I've devoted a non-trivial chunk of this space to talking about how events and shocks that influence the nutritional intake and disease status in utero and during the early childhood years may play a large role in determining the health, education, earnings, and general well-being later in life. Research on the early life origins of disease and poverty has become popular in economics, as evidenced by the number of studies on this topic presented at the ASHE conference.
While all of these papers were interesting, four stood out:
1) Marten Lindeboom and colleagues looked at the impact of the 1846-47 Dutch Potato Famine on subsequent mortality risk. Their research strategy was to use the discontinuous timing of the famine, to compare cohorts in utero during the famine to those born just before and just after this period. They find strong links between famine exposure and mortality risk for men aged 50 and above, but not for women. These results are consistent with biological theories that posit that males are more vulnerable to shocks early in life than females.
2) Martin Salm, my discussant at the conference, presented some interesting work on the extent to which health contributes to the link between socioeconomic status across generations. Martin and his coauthor found that 20-30% of the correlation between parental education and child cognitive skills can be explained by childhood health conditions.
3) Tania Barham examined the effect of health interventions in Bangladesh, in particular the staggered introduction of child vaccination programs in the 1980s, on cognitive development. Using this variation, along with mother fixed effects, she finds strong links between early life exposure to these public health programs and the child's mini-mental state exam scores later in life.
4) Daniel Rees and Joseph Sabia studied the causal effect of breastfeeding on academic achievement. To get at causal inference, they utilize the variation in breastfeeding across the children of a given mother, with the assumption being that, conditional on the mother and a rich set of control for other child-specific prenatal and postnatal behaviors, this variation is essentially exogenous with respect to outcomes of interest. They find strong effects of breastfeeding on later outcomes.
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Behavioral economics, also an oft discussed subject in this blog, was also on display at the ASHE conference. Jody Sindelar, who happens to be my dissertation supervisor, gave a fantastic talk on the importance of behavioral economics to health economics. Mainstream microeconomics rests on the neoclassical model, where individuals rationally calculate all (discounted) costs and benefits before making a decision. The feeling among many economists is that the workhorse neoclassical models do pretty well in explaining most phenomena, and that behavioral economics is a fun curiousity with limited policy interest.
Jody's talk served as a reminder that, especially in health care, behavioral economics may offer important policy relevant insights. Of the series of interesting examples she presented, my favorite was from international organ donation rates: countries with presumed consent legislation (i.e., you have to opt-out to get out of donating your organs) have higher rates of donation that those with opt-in laws (i.e., you have to give someone permission to take your organs). Neoclassical economics doesn't quite explain this; behavioral economics does. The policy significance of some extra organs for extremely thin organ markets is quite large.
Brian Elbel, a graduate from my program at Yale and now a professor at NYU, gave an interesting talk on his experimental work studying the behavioral economics of choosing a Medicare managed care plan. Briefly, Brian found that consumers tend make suboptimal choices regarding their health care plans, or defer these choices altogether, when presented with a larger number of options (which is antithetical to neoclassical theories predicting increased efficiency with greater choice) and when bad options are presented along with good ones. His experimental evidence, along with his econometric evidence from another paper, suggest the power of behavioral economics in explaining choices related to a very important government program.
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The final plenary session at the conference was given by Gary Becker, a Nobel laureate who revolutionized economics by extending the field to the analysis of phenomena like childbearing, child investments, polygamy, crime, discrimination, etc. (He's also a fine blogger: check out the Becker-Posner blog in the links sidebar). Becker's talk was based on his latest research, looking at the total returns to education. The basic idea was that economists have focused greatly on the wage returns to education. However, the value of education likely goes well beyond wages: a slew of studies have shown strong correlations between an individual's education and his/her health, happiness, the probability of marriage and the "quality" of spouse, and the educational attainment and health of his/her children.
Becker's talk focused on an interesting puzzle: the recent boom in college education. More people in the U.S., especially women, are attending and completing college as opposed to even 15-20 years ago. Becker suggested that such a boom is likely driven by changes in the returns to education. As such, Becker investigated where the growth in the returns to college might be coming from. My favorite slide in the presentation showed the marriage probabilities of women as a function of high school, college, and post-graduate education. In the 1960s, women with graduate degrees were much less likely to get married their those women who finished high school or college. Today, the relationship between marriage probabilities and the woman's level of education is monotone increasing across all levels of education!
Another interesting puzzle from the Becker talk: if college education has such high total returns, why don't more people take the meal ticket? Becker commented that this is a question he is currently struggling with and that perhaps those who end up finding an answer to this would themselves win a Nobel prize. In a room with nearly a thousand health economists, I saw at least half instinctively lurch for their pens and notebooks as soon as he said this!
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