Access to information via social media is one of the biggest differentiators of public health crises today. During the early stages of the Covid-19 outbreak in January 2020, we conducted an experiment in Wuhan, China to assess the impact of viral social media content on pro-social and trust behaviours and preferences towards risk taking with known and unknown probabilities. Prior to the experiment, participants viewed one of two videos that had been widely and anonymously shared on Chinese social media: a central government leader visiting a local hospital and supermarket, or health care volunteers transiting to Wuhan. In a control condition, participants watched a Neutral video, unrelated to the crisis. Viewing one of the leadership or volunteer videos leads to higher levels of pro-sociality and lesser willingness to take risks in an ambiguous situation relative to the control condition. The leadership video, however, induces lower levels of trust. We provide evidence from two post-experiment surveys that the video’s impact on pro-sociality is modulated by influencing the viewer’s affective emotional state.

Loss framing and checklist formatting are two oft-cited tools for encouraging behavior change, but there is little causal evidence on their impact in field settings. We partnered with the City of Philadelphia to test the effectiveness of these tools to increase completion of the City’s wellness program. In our experiment, 5235 City employees and retirees were randomly assigned to receive one of four postcard versions (using a 2 × 2 design), whereby we varied both framing (gain or loss) and how instructions were provided (information only or information in checklist format). Our results suggest that neither loss framing nor the checklist formatting significantly influenced the likelihood that individuals would complete the wellness tasks, or how quickly they completed the tasks. We conclude that this specific form of employee behavior may be difficult to influence through the “passive” behavioral interventions we tested, and suggest that a more “active” approach may be required in such instances.

Governments across the world have implemented restrictive policies to slow the spread of COVID-19. Recommended face mask use has been a controversially discussed policy, among others, due to potential adverse effects on physical distancing. Using a randomized field experiment (N = 300), we show that individuals kept a significantly larger distance from someone wearing a face mask than from an unmasked person during the early days of the pandemic. According to an additional survey experiment (N = 456) conducted at the time, masked individuals were not perceived as being more infectious than unmasked ones, but they were believed to prefer more distancing. This result suggests that wearing a mask served as a social signal that led others to increase the distance they kept. Our findings provide evidence against the claim that mask use creates a false sense of security that would negatively affect physical distancing. Furthermore, our results suggest that behavior has informational content that may be affected by policies.

This study examines disparities in health and nutrition among native and Syrian refugee children in Turkey. To understand the need for targeted programs addressing child well-being among the refugee population, we analyze the Turkey Demographic and Health Survey (TDHS) – which provides representative data for a large refugee and native population. We find no evidence of a difference in infant or child mortality between refugee children born in Turkey and native children. However, refugee infants born in Turkey have lower birthweight and age-adjusted weight and height than native infants. When we account for a rich set of birth and socioeconomic characteristics that display substantial differences between natives and refugees, the gaps in birthweight and age-adjusted height persist, but the gap in age-adjusted weight disappears. Moreover, the remaining gaps in birthweight and anthropometric outcomes are limited to the lower end of the distribution. The observed gaps are even larger for refugee infants born before migrating to Turkey, suggesting that the remaining deficits reflect conditions in the source country before migration rather than deficits in access to health services within Turkey. Finally, comparing children by the country of their first trimester, we find evidence of the detrimental effects of stress exposure during pregnancy.

Since 2006, Rwanda has experienced a substantial rise in the facility-based delivery (FBD) rate, attributed to various health initiatives. This paper investigates the impact of multiple health reforms on maternal service utilization and neonatal mortality rates. Employing a difference-in-differences framework utilizing geographical variation in the baseline FBD rate, our estimates indicate a 10–17 percentage point increase in FBD and a 0.15–0.18 times increase in the number of antenatal care visits. While our analysis indicates some evidence of a reduction in neonatal mortality rates, the findings are inconclusive. Nevertheless, our results suggest that the effect of the reforms on neonatal mortality rates was weakly intensified for those residing near district hospitals providing care for complicated pregnancies.

The consequences of legal access to medical marijuana for individuals' well-being are controversially assessed. We contribute to the discussion by evaluating the impact of the introduction of medical marijuana laws across US states on self-reported mental health considering different motives for cannabis consumption. Our analysis is based on BRFSS survey data from close to eight million respondents between 1993 and 2018 that we combine with information from the NSDUH to estimate individual consumption propensities. We find that eased access to marijuana through medical marijuana laws reduce the reported number of days with poor mental health for individuals with a high propensity to consume marijuana for medical purposes and for those individuals who likely suffer from frequent pain.

Using the public-use files of the Canadian Community Health Survey and a difference-in-differences methodology, we estimate the impact of a universal income transfer (the Universal Child Care Benefit) on food insecurity, separately for adults and children within households. The income transfer reduced the risk of overall food insecurity by 20% at the child level, and the effect was larger in households with lower education or income. The transfer also reduced the likelihood of moderate/severe food insecurity among adults in single-parent families, as well as adults and children in households with secondary education or less. These findings withstand several robustness checks.

