The role of education in health policy reform outcomes: evidence from Japan.

This study analyzes the role of education in the outcomes of the reform of the Japanese annual health checkup program. In April 2008, the annual checkup was redesigned to address concerns about metabolic syndrome. As the checkup is mandatory only for salaried workers, their participation rate is significantly higher than other workers; thus, they were most affected by the reform. Using institutional information, a difference-in-differences estimation was conducted with salaried workers as the treatment group and self-employed workers as the control group. We found that the reform caused significant changes in health behaviors and outcomes only among university graduates who were at a relatively high risk of metabolic syndrome. This highly educated group increased their physical activity, brought energy intake close to an ideal level, and achieved significant weight loss and BMI reduction to levels that minimize all-cause mortality among middle-aged Japanese. A secondary analysis implies that the difference in cognitive functioning test scores may be a critical factor in explaining the heterogeneous responses to the reform, suggesting that thoroughly well-articulated recommendations for healthy behaviors are needed in order to improve reform uptake.

Approaches for disease prioritization and decision-making in animal health, 2000-2021: a structured scoping review.

This scoping review identifies and describes the methods used to prioritize diseases for resource allocation across disease control, surveillance, and research and the methods used generally in decision-making on animal health policy. Three electronic databases (Medline/PubMed, Embase, and CAB Abstracts) were searched for articles from 2000 to 2021. Searches identified 6, 395 articles after de-duplication, with an additional 64 articles added manually. A total of 6, 460 articles were imported to online document review management software (sysrev.com) for screening. Based on inclusion and exclusion criteria, 532 articles passed the first screening, and after a second round of screening, 336 articles were recommended for full review. A total of 40 articles were removed after data extraction. Another 11 articles were added, having been obtained from cross-citations of already identified articles, providing a total of 307 articles to be considered in the scoping review. The results show that the main methods used for disease prioritization were based on economic analysis, multi-criteria evaluation, risk assessment, simple ranking, spatial risk mapping, and simulation modeling. Disease prioritization was performed to aid in decision-making related to various categories: (1) disease control, prevention, or eradication strategies, (2) general organizational strategy, (3) identification of high-risk areas or populations, (4) assessment of risk of disease introduction or occurrence, (5) disease surveillance, and (6) research priority setting. Of the articles included in data extraction, 50.5% had a national focus, 12.3% were local, 11.9% were regional, 6.5% were sub-national, and 3.9% were global. In 15.2% of the articles, the geographic focus was not specified. The scoping review revealed the lack of comprehensive, integrated, and mutually compatible approaches to disease prioritization and decision support tools for animal health. We recommend that future studies should focus on creating comprehensive and harmonized frameworks describing methods for disease prioritization and decision-making tools in animal health.

The Impact of Financial Literacy on Household Health Investment: Empirical Evidence from China.

Based on the 2019 China Household Finance Survey (CHFS) data, this paper used factor analysis to measure the level of financial literacy of surveyed householders and used the Probit model and the negative binomial model to test the impact of financial literacy (FL) on household health investment (HHI). The results show that: (1) FL is an essential influencing factor in increasing participation in HHI, and householders with a higher level of FL are also more willing to pay for diversified investments. (2) We split the FL level from the two dimensions of knowledge and ability. We found that the primary FL (including financial knowledge, computing ability, and correct recognition of investment product risk) plays a more critical role in the investment decision process. (3) When information sources, health knowledge, and family income are used as mediating variables, FL can influence the decisions of HHI in three ways: expanding information sources, enriching health knowledge, and alleviating income constraints. (4) By analyzing the heterogeneity of household heads in different regions and with different personal characteristics, we found that the medical level of the household location and the life and work experience of the householders played a moderating role.

Does financial literacy influence preventive health check-up behavior in Japan? a cross-sectional study.

