1. My thesis committee chair Jody Sindelar, along with Bill Gallo and Tracy Falba on the relationship between deviations from one's a priori expectations about working and subsequent depression among those around retirement age. While causality is always difficult to establish, the symmetric correlation between working longer OR shorter than expected and depressive symptoms is striking and consistent with "feelings of loss of control" type explanations for depression:
"We found significant effects on depression at age 62 both for full-time workers who expected not to be working full-time, and for participants not working full-time who expected to be doing so. These results hold even after adjustment for earlier depressive symptoms, sociodemographic and other relevant controls. The findings suggest that working longer and retiring earlier than expected each may compromise psychological well-being. The current financial crisis may result in both scenarios as some workers may have to work longer than expected due to the decline in pension and other wealth while others may retire earlier due to job loss."
2. A fantastic back-and-forth between filmmaker Oliver Stone and venerable journalists Bob Woodward, Ron Suskund and Jacob Weisberg on Stone's new tragi-comic-biopic W and the Bush (II) presidency more generally. By the way, if you haven't seen W. yet, you should.
3. Dan Ariely presents evidence that conservatives may have a better sense of humor than liberals. Surprising? Not to me.
4. Chris Blattman on pictoral descriptions of the world wealth distribution from 1 AD onwards.
5. The financial crisis and funding for college athletics.
Wednesday, October 29, 2008
Thursday, October 23, 2008
Links on Early Life Origins of Health
1) Olivia Judson this week on the possible effects of early life influences (in particular maternal obesity and its affects on the fetus) on political behavior later in life (hat tip: Daniel Rothschild).
I'm glad to see this stuff in the popular press: some of my colleagues and I are looking at the influence of birth year and early childhood conditions on people's forward looking behavior, aversion to risk and expectations later in life, and pieces like this should whet the public's appetite! I'll be summarizing preliminary results of that research, as well as other work (including the early life effects on obesity) in a later post. Stay tuned.
2) In an earlier post, I briefly discussed a paper by Douglas Almond and Bhaskar Mazumdar about the negative effects of being in the womb during Ramadan on health outcomes later in life. A working version of the paper is now available via the NBER. The authors find these stunning results for two separate samples/populations: Arabs in Michigan and Muslims in Uganda.
3) But are early life influences quantitatively important in explaining trends in population health? Are such influences important levers for public policy? This recent Slate article suggests that the answer for both questions is "no." Here are two excerpts:
"The problem, though, is that large-scale problems also wrongly get blamed on the womb—and, by extension, on the woman who houses it. Womb-centric predictions of a child's future—whether rooted in supposed genetic disparities, gestational maternal-fetal conflict, eating habits during pregnancy, or whatever else—always undersell the role of one's later environment...
"Turning to the womb to explain complex social and public-health problems ultimately means people have given up on changing the things that really matter. That's too bad. The truth is that nothing in this world worth having comes easy. And as any hard-working student who made it to college, overweight person who's changed his or her lifestyle, or adult who's worked through depression can tell you, at some point you have to stop blaming your issues on your mother's uterus."
I think the author misfires on two of his (implicit) points. First, early life conditions do not occur deterministically. Public policy has tremendous scope to intervene into the health of pregnant women and newborns, and these interventions have been shown to have positive health and socioeconomic benefits both in the long-run and across generations. Second, while we can't retrospectively change what happened to a grown-up when he/she was in the womb, those experiences may still be important for the kinds of "here and now" interventions the author suggests we should focus on. For example, in my own work, I find that the body weight and blood pressure of individuals who experienced adverse economic shocks early in life is much more sensitive to food prices and income in comparison to those who did not.
Where I think the author does have a case is that we don't know for sure the extent to which these gestational and early childhood influences can explain cross-sectional and time-series trends in health outcomes. This is a question I am really interested in tackling, though I haven't really been able to get the data I need.
I'm glad to see this stuff in the popular press: some of my colleagues and I are looking at the influence of birth year and early childhood conditions on people's forward looking behavior, aversion to risk and expectations later in life, and pieces like this should whet the public's appetite! I'll be summarizing preliminary results of that research, as well as other work (including the early life effects on obesity) in a later post. Stay tuned.
2) In an earlier post, I briefly discussed a paper by Douglas Almond and Bhaskar Mazumdar about the negative effects of being in the womb during Ramadan on health outcomes later in life. A working version of the paper is now available via the NBER. The authors find these stunning results for two separate samples/populations: Arabs in Michigan and Muslims in Uganda.
