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Posts Tagged ‘health’

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 (Ep. 109)

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 (abstract; PDF) 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.”


Long Commutes: Bad for the Heart

A new study finds that, in addition to being a real downer, long commutes are related to bad health. Conducted by Christine Hoehner, Carolyn E. Barlow, Peg Allen, and Mario Schootman, the study found that long commutes are correlated with higher blood pressure and bigger waistlines.  “This is the first study to show that people who commute long distances to work were less fit, weighed more, were less physically active and had higher blood pressure,” said Hoehner. “All those are strong predictors of heart disease, diabetes, and some cancers.”


Early Retirement: Bad For Your Health?

Retirement ages have been trending up, as governments struggle to deal with escalating financial burdens. That might be sad news for would-be retirees — but maybe they’ll change their mind if they look at this new research from Andreas Kuhn, Jean-Philippe Wuellrich, and Josef Zweimüller. They examine the effects of early retirement on a sample of Austrian blue-collar workers:

We find that a reduction in the retirement age causes a significant increase in the risk of premature death – defined as death before age 67 – for males but not for females. The effect for males is not only statistically significant but also quantitatively important. According to our estimates, one additional year of early retirement causes an increase in the risk of premature death of 2.4 percentage points (a relative increase of about 13.4%; or 1.8 months in terms of years of life lost). In line with expectations, we find that IV estimates are considerably smaller than the simple OLS estimates, both for men and for women. This is consistent with negative health selection into retirement and underlines the importance of a proper identification strategy when estimating the causal impact of early retirement on mortality. Our results also indicate that the causal effect of early retirement on mortality for females is zero, suggesting that the negative association between retirement age and mortality in the raw data is entirely due to negative health selection. There are several reasons why male but not female blue-collar workers suffer from higher mortality (eg women may be more health-conscious and adopt less unhealthy behaviours than men; they may be more active after permanently exiting the labour market due to their higher involvement in household activities).


Are Bilingual Immigrants Healthier?

A new study by Ariela Schachter, Rachel Tolbert Kimbro, and Bridget K. Gorman found that strong English skills and native language skills are associated with better health for immigrants. Using language as an indicator of adaptiveness to a new country, the researchers set out to investigate the “healthy immigrant effect”:

The “healthy immigrant effect”—whereby immigrants initially appear healthier than the native-born, although with time in the U.S. their health status declines—continues to puzzle scholars. Acculturation, or the process by which immigrants adapt to a host country, is a primary explanation of this phenomenon.


End of Illness Author David Agus Answers Your Questions

We recently solicited your questions for David Agus, the oncologist author of The End of Illness. Now he’s back with answers, including: the numbers on taking aspirin, how to get the most from a doctor visit, and the top 10 actions to reduce your cancer risk. I can guarantee you that his answers will enlighten and thrill some people and enrage and confound others. Thanks to everyone for their participation, and especially to Agus for the thorough answers. 

Q. I’m a 4th year medical student, and I watched your interview on The Daily Show when it first aired and really took issue with the way you presented many of these things. It seemed that you simplified your “solutions” to the point that it may actually be dangerous for people to listen to what you suggested. For example, you implied that everyone should be taking aspirin.


Bring Your Questions for End of Illness Author David Agus

Here’s an obvious but sobering thought: every one of us will someday get sick and die. And here’s a happier thought: with ever-advancing medical technology and research, we can now avoid many kinds of illnesses and add more years to our lifespan.

The oncologist David Agus lives halfway between those two thoughts. He is a professor at USC, the founder of Oncology.com, a co-founder of Navigenics, and now the author of The End of Illness. Most impressively, perhaps, he was recently a guest on The Daily Show. 

The End of Illness is Agus’s take on how the body works and why it fails. Along the way, he challenges a lot of conventional wisdom about health with academic studies and his own medical experience. Arguments in the book include: that taking vitamins may increase the risk of cancer; that sitting at a desk all day may be as damaging as smoking; and that you can tell something about a patient’s health based on whether she wears high-heel shoes. One review of the book reads: “A ‘rock star’ doctor says throw away the vitamins, load up on baby aspirin, and keep moving.”


Retirement Kills (Ep. 75)

Are you bummed out that you might have to postpone retirement for financial reasons?

Well, there may be a silver lining: it looks like retirement may be bad for your health. That’s the topic of our latest Freakonomics Radio on Marketplace podcast, “Retirement Kills.” (You can download/subscribe at iTunes, get the RSS feed, listen via the media player above, or read the transcript below.)

The Great Recession has put a lot of retirement plans on hold, often at the behest of governments who can’t afford to pay pensions. Germany, the U.K., and France have all upped their retirement ages.  And the U.S. is seeing a lot more older workers as well. Lisa Boily of the Bureau of Labor Statistics tells us that people 55 and older are expected to represent 25 percent of the labor force by 2020.