BACKGROUND: General health check-ups are an important element of healthcare, as they are designed to detect diseases, thereby reducing morbidity and mortality. Recent studies have found that financial literacy promotes preventive healthcare usage and reduces risky health behaviors such as smoking, lack of exercise, and gambling. Based on this evidence, we hypothesize that financial literacy, as a rational decision-making tool, is positively associated with health check-up behavior in Japan. METHODS: We extracted data on financial literacy, the main explanatory variable of this study, from the 2010 wave of the Preference Parameter Study (PPS) of Osaka University. Data on health check-up behavior as a dependent variable, along with control variables, were obtained from the 2011 PPS wave. Our sample focused on Japan's middle-aged working population (40-64 years), and we applied probit regressions to test our hypothesis. RESULTS: Our final sample size was 2,208 participants after merging the two datasets. Descriptive statistics show that respondents had moderate financial literacy (mean = 0.62, SD = 0.33), low financial education (mean = 0.17, SD = 0.38), and low participation (mean = 31.75%, SD = 46.56%) in the health check-up. The probit regression analysis showed that financial literacy is insignificantly associated with health check-up behavior in Japan (coefficient = -0.0229; 95% CI: -0.2011-0.1551; p-value = 0.801). However, demographic factors such as being male (coefficient = -0.2299; 95% CI: -0.3649--0.0950; p-value = 0.001), older (coefficient = 0.0280; 95% CI: 0.0188 - 0.0371; p-value = 0.000), and married (coefficient = 0.3217; 95% CI: 0.0728 - 0.5705; p-value = 0.011), as well as risky health behavior such as smoking (coefficient = -0.2784; 95% CI: -0.4262--0.1305; p-value = 0.000) are significantly related to health check-up behavior. CONCLUSIONS: Our results suggest that financial literacy insignificantly motivates people to behave rationally and understand the value of health check-ups as a tool for sustainable health.

How Does Public Health Investment Affect Subjective Well-Being? Empirical Evidence from China.

Maximizing or improving residents' subjective well-being is one of the basic purposes of public expenditure. As an important component of public expenditure, the impact of public health investment on residents' subjective well-being receives considerable attention. Regarding the empirical evidence, this paper measures residents' subjective well-being from the perspectives of overall cognitive happiness, life satisfaction, positive emotions and negative emotions, on the basis of a multi-level structural model of subjective well-being. Factor analysis is used to estimate the subjective well-being of residents at the province level in China, based on the China Family Panel Studies of 2018. In addition, structural equation modeling is employed to explore the impact of public health investment and its regional disparity on the subjective well-being of residents. The empirical results show that public health investment has a significant positive effect on residents' subjective well-being. Moreover, there is an inverted U-shaped relationship between the regional disparity of public health investment and residents' subjective well-being. Further study illustrates that the effects of public health investment and its regional disparity on residents' subjective well-being are heterogeneous by group. Public health investment has a greater impact on the well-being of low- and middle-income, eastern and urban residents than high-income, midwest and rural residents.

Direct and indirect effects of health expenditure on economic growth in China.

Background: The main social contradictions in China have changed: the core concept is high quality development. Health care investment improves the health of residents and promotes regional economic growth. Aims: To analyse the direct and indirect economic effects of health expenditure during 2012-2018 and to test whether China's investment in health care meets the requirements for high quality development. Method: We selected spatial panel data reflecting the input and output of health resources. We used the knowledge production function and a model of spatial economics to conduct empirical analysis of 31 provinces to show the effects of health expenditure on economic growth. Results: Economic development (LnGDP) was the dependent variable; explanatory variables included health financial input (LnHI), health personnel input (LnHR), health assets (LnCW) and health insurance expenditure (LnHIE). The regression coefficients for indirect, direct and total effects of LnHI were 0.4346, 0.0623 and 0.4970 respectively (all statistically significant). The direct effect coefficient of LnHR (0.3343) was statistically significant. The regression coefficients for the indirect and total effects were -0.6779 and -0.3436, respectively. The direct, indirect and total effect regression coefficients for LnCW and LnHIE were all statistically significant. Conclusion: Both LnHI and LnHIE positively promote economic growth within provinces and in neighbouring provinces, i.e. there are direct and indirect positive effects from investing in health care. Increasing the input of health care personnel can promote the economic growth of a province but not that of neighbouring provinces. Overall planning and coordinated development will facilitate high quality development and economic advancement.

