Racism as a determinant of health: a systematic review and meta-analysis

Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants.<br /

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Essays on Macroeconomics and Oil

In these essays, I examine (i) the empirical methods that are widely used in the literature to measure total factor productivity growth and (ii) the impact of nationalization on productivity in the oil industry. The first chapter, which is an ongoing work with SHI, Wei, investigates two empirical measures, quantity-based (primal) measure and price-based (dual) measure, of total factor productivity growth. My co-author and I analyze how these two measures are affected by output market imperfection or variable capacity utilization. We find that under constant-returns-to-scale production function assumption, existence of the imperfect competition in the output market creates a gap between the measured TFP growth and the true TFP growth, no matter which method is used. However, theoretically, it does not affect the equivalence between the two measures. Under variable capacity utilization, we show that constant-returns-to-scale assumption is almost enough to guarantee the validity of the two methods in correctly capturing the true TFP growth. In the second and third chapters, I analyze the link between nationalization and productivity. The second chapter documents the trends in expropriation acts, and evaluates the impact of expropriations on labor productivity of resource-rich developing countries in the oil industry. In the first part of this chapter, I investigate the trends in the expropriation acts that took place in 102 developing countries during the period 1922-2006. I find that more than half of the acts occurred between 1970 and 1976, there has been an increase in the number of expropriations in recent years, and the extractive sector including petroleum is more likely to be expropriated. Motivated by these facts, in the second part, I examine the oil industry in a period of widespread expropriations, the 1970s. In a sample of major oil-producing countries including OPEC and non-OPEC members, I show that losses in relative labor productivity after nationalization range from 25 percent to 55 percent. In the third chapter, I attempt to provide an answer for why nationalization is associated with lower productivity by examining the case of the 1975 Venezuelan oil industry nationalization. The first part of the chapter documents the facts. I find that prior to nationalization there was a significant contraction in manpower (particularly in the foreign work force) and exploration, and an increase in production and productivity. Production and productivity declined sharply, however, by the beginning of the nationalization process. This decline continued even after the process was finalized and a substantial expansion took place in the industry. In the second part, I explain these facts by using a dynamic partial equilibrium framework for nonrenewable resources featured by imperfect substitutability between domestic and foreign workers. The anticipation of nationalization preceding 1970 can explain the drop in the total work force at the expense of lower exploration which accompanies increasing productivity. The lost foreign expertise can explain the path of productivity during and after nationalization. A comparison of the simulated and actual time series shows that around 56 percent of the increase in productivity prior to 1970, and about 39 percent of the decline in productivity during and after the nationalization process can be attributed to the proposed mechanism

Essays on Macroeconomics and Oil

In these essays, I examine (i) the empirical methods that are widely used in the literature to measure total factor productivity growth and (ii) the impact of nationalization on productivity in the oil industry. The first chapter, which is an ongoing work with SHI, Wei, investigates two empirical measures, quantity-based (primal) measure and price-based (dual) measure, of total factor productivity growth. My co-author and I analyze how these two measures are affected by output market imperfection or variable capacity utilization. We find that under constant-returns-to-scale production function assumption, existence of the imperfect competition in the output market creates a gap between the measured TFP growth and the true TFP growth, no matter which method is used. However, theoretically, it does not affect the equivalence between the two measures. Under variable capacity utilization, we show that constant-returns-to-scale assumption is almost enough to guarantee the validity of the two methods in correctly capturing the true TFP growth. In the second and third chapters, I analyze the link between nationalization and productivity. The second chapter documents the trends in expropriation acts, and evaluates the impact of expropriations on labor productivity of resource-rich developing countries in the oil industry. In the first part of this chapter, I investigate the trends in the expropriation acts that took place in 102 developing countries during the period 1922-2006. I find that more than half of the acts occurred between 1970 and 1976, there has been an increase in the number of expropriations in recent years, and the extractive sector including petroleum is more likely to be expropriated. Motivated by these facts, in the second part, I examine the oil industry in a period of widespread expropriations, the 1970s. In a sample of major oil-producing countries including OPEC and non-OPEC members, I show that losses in relative labor productivity after nationalization range from 25 percent to 55 percent. In the third chapter, I attempt to provide an answer for why nationalization is associated with lower productivity by examining the case of the 1975 Venezuelan oil industry nationalization. The first part of the chapter documents the facts. I find that prior to nationalization there was a significant contraction in manpower (particularly in the foreign work force) and exploration, and an increase in production and productivity. Production and productivity declined sharply, however, by the beginning of the nationalization process. This decline continued even after the process was finalized and a substantial expansion took place in the industry. In the second part, I explain these facts by using a dynamic partial equilibrium framework for nonrenewable resources featured by imperfect substitutability between domestic and foreign workers. The anticipation of nationalization preceding 1970 can explain the drop in the total work force at the expense of lower exploration which accompanies increasing productivity. The lost foreign expertise can explain the path of productivity during and after nationalization. A comparison of the simulated and actual time series shows that around 56 percent of the increase in productivity prior to 1970, and about 39 percent of the decline in productivity during and after the nationalization process can be attributed to the proposed mechanism

RWP 14-06Productivity, Nationalization, and the Role of “News”: Lessons from the 1970s †

The number of occurrences of an old phenomenon, expropriation of foreign-owned property, had peaked in the 1970s, and virtually every significant oil-producing developing country had nationalized its oil. Nationalization again was on the rise in the 2000s. Using novel data, this paper examines nationalization and its effect on productivity. First, we document historical global trends in expropriations, and examine the effect from the 1960s to the 1990s in a sample of oil-producing developing countries. We show that nationalization brings significant productivity losses. Then, we focus on Venezuela, presenting new extensive and detailed data. In Venezuela, productivity fell sharply immediately ahead of nationalization. We suggest a less-explored channel through which nationalization affects productivity: in anticipation of nationalization, producers reduce exploration, lower employment, and increase extraction. Guided by a quantitative dynamic partial equilibrium framework for nonrenewable resources disciplined by features of the Venezuelan data, we then examine the effect of nationalization on productivity. A comparison of the simulated and time series shows that the carefully calibrated model can explain 84 percent of the productivity pattern over 1961-1980 in the Venezuelan oil industry. † I am grateful to Lee E. Ohanian for his guidance and support, and to Paco Buera, Satyajit Chatterjee, Burcu Eyigungor, Roger E. A. Farmer, Aaron Tornell, and Mark L. J. Wright for insightful discussions and comments. I also thank Gonzal