The Effect of Schooling on Mortality: New Evidence From 50,000 Swedish Twins.

By using historical data on about 50,000 twins born in Sweden during 1886-1958, we demonstrate a positive and statistically significant relationship between years of schooling and longevity. This relation remains almost unchanged when exploiting a twin fixed-effects design to control for the influence of genetics and shared family background. This result is robust to controlling for within-twin-pair differences in early-life health and cognitive ability, as proxied by birth weight and height, as well as to restricting the sample to MZ twins. The relationship is fairly constant over time but becomes weaker with age. Literally, our results suggest that compared with low levels of schooling (less than 10 years), high levels of schooling (at least 13 years of schooling) are associated with about three years longer life expectancy at age 60 for the considered birth cohorts. The real societal value of schooling may hence extend beyond pure labor market and economic growth returns. From a policy perspective, schooling may therefore be a vehicle for improving longevity and health, as well as equality along these dimensions.

Horizontal inequality in rationing by waiting lists.

The objective of this article was to investigate the existence of horizontal inequality in access to care for six categories of elective surgery in a publicly funded system, when care is rationed through waiting lists. Administrative waiting time data on all elective surgeries (n = 4,634) performed in Ostergötland, Sweden, in 2007 were linked to national registers containing variables on socioeconomic indicators. Using multiple regression, we tested five hypotheses reflecting that more resourceful groups receive priority when rationing by waiting lists. Low disposable household income predicted longer waiting times for orthopedic surgery (27%, p < 0.01) and general surgery (34%, p < 0.05). However, no significant differences on the basis of ethnicity and gender were detected. A particularly noteworthy finding was that disposable household income appeared to be an increasingly influential factor when the waiting times were longer. Our findings reveal horizontal inequalities in access to elective surgeries, but only to a limited extent. Whether this is good or bad depends on one's moral inclination. From a policymaker's perspective, it is nevertheless important to recognize that horizontal inequalities arise even though care is not rationed through ability to pay.

Breaking bad habits by education - smoking dynamics among Swedish women.

In a dynamic Two-Part Model (2 PM), we find the effect of previous smoking on the participation decision to be decreasing with education among Swedish women, i.e. more educated are less state dependent. However, we do not find an analogous effect of education on the conditional intensity of consumption.

The influence of economic incentives and regulatory factors on the adoption of treatment technologies: a case study of technologies used to treat heart attacks.

The Technological Change in Health Care Research Network collected unique patient-level data on three procedures for treatment of heart attack patients (catheterization, coronary artery bypass grafts and percutaneous transluminal coronary angioplasty) for 17 countries over a 15-year period to examine the impact of economic and institutional factors on technology adoption. Specific institutional factors are shown to be important to the uptake of these technologies. Health-care systems characterized as public contract systems and reimbursement systems have higher adoption rates than public-integrated health-care systems. Central control of funding of investments is negatively associated with adoption rates and the impact is of the same magnitude as the overall health-care system classification. GDP per capita also has a strong role in initial adoption. The impact of income and institutional characteristics on the utilization rates of the three procedures diminishes over time.

Why the econometrician is in good spirits: a workshop through the looking glass.

Vita brevis, ars longa (or...life is too short for abstracts).

Societal costs of air pollution-related health hazards: A review of methods and results.

This paper aims to provide a critical and systematic review of the societal costs of air pollution-related ill health (CAP), to explore methodological issues that may be important when assessing or comparing CAP across countries and to suggest ways in which future CAP studies can be made more useful for policy analysis. The methodology includes a systematic search based on the major electronic databases and the websites of a number of major international organizations. Studies are categorized by origin - OECD countries or non-OECD countries - and by publication status. Seventeen studies are included, eight from OECD countries and nine from non-OECD countries. A number of studies based on the ExternE methodology and the USA studies conducted by the Institute of Transportation are also summarized and discussed separately. The present review shows that considerable societal costs are attributable to air pollution-related health hazards. Nevertheless, given the variations in the methodologies used to calculate the estimated costs (e.g. cost estimation methods and cost components included), and inter-country differences in demographic composition and health care systems, it is difficult to compare CAP estimates across studies and countries. To increase awareness concerning the air pollution-related burden of disease, and to build links to health policy analyses, future research efforts should be directed towards theoretically sound and comprehensive CAP estimates with use of rich data. In particular, a more explicit approach should be followed to deal with uncertainties in the estimations. Along with monetary estimates, future research should also report all physical impacts and source-specific cost estimates, and should attempt to estimate 'avoidable cost' using alternative counterfactual scenarios.

The Danish effect on Swedish alcohol costs. An analysis based on hospitalization data from southern Sweden.

This study investigated: (a) the cost and change in hospitalizations related to alcohol misuse for the healthcare sector and (b) the effect of distance to the border on alcohol-related hospitalization costs. The first objective was analyzed using descriptive statistics and the second using ordinary least squares regression on aggregated municipality data. The total cost decreased marginally during the study period while the number of patient-cases decreased substantially, presenting evidence of a substitution towards outpatient care. The increase in average treatment cost and the almost constant total cost provide evidence for a societal increase in the burden of alcohol-related diseases. We found a negative effect for distance to Denmark on alcohol-related hospitalization cost for the year 2003. The effect was smaller for 1998, suggesting that the increase in private import quotas during the study period has affected individuals' consumption level and/or consumption pattern. We also found indications that the increase in import quotas lead to a higher cost increase for heavy consumers than for low consumers.

Globalization, democracy, and child health in developing countries.