Part of this is simple demographics — the graying of the baby boom — but Americans are also working longer.


Are We Really Losing 1% of GDP Due to Poor Health? Also, a Poll on Polling

We’ve been writing a lot about obesity recently. First, it was this study about projected future obesity rates, then we covered Denmark’s saturated fat tax, which Steve Sexton then criticized for being inefficient. So, if you’re tired of reading fat-related posts on our blog, I get it. But as long as reports like this one from Gallup keep coming out, we’re going to keep writing about them, especially when they include so many interesting conversation points.

Here are the top-line numbers:

About 86% of full-time American workers are above normal weight or have at least one chronic condition. These workers miss a combined estimate of 450 million more days of work each year than their healthy counterparts, resulting in an estimated cost of more than $153 billion in lost productivity per year. That’s roughly 1% of GDP.


When Young People Need the Elevator

An e-mail from Brazil:

My name is Mauricio Castro, I have a social communications degree and teach interface design and multimedia systems.
I have a story I’d like to share with you guys.
I live in a nice neighborhood in the city of Vitória, Brazil. Being close to the beach, the city code forbids tall buildings in order to maintain sunlight in the sand all time. The maximum floor number is three.
So it’s only natural that most buildings here don’t have elevators. Even some new ones are presented only with stairs, especially those built for the younger customers.
So I went to the health clinic the other day and the nurse was telling me about the rising numbers of youngsters suffering from strokes. There are lots of explanations for these numbers rising, but mostly lifestyle and drug abuse.


Study: Early Bedtimes Keep Kids Slimmer

A new study out of Australia shows that children who go to sleep early and wake up early are less likely to be obese. The results, published in the Oct. 1 issue of the journal Sleep, indicate that it’s not so much the amount of sleep kids get, but the times at which they get it that has the biggest impact on their weight.


Physical Activity During the Recession: More Voluntary Exercise, Less Exertion

Last month, we wrote about data pulled from the American Time Use Survey (ATUS), examining how Americans spend their lost work hours during the recession. While 32% of foregone work hours were spent watching TV and sleeping (not great, though sleeping is helpful), 15% of that time went to “other leisure,” among which, there is “listening to music” and “being on the computer,” as well as “exercise and recreation.”
Two new studies (both coauthored by Dhaval M. Dave of Bentley University) drill further into that ATUS data to paint a more complete picture of our exercise and physical activity habits, and ultimately, what impact they have on our health. The first finds that during the recession, we engage in more voluntary exercise, but have less exertion. Part of this has to do with the difference between exercise and physical activity — the latter is seen as the healthier of the two. (Better to walk to work everyday than do sit-ups twice a week.) With the loss of work, comes a loss of physical activity — particularly with the types of jobs we’ve lost.


Why It's Better to be Beta than Alpha

“Uneasy lies the head that wears a crown.”

That’s from William Shakespeare’s Henry IV, Part 2. The point is that it’s not easy being No. 1; constantly having to watch your back, stressing over who might be angling to knock you off, and steal your crown.
Four hundred years later, scientists are finally getting around to proving that axiom. A new study of baboons shows that being the alpha male in a group dynamic may not be worth the stress the position imposes. Here’s the abstract:

In social hierarchies, dominant individuals experience reproductive and health benefits, but the costs of social dominance remain a topic of debate. Prevailing hypotheses predict that higher-ranking males experience higher testosterone and glucocorticoid (stress hormone) levels than lower-ranking males when hierarchies are unstable but not otherwise. In this long-term study of rank-related stress in a natural population of savannah baboons (Papio cynocephalus), high-ranking males had higher testosterone and lower glucocorticoid levels than other males, regardless of hierarchy stability. The singular exception was for the highest-ranking (alpha) males, who exhibited both high testosterone and high glucocorticoid levels. In particular, alpha males exhibited much higher stress hormone levels than second-ranking (beta) males, suggesting that being at the very top may be more costly than previously thought.


Is It Time to End the "War on Salt"?

The assault on dietary salt has been growing, and salt sales have been trending slightly downward. Is this a good fight?
According to Scientific American, perhaps not:

This week a meta-analysis of seven studies involving a total of 6,250 subjects in the American Journal of Hypertension found no strong evidence that cutting salt intake reduces the risk for heart attacks, strokes or death in people with normal or high blood pressure. In May European researchers publishing in the Journal of the American Medical Association reported that the less sodium that study subjects excreted in their urine—an excellent measure of prior consumption—the greater their risk was of dying from heart disease. These findings call into question the common wisdom that excess salt is bad for you, but the evidence linking salt to heart disease has always been tenuous.

(HT: Eric Jones)


If You Have to Walk Outside to Smoke, Does the Exercise Benefit Counteract the Smoking?

A reader named Aras Gaure, who identifies himself as a