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Article

Developmental Origins of Health Inequality  

Gabriella Conti, Giacomo Mason, and Stavros Poupakis

Building on early animal studies, 20th-century researchers increasingly explored the fact that early events—ranging from conception to childhood—affect a child’s health trajectory in the long-term. By the 21st century, a wide body of research had emerged, incorporating the original fetal origins hypothesis into the developmental origins of health and disease. Evidence from Organization for Economic Cooperation and Development (OECD) countries suggests that health inequalities are strongly correlated with many dimensions of socioeconomic status, such as educational attainment, and that they tend to increase with age and carry stark intergenerational implications. Different economic theories have been developed to rationalize this evidence, with an overarching comprehensive framework still lacking. Existing models widely rely on human capital theory, which has given rise to separate dynamic models of adult and child health capital within a production function framework. A large body of empirical evidence has also found support for the developmental origins of inequalities in health. On the one hand, studies exploiting quasi-random exposure to adverse events have shown long-term physical and mental health impacts of exposure to early shocks, including pandemics or maternal illness, famine, malnutrition, stress, vitamin deficiencies, maltreatment, pollution, and economic recessions. On the other hand, studies from the 20th century have shown that early interventions of various content and delivery formats improve life course health. Further, given that the most socioeconomically disadvantaged groups show the greatest gains, such measures can potentially reduce health inequalities. However, studies of long-term impacts as well as the mechanisms via which shocks or policies affect health, and the dynamic interaction among them, are still lacking. Mapping the complexities of those early event dynamics is an important avenue for future research.

Article

Disability and Economic Development  

Marc Suhrcke

While definitional and measurement problems pose a challenge, there is no doubt that disability affects a noticeable share of the population, the vast majority of whom live in low- and middle-income countries (LMICs). The still comparatively scarce empirical data and evidence suggests that disability is closely associated with poverty and other indicators of economic deprivation at both the country and—if with slightly greater nuance—at the individual/household level. There is also a growing body of evidence documenting the sizeable additional costs incurred by persons with disabilities (PwDs) as a direct or indirect consequence of their disability, underlining the increased risk of PwDs (and the households they are part of) falling under the absolute poverty line in any given LMIC. Looking ahead, there remains considerable scope for more evidence on the causal nature of the link between disability and poverty, as well as on the (cost-)effectiveness of interventions and policies attempting to improve the well-being of PwDs.

Article

The Early Origins of the Civil Rights Movement in the United States: An Analysis of the Growth of the NAACP  

Daniel Aaronson, Jala Abner, Mark Borgschulte, and Bhashkar Mazumder

A newly digitized panel of county-level branch activity of the National Association for the Advancement of Colored People (NAACP) is used to describe the potential factors underlying the expansion of political participation in the American South, with a particular emphasis on the short period from the late 1930s through the 1940s. This period has long been recognized for its significant progress in reducing sizable racial gaps in labor market outcomes. But little work in economics has considered the role of political participation in shaping that progress. As the preeminent civil rights organization prior to the 1950s, the NAACP provides a natural lens in which to explore the expansion in political activism during this crucial period. Associative evidence suggests that a few potential channels could be especially worthy of future study, including the role of demographics, increased human capital, expansion in labor demand driven by wartime efforts, reduction in racial violence, latent political activism, and expansions in political and social networks, all of which have been highlighted in a variety of history and social science literatures. However, careful causal empirical work does not currently exist on these factors. Filling in this hole is important for providing compelling evidence on the origins of the 20th century’s most important U.S. political movement, as well as adding to a growing literature in political economy and development economics which examines the role that grassroots activism has played on economic growth and income inequality around the world.

Article

Econometrics of Stated Preferences  

Denzil G. Fiebig and Hong Il Yoo

Stated preference methods are used to collect individual-level data on what respondents say they would do when faced with a hypothetical but realistic situation. The hypothetical nature of the data has long been a source of concern among researchers as such data stand in contrast to revealed preference data, which record the choices made by individuals in actual market situations. But there is considerable support for stated preference methods as they are a cost-effective means of generating data that can be specifically tailored to a research question and, in some cases, such as gauging preferences for a new product or non-market good, there may be no practical alternative source of data. While stated preference data come in many forms, the primary focus in this article is data generated by discrete choice experiments, and thus the econometric methods will be those associated with modeling binary and multinomial choices with panel data.

