data from 35 European countries for 2002-2014. Multi-level analysis with three levels were run for men and women separately. Results revealed differences in how individual-level unemployment related to well-being depending on the age group, with pre-retirement age group adults’ health and well-being suffering the most. Also, macroeconomic indicators were found to moderate the relationship between individual-level unemployment and subjective health and well-being with some noticeable differences between age groups, and with GDP trend having the most sizeable influence

The Relationship between the Prevalence of the Urgent and Emergency Care Vanguard Participance and Delayed Transfers of Care in English Local Authorities

This paper examines the relationship between the prevalence of the urgent and emergency care vanguard (UEC) at the local authority level and their delayed transfers of care (DTOC) rates in England. We created a novel measure of exposure to UEC vanguards based on the residence of patients who used UEC partner hospitals, and we group it by the level of exposure (high, medium, low, none). We use this measure to estimate the effect of UEC vanguards on DTOC rates and then on DTOC rates by sector and a range of reasons associated with the delay. The analysis was run at the local authority level (LA) using quarterly data from NHS England for 150 English LAs from the years 2012–2017. We find a statistically significant UEC exposure effect of around 0.3% reduction in total DTOC to a 1% increase of UEC exposure (equivalent to 775 DTOC days per local authority per quarter in high UEC exposure areas), a result robust to various specification checks. Nonacute sector DTOC was found to be more responsive to UEC vanguards in comparison to acute sector DTOC (0.4% and 0.3% reductions, respectively, to every 1% of UEC exposure). DTOC due to social care was particularly responsive to UEC exposure (0.7% reduction to 1% exposure). DTOC reasons associated with the highest impact of UEC exposure were as follows: awaiting a care package at own home, waiting for further NHS nonacute care, and completion of assessment (reductions of 0.5%, 0.3%, and 0.3% to 1% exposure, respectively). All three reasons were originally associated with the largest number of DTOC days. These findings further advocate for UEC vanguards having been successful at alleviating the pressure on hospitals related to DTOC

Heterogeneity in the effect of obesity on future long-term care use in England

Although there is some recent evidence around the effects of obesity on health care utilisation and costs, not much is known about the relationship between obesity and long-term care utilisation (Public Health England, 2013). Few studies from the USA find that obesity increases the risk of nursing home admissions and use of personal care assistance (Elkins et al. 2006, Ziza et al. 2002, Resnik et al. 2005, Yang and Zhang 2014). Nizalova, Gousia and Forder (2017) show that obesity leads to higher use of informal care but find no effect on other types of long-term care. In this study we explore whether the effect on various types of care differs depending on the degree of obesity among older people in England and whether the findings are sensitive to the incorporation of information on long-term care use prior to death. We find that in addition to the obesity at the level of BMI between 25 and 45 representing a risk for future use of informal care, (super) obesity at the level of BMI at 45 and greater represents a significant risk for all types of care use, including social care and nursing home/residential care

The impact of formal care provision on informal care receipt for people over 75 in England

In this study, we examine the relationship between formal care provision and informal care receipt from within the household for people over 75 years old using data from the British Household Panel Survey between 1991 and 2009. To address potential concerns about endogeneity of formal care we use a ‘spatial lag’ instrumental variable. We find a negative and statistically significant effect of formal care provision on informal care receipt from within the household, suggesting a substantial degree of substitutability between these two modes of care. These findings provide grounds for estimates of savings in the cost of informal care enabled by spending on formal care, which is important in light of the effects of the caregiving burden and associated responsibilities on carer’s labour market participation

Effects of unemployment and insecure jobs on youth wellbeing in Europe: economic development and business cycle fluctuations