Regulation of genetically engineered (GE) mosquitoes as a public health tool: a public health ethics analysis.

BACKGROUND: In recent years, genetically engineered (GE) mosquitoes have been proposed as a public health measure against the high incidence of mosquito-borne diseases among the poor in regions of the global South. While uncertainties as well as risks for humans and ecosystems are entailed by the open-release of GE mosquitoes, a powerful global health governance non-state organization is funding the development of and advocating the use of those bio-technologies as public health tools. In August 2016, the US Food and Drug Agency (FDA) approved the uncaged field trial of a GE Aedes aegypti mosquito in Key Haven, Florida. The FDA's decision was based on its assessment of the risks of the proposed experimental public health research project. The FDA is considered a global regulatory standard setter. So, its approval of the uncaged field trial could be used by proponents of GE mosquitoes to urge countries in the global South to permit the use of those bio-technologies. METHOD: From a public health ethics perspective, this paper evaluates the FDA's 2016 risk assessment of the proposed uncaged field trial of the GE mosquito to determine whether it qualified as a realistic risk evaluation. RESULTS: The FDA's risk assessment of the proposed uncaged field trial did not proximate the conditions under which the GE mosquitoes would be used in regions of the global South where there is a high prevalence of mosquito-borne diseases. CONCLUSION: Given that health and disease have political-economic determinants, whether a risk assessment of a product is realistic or not particularly matters with respect to interventions meant for public health problems that disproportionately impact socio-economically marginalized populations. If ineffective public health interventions are adopted based on risk evaluations that do not closely mirror the conditions under which those products would actually be used, there could be public health and ethical costs for those populations.

Crowding-Out or Crowding-In: Government Health Investment and Household Consumption.

This paper explores the relationship of government health investment and household consumption by applying a panel fixed effects model and Sobel-Goodman mediation tests to inland Chinese provinces. The empirical results highlight that government health investment has a crowding-in effect and can thus promote household consumption. Furthermore, the promotion effect on non-medical health consumption is greater than that on medical health consumption. The promotion effect of government health investment on rural household consumption is higher than that on urban household consumption, and the promotion effect on household consumption for northern provinces is higher than that in southern provinces. This heterogeneous effect is closely related to the difference between urban and rural development; and the economic levels of the northern and South regions. The mediation tests found that government health investment mainly promotes regional economic growth, and then increases household consumption. In the economic and social development process, the government should implement more effective medical and health care measures to increase social medical and health investment to improve the consumption level of households.

Population Aging, Health Investment and Economic Growth: Based on a Cross-Country Panel Data Analysis.

With the economic development of various countries and the deepening of population aging, health plays an increasingly important role in the macro-economy. How to meet the growing health needs as well as promote the economy has captured the attention of the world. Therefore, whether health investment can promote economic growth is an important theoretical and practical issue. An extended Mankiw-Romer-Weil model (MRW) with human health capital and population aging is employed to examine the impact on economic growth from population aging and health investment. On the basis of the theoretical model, this paper uses the LSDV and TSLS methods to carry out an empirical study based on cross-country panel data during the period 2000-2016. The empirical results show that health investment plays a significant role in promoting economic growth, and there is an inverted U-shaped relationship between population aging and economic growth. The impacts on economic growth from health investment and population aging can weaken each other. In addition, this paper also finds that health investment structure and the proportion of government health investment to total government spending can affect economic growth.