3) But are early life influences quantitatively important in explaining trends in population health? Are such influences important levers for public policy? This recent Slate article suggests that the answer for both questions is "no." Here are two excerpts:
"The problem, though, is that large-scale problems also wrongly get blamed on the womb—and, by extension, on the woman who houses it. Womb-centric predictions of a child's future—whether rooted in supposed genetic disparities, gestational maternal-fetal conflict, eating habits during pregnancy, or whatever else—always undersell the role of one's later environment...
"Turning to the womb to explain complex social and public-health problems ultimately means people have given up on changing the things that really matter. That's too bad. The truth is that nothing in this world worth having comes easy. And as any hard-working student who made it to college, overweight person who's changed his or her lifestyle, or adult who's worked through depression can tell you, at some point you have to stop blaming your issues on your mother's uterus."
I think the author misfires on two of his (implicit) points. First, early life conditions do not occur deterministically. Public policy has tremendous scope to intervene into the health of pregnant women and newborns, and these interventions have been shown to have positive health and socioeconomic benefits both in the long-run and across generations. Second, while we can't retrospectively change what happened to a grown-up when he/she was in the womb, those experiences may still be important for the kinds of "here and now" interventions the author suggests we should focus on. For example, in my own work, I find that the body weight and blood pressure of individuals who experienced adverse economic shocks early in life is much more sensitive to food prices and income in comparison to those who did not.
Where I think the author does have a case is that we don't know for sure the extent to which these gestational and early childhood influences can explain cross-sectional and time-series trends in health outcomes. This is a question I am really interested in tackling, though I haven't really been able to get the data I need.
Thursday, October 16, 2008
I'm Fired!
My fantasy football team, following an almost miracle season, has regressed back to the mean this year. I am currently 2-4 and have the lowest point total of the 12 teams in our annual league. I attribute a lot of this to injuries: the three starting wide receivers I drafted are all out (two indefinitely and one for the year), as well as two of my defensive players. Furthermore, the league draft having been before the end of preseason, I found myself with two QBs with strong training-camp buzzes that turned out to be unusually poor forecasts. All in all, an idiosyncratic mess.
But, I look at my lifetime record (I average about a 6th place finish out of 12 teams) and realized that there is likely a persistent component to my lack of titles and general mediocrity. I also noticed that Yahoo! Fantasy Football has a new feature where people can co-manage a single fantasy team.
Given all this, I've decided to fire myself as the general manager of my team, and outsource the responsibilities of drafting and early season waiver-wire moves to someone else. I will still retain final authority over decision-making and retain the capacity to make some moves myself, but all of this will be in a much reduced role.
My firing of myself is effective immediately. I am currently looking for someone with at least five years of fantasy football experience (from competitive leagues, with a successful track record) to take over the GM role of the team. Let me know if you are interested.
But, I look at my lifetime record (I average about a 6th place finish out of 12 teams) and realized that there is likely a persistent component to my lack of titles and general mediocrity. I also noticed that Yahoo! Fantasy Football has a new feature where people can co-manage a single fantasy team.
Given all this, I've decided to fire myself as the general manager of my team, and outsource the responsibilities of drafting and early season waiver-wire moves to someone else. I will still retain final authority over decision-making and retain the capacity to make some moves myself, but all of this will be in a much reduced role.
My firing of myself is effective immediately. I am currently looking for someone with at least five years of fantasy football experience (from competitive leagues, with a successful track record) to take over the GM role of the team. Let me know if you are interested.
Wednesday, October 8, 2008
Random Thoughts from Cape Town
I have about two days left here in Cape Town and decided that this would be an appropriate time to reflect on what has been a great experience. I came here with the intention of finishing off one paper, and starting the second. As was the case with my last trip here, I leave the region with some great experiences and some new puzzles to ponder. Here are a collection of random thoughts I have (too tired to string these together in the usual thematic piece). Enjoy.
****
On the plane ride over, I saw this great movie called The Visitor. It's about a tenured widower academic (a development economist!) who is going through the motions in life, until he meets an illegal immigrant who he eventually shares his apartment with and starts learning the African drums from. The immigrant chap is eventually arrested and detained, and the academic works hard to get him out, forming life changing relationships with the drummer and the drummer's wife and mother in the process. It is an uplifting, sad and thoughtful movie, all at once, and perhaps one of the best movies I've seen in the last few months. Furthermore, Richard Jenkins, who plays the academic, gives an incredible performance and should win awards for this.