Article

The Economic Benefits of Education for the Reduction of Crime  

Joel Carr, Olivier Marie, and Sunčica Vujić

Historically, social observers have repeatedly noted a correlation between education and crime, observing that individuals with lower levels of education are more likely to commit crime. However, the relationship between education and crime is complex, and it is important to clearly establish causality to determine if investing in education can effectively reduce crime. Merely observing persistent educational-attainment inequalities between offenders and non-offenders is not sufficient to make any causal claims about the underlying relationship between education and crime. Many other factors can influence an individual’s decision to stay in school or commit a crime, and these factors need to be accounted for when estimating the relationship between education and crime. Economists theoretically predicted in the late 1960s that education, via its positive effect on future earnings, would reduce the probability of criminal participation. Empirical studies have since used various econometric methods to establish that, on average, education has a strong causal crime-reducing effect. One strand of this literature has established in various contexts that individuals from cohorts forced by law to stay longer in school were much less likely to end up in court or prison. There is, however, still much to be discovered about the effect of education on crime, such as the underlying mechanisms related to income or non-cognitive effects, and heterogeneities by context, education level and quality, and individual characteristics. Overall, economists widely agree that investing in education is an efficient public-spending strategy to effectively reduce crime.

Article

The Economic Effect of Vocational Education on Student Outcomes  

Shaun M. Dougherty and Walter G. Ecton

As long as formal education has existed, there has been a clear connection between education and preparation for employment. In much of the world, formal educational systems have come to include vocational education and training (VET) as part of secondary education. In these spaces, individuals can receive continued training in general skills related to reading, writing, and mathematics while also pursuing specific skills in prescribed vocational or technical programs (e.g., skilled trades, culinary arts, information technology, health services). Across all countries and associated educational systems, a tension exists between whether to invest educational dollars in general versus specific skill development. On the one hand, general skills allow for transferability and likely support adaptability across workplace settings and in response to changes in employment conditions. On the other hand, secondary school completion is not universal, even in rich countries, and there are often large penalties or social costs to not completing secondary education. Furthermore, across countries of varying GDP levels, the question about how to best prepare individuals for entry into and success in the workforce is a persistent one. Evidence suggests that the payoff to investments in VET vary considerably, and that context and the characteristics of participants likely inform the expected returns to such investments. For instance, there is strong evidence across contexts that male participants in VET are likely to benefit in the short- to medium-term with respect to employment and earnings, and possibly also engage in less crime. Unresolved, however, is whether these payoffs persist in the longer term. In contrast, for women the estimated returns appear to be more context dependent. Some research shows reduced fertility and greater financial independence of women participating in VET programs in less-developed countries, but evidence is mixed in other settings. All evidence underscores that the payoff to VET is likely tied to the extent to which it adapts to contemporary economic needs, including extending the amount of total formal education that participants might otherwise receive.

Article

Economic Evaluation of Medical Devices  

Michael Drummond, Rosanna Tarricone, and Aleksandra Torbica

There are a number of challenges in the economic evaluation of medical devices (MDs). They are typically less regulated than pharmaceuticals, and the clinical evidence requirements for market authorization are generally lower. There are also specific characteristics of MDs, such as the device–user interaction (learning curve), the incremental nature of innovation, the dynamic nature of pricing, and the broader organizational impact. Therefore, a number of initiatives need to be taken in order to facilitate the economic evaluation of MDs. First, the regulatory processes for MDs need to be strengthened and more closely aligned to the needs of economic evaluation. Second, the methods of economic evaluation need to be enhanced by improving the analysis of the available clinical data, establishing high-quality clinical registries, and better recognizing MDs’ specific characteristics. Third, the market entry and diffusion of MDs need to be better managed by understanding the key influences on MD diffusion and linking diffusion with cost-effectiveness evidence through the use of performance-based risk-sharing arrangements.