The relationship between public and private health investment and economic development based on the overlapping generations (olg) model / Relação entre investimento público e privado em saúde e desenvolvimento econômico com base no modelo de gerações sobrepostas (olg) / Investigación sobre la relación entre la inversión en salud pública y privada y el desarrollo económico a partir del modelo de generación superpuesta

ABSTRACT As an important part of human capital, healthy human capital plays a great role in promoting economic development. Based on the overlapping generations (OLG) model, this study establishes a correlation analysis model between healthy human capital and economic growth. This model takes utility maximization as the theoretical carrier to study how individuals promote economic growth while pursuing the maximization of their own health capital accumulation. The model can analyze the promotion mechanism of healthy human capital on economic growth, so as to provide decision support for relevant personnel. Taking the panel data of 11 provinces and cities in China as samples, this paper makes an empirical analysis of the model. The results show that healthy human capital investment in coastal areas is generally high, and the relationship between healthy human capital and economic growth conforms to the inverted U-shaped development model, so we should pay attention to the reasonable proportion of healthy human capital investment. In addition, from the fitting effect of the regression model, the F-statistic values of model 1 and model 2 are 672.6327 and 1240.188, which shows that the fitting accuracy of the two regression models is higher.

RESUMO Como parte importante do capital humano, o capital humano saudável desempenha um grande papel na promoção do desenvolvimento econômico. Com base no modelo de gerações gerações sobrepostas (OLG), este estudo estabelece um modelo de análise de correlação entre o capital humano saudável e o crescimento econômico. Este modelo leva à maximização da utilidade como suporte teórico para estudar como os indivíduos promovem o crescimento econômico, enquanto procedem à maximização de sua própria acumulação de capital saudável. O modelo pode analisar o mecanismo de promoção de capital humano saudável em crescimento econômico, de modo a fornecer suporte de decisão para os profissionais. Tomando os dados do painel de 11 províncias e cidades da China como amostra, o presente estudo faz uma análise empírica do modelo. Os resultados mostram que o investimento em capital humano para a saúde nas zonas costeiras é geralmente elevado, e a relação entre o capital humano saudável e o crescimento econômico está em conformidade com o modelo de desenvolvimento invertido em forma de U, pelo que devemos prestar atenção à proporção razoável de investimento em capital humano saudável. Além disso, a partir do efeito de ajuste do modelo de regressão, os valores F-estatísticos do modelo 1 e do modelo 2 são 672.6327 e 1240.188, o que mostra que a precisão de ajuste dos dois modelos de regressão é maior.

RESUMEN Como parte importante del capital humano, la salud juega un papel importante en la promoción del desarrollo económico. Basado en el modelo de generaciones superpuestas (OLG), este estudio establece un modelo de análisis de correlación entre capital humano saludable y crecimiento económico. Este modelo toma la maximización de la utilidad como portador teórico para estudiar cómo los individuos promueven el crecimiento económico mientras persiguen la maximización de su propia acumulación de capital en salud. El modelo puede analizar el mecanismo de promoción del capital humano saludable sobre el crecimiento económico, a fin de brindar apoyo a las decisiones del personal relevante. Tomando como muestra los datos de panel de 11 provincias y ciudades de China, este artículo realiza un análisis empírico del modelo. Los resultados muestran que la inversión de capital humano saludable en las áreas costeras es generalmente alta, y la relación entre capital humano saludable y crecimiento económico se ajusta al modelo de desarrollo en forma de U invertida, por lo que debemos prestar atención a la proporción razonable de inversión de capital humano saludable. Además, del efecto de ajuste del modelo de regresión, los valores del estadístico F del modelo 1 y del modelo 2 son 672,6327 y 1240,188, lo que muestra que la precisión de ajuste de los dos modelos de regresión es mayor.

Birth order, parental health investment, and health in childhood.

We analyze the relationship between birth order, parental health investment and children's health using administrative data from Austria. We show that later-born children have better health endowments at birth. They are less likely born preterm or with a low birth weight, and less likely hospitalized for perinatal conditions. We also find significant birth order differences in parental health investment in early childhood. Later-born children are less likely to participate in preventive medical screenings and their vaccine uptake rates are lower. Our analysis indicates that these birth order differences in parental health investments are not driven by children's health endowments. Thus, we do not find evidence for compensatory behavior of parents. We discuss alternative explanations, such as the role of resource constraints. Furthermore, we show, that the initial health inequalities extend into middle childhood. Later-born children show a better health status in school health checks, they consume less medication and are less often hospitalized.

The Impact of Health Investment on Industrial Structure: "Spillover" or "Crowding Out"?-Evidence From Emerging Market Countries.

Using national dynamic panel data from 21 emerging markets between 1999 and 2020 and bidirectional fixed effect and threshold regression methods, this paper evaluated the impact of health investment on industrial structure upgrading from two aspects of economic output and economic structure. The results showed that: (1) public health investment and private health investment have a crowding out effect on the added value of primary and secondary industries, and the crowding out effect of public health investment is greater than that of private health investment; (2) Public health investment and private health investment have a spillover effect on the added value of the tertiary industry, and the spillover effect of public health investment is greater than that of private health investment; (3) Both public and private health investment contribute to the transfer of the labor force to the tertiary industry, and tests showed the baseline regression results were robust and reliable; (4) The relationship between health investment and industrial structure upgrading was non-linear. As per capital GDP increases, the inhibition effect of public health investment on industrial structure upgrading gradually weakens whilst the promotion effect of private health investment on industrial structure upgrading gradually increases. The results of this study clarify how health investment affects industrial structure, and offers new guidance for health investment policy formulation in emerging market countries.

The Impact of Health Investment on Economic Growth: Evidence from China.

BACKGROUND: Currently, China is carrying forward "Healthy China" construction. Thus, health investment has gradually become an important issue concerned by the Chinese government. Exploring the influence of health investment on economic growth under this background is of great theoretical and realistic significance for realizing economic transformation and upgrading in China. METHODS: Thirty-one provincial regions in China were selected as research objects. Based on the panel data during 2000-2017, difference-generalized method of moment (D-GMM) and system-generalized method of moment (S-GMM) were comprehensively used to estimate the dynamic panel model from the national perspective, combining the fixed effects model (FE) estimation method to estimate the static panel model from the regional perspective, so as to investigate the relationships among governmental, residential health investment, and economic growth. RESULTS: First, the governmental and residential health investments have positive effects on economic growth. Second, from the perspective of different regions, the governmental and residential health investments present positive correlations with economic growth, but the correlations present a progressively decreasing trend from the east to west. CONCLUSION: The Chinese government needs to steadily increase governmental health investment, elevate the level of residents' health expenditure, promote the development of the health industry, and finally facilitate sustainable economic growth in China.

Factors related to health civic engagement: results from the 2018 National Survey of Health Attitudes to understand progress towards a Culture of Health.

BACKGROUND: Civic engagement, including voting, volunteering, and participating in civic organizations, is associated with better psychological, physical and behavioral health and well-being. In addition, civic engagement is increasingly viewed (e.g., in Robert Wood Johnson Foundation's Culture of Health action framework) as a potentially important driver for raising awareness of and addressing unhealthy conditions in communities. As such, it is important to understand the factors that may promote civic engagement, with a particular focus on the less-understood, health civic engagement, or civic engagement in health-related and health-specific activities. Using data from a nationally representative sample of adults in the United States (U.S.), we examined whether the extent to which individuals feel they belong in their community (i.e., perceived sense of community) and the value they placed on investing in community health were associated with individuals' health civic engagement. METHODS: Using data collected on 7187 nationally representative respondents from the 2018 National Survey of Health Attitudes, we examined associations between sense of community, valued investment in community health, and perceived barriers to taking action to invest in community health, with health civic engagement. We constructed continuous scales for each of these constructs and employed multiple linear regressions adjusting for multiple covariates including U.S. region and city size of residence, educational attainment, family income, race/ethnicity, household size, employment status, and years living in the community. RESULTS: Participants who endorsed (i.e., responded with mostly or completely) all 16 sense of community scale items endorsed an average of 22.8% (95%CI: 19.8-25.7%) more of the health civic engagement scale items compared with respondents who did not endorse any of the sense of community items. Those who endorsed (responded that it was an important or top priority) all items capturing valued investment in community health endorsed 14.0% (95%CI: 11.2-16.8%) more of the health civic engagement items than those who did not endorse any valued investment in community health items. CONCLUSIONS: Health civic engagement, including voting and volunteering to ultimately guide government decisions about health issues, may help improve conditions that influence health and well-being for all. Focusing on individuals' sense of community and highlighting investments in community health may concurrently be associated with increased health civic engagement and improved community and population health.

O processo de incorporação de tecnologias em saúde no Brasil em uma perspectiva internacional / Health technology assessment in Brazil - an international perspective

Resumo Dado o impacto financeiro da incorporação de novas tecnologias em saúde, é um desafio para os gestores escolher qual delas deve ser incorporada e quando isto deve ocorrer. Assim, é necessário contar com um processo de avaliação e de incorporação de tecnologias baseado em critérios transparentes e objetivos. Neste trabalho objetivou-se analisar o processo nacional da Comissão Nacional de Incorporação de Tecnologias em Saúde do Ministério da Saúde (Conitec) e compará-lo com o de agências de países de referência: Austrália, Canadá e Reino Unido. Utilizaram-se as seguintes categorias para a comparação: estrutura, indicação e seleção de temas, condução da revisão de evidências, uso de Avaliação Tecnológica em Saúde (ATS) na tomada de decisão, produtos do programa de ATS, divulgação e transparência. O processo da Conitec legalmente previsto apresentou mais similaridades do que distinções em comparação com os das agências estudadas. As principais diferenças foram em relação a: composição dos comitês, apresentação de recursos, avaliação do programa, seleção e prazos para oferta da tecnologia incorporada. Apesar dos avanços, a incorporação de tecnologias em saúde no Brasil deve buscar a melhoria contínua.

Abstract Given the financial impact of the adoption of new health technologies in health systems, choosing what technology should be introduced and when poses a major challenge for health managers. The health technology assessment (HTA) process should therefore be underpinned by transparent and objective criteria. The objective of this study was to analyze HTA processes in Brazil, overseen by the National Commission for the Incorporation of Health Technology (CONITEC), and to compare these processes with those in countries considered to be at the forefront of this field: Australia, Canada, and the United Kingdom. The following categories were used for the comparative analysis: program structure, definition and selection of topics, evidence review, use of HTA in decision making, program products and dissemination, and transparency. The findings show that there are more similarities than differences between these countries' processes and the CONITEC processes. The main differences identified were: composition of committees, entitlement to appeal, program evaluation, and timeframes for the implementation of recommendations/decisions. Despite making major strides in recent years, Brazil should continue to promote continuous improvement of its HTA process.

A Balanced Investment Portfolio For Equitable Health And Well-Being Is An Imperative, And Within Reach.

Health investments, defined as formal expenditures to either produce or care for health, in the US are extremely inefficient and have yet to unlock the country's full potential for equitable health and well-being. A major reason for such poor performance is that the US health investment portfolio is out of balance, with too much spent on certain aspects of health care and not enough spent to ensure social, economic, and environmental conditions that are vital to maintaining health and well-being. This commentary summarizes the evidence for this assertion, along with the opportunities and challenges involved in rebalancing investments in ways that would improve overall population health, reduce health gaps, and help build a culture of health for all Americans.

A new approach to managing work-related road traffic injury: The development of a health investment framework.

OBJECTIVE: Statistics indicate that employees commuting or traveling as part of their work are overrepresented in workplace injury and death. Despite this, many organizations are unaware of the factors within their organizations that are likely to influence potential reductions in work-related road traffic injury. METHODS: This article presents a multilevel conceptual framework that identifies health investment as the central feature in reducing work-related road traffic injury. Within this framework, we explore factors operating at the individual driver, workgroup supervisor, and organizational senior management levels that create a mutually reinforcing system of safety. RESULTS: The health investment framework identifies key factors at the senior manager, supervisor, and driver levels to cultivating a safe working environment. These factors are high-performance workplace systems, leader-member exchange and autonomy, trust and empowerment, respectively. The framework demonstrates the important interactions between these factors and how they create a self-sustaining organizational safety system. CONCLUSIONS: The framework aims to provide insight into the future development of interventions that are strategically aligned with the organization and target elements that facilitate and enhance driver safety and ultimately reduce work-related road traffic injury and death.

Economic Growth, Health Input and Investment Benefits: Empirical Study Based on FAVAR Model / 中国卫生经济

Objective:To make full use of existing variables set,study on the dynamic connection between economic growth,health input and investment benefits.Methods:Using Factor Augmented VAR(FAVAR) to draw common factors and perform VAR estimation with the variables sets.Results:The impact of economic growth on health output had two sides.Increasing health input would significantly stimulate health output and economic growth.The increase of health level would promote economic growth in short time and hamper in the long run.Conclusion:The government should increase health input and consider the health loss brought by economic growth.It should prevent the not rich but old risk with the pursuit of health benefit.

The Effects of Parental Health Shocks on Adult Offspring Smoking Behavior and Self-Assessed Health.

An important avenue for smoking deterrence may be through familial ties if adult smokers respond to parental health shocks. In this paper, we merge the Original Cohort and the Offspring Cohort of the Framingham Heart Study to study how adult offspring smoking behavior and subjective health assessments vary with elder parent smoking behavior and health outcomes. These data allow us to model the smoking behavior of adult offspring over a 30-year period contemporaneously with parental behaviors and outcomes. We find strong 'like father, like son' and 'like mother, like daughter' correlations in smoking behavior. We find that adult offspring significantly curtail their own smoking following an own health shock; however, we find limited evidence that offspring smoking behavior is sensitive to parent health, with the notable exception that women significantly reduce both their smoking participation and intensity following a smoking-related cardiovascular event of a parent. We also model the subjective health assessment of adult offspring as a function of parent health, and we find that women report significantly worse health following the smoking-related death of a parent. Copyright © 2015 John Wiley & Sons, Ltd.

Economic growth and the demand for dietary quality: Evidence from Russia during transition.

The increasing incidence of nutrition-related chronic diseases worldwide has raised people's awareness of dietary quality. Most existing studies on the topic of changing nutrition patterns measure dietary quality by single macronutrient indicators or anthropometric outcomes. However, such an approach is often too narrow to provide a picture of overall dietary quality and is sometimes even misleading. This study contributes to the existing literature by taking into account that the analysis of dietary quality comprises two dimensions: the adequate intake of vitamins and minerals, as well as the moderate intake of nutrients that increase the risk of chronic diseases. Thereby, we apply Grossman's health investment model to the analysis of the demand for dietary quality, explicitly addressing the different dimensions of dietary quality and the intertemporal character of health investments. We apply our approach to Russia using data from the Russia Longitudinal Monitoring Survey from 1996 to 2008. Our results show that intake levels of vitamins and minerals as well as saturated and total fatty acids increased after 1998 along with economic recovery, while the intake of fiber decreased. Our econometric results imply an income elasticity of vitamins and minerals of 0.051, and an income elasticity of fats of 0.073. Overall, our results are in line with an ongoing nutrition transition in the Russian Federation, which is marked by decreasing deficiencies in vitamins and minerals, as well as the increasing consumption of fats with its accompanying negative health consequences.