Measurement 8

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Measurement 8 9

• Health

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Health indicators

• Health risks
• Nutrition Water / Sanitation Tobacco, Alcohol
  consumption
• Morbidity / Health status
• Incidence (new cases flows) Prevalence
  (infectionstocks)
• ex. HIV seropositivity
• Direct measurement (vision, audition,
  respiration, blood test)
• Symptoms (absent from work for sickness, often
  feels crying...)
• Self-declaration been sick in the past 15 days?
  ? seen a doctor?
• Mortality
• Infant Neonatal (1st month of life)
  Postnatal (1st year of life) 1q0
• Under-five Infant Child 4q0
• Adult mortality (between 15 and 60)
• Life expectancy
• Mortality by causes of death

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Health systems and health policy

• Public and private expenditures
• Prevention (health risks) treatment
• Insurance
• Number of dispensaries, of hospital beds
• Number of physicians, nurses
• Availability and price of medicines
• Vaccination rates

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Correlates of Health

• Correlates
• Individual genetic predispositions
• Social background, education, income
• Ex1 Life expectancy according to occupation
• (around 10 years of diff. between a university
  teacher and an unskilled worker)
• Ex2 Children height stature inequality between
  and within countries

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Equity (1)

• Outcome f(C,P)R
• C circumstances PPolicy Rresponsibility
• P ex-ante intervention or ex-post compensation
• 2 principles of equality of opportunity
• Natural reward P should let R its impact
• Compensation P should equalize f(C,P)
• Ex. Expenditures for cancer or AIDS
• C social origin (e.g. white/blue-collar,
  white/black...)
• R individual behavior (ex. smoking, sex)
• P public subsidy (cure of cancer, tri-therapy)

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Equity (2)
Rows Social origin Cols Risk level within
each social origin Cells Costs of treat-ment

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Nutrition

• Nutritional intakes quantity of food,
  subsistence basket (see Roman example) quality
  of food
• Nutritional outcomes height, weight

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What does height reflect?
Individual stature genetics - exposure to
infectious pathogens nutrition during
growth Mean group stature genetics 0 ? !
Differential mortality exposure to
pathogens nutrition Weight, Quételet index (or
BMI) more short-term ? obesity, anorexia
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When is height determined?
Children growth timing In utero (ex.
phylloxera) From 0 to 2 From 2 to 5
Stabilization period During puberty
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Height and income

• Not much correlated with income
• Differential mortality
• Quantity and quality of calories
• Quality of the diet
• Causality
• Height and future wages
• Parental income and height (ex. Cocoa crisis in
  Côte dIvoire, phylloxera in France)

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Tall Africans, Small Indians
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Height stature
John Strauss Duncan Thomas, Health, Nutrition
and Economic Development, Journal of Economic
Literature, 36(2), 1998.
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(No Transcript)
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HIV/AIDS
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HIV/AIDS Epidemics

• Epidemiology and prevention
• Still not very well-known epidemics
• Heterosexual and a more feminine
• The epidemics is in fact rather evenly
  distributed at high incidence rates
• Strong sensitivity with respect to safe behavior
• Large fall of life expectancy and of population
  growth
• Orphans
• Costly medecine
• Opportunistic infections around 360 (2000
  prices) /year /adult
• HAART (Tri-Therapies)  around 1000
• Mother-baby transmission
• Economic impact 5 main channels
• Medium-term
• Labor supply (dependence ratio, skill
  composition) ?household information
• Illness and labor productivity ?work
  participation information
• Enterprises and administrations disorganization ?
  specific surveys
• Long-term

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HIV/AIDS Prevalence Measurement

• Pre-natal visits ? blood test
• ? Bias to be corrected not all women go to a
  pre-natal visit (80 women in Cote dIvoire) a
  sample of pre-natal visits is not a sample of
  women seropositivity of men remains unknown
• Population surveys
• ? Saliva tests or blood tests?

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Morbidity self-declaration bias

• Cote dIvoire 2-5 years old children
• Sick in the 15 days preceding the interview
• 1988 16 if cons.per cap.ltmedian, 17 otherwise
• 1993 idem, 10 vs. 11
• Often encountered spurious correlation child
  care and preference attrition
• Cocoa producers compared to other farmers
• Cocoa p. wealthier by 20 in 1988, but at par in
  1993
• 1988 19 sick in other farmers vs. 11 in cocoa
  producing households
• 1993 11 other farmers, 10 cocoa producers
• Double difference (10-11)-(11-19)7
• Wald estimator 7/-20 0.35 income elasticity

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Mortality

• Mortality rates
• 1q0 Cohort of born in t jan.dec. ? dead in
  t1 jd
• 4q1 Cohort of survivors in t1 j.d. ? dead
  between t4 and t5
• 4q0 1q0 (1-1q0)4q1
• 1qa proba of dying between age a and age a1
• tpa proba of surviving from age a to age at
  (tpT 0)
• Life expectancy at age h
• La St0,..,T t tpa tqt1 (tpT 0 1qT 1)

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Rome (1)

• Measure welfare in Rome in comparison with
• GDP? Rather impossible
• Height stature of skeletons? They burnt their
  dead (except in Pompeii)
• Unskilled laborers household purchasing power
• Wages and prices in denarii (? silver grams)
  from the Diocletian edict (maximum prices for
  inflation control)
• Bare bone basket

Robert C. Allen, Oxford University, 2007 How
Prosperous were the Romans? Evidence from
Diocletians Price Edict (301 AD)
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Rome (2)
Robert C. Allen, Oxford University, 2007 How
Prosperous were the Romans? Evidence from
Diocletians Price Edict (301 AD)
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Rome (3)
Robert C. Allen, Oxford University, 2007 How
Prosperous were the Romans? Evidence from
Diocletians Price Edict (301 AD)
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Roman life expectancy