Article

Economic Evaluation of Medical Screening  

Eline Aas, Emily Burger, and Kine Pedersen

The objective of medical screening is to prevent future disease (secondary prevention) or to improve prognosis by detecting the disease at an earlier stage (early detection). This involves examination of individuals with no symptoms of disease. Introducing a screening program is resource demanding, therefore stakeholders emphasize the need for comprehensive evaluation, where costs and health outcomes are reasonably balanced, prior to population-based implementation. Economic evaluation of population-based screening programs involves quantifying health benefits (e.g., life-years gained) and monetary costs of all relevant screening strategies. The alternative strategies can vary by starting- and stopping-age, frequency of the screening and follow-up regimens after a positive test result. Following evaluation of all strategies, the efficiency frontier displays the efficient strategies and the country-specific cost-effectiveness threshold is used to determine the optimal, i.e., most cost-effective, screening strategy. Similar to other preventive interventions, the costs of screening are immediate, while the health benefits accumulate after several years. Hence, the effect of discounting can be substantial when estimating the net present value (NPV) of each strategy. Reporting both discounting and undiscounted results is recommended. In addition, intermediate outcome measures, such as number of positive tests, cases detected, and events prevented, can be valuable supplemental outcomes to report. Estimating the cost-effectiveness of alternative screening strategies is often based on decision-analytic models, synthesizing evidence from clinical trials, literature, guidelines, and registries. Decision-analytic modeling can include evidence from trials with intermediate or surrogate endpoints and extrapolate to long-term endpoints, such as incidence and mortality, by means of sophisticated calibration methods. Furthermore, decision-analytic models are unique, as a large number of screening alternatives can be evaluated simultaneously, which is not feasible in a randomized controlled trial (RCT). Still, evaluation of screening based on RCT data are valuable as both costs and health benefits are measured for the same individual, enabling more advanced analysis of the interaction of costs and health benefits. Evaluation of screening involves multiple stakeholders and other considerations besides cost-effectiveness, such as distributional concerns, severity of the disease, and capacity influence decision-making. Analysis of harm-benefit trade-offs is a useful tool to supplement cost-effectiveness analyses. Decision-analytic models are often based on 100% participation, which is rarely the case in practice. If those participating are different from those not choosing to participate, with regard to, for instance, risk of the disease or condition, this would result in selection bias, and the result in practice could deviate from the results based on 100% participation. The development of new diagnostics or preventive interventions requires re-evaluation of the cost-effectiveness of screening. For example, if treatment of a disease becomes more efficient, screening becomes less cost-effective. Similarly, the introduction of vaccines (e.g., HPV-vaccination for cervical cancer) may influence the cost-effectiveness of screening. With access to individual level data from registries, there is an opportunity to better represent heterogeneity and long-term consequences of screening on health behavior in the analysis.

Article

Economic Incentives, Risk Behaviors, and HIV  

Sandra G. Sosa-Rubí and Omar Galárraga

Conditional economic incentives are a theoretically grounded approach for eliciting behavior change. The rationale stems from present-biased preferences, by which individuals attach greater value to benefits in the present and heavily discount long-term health. A growing literature documents the use of economic incentives in the HIV field. Small and frequent conditional economic incentives offered to vulnerable populations can contribute to behavior change. Economic incentives accompanied with other strategies can help overcome obstacles to access health services and in general seem to improve linkage to HIV care, prevention interventions, and adherence to HIV treatment. Future identification of promising combinations of intervention components, modalities, and strategies may yield maximum impact.

Article

Economics and Genetics  

Jason M. Fletcher

Two interrelated advances in genetics have occurred which have ushered in the growing field of genoeconomics. The first is a rapid expansion of so-called big data featuring genetic information collected from large population–based samples. The second is enhancements to computational and predictive power to aggregate small genetic effects across the genome into single summary measures called polygenic scores (PGSs). Together, these advances will be incorporated broadly with economic research, with strong possibilities for new insights and methodological techniques.

Article

Economics of Cancer Prevention and Control  

Ya-Chen Tina Shih

The goal of cancer prevention and control is to reduce cancer risk, morbidity, and mortality through transdisciplinary collaborations across biomedical, behavioral, and social sciences. Risk reduction, early detection, and timely treatment are the rationales behind policy efforts to promote cancer prevention. Economics makes three important contributions to cancer prevention and control research. Firstly, research built upon the human capital model by Grossman and the insurance model by Ehrlich and Becker offers solid theoretical foundations to study human behaviors related to preventive care. Secondly, economic evaluation provides useful analytical tools to assess the “cancer premium” (through the stated preference research approach) and to identify the optimal screening strategy (through cost-effectiveness analysis). Lastly, the rich set of quantitative methods in applied economics contributes to the estimation of the relative contribution of prevention versus treatment in the reduction of cancer mortality and the evaluation of the impact of guidelines to regulate screening practices or policy initiatives to promote cancer screening.

