A Simple Invention to Help Women’s Health

BBC News reports the story of Arunachalam Muruganantham, a school dropout in rural India who invented a technology that could vastly improve reproductive health for women. The user-friendly technology relies on simple machines to produce sanitary pads at a low cost, a boon for women unwilling or unable to pay for the higher-priced sanitary pads in stores.

[Muruganantham] discovered that hardly any women in the surrounding villages used sanitary pads - fewer than one in 10. His findings were echoed by a 2011 survey by AC Nielsen, commissioned by the Indian government, which found that only 12% of women across India use sanitary pads.

Muruganantham says that in rural areas, the take-up is far less than that. He was shocked to learn that women don't just use old rags, but other unhygienic substances such as sand, sawdust, leaves and even ash.

Women who do use cloths are often too embarrassed to dry them in the sun, which means they don't get disinfected. Approximately 70% of all reproductive diseases in India are caused by poor menstrual hygiene - it can also affect maternal mortality.

Does Breastfeeding Reduce Childhood Disability?

A new (gated) NBER paper looks at the relationship between breastfeeding and childhood disability.  The author, George Wehby, finds that a longer duration of breastfeeding is associated with a slightly lower risk of child disability:

Little is known about whether breastfeeding may prevent disabilities throughout childhood. We evaluate the effects of breastfeeding on child disability using data from the National Survey of Family Growth merged to the National Health Interview Survey for a large nationally representative sample of children aged 1 to 18 years from the U.S. including over 3,000 siblings who are discordant on breastfeeding status/duration. We focus on a mother fixed effect model that compares siblings in order to account for family-level unobservable confounders and employ multiple specifications including a dynamic model that accounts for disability status of the prior child. Breastfeeding the child for a longer duration is associated with a lower risk of child disability, by about 0.2 percentage-points per month of breastfeeding. This effect is only observed on the intensive margin among breastfed children, as any breastfeeding has no effect on the extensive margin. We conclude that very short breastfeeding durations are unlikely to have an effect on reducing disability risk.

College Makes You Healthy

At the core of the debate over the value of college is a collage of evidence showing that it produces better lifetime outcomes not just in income but in health and happiness. How does this happen? And how can we be sure that we aren't just seeing a selection bias -- i.e., that people who go to college would have been richer, healthier, and happier in any case?

Here's a new working paper (abstract; PDF), by Kasey Buckles, Andreas Hagemann, Ofer Malamud, Melinda Morrill, and Abigail Wozniak which purports to show the long-term health effects of a college education. Granted, their data stretches back to the Vietnam War draft (a good instrumental variable, which other researchers have used) but their findings are significant nonetheless.

We exploit exogenous variation in college completion induced by draft-avoidance behavior during the Vietnam War to examine the impact of college completion on adult mortality.  Our preferred estimates imply that increasing college completion rates from the level of the state with the lowest induced rate to the highest would decrease
cumulative mortality by 28 percent relative to the mean.  Most of the reduction in mortality is from deaths due to cancer and heart disease.  We also explore potential mechanisms, including differential earnings, health insurance, and health behaviors, using data from the Census, ACS, and NHIS.

Differential earnings and health insurance are of course related to the income boost that college graduates receive. It is the "health behaviors" that are learned/adopted by college graduates that are especially interesting.

Beer for Babies and the Tapeworm Diet

In our podcast “100 Ways to Fight Obesity," Steve Levitt and David Laibson discuss the possibility of using tapeworms to fight weight gain. (Seriously.) That prompted a reader named Scott Genevish to send us a real-seeming (?) old advertisement for "Sanitized Tapeworms, Jar Packed" (below). It was accompanied by a bunch of other old ads that are all, from the perspective of 2013, radically outdated for one reason or another. I have no idea if all the ads are real; I'm sure most of them have made the online rounds before. Still, it might be worth a look -- especially when you think about how the line between repugnant and not repugnant can shift over time, sometimes faster and more dramatically than you'd ever predict.

Who Steals Healthcare Insurance?

What happens when a firm starts a "dependent verification" program designed to make sure that its employees are carrying only legitimate dependents on their health insurance? The economists Michael Geruso and Harvey Rosen ask that question in a new working paper called "Fraud in the Workplace? Evidence from a Dependent Verification Program" (abstract; PDF). A few key sections are bolded below:

In recent years many employers, both in the private and public sectors, have implemented dependent verification (DV) programs, which aim to reduce employee benefits costs by ensuring that ineligible persons are not enrolled in their health plan as dependents. However, little is known about their efficacy. In this paper, we evaluate a DV program using a panel of health plan enrollment data from a large, single-site employer who implemented it several years ago. We find that relative to all other years, dependents were 2.7 percentage points less likely to be reenrolled in the year that DV was introduced, indicating that this fraction of dependents was ineligibly enrolled prior to the program’s introduction. These disenrollment effects were especially large for same-sex partners and older children. We show that the program did not induce employees to leave the employer’s plan and (say) put themselves and their dependents on the spouse’s plan. We also show that disenrollment occurred because dependents were actually ineligible, not because of compliance costs that might be associated with providing documentation. The DV program saved about $46 per enrolled employee. A considerable fraction of these cost savings came from removing older children who didn’t meet additional criteria. Therefore, the dependent coverage provision of the Affordable Care Act of 2010, which essentially renders all children up to age 26 eligible in all employer health plans, will substantially limit the future cost saving potential of such programs. Hence, as the state governments and private employers that have implemented DV programs adapt to the new regulatory environment, the popularity of dependent verification programs may well diminish.