Highly recommended.
****
I absolutely love the University of Cape Town. Aside being located on the side of Table Mountain (and thus offering incredible views of both the mountain side and the city below), UCT is one of the best academic institutions on the continent, and the research that is going on here is really interesting. You often get a good grip on the quality of the research in an institution from the comments you get during a seminar. At my seminar, the feedback was ridiculously sharp and useful - definitely one of the best academic experiences of my young research career.
****
Speaking of UCT, I got a chance to revisit the owner of the Chinese food stall here, who made an appearance in one of my earlier posts on incentives to induce environmentally friendly behavior. The gentleman is still offering his R0.50 discount to those who bring their own plates or containers for food, though, he noted sadly, few people take him up on that these days. He seemed quite distraught to keep having to dole out styrofoam containers. I told him that it might be time to up the incentive, to which he laughed in response.
I don't think he is going to take me up on this.
****
One of the best ways to spend a day in Cape Town is to hike up Table Mountain and/or Lion's Head. Both offer stunning vistas of the city and surrounding suburbs. My body continues to revolt after the two hikes I've done here, but spending a day out in the sun, walking and climbing on paths surrounded by spring colors and geckos was pretty mind blowing.
Also mind blowing are Chandini restaurant in Woodstock (amazing Indian food), the Royale Eatery (at least 15 options for vegetarian burgers) and the High Life (Hare Krishna) food stall at UCT.
****
Of course, the trip wasn't all fun and games - at least in the recreational sense. My colleague and I spent most of our time working (fun and games, though of a different sort, in my book), and are onto some new research questions. In particular, we are going to look at links between economic vulnerability and shocks and risky sexual behaviors. More on that in a later post...
All in all, this has been a great trip: productive, fun, and thought-provoking. And it's been great also to create partnerships that could spur projects and travel opportunities in the future.
****
On the plane ride over, I saw this great movie called The Visitor. It's about a tenured widower academic (a development economist!) who is going through the motions in life, until he meets an illegal immigrant who he eventually shares his apartment with and starts learning the African drums from. The immigrant chap is eventually arrested and detained, and the academic works hard to get him out, forming life changing relationships with the drummer and the drummer's wife and mother in the process. It is an uplifting, sad and thoughtful movie, all at once, and perhaps one of the best movies I've seen in the last few months. Furthermore, Richard Jenkins, who plays the academic, gives an incredible performance and should win awards for this.
Highly recommended.
****
I absolutely love the University of Cape Town. Aside being located on the side of Table Mountain (and thus offering incredible views of both the mountain side and the city below), UCT is one of the best academic institutions on the continent, and the research that is going on here is really interesting. You often get a good grip on the quality of the research in an institution from the comments you get during a seminar. At my seminar, the feedback was ridiculously sharp and useful - definitely one of the best academic experiences of my young research career.
****
Speaking of UCT, I got a chance to revisit the owner of the Chinese food stall here, who made an appearance in one of my earlier posts on incentives to induce environmentally friendly behavior. The gentleman is still offering his R0.50 discount to those who bring their own plates or containers for food, though, he noted sadly, few people take him up on that these days. He seemed quite distraught to keep having to dole out styrofoam containers. I told him that it might be time to up the incentive, to which he laughed in response.
I don't think he is going to take me up on this.
****
One of the best ways to spend a day in Cape Town is to hike up Table Mountain and/or Lion's Head. Both offer stunning vistas of the city and surrounding suburbs. My body continues to revolt after the two hikes I've done here, but spending a day out in the sun, walking and climbing on paths surrounded by spring colors and geckos was pretty mind blowing.
Also mind blowing are Chandini restaurant in Woodstock (amazing Indian food), the Royale Eatery (at least 15 options for vegetarian burgers) and the High Life (Hare Krishna) food stall at UCT.
****
Of course, the trip wasn't all fun and games - at least in the recreational sense. My colleague and I spent most of our time working (fun and games, though of a different sort, in my book), and are onto some new research questions. In particular, we are going to look at links between economic vulnerability and shocks and risky sexual behaviors. More on that in a later post...
All in all, this has been a great trip: productive, fun, and thought-provoking. And it's been great also to create partnerships that could spur projects and travel opportunities in the future.
Tuesday, October 7, 2008
Circumcision, HAART and Behavior
Male circumcision is a hot topic among academics and policy-makers alike. A recent randomized controlled clinical trial suggests that the decrease in transmission rates from circumcision could rival those from putative AIDS vaccines (around a 60% in the odds of contracting HIV).