Good health is crucial for human and economic development. In particular poor health in childhood is of utmost concern since it causes irreversible damage and has implications later in life. Recent research suggests globalization is a strong force affecting adult and child health outcomes. Yet, there is much unexplained variation with respect to the globalization effect on child health, in particular in low- and middle-income countries. One factor that could explain such variation across countries is the quality of democracy. Using panel data for 70 developing countries between 1970 and 2009 this paper disentangles the relationship between globalization, democracy, and child health. Specifically the paper examines how globalization and a country's democratic status and historical experience with democracy, respectively, affect infant mortality. In line with previous research, results suggest that globalization reduces infant mortality and that the level of democracy in a country generally improves child health outcomes. Additionally, democracy matters for the size of the globalization effect on child health. If for example Côte d'Ivoire had been a democracy in the 2000-2009 period, this effect would translate into 1200 fewer infant deaths in an average year compared to the situation without democracy. We also find that nutrition is the most important mediator in the relationship. To conclude, globalization and democracy together associate with better child health in developing countries.

Habit versus choice: the process of decision-making in health-related behaviour.

Social differences in the role of habits in health-related behaviour are explored within both sociology and economics, where we define habits as non-reflective, repetitive behaviour. The corresponding theoretical perspectives are the habitus theory, the theory of individualization, and habits as rational decision rules. Sixteen thematically structured interviews are analysed using qualitative methodology. Three aspects of habits emerged from the narrative: the association between habits and preferences, habits as a source of utility, and the relationship between habits and norms. We find that people in lower social positions are more inclined to rely on their habits and are accordingly less likely to change their behaviour. These differences are reinforced as not only the disposition to maintain habits but also the tendency to conceive of the habitual as something good seems to be strengthened in lower social positions. We also note that the intensified individualization that characterizes current society erodes the basis for habit-governed behaviour, which may also contribute to social differences in well-being. Finally, we find that the scientific dialogue has enriched both scientific paradigms, and suggest as a tentative hypothesis that the traditional economic rational-actor model may be relatively less applicable to those with limited resources.

Health care for the elderly: two cases of technology diffusion.

Diffusion of medical technology and the growing proportion of elderly people in the population are generally regarded as major contributors to the increasing health care expenditure in the industrialised world. This study explores the importance of one specific factor in this process, the change in the use of technology among elderly patients. In some instances, a new technology is first used among younger patients and then gradually extended to the elderly. Two such cases are studied, both representing costly procedures: coronary bypass surgery (treatment of coronary heart disease) and dialysis (treatment of uraemia). In both cases, we demonstrate significant diffusion to older age groups. It is also tentatively concluded that the diffusion of technology could have an important effect on per capita health care expenditure among the oldest of the old.

Time to disable DALYs? On the use of disability-adjusted life-years in health policy.

The concept of disability-adjusted life years (DALYs) has rapidly gained in popularity in health policy, and considerable research resources are being allocated to this field. Proponents of DALYs suggest that the measure can be used both as a "gross domestic product of health" and to help in setting priorities in health policy. This study investigates the usefulness of DALYs and contends that DALYs, as the measure is currently understood, cannot be used for either of these two purposes. The DALYs procedure does not produce a useful measure of population health, and its use in priority setting is ethically questionable.

Income inequality and health: importance of a cross-country perspective.

This paper uses a unique dataset-containing information collected in 2006 on individuals aged 40-79 in 21 countries throughout the world to examine whether individual income, relative income in a reference group, and income inequality are related to health status across middle/low and high-income countries. The dependent variable is self-assessed health (SAH), and as a robustness check, activities of daily living (ADL) are considered. The focus is particularly on assumptions regarding an individual's reference group and on how the estimated relationships depend on the level of economic development. Correcting for national differences in health reporting behavior, individual absolute income is found to be positively related to individual health. Furthermore, in the high-income sample, there is strong evidence that average income within a peer-age group is negatively related to health, thus supporting the relative income hypothesis. In middle/low-income countries, it is instead average regional income that is negatively associated with health. Finally, there is evidence of a negative relationship between income inequality and individual health in high-income countries. Overall, the results suggest that there might be important differences in these relationships between high-income and middle/low-income countries.

Health. Happiness. Inequality.

At the beginning of June 2010, the conference 'Health. Happiness. Inequality. Modelling the Pathways between Income Inequality and Health' was held in Darmstadt, Germany. Invited speakers and presenters traveled from all over the world; and researchers from several different subdisciplines were represented at the conference. The common denominator of participants was an interest in how societal income inequality affects individual health and life satisfaction. New and fascinating research results were presented and participants engaged in many interesting discussions.

Polarization in the reaction to health-risk information: a question of social position?

Dissemination of risk information is ubiquitous in contemporary society. We explore how individuals react in everyday life to health-risk information, based on what they report in personal interviews. Health-risk information was without exception recognized as unstable and inconsistent. This conformity, however, did not extend to the narratives regarding how health-risk information should be handled. Two opposite positions (ideal-typical strategies) are presented. Either you tend to process and evaluate new information or you tend to ignore it as a whole. Our attempt to reveal the underlying rationality in these two very different approaches involved the exploration of three different avenues of interpretation and brings together two scientific paradigms--economics and sociology--that provide the framework for our analysis. First, we suggest that a greater long-term experience of explicit choice implies that this kind of action becomes more natural and less resource consuming, whereas a reliance on habits in daily life--a natural adjustment to a lack of resources--makes it is more costly to bother about new information. Second, with fewer resources in the short run, fewer opportunities to mitigate bad outcomes, and greater exposure to social and material risks, one is less likely to devote resources to deal with health-risk information. Third, there are several possible links between a low propensity to take account of risk information and a high relative importance of genuine uncertainty in one's life. These theoretical perspectives provide a viable set of hypotheses regarding mechanisms that may contribute to social differences in the response to health-risk information.