The next time you're counting up all the reasons why employer-based healthcare insurance is a bad idea, you can include this one, too.

Is It Unethical to Not Hire Smokers?

That is the question asked in a New England Journal of Medicine column by Harald Schmidt, Kristin Voigt, and Ezekiel J. Emanuel:

Finding employment is becoming increasingly difficult for smokers. Twenty-nine U.S. states have passed legislation prohibiting employers from refusing to hire job candidates because they smoke, but 21 states have no such restrictions. Many health care organizations, such as the Cleveland Clinic and Baylor Health Care System, and some large non–health care employers, including Scotts Miracle-Gro, Union Pacific Railroad, and Alaska Airlines, now have a policy of not hiring smokers — a practice opposed by 65% of Americans, according to a 2012 poll by Harris International.

Surprising New Findings on Obesity

One of the first Freakonomics Radio podcasts we made was an episode about the (surprisingly tenuous) link between obesity and health problems. A new study in The Journal of the American Medical Association finds that "Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality."  Writing for The Daily Beast, Kent Sepkowitz explains:

Compared to people with a normal weight (a BMI less than 25), the overweight (BMI between 25 to 30) had a 6 percent lower mortality rate—and both groups had a rate about 15 percent lower than the obese, especially the very obese (BMI above 35).

The explanation for the finding is uncertain. Perhaps the pleasantly plump but not obese have an extra reserve—a literal spare tire—that confers a survival advantage should they become seriously ill, whereas the lean-iacs do not. Or maybe the thin ones were thin because of a serious illness that, in the course the various studies, killed them. Or maybe the thin ones were thin because they were chain smokers living off Scotch and potato chips. Or just maybe the occasional pig-out does soothe the soul and make for a happier, healthier individual.

(HT: Andrew Sullivan)

How to Live Longer: a New Marketplace Podcast

Our latest Freakonomics Radio on Marketplace podcast is called "How to Live Longer." (You can download/subscribe at iTunes, get the RSS feed, listen via the media player in the post, or read the transcript below.)

It looks into why Hall of Fame inductees, Oscar winners, and Nobel laureates seem to outlive their peers. The deeper question in the podcast concerns the relationship between status (not income!) and longevity -- a fascinating, complex, and controversial topic (here's a good place to start reading) about which I believe we'll hear a great deal in years to come. It will be valuable to know what kind of "status boosts" confer health advantages and, conversely, how disappointment and the like can chip away at us.

This podcast was timed to coincide with two events this week: the annual Baseball Hall of Fame election, in which no players were selected this year for the first time since 1996 (here's ESPN's take and here's a useful statistical snapshot); and the announcement of this year's Oscar nominees.

The Benefits of the Safety Net

A new working paper (abstractPDF) by Hilary W. Hoynes, Diane Whitmore Schanzenbach, and Douglas Almond examines the effects of in utero and childhood access to the social safety net, specifically food stamps:

A growing economics literature establishes a causal link between in utero shocks and health and human capital in adulthood. Most studies rely on extreme negative shocks such as famine and pandemics. We are the first to examine the impact of a positive and policy-driven change in economic resources available in utero and during childhood. In particular, we focus on the introduction of a key element of the U.S. safety net, the Food Stamp Program, which was rolled out across counties in the U.S. between 1961 and 1975. We use the Panel Study of Income Dynamics to assemble unique data linking family background and county of residence in early childhood to adult health and economic outcomes.

You Really Are What You Eat

In a new working paper (PDF; abstract), economists David G. Blanchflower, Andrew J. Oswald, and Sarah Stewart-Brown argue that you actually are what you eat:

Humans run on a fuel called food.  Yet economists and other social scientists rarely study what people eat.  We provide simple evidence consistent with the existence of a link between the consumption of fruit and vegetables and high well-being.  In cross-sectional data, happiness and mental health rise in an approximately dose-response way with the number of daily portions of fruit and vegetables. The pattern is remarkably robust to adjustment for a large number of other demographic, social and economic variables.  Well-being peaks at approximately 7 portions per day.  We document this relationship in three data sets, covering approximately 80,000 randomly selected British individuals, and for seven measures of well-being (life satisfaction, WEMWBS mental well-being, GHQ mental disorders, self-reported health, happiness, nervousness, and feeling low).

One major note: the researchers caution that reverse causality may be an issue. That is, rather than fruit and vegetables causing well-being, it may be that well-adjusted people prefer eating a lot of fruit and vegetables. The authors recommend additional "randomized trials to explore the consequences for mental health of different levels of fruit-and-vegetable consumption."