This is quite impressive, but, as my colleague Brendan here in Cape Town suggests, the public health benefits of a wide-scale circumcision program will likely be smaller than what is seen in clinical trials. The argument is that people will be encouraged to take up circumcision because it will lower their risk of contracting the disease. Men may who choose to get circumcised may then engage in more risky sexual behavior thereafter as a response to lower perceived risks, thus undoing some of the benefits of circumcision seen in the clinical evidence. The take home point is that policymakers should be careful when extrapolating from randomized clinical trials, and that behavioral responses to new public health policies may alter (sometimes radically) the efficacy of new interventions.
On a related note: an interesting piece from 2006 in the Quarterly Journal of Economics examines the effects of the development and roll-out of HAART on HIV incidence rates. The authors find that people on HAART take up more sexual partners as a result of being healthier. While the infectiousness of those on HAART is lower from those who are not treated, the authors contend that this phenomenon increases the risk of an HIV- individual contracting the disease: more HIV+ are engaged in sexual activity. They go on to argue that HAART may lower the welfare for those who are not infected with the virus. (Technical note: to establish causality, the authors use state-level differences in Medicaid generosity towards HAART to predict HAART use, and then use that predicted value in their models for risky behaviors).
This is quite impressive, but, as my colleague Brendan here in Cape Town suggests, the public health benefits of a wide-scale circumcision program will likely be smaller than what is seen in clinical trials. The argument is that people will be encouraged to take up circumcision because it will lower their risk of contracting the disease. Men may who choose to get circumcised may then engage in more risky sexual behavior thereafter as a response to lower perceived risks, thus undoing some of the benefits of circumcision seen in the clinical evidence. The take home point is that policymakers should be careful when extrapolating from randomized clinical trials, and that behavioral responses to new public health policies may alter (sometimes radically) the efficacy of new interventions.
On a related note: an interesting piece from 2006 in the Quarterly Journal of Economics examines the effects of the development and roll-out of HAART on HIV incidence rates. The authors find that people on HAART take up more sexual partners as a result of being healthier. While the infectiousness of those on HAART is lower from those who are not treated, the authors contend that this phenomenon increases the risk of an HIV- individual contracting the disease: more HIV+ are engaged in sexual activity. They go on to argue that HAART may lower the welfare for those who are not infected with the virus. (Technical note: to establish causality, the authors use state-level differences in Medicaid generosity towards HAART to predict HAART use, and then use that predicted value in their models for risky behaviors).
Friday, October 3, 2008
It's About Time
As of this past Wednesday, Medicare has stopped paying for procedures they deem to be the result of medical errors (great piece on it here). This was a long time coming. The hullabaloo around medical errors is now about a decade old, and several large private insurers in the interim realized the folly in paying doctors and hospitals to make mistakes. Glad to see the Feds followed suit.
I have a few questions though. This policy will only be effective if errors can be identified and there aren't other means the game the system. The new Medicare policy appears to hold up on the first ground (they have a list of specific things they won't pay for), but it is not clear to me that doctors or hospitals couldn't a) pass the costs on the patients or b) use different codes to procure payment. The linked article suggests that Medicare has a way around (a). I'd love to hear about it if any of you have more information.
This policy is a good idea from the standpoint that there are welfare losses due to medical errors and that people should never be paid for doing something wrong. On the flip side, my sense is that the impact of this policy on health care costs will be minimal, at best. The importance of medical errors as a money drain has long been overstated. It's nice to see the aforementioned popular press article get this point right.
I have a few questions though. This policy will only be effective if errors can be identified and there aren't other means the game the system. The new Medicare policy appears to hold up on the first ground (they have a list of specific things they won't pay for), but it is not clear to me that doctors or hospitals couldn't a) pass the costs on the patients or b) use different codes to procure payment. The linked article suggests that Medicare has a way around (a). I'd love to hear about it if any of you have more information.
This policy is a good idea from the standpoint that there are welfare losses due to medical errors and that people should never be paid for doing something wrong. On the flip side, my sense is that the impact of this policy on health care costs will be minimal, at best. The importance of medical errors as a money drain has long been overstated. It's nice to see the aforementioned popular press article get this point right.
Thursday, October 2, 2008
Incentives and HIV/AIDS
I'm now in Cape Town, South Africa, finishing off some research with my colleague Brendan Maughan-Brown and starting some fresh work, as well. It's definitely great to be back here, and away from the dissertation and financial crisis (kind of - the South African market went tumbling after the failure of the bailout, and my e-trade account looks destitute), if at least for a few days.