Exploiting the fact that hypertension is diagnosed when a person’s blood pressure reading exceeds a medically specified threshold (90 mmHg for diastolic blood pressure or 140 mmHg for systolic blood pressure), this study estimates the effect of a first-ever hypertension diagnosis on Chinese adults’ alcohol consumption using a two-dimensional regression discontinuity design. Analyzing data on 10,787 adults from the China Health and Nutrition Survey, our estimation reveals that hypertension diagnoses based on diastolic blood pressure readings exert a number of desirable effects. Hypertensive adults’ drinking frequency and the incidence of excessive drinking among them were reduced by 1.2 times/week and 17.9 percentage points, respectively, about three years after the diagnosis. Meanwhile, their beer and Chinese spirits (Baijiu) intakes were reduced by 518.6 ml/week and 194.8 ml/week, respectively. Interestingly, we also found modest evidence that hypertension diagnoses based on diastolic blood pressure readings increase Chinese adults’ wine intake, suggesting a substitution pattern upon hypertension diagnoses. In contrast, based on systolic blood pressure readings, no significant effects of hypertension diagnoses on alcohol consumption were found.

Expansions of Medicaid family planning services have been associated with decreases in pregnancy rates. Access to a broader range of medical, non-family planning services may influence pregnancy rates as well if the increased exposure to medical services spills over to other kinds of behaviour. Using a difference-in-difference approach, I examine the impact of the Affordable Care Act (ACA) Medicaid expansions on the propensity of low-income, single women to become single mothers. Previous expansions of Medicaid family planning services allow us to also investigate the influence of access to other medical services (i.e. non-family planning). I find that although access to contraceptives is associated with a reduction in the propensity of becoming a single mother among adult, low-income women, medical services beyond access to contraceptives can provide additional impacts.

Numerous studies have confirmed the relationship between individual risk and time preference and obesity. Nevertheless, none has studied the effect of these attitudes on chronic (long-term) obesity. This study used Indonesia Family Life Survey (IFLS) data from 16,366 individuals. It tracked their obesity status in 2007 and 2014 by calculating body mass index, the ratio between body weight and square of height. Besides the conventional risk-averse and risk-tolerant behaviour, the IFLS sample includes people who fear uncertainty related to the status quo bias. The ordered logit regression results show that past impatience, risk tolerance, and status quo bias behaviour (in 2007) are associated with transient or chronic obesity, while only current behaviour of status quo bias (in 2014) is associated with obesity. Furthermore, our study confirms that chronic obesity in Indonesia is prevalent among highly educated, high-income, and urban-centric individuals, exacerbated by impatience, risk tolerance, and uncertainty aversion. Thus, providing information on the risk of obesity and food calories, giving the incentive to avoid obesity, and improving the quality of built environments such as public parks, public transportation, and footpath could help prevent the rising obesity prevalence.

The government of Uganda introduced an education reform that eliminated school fees for primary school-age children in 1997. This paper finds that an increase in education, generated by the reform, has a positive impact on women's empowerment. Specifically, an increase in schooling, due to the reform, improves women's involvement in decision making within the household by increasing their likelihood of having a final say on issues related to their own health, about large household expenses, and regarding visits to family or relatives. Education enhances women's cognitive ability but has no impact on women's labor market opportunities and attitudes toward gender-based violence.

Studies of health care expenditure often exclude explanatory variables measuring wealth, despite the intuitive importance and policy relevance. We use the Household, Income and Labour Dynamics in Australia Survey to assess impacts of income and wealth on health expenditure. We investigate four different dependent variables related to health expenditure and use three main methodological approaches. These approaches include a first difference model and introduction of a lagged dependent variable into a cross-sectional context. The key findings include that wealth tends to be more important than income in identifying variation in health expenditure. This applies for health variables which are not directly linked to means testing, such as spending on health practitioners and for being unable to afford required medical treatment. In contrast, the paper includes no evidence of different impacts of income and wealth on spending on medicines, prescriptions or pharmaceuticals. The results motivate two novel policy innovations. One is the introduction of an asset test for determining rebate eligibility for private health insurance. The second is greater focus on asset testing, rather than income tests, for a wide range of general welfare payments that can be used for health expenditure. Australia's world-leading use of means testing can provide a test case for many countries.

Long-term exposure to extreme temperatures could threaten individuals' mental health and psychological wellbeing. This study aims to investigate the long-term impact of cumulative exposure to extreme temperature. Differently from existing literature, we define extreme temperature exposure in relative terms based on local temperature patterns. Combining the China Health and Retirement Longitudinal Study and environmental data from the U.S. National Oceanic and Atmospheric Administration from 2011 to 2015, this study demonstrates that heat and cold exposure days in the past year significantly increase the measured depression level of adults over age 45 by 1.75 and 3.00 per cent, respectively, controlling for the city, year, and individual fixed effects. The effect is heterogeneous across three components of depression symptoms as well as age, gender, and areas of residency, and air conditioning and heating equipment are effective in alleviating the adverse impact of heat and cold exposure. The estimation is robust and consistent across a variety of temperature measurements and model modifications. Our findings provide evidence on the long-term and accumulative cost of extreme temperature to middle-aged and elderly human capital, contributing to the understanding of the social cost of climate change and the consequent health inequality.