In terms of its societal impact, the global financial crisis of 2008 was considered to be the most significant crisis since the Great Depression in 1929 (Rollero and Tartaglia, 2009), and it is often referred to as the Great Recession. Ever since, Europeans, and particularly young Europeans, have been facing a threatening work situation because unemployment rates have increased substantially in most European countries (Chung et al, 2012; Eurostat, 2014). At the same time, temporary employment has followed suit, albeit at a lower speed, but affecting mostly young people. , Empirical evidence suggests that unemployment and job insecurity have detrimental effects on individuals’ well-being, and not only in the general population (for reviews see Sverke et al, 2002; De Witte, 2005; Cheng and Chan, 2008; see McKee-Ryan et al, 2005, for a meta-analysis) but also among young people (see Voßemer and Eunicke, 2015). Hence, it is important to investigate the outcomes of unfavourable labour market conditions for young people in Europe, because employment opportunities mark young individuals’ transition to adulthood (Bynner and Parsons, 2002). Any attempt to fully understand the conditions under which young people facing unemployment and job insecurity are particularly vulnerable must also account for the role of macrolevel moderators, given the large variations in social policies and economic growth observed across the different European countries (Voßemer et al, 2018). Although it is plausible to think that the strength of the individual-level effects of unemployment and job insecurity on well-being may vary between poorer and richer countries, few studies have looked at potential cross-country differences and the role of macrolevel moderators in understanding this relationship (for example Eichhorn, 2013; Wulfgramm, 2014). Most of these studies focused on the moderating role of labour market policies or the countries’ economic conditions, often measuring either GDP per capita or the country-level unemployment rate (UR). However, these two measures may have a completely different meaning when examined as moderators, and they should not be viewed as being interchangeable. First, GDP and UR do not substitute each other, because some countries often experience jobless growth, whereas others may experience a decrease in UR due to a concerted effort by the government without any increase in GDP per capita. Second, conceptually, GDP and UR underline different phenomena. Thus, when they are investigated simultaneously, different mechanisms are being discerned and tested. GDP per capita reflects the level of resources per citizen available in the country such as employment-related (for example, unemployment benefits) or health-related (including health expenditure) resources. The present analysis focuses on GDP as an overall measure that captures all kinds of societal support and the capacity of the government to provide such support. In this way, it captures the broader context in contrast to previous empirical attempts that looked at specific policy measures (Voßemer et al, 2018). Based on conservation of resources (COR) theory (Hobfoll, 1989), it is argued that higher levels of GDP may buffer the detrimental effects on well-being of unemployment and job insecurity, because in countries with a higher GDP, people have access to more resources when they face difficult times – irrespective of that country’s UR. When the level of resources (as measured by the GDP) is held constant, there are two potential mechanisms to consider regarding the moderating role of UR. On the one hand, based on the principle of social comparison or the norm (see Clark, 2003), unemployment is likely to hurt less when there are more unemployed people around, because it is attributed externally and not to one’s own, personal failure. On the other hand, from the standard economics perspective, higher UR means fewer prospects of finding a job for those currently unemployed – hence, strengthening the unfavourable effect of own unemployment. In reality though, both mechanisms are likely to be in place, and one can determine only empirically which of the two effects prevails. The current analysis investigates the moderating role of both GDP per capita and UR simultaneously as moderators of the relationship between unemployment/job insecurity and well-being. This attempts to distinguish the economic (that is, resource) effect from the social norm effect. The GDP per capita is expected to represent mostly an economic resource. Even though the UR is likely to combine both economic and social norm considerations, this study expects that the effect of UR will mainly capture the social norm effect when simultaneously controlling for GDP. Furthermore, the study also distinguishes between the moderating role of long-term trajectories and business cycle fluctuations, given their different nature with respect to the formation of individual expectations. Macroeconomics has long been preoccupied with the separation of long-term trends in key indicators from short-term business cycle fluctuations. There are two reasons to think that such a separation is relevant when analysing the moderating effect of macroeconomic conditions on the relationship between employment status and well-being. If one considers the resource availability argument (Hobfoll, 1989), the underlying reason for the separation of the long-term trend from the business cycle fluctuation lies within the state budgeting process. The budget is set annually, based on historic information and future spending forecasts. Therefore, it is more likely that short-term fluctuations will send a weaker signal to individuals with regards to resource availability compared to that from the long-term GDP trajectory. A similar mechanism is likely to be in place with regards to UR: a long-term unemployment trajectory should send a stronger signal to individuals with regards to social comparison than the business cycle fluctuation

Understanding policy amenable risk factors: Alcohol consumption and long-term care use among people over 65 years old

This study aims to explore the effect of past alcohol consumption frequency on formal and informal long-term care (LTC) use in old age and explore the different channels through which it may affect LTC use. The existing literature has mainly focused on risk factors associated with a nursing home entry, but this evidence is outdated, not UK-focused, and does not look into other types of care, such as informal care. The results of this study will help in modelling the future demand for various types of care and the corresponding public spending. We use the English Longitudinal Study of Ageing (ELSA) (2002-2017) dataset to conduct longitudinal, individual-level analysis. We explore how the previous frequency of alcohol consumption affects formal and informal care use. We focus on people aged 65 and over with no previous LTC use and run regressions with and without instrumental variables (IV) to estimate how alcohol consumption patterns in the previous wave (2 years before) affect formal and informal care use. For IV regressions, we use the polygenic score for alcohol use, available for a subsample of ELSA respondents, as an instrument while also accounting for sociodemographic characteristics, lifestyle choices, and health conditions. The main IV estimates suggest that frequent alcohol consumption has a weakly significant positive effect on the onset of formal LTC care use compared to none/rare drinking. This relationship diminishes and is not statistically significant when we directly control for health status. We find no statistically significant effect towards informal LTC use. These results contrast with the estimates without IV, which suggest that frequent alcohol consumption is negatively associated with informal care use and no or weakly negative association with formal care use. Our findings suggest that unobserved confounding is important when studying the relationship between alcohol consumption and LTC. We hypothesise that primarily alcohol effects LTC through its adverse effect on health. In addition, unobserved factors like preferences towards seeking care, social behaviour may be related to alcohol consumption and affect access to care. We speculate alcohol may have a damaging effect on personal relationships and could indicate the burden eventually falling on formal care. In as far as the polygenic score IV can account for unobserved preference-behaviour differences, the results (weakly) support the hypothesis that these latter processes are relevant, especially for informal care use

The impact of formal care on informal care for people over 75 in England

In this study, we examine the relationship between formal care provision and informal care receipt from within and outside the household for people over 75 years old using data from the British Household Panel Survey between 1991 and 2009. To address potential concerns about endogeneity of formal care we use a set of instrumental variables including a novel care eligibility variable. We find a negative and statistically significant effect of formal care on informal care from within the household, suggesting a substantial degree of substitutability between these two modes of care. With regards to informal care provided from outside the household, although the effect is still negative, the degree of substitutability is substantially smaller and mostly not statistically significant. These findings support current discussions and policies towards the implementation of an integrated care system, providing grounds for estimates of savings in the cost of informal care enabled by spending on formal care