More so than usual, incentives and behavior have been front and center in my mind. Not surprising, as these topics figure centrally in a paper Brendan and I just presented and submitted for publication (see here for an earlier post on the topic). Some background: HIV/AIDS is a big problem in South Africa, with perhaps as much as 20% of the working age population afflicted by the disease. South African public policy towards the disease involves two main components: government provided antiretrovirals and disability grants. The latter is the focus of our work.
Disability grants are very large transfers given to poor individuals who are too sick to work. Once these individuals become healthy again, the grant is revoked. However, the problem in South Africa is that high rates of unemployment (up to 40% in some areas) make it likely that many individuals will not be able to find jobs post losing their grants. A fair amount of scholars and policy-wonks worry that this may create a perverse incentive for individuals to forego or modulate their antiretroviral treatment in order to remain eligible for grants.
We decided to investigate this issue by using some interesting data on individuals with HIV/AIDS taking treatment who were followed during the period 2004-2007. Our main finding is that, while losing a disability grant is associated with drops in individual and household income, people do not get sicker and continue to adhere to treatment. We find that households appear to use other strategies to cope with the loss of a grant, including transferring young children (dependents) to other households. In all of our models, we try to account for a host of factors that might bias our results (individuals on disability grants might be worse off because they need to meet a means test, or better off because they are good at pro-actively getting what they want or obtaining social transfers; the causality between the outcomes and disability grant receipt might run the other way, etc).
I'm not too surprised by these findings. It seems a bit much to think that someone who has been AIDS-sick would want to go through that again under any circumstances. In the words of a University of Cape Town researcher who attended the seminar Brendan and I gave: "being poor is better than being dead."
Another interesting thing we found was that individuals were receiving disability grants long after their eligibility should have been up (people on highly active antiretrovirals get better within six to nine months). This, along some other interesting evidence, leads us to believe that people are really good at gaming the social security system. So perhaps this is another reason why people aren't responding to the perverse incentive: there are other ways to survive (that confer far less risk and disutility), including taking advantage of a broken system.
Drop me a line if you have any questions about our work: I'm really excited about this project and the several extensions we have planned, and would certainly love to discuss.
More so than usual, incentives and behavior have been front and center in my mind. Not surprising, as these topics figure centrally in a paper Brendan and I just presented and submitted for publication (see here for an earlier post on the topic). Some background: HIV/AIDS is a big problem in South Africa, with perhaps as much as 20% of the working age population afflicted by the disease. South African public policy towards the disease involves two main components: government provided antiretrovirals and disability grants. The latter is the focus of our work.
Disability grants are very large transfers given to poor individuals who are too sick to work. Once these individuals become healthy again, the grant is revoked. However, the problem in South Africa is that high rates of unemployment (up to 40% in some areas) make it likely that many individuals will not be able to find jobs post losing their grants. A fair amount of scholars and policy-wonks worry that this may create a perverse incentive for individuals to forego or modulate their antiretroviral treatment in order to remain eligible for grants.
We decided to investigate this issue by using some interesting data on individuals with HIV/AIDS taking treatment who were followed during the period 2004-2007. Our main finding is that, while losing a disability grant is associated with drops in individual and household income, people do not get sicker and continue to adhere to treatment. We find that households appear to use other strategies to cope with the loss of a grant, including transferring young children (dependents) to other households. In all of our models, we try to account for a host of factors that might bias our results (individuals on disability grants might be worse off because they need to meet a means test, or better off because they are good at pro-actively getting what they want or obtaining social transfers; the causality between the outcomes and disability grant receipt might run the other way, etc).
I'm not too surprised by these findings. It seems a bit much to think that someone who has been AIDS-sick would want to go through that again under any circumstances. In the words of a University of Cape Town researcher who attended the seminar Brendan and I gave: "being poor is better than being dead."
Another interesting thing we found was that individuals were receiving disability grants long after their eligibility should have been up (people on highly active antiretrovirals get better within six to nine months). This, along some other interesting evidence, leads us to believe that people are really good at gaming the social security system. So perhaps this is another reason why people aren't responding to the perverse incentive: there are other ways to survive (that confer far less risk and disutility), including taking advantage of a broken system.
Drop me a line if you have any questions about our work: I'm really excited about this project and the several extensions we have planned, and would certainly love to discuss.
Subscribe to:
Posts (Atom)