Given change in the universal developmental agenda and the quality of governance in the last two decades, this paper re-examines the relationship between governance, health expenditure and maternal mortality using panel data for 184 countries from 1996 to 2019. By employing the ‘dynamic panel data regression model’, the study reveals that a one-point improvement in the governance index decreases maternal mortality by 10–21%. We also find that good governance can better translate health expenditure into improved maternal health outcomes through effective allocation and equitable distribution of available resources. These results are robust to alternative instruments, alternative dependent variables (such as infant mortality rate and life expectancy), estimation by different governance dimensions and at the sub-national level. Additional findings using ‘Quantile regression’ estimates show that the quality of governance matters more than the health expenditure in countries with a higher level of maternal mortality. While the ‘Path regression’ analysis exhibits the specific direct and indirect mechanisms through which the causal inference operates between governance and maternal mortality.

Have people in China moved from more polluted cities to less polluted ones? We merge city-level air pollution data from 2003 to 2016 with migration data from a nationally representative sample. We estimate a linear model and a conditional logit model, and employ air pollution from distant sources carried by the wind as an instrument for local air pollution to address the potential concern that air pollution is endogenous to local economic activities. We make a distinction between out-migration that left some family members behind and whole-household out-migration, and discover that the former was more responsive to air pollution than the latter. The decline in net in-migration in response to an increase in air pollution was driven by both a decrease in gross in-migration and an increase in gross out-migration. We find suggestive evidence that out-migrants brought their children with them, but some aged parents were left behind.

This article addresses three main issues: the relationship between commute time and sickness absence, the heterogeneity of the commuting–absenteeism effect between rural migrants and urban citizens, and the effect of China’s Hukou system on the commuting–absenteeism effect. It applies a unique set of employer–employee matched data in China and a zero-inflated negative binomial model. We find clear evidence that a longer commuting time contributes to an increase in sickness absence. The heterogeneity of the commuting–absenteeism effect can also be confirmed: longer commuting leads to higher absence rates for urban citizens but not for rural migrants. Furthermore, we explore the effect of commuting on a set of health-related outcomes. The estimations demonstrate that commuting time has a significant impact on health-related outcomes for both migrants and urban citizens, but unequal access to housing provision and to social health insurance in the Hukou system may mean that rural migrants resort to more informal medical services and thus lack access to the official sickness certificate required to seek legal sickness absence. We recommend accelerated reform of the Hukou system to encourage rural workers to seek appropriate and timely medical services, thereby reducing public health risks.

A regulatory liability-based approach to reducing foodborne illnesses is widely used in the U.S. But how effective is it? We exploit regulatory regime variation across states and over time to examine the relationship between product liability laws and reported foodborne illnesses. We find a positive and statistically significant relationship between strict liability with punitive damages and the number of reported foodborne illnesses. We find, however, no statistically significant relationship between strict liability with punitive damages and the number of foodborne illness-related hospitalizations and deaths.

The paper investigates the validity of individual perceptions of heart disease risks, and examines how information and risk perceptions affect marginal willingness to pay (MWTP) to reduce risk, using data from a stated preference survey. Results indicate that risk perceptions held before receiving risk information are plausibly related to objective risk factors and reflect individual-specific information not found in aggregate measures of objective risk. After receiving information, individuals’ updates of prior risk assessments are broadly consistent with Bayesian learning. Perceived heart disease risks thus satisfy construct validity and provide a valid basis for inferring MWTP to reduce risk. Consistent estimators of the relationship of MWTP to endogenously perceived risk are developed. Estimating MWTP based on objective rather than subjective risks causes misleading inferences about benefits of risk reduction. An empirical case study shows that estimated benefits may be as much as 60–98 % higher when estimated using individuals’ heterogeneous perceptions of risk than when using aggregate estimates of objective risk. The main contributions include assessing the validity of risk perceptions and their updating, consistently estimating the relationship between MWTP and endogenously perceived risk, and demonstrating the importance of employing risk perception information for accurate benefit measurement.

This study investigates the relationship between household utilization of food services and retailers and the healthfulness of purchases using data from the 2013 Food Acquisition and Purchase Survey. Overall, our findings suggest that the associations between food service or retailer utilization and the healthfulness of purchases are limited. Thus, interventions may need to be targeted to specific households based on patterns of utilization. We also find evidence for an interdependent relationship between food at home and away from home food shopping behaviors with implications for the healthfulness of purchases.