Article

The Economics of Childhood and Adolescent Obesity  

Nathan Tefft

Obesity is widely recognized as a chronic disease characterized by an elevated risk of adverse health conditions in association with excess body fat accumulation. Obesity prevalence reached epidemic proportions among adults in the developed world during the second half of the 20th century, and it has since become a major public health concern around the world, particularly among children and adolescents. The economics of childhood and adolescent obesity is a multi-faceted field of study that considers the numerous determinants, consequences, and interventions related to obesity in those populations. The central economic framework for studying obesity is a life-cycle decision-making model of health investment. Health-promoting investments, such as nutritional food, healthcare, and physical activity, interact with genetic structure and risky health behaviors, such as unhealthy food consumption, to generate an accumulation or decumulation of excess body fat over time. Childhood and adolescence are the primary phases of physical and cognitive growth, so researchers study how obesity contributes to, and is affected by, the growth processes. The subdiscipline of behavioral economics offers an important complementary perspective on health investment decision processes, particularly for children and adolescents, because health investments and participation in risky health behaviors are not always undertaken rationally or consistently over time. In addition to examining the proximate causes of obesity over the life cycle, economists study obesity’s economic context and resulting economic burden. For example, economists study how educational attainment, income, and labor market features, such as wage and work hours, affect childhood and adolescent obesity in a household. Once obesity has developed, its economic burden is typically measured in terms of excess healthcare costs associated with increased health risks due to higher obesity prevalence, such as earlier onset of, and more severe, diabetes. Obesity among children and adolescents can lead to even higher healthcare costs because of its early influence on the lifetime trajectory of health and its potential disruption of healthy development. The formulation of effective policy responses to the obesity epidemic is informed by economic research. Economists evaluate whether steps to address childhood and adolescent obesity represent investments in health and well-being that yield private and social benefits, and they study whether existing market structures fail to appropriately motivate such investments. Potential policy interventions include taxation of, or restricting access to, obesogenic foods and other products, subsidization of educational programs about healthy foods and physical activity inside and outside of schools, ensuring health insurance coverage for obesity-related preventive and curative healthcare services, and investment in the development of new treatments and medical technologies.

Article

The Economics of Cognitive Aging  

Fabrizio Mazzonna and Franco Peracchi

Population aging, the combined effect of declining fertility and rising life expectancy, is one of the fundamental trends observed in developed counties and, increasingly, in developing countries as well. A key aspect of the aging process is the decline of cognitive ability. Cognitive aging is an important and complex phenomenon, and its risk factors and economic consequences are still not well understood. For instance, the relationship between cognitive aging and productivity matters for long-term economic growth. Cognitive functioning is also crucial for decision-making because it influences individuals’ ability to process information and to make the right choices, and older individuals are increasingly required to make complex financial, health, and long-term-care decisions that might affect their health, resources, and welfare. This article presents evidence from economics and other fields that have investigated this phenomenon from different perspectives. A common empirical finding is the hump-shaped profile of cognitive performance over the life cycle. Another is the large variability of observed age profiles, not only at the individual level but also across sociodemographic groups and countries. The age profiles of cognitive performance also vary depending on the cognitive task considered, reflecting the different combinations of cognitive skills that they require. The literature usually distinguishes between two main types of cognitive skills: fluid intelligence and crystallized intelligence. The first consists of the basic mechanisms of processing new information, while the second reflects acquired knowledge. Unlike fluid intelligence, which declines rapidly as people get older, crystallized intelligence tends to be maintained at older ages. Differences in the age profiles of cognitive performance across tasks partly reflect differences in the importance of these two types of intelligence. For instance, tasks where learning, problem-solving, and processing speed are essential tend to be associated with a faster decline, while tasks where experience matters more tend to be associated with a slower decline. Various life events and behaviors over the life cycle also contribute to the large heterogeneity in the observed age profiles of cognitive performance. This source of variation includes not only early-life events and investments (e.g., formal education), but also midlife and later-life events (e.g., health shocks) and individual choices (e.g., health behaviors or retirement). From an economic viewpoint, cognitive abilities may be regarded as one dimension of human capital, along with education, health, and noncognitive abilities. Economists have mainly focused their attention on human capital accumulation, and much less so on human capital deterioration. One explanation is that early-life investments appears to be more profitable than investments later in life. However, recent evidence from neuropsychology suggests that the human brain is malleable and open to enhancement even later in adulthood. Therefore, more economic research is needed to study how human capital depreciates over the life cycle and whether cognitive decline can be controlled.

