What will the cardiovascular disease slowdown cost? Modelling the impact of CVD trends on dementia, disability, and economic costs in England and Wales from 2020–2029

Publisher Copyright: © 2022 Collins et al.Background There is uncertainty around the health impact and economic costs of the recent slowing of the historical decline in cardiovascular disease (CVD) incidence and the future impact on dementia and disability. Methods Previously validated IMPACT Better Ageing Markov model for England and Wales, integrating English Longitudinal Study of Ageing (ELSA) data for 17,906 ELSA participants followed from 1998 to 2012, linked to NHS Hospital Episode Statistics. Counterfactual design comparing two scenarios: Scenario 1. CVD Plateau—age-specific CVD incidence remains at 2011 levels, thus continuing recent trends. Scenario 2. CVD Fall—age-specific CVD incidence goes on declining, following longer-term trends. The main outcome measures were age-related healthcare costs, social care costs, opportunity costs of informal care, and quality adjusted life years (valued at £60,000 per QALY). Findings The total 10 year cumulative incremental net monetary cost associated with a persistent plateauing of CVD would be approximately £54 billion (95% uncertainty interval £14.3-£96.2 billion), made up of some £13 billion (£8.8-£16.7 billion) healthcare costs, £1.5 billion (-£0.9-£4.0 billion) social care costs, £8 billion (£3.4-£12.8 billion) informal care and £32 billion (£0.3-£67.6 billion) value of lost QALYs. Interpretation After previous, dramatic falls, CVD incidence has recently plateaued. That slowdown could substantially increase health and social care costs over the next ten years. Healthcare costs are likely to increase more than social care costs in absolute terms, but social care costs will increase more in relative terms. Given the links between COVID-19 and cardiovascular health, effective cardiovascular prevention policies need to be revitalised urgently.Peer reviewe

Rental Housing Assistance for the 21st Century

Current rental housing assistance programs are not designed to provide a safety net for people whose lives are volatile, or to encourage poor people to live in good locations. These failings can be corrected. HUD should establish a program of rental insurance-like mortgage insurance, but for renters. Low income housing assistance formulas should be revised to reward good neighborhood features, and punish bad

Modelling the Health Impact of an English Sugary Drinks Duty at National and Local Levels

Increasing evidence associates excess refined sugar intakes with obesity, Type 2 diabetes and heart disease. Worryingly, the estimated volume of sugary drinks purchased in the UK has more than doubled between 1975 and 2007, from 510ml to 1140ml per person per week. We aimed to estimate the potential impact of a duty on sugar sweetened beverages (SSBs) at a local level in England, hypothesising that a duty could reduce obesity and related diseases. Methods and Findings We modelled the potential impact of a 20% sugary drinks duty on local authorities in England between 2010 and 2030. We synthesised data obtained from the British National Diet and Nutrition Survey (NDNS), drinks manufacturers, Office for National Statistics, and from previous studies. This produced a modelled population of 41 million adults in 326 lower tier local authorities in England. This analysis suggests that a 20% SSB duty could result in approximately 2,400 fewer diabetes cases, 1,700 fewer stroke and coronary heart disease cases, 400 fewer cancer cases, and gain some 41,000 Quality Adjusted Life Years (QALYs) per year across England. The duty might have the biggest impact in urban areas with young populations. Conclusions This study adds to the growing body of evidence suggesting health benefits for a duty on sugary drinks. It might also usefully provide results at an area level to inform local price interventions in England

Housing Subsidies and Homelessness: A Simple Idea

Reducing homelessness is an indisputable social good, and housing subsidies offer one way to do so. However, subsidies come in many different varieties and are intricately bound up with economic and social policies. This paper, written by one of North America’s leading urban economists, cuts through the tangle and argues that the simplest approach is the best. The ideal way to deter people from harmful acts is to reward them for abstaining. Thus, to combat homelessness, governments should offer housing allowances to people for every night they are not homeless. This optimal homelessness-reducing home allowance (OHRHA) is open to adjustment to suit individual circumstances and the effects of homelessness on different demographics. It is meant to reduce homelessness by aligning individual and societal incentives, forcing people to bear the consequences or realize the benefits that their actions impose on others. The author explores methods for financing OHRHA, examines means for tailoring it to meet the diverse needs of the homeless and discusses the policy’s effect on urban housing markets, all while comparing and contrasting the proposal to existing homelessness-reduction measures in Alberta, Canada and the US

Witness Intimidation

Witness intimidation involves strategic complexity and two-sided uncertainty: criminals cannot know whether threats will deter witnesses, and witnesses cannot know whether threats will be carried out. We model this interaction and explore how rates of intimidation, testimony, and conviction respond to changes in the value of testimony, relations between the police and the community, and witness protection programs. If the value of testimony rises, criminals face stronger incentives to threaten, but threats are less credible. The increase in threats may be large enough to offset the greater value of testimony, with the paradoxical outcome that fewer criminals are convicted. Counterintuitive results are most likely when witness intimidation is a severe problem: few witnesses testify although prosecutors are competent. When the harm faced by witnesses depends on whether the criminal is convicted, communities can be trapped in equilibria with collective silence: no witness testifies because none expects others to testify.

The Racial Geography of Vice

Street vice (anonymous prostitution, gambling, and the sale of illicit drugs) is spatially concentrated, con…ned largely to black neighborhoods in central cities, even though demand is quite evenly distributed throughout the general population. We show how this pattern can arise through the interacting location decisions of sellers, buyers, and non-user households. Areas with high demand density (cities) have lower prices and more tightly packed sellers in equilibrium relative to areas with lower demand density (suburbs) under autarky. When trade between city and suburb is possible, competitive pressure from the city lowers suburban prices and seller density. Higher income households distance themselves from street vice, causing the exposed population to become poorer and disproportionately black. Even mild preferences over neighborhood racial composition can then induce lower income whites to exit, resulting in racial segregation. The relationship between segregation and exposure to vice can be non-monotonic and discontinuous: decreased segregation implies greater sorting by income, and hence larger wage disparities between city and suburb. If such disparities get too large, all sales can shift discontinuously to the city and result in higher overall black exposure even though more blacks now reside in the suburbs

Turnover Reflects Specific Training Better Than Wages Do

Turnover falls with tenure — this is one of the best established empirical regularities of labor economics — but finding a tenure effect on wages seems to be very hard. Within-job wage cuts do not seem very uncommon either. We reconcile these findings by revisiting an old question: how gains from firm specific training are split between workers and firms. The division is determined by a stationary distribution of outside offers. The model is ex post monopsony: the lower a wage a firm pays to a specifically trained worker, the more profit it makes and the more eager it is to have her stay, but the more likely she is to leave. The optimal time paths of wages and turnover probabilities show that even if marginal product is increasing, wages need not be increasing; but rising marginal product always implies a falling turnover rate

Social programs and household size: evidence from New York city

Household size, Housing subsidies, Income subsidies, New York, Social programs,