Booms and booze: on the relationship between macroeconomic conditions and alcohol consumption.

This paper investigates the relationship between macroeconomic conditions and alcohol consumption using country-level data from 159 countries between 1961 and 2004. We use the change in per capita alcohol consumption as the main dependent variable and the growth of per capita gross domestic product as main independent variable. Overall, we find a robust procyclical relationship. Furthermore, our results suggest that whereas high-, middle-, and low-middle income countries show a clear procyclical trend, drinking behavior in low-income countries remains largely unchanged following macroeconomic shocks. Studying different alcoholic beverages, our results indicate that the consumption of spirits is most sensitive to economic swings, whereas the consumption of wine and beer is less elastic.

The hedonic placebo effect of traditional medicines

To date, the scientific evidence on traditional medicines is scant and under-developed, yet, paradoxically individuals continue to use it and claim high satisfaction levels. What can explain this effect? Using self-collected data from Ghana we argue that variations in satisfaction across individuals can be attributed to the hedonic placebo effect gained from using traditional medicines, in which processes involved with its consumption are as important, if not more important, than measures of self-reported health outcome. Findings suggest that individuals’ health seeking behaviour should be evaluated using procedural, as well as outcome, utility

Does culture matter at all in explaining why people still use traditional medicines?

Why do individuals still use traditional medicines when modern treatments are available? Economic explanations for an individual’s use of traditional instead of modern medicines are scarce and often fail to consider explanations beyond the conventional. This paper puts forward an economic explanation for the use of traditional medicine. First, traditional medicines were the default form of health care available in pre-colonial times where industry influence was yet to develop. Hence, both those individuals who exhibit lower incomes and are left out of health insurance coverage are more likely to use traditional medicines. Second, cultural attitudes and ethnic group controls explain variation in utilisation, even among those who have health insurance. Results are suggestive of the validity of cultural interpretations

Rationales for traditional medicines utilisation and its equity implications: the case of Ghana

Individuals all over the world continue to utilise traditional health care, but there is very little understanding of why this is the case, especially in light of increased availability and accessibility of effective pharmaceutical medicine and other modern technologies. The overarching objective of this thesis is to investigate rationales for utilisation of traditional medicines, using Ghana as a case study. This thesis argues that institutional constraints and cultural preferences inherited from the past shape pluralistic health systems and, consequently, individual health-seeking behaviour. The thesis fuses investigative approaches from different disciplines (e.g. anthropology, economics, psychology) and uses statistical methods to analyse four aspects of medicines utilisation: the role of culture, income, the possibility of a placebo effect in use and finally, the distributional consequences manifested in utilisation inequities. Findings indicate that cultural attitudes and income constraints are associated with use of traditional systems, and users report high rates of satisfaction that are attributable to procedural factors. Inequities are shown to differ according to whether traditional medicines are included in analysis. Generally, this thesis advocates a holistic approach with respect to health systems, as opposed to interpreting traditional systems as simply appendages to modern health care systems; the latter perspective is liable to yield observers only a partial story of medicines utilisation and its impact on equity

Cultural persistence and the ‘Herbal Medicine Paradox’: evidence from cross-section European data

The continued use of herbal or traditional remains despite the proliferation of modern medicine has been labelled as the "herbal medicines paradox" (HMP). This hypothesis can be explained by the persistence of attitudes across cultural boundaries. We draw on evidence form secondary analysis of individual level migration data to test the persistence in the use of herbal medicines in relation to norms in the person’s country of birth (or home country). We study the association between attitudes towards herbal medicine treatments of first (N=3630) and second generation (N=1618) immigrants in thirty European countries and those of ninety different sending country origins. We find robust evidence of an association which is stronger for the second migrants on maternal and paternal lineages, which exhibits significant heterogeneity based on migrants’ country of origin, and is robust to different samples. Our estimates are consistent with a cultural explanation for the HMP

Cultural persistence of health capital: evidence from European migrants

Culture is an under-studied determinant of health production and seldom measured. This paper empirically examines the persistence in the association between the health capital assessments of first and second-generation migrants with that of their ancestral countries. We draw on European data from 30 countries, including over 90 countries of birth and control for timing of migration, selective migration and other controls including citizenship and cultural proxies. Our results show robust evidence of cultural persistence of health assessments. Culture persists, rather than fades, and further, appears to strengthen over generations. We estimate a one standard deviation increase in ancestral health assessment increases first generation migrant’s health assessments by an average of 16%, and that of second generation migrants between 11% and 25%. Estimates are heterogeneous by gender (larger for males) and lineage (larger for paternal lineage)

Identifying health system value dimensions: more than health gain?

Publicly funded health system reforms increasingly require the evaluation of competing programs. However, programs are made of multidimensional attributes of value (where value refers to latent expectations of health system improvement). This paper identifies the design, implementation and validation of a methodology to elicit health system values to guide health care priority setting. The exercise suggests that the proposed mixed methods methodology is suitable for eliciting and validating health system values, and its findings show that pursuing health gain alone does not fully capture the dimensions of health system value. More specifically, we identify a list of health system values (elicited by both potential and actual users) and classify them in terms of process related values (e.g., shorter waiting lists, greater choice etc) and improvements in health system equity in addition to value derived from health gain

A health 'Kuznets' curve'? Cross-section and longitudinal evidence on concentration indices

The distribution of income related health inequalities appears to exhibit changing patterns when both developing countries and developed countries are examined. This paper tests for the existence of a health Kuznets' curve, that is an inverse U-shape pattern between economic developments measured by GDP per capita) and income-related health inequalities (as measured by concentration indices). We draw upon both cross section (the World Health Survey) and a long longitudinal (the European Community Household Panel survey) dataset. Our results suggest evidence of a health Kuznets' curve on per capita income. Our findings point towards the existence of a polynomial association where inequalities decline when GDP per capita reaches a magnitude ranging between $26,000 and$38,700.That is, income-related health inequalities rise with GDP per capita, but tail off once a threshold level of economic development has been attained

Eliciting health care priorities in developing countries: experimental evidence from Guatemala

While some methods for eliciting preferences to assist participatory priority setting in health care in developed countries are available, the same is not true for poor communities in developing countries whose preferences are neglected in health policy making. Existing methods grounded on self-interested monetary valuations may be inappropriate for developing country settings where community care is provided through ‘social allocation’ mechanisms. This paper proposes and examines an alternative methodology for eliciting preferences for health care programs specifically catered for rural and less literate populations but which is still applicable in urban communities. Specifically, the method simulates a realistic collective budget allocation experiment, to be implemented in both rural and urban communities in Guatemala. We report evidence revealing that participatory budget-like experiments are incentive compatible mechanisms suitable for revealing collective preferences, while simultaneously having the advantage of involving communities in health care reform processes

Participatory health system priority setting: evidence from a budget experiment

Budget experiments can provide additional guidance to heath system reform requiring the identification of a subset of programs and services that accrue the highest social value to ‘communities’. Such experiments simulate a realistic budget resource allocation assessment among competitive programs, and position citizens as decision makers responsible for making ‘collective sacrifices’. This paper explores the use of a participatory budget experiment (with 88 participants clustered in social groups) to model public health care reform, drawing from a set of realistic scenarios for potential health care users. We measure preferences by employing a contingent ranking alongside a budget allocation exercise (termed ‘willingness to assign’) before and after program cost information is revealed. Evidence suggests that the budget experiment method tested is cognitively feasible and incentive compatible. The main downside is the existence of ex-ante “cost estimation” bias. Additionally, we find that participants appeared to underestimate the net social gain of redistributive programs. Relative social value estimates can serve as a guide to aid priority setting at a health system level