Article

The Economics of Diet and Obesity: Public Policy  

Fabrice Etilé

The rise in obesity and other food-related chronic diseases has prompted public-health officials of local communities, national governments, and international institutions to pay attention to the regulation of food supply and consumer behavior. A wide range of policy interventions has been proposed and tested since the early 21st century in various countries. The most prominent are food taxation, health education, nutritional labeling, behavioral interventions at point-of-decision, advertising, and regulations of food quality and trade. While the standard neoclassical approach to consumer rationality provides limited arguments in favor of public regulations, the recent development of behavioral economics research extends the scope of regulation to many marketing practices of the food industry. In addition, behavioral economics provides arguments in favor of taxation, easy-to-use front-of-pack labels, and the use of nudges for altering consumer choices. A selective but careful review of the empirical literature on taxation, labeling, and nudges suggests that a policy mixing these tools may produce some health benefits. More specifically, soft-drink taxation, front-of-pack labeling policies, regulations of marketing practices, and eating nudges based on affect or behavior manipulations are often effective methods for reducing unhealthy eating. The economic research faces important challenges. First, the lack of a proper control group and exogenous sources of variations in policy variables make evaluation very difficult. Identification is challenging as well, with data covering short time periods over which markets are observed around slowly moving equilibria. In addition, truly exogenous supply or demand shocks are rare events. Second, structural models of consumer choices cannot provide accurate assessment of the welfare benefits of public policies because they consider perfectly rational agents and often ignore the dynamic aspects of food decisions, especially consumer concerns over health. Being able to obtain better welfare evaluation of policies is a priority. Third, there is a lack of research on the food industry response to public policies. Some studies implement empirical industrial organization models to infer the industry strategic reactions from market data. A fruitful avenue is to extend this approach to analyze other key dimensions of industrial strategies, especially decisions regarding the nutritional quality of food. Finally, the implementation of nutritional policies yields systemic consequences that may be underestimated. They give rise to conflicts between public health and trade objectives and alter the business models of the food sector. This may greatly limit the external validity of ex-ante empirical approaches. Future works may benefit from household-, firm-, and product-level data collected in rapidly developing economies where food markets are characterized by rapid transitions, the supply is often more volatile, and exogenous shocks occur more frequently.

Article

The Economics of Diet and Obesity: Understanding the Global Trends  

Fabrice Etilé and Lisa Oberlander

In the last several decades obesity rates have risen significantly. In 2014, 10.8% and 14.9% of the world’s men and women, respectively, were obese as compared with 3.2% and 6.4% in 1975. The obesity “epidemic” has spread from high-income countries to emerging and developing ones in every region of the world. The rising obesity rates are essentially explained by a rise in total calorie intake associated with long-term global changes in the food supply. Food has become more abundant, available, and cheaper, but food affluence is associated with profound changes in the nutritional quality of supply. While calories have become richer in fats, sugar, and sodium, they are now lower in fiber. The nutrition transition from starvation to abundance and high-fat/sugar/salt food is thus accompanied by an epidemiological transition from infectious diseases and premature death to chronic diseases and longer lives. Food-related chronic diseases have important economic consequences in terms of human capital and medical care costs borne by public and private insurances and health systems. Technological innovations, trade globalization, and retailing expansion are associated with these substantial changes in the quantity and quality of food supply and diet in developed as well as in emerging and rapidly growing economies. Food variety has significantly increased due to innovations in the food production process. Raw food is broken down to obtain elementary substances that are subsequently assembled for producing final food products. This new approach, as well as improvements in cold chain and packaging, has contributed to a globalization of food chains and spurred an increase of trade in food products, which, jointly with foreign direct investments, alters the domestic food supply. Finally, technological advancements have also favored the emergence of large supermarkets and retailers, which have transformed the industrial organization of consumer markets. How do these developments affect population diets and diet-related diseases? Identifying the contribution of supply factors to long-term changes in diet and obesity is important because it can help to design innovative, effective, and evidence-based policies, such as regulations on trade, retailing, and quality or incentives for product reformulation. Yet this requires a correct evaluation of the importance and causal effects of supply-side factors on the obesity pandemic. Among others, the economic literature analyzes the effect of changes in food prices, food availability, trade, and marketing on the nutrition and epidemiological transitions. There is a lack of causal robust evidence on their long-term effects. The empirical identification of causal effects is de facto challenging because the dynamics of food supply is partly driven by demand-side factors and dynamics, like a growing female labor force, habit formation, and the social dynamics of preferences. There are several important limitations to the literature from the early 21st century. Existing studies cover mostly well-developed countries, use static economic and econometric specifications, and employ data that cover short periods of time unmarked by profound shifts in food supply. In contrast, empirical research on the long-term dynamics of consumer behavior is much more limited, and comparative studies across diverse cultural and institutional backgrounds are almost nonexistent. Studies on consumers in emerging countries could exploit the rapid time changes and large spatial heterogeneity, both to identify the causal impacts of shocks on supply factors and to document how local culture and institutions shape diet and nutritional outcomes.

Article

The Economics of Early Interventions Aimed at Child Development  

Samuel Berlinski and Marcos Vera-Hernández

A set of policies is at the center of the agenda on early childhood development: parenting programs, childcare regulation and subsidies, cash and in-kind transfers, and parental leave policies. Incentives are embedded in these policies, and households react to them differently. They also have varying effects on child development, both in developed and developing countries. We have learned much about the impact of these policies in the past 20 years. We know that parenting programs can enhance child development, that centre based care might increase female labor force participation and child development, that parental leave policies beyond three months don’t cause improvement in children outcomes, and that the effects of transfers depend much on their design. In this review, we focus on the incentives embedded in these policies, and how they interact with the context and decision makers to understand the heterogeneity of effects and the mechanisms through which these policies work. We conclude by identifying areas of future research.

Article

The Economics of End-of-Life Spending  

Hans Olav Melberg

End-of-life spending is commonly defined as all health costs in the 12 months before death. Typically, the costs represent about 10% of all health expenses in many countries, and there is a large debate about the effectiveness of the spending and whether it should be increased or decreased. Assuming that health spending is effective in improving health, and using a wide definition of benefits from end-of-life spending, several economists have argued for increased spending in the last years of life. Others remain skeptical about the effectiveness of such spending based on both experimental evidence and the observation that geographic within-country variations in spending are not correlated with variations in mortality.

Article

The Economics of Families and Health  

Susan Averett and Jennifer Kohn

An individual’s health is produced in large part by family investments that start before birth and continue to the end of life. The health of an individual is intertwined with practically every economic decision including education, marriage, fertility, labor market, and investments. These outcomes in turn affect income and wealth and hence have implications for intergenerational transfer of economic advantage or disadvantage. A rich body of theoretical and empirical work considers the role of the family in health production over the life cycle and the role of health in household economic decisions. This literature starts by considering family inputs regarding health at birth, then moves through adolescence and midlife, where relationship decisions affect health. After midlife, health, particularly the health of family members, becomes an input into retirement and investment decisions. The literature on family and health showcases economists’ skills in modeling complex family dynamics, deriving theoretical predictions, and using clever econometric strategies to identify causal effects.

Article

The Economics of Infectious Diseases  

Katharina Hauck

Economics can make immensely valuable contributions to our understanding of infectious disease transmission and the design of effective policy responses. The one unique characteristic of infectious diseases makes it also particularly complicated to analyze: the fact that it is transmitted from person to person. It explains why individuals’ behavior and externalities are a central topic for the economics of infectious diseases. Many public health interventions are built on the assumption that individuals are altruistic and consider the benefits and costs of their actions to others. This would imply that even infected individuals demand prevention, which stands in conflict with the economic theory of rational behavior. Empirical evidence is conflicting for infected individuals. For healthy individuals, evidence suggests that the demand for prevention is affected by real or perceived risk of infection. However, studies are plagued by underreporting of preventive behavior and non-random selection into testing. Some empirical studies have shown that the impact of prevention interventions could be far greater than one case prevented, resulting in significant externalities. Therefore, economic evaluations need to build on dynamic transmission models in order to correctly estimate these externalities. Future research needs are significant. Economic research needs to improve our understanding of the role of human behavior in disease transmission; support the better integration of economic and epidemiological modeling, evaluation of large-scale public health interventions with quasi-experimental methods, design of optimal subsidies for tackling the global threat of antimicrobial resistance, refocusing the research agenda toward underresearched diseases; and most importantly to assure that progress translates into saved lives on the ground by advising on effective health system strengthening.

Article

The Economics of Informal Care  

Courtney Van Houtven, Fiona Carmichael, Josephine Jacobs, and Peter C. Coyte

Across the globe, the most common means of supporting older disabled adults in their homes is through “informal care.” An informal carer is a family member or friend, including children or adults, who help another person because of their illness, frailty, or disability. There is a rich economics literature on the direct benefits of caregiving, including allowing the care recipient to remain at home for longer than if there was no informal care provided. There is also a growing literature outlining the associated costs of care provision. Although informal care helps individuals with disabilities to remain at home and is rewarding to many carers, there are often negative effects such as depression and lost labor market earnings that may offset some of these rewards. Economists have taken several approaches to quantify the net societal benefit of informal care that consider the degree of choice in caregiving decisions and all direct and indirect benefits and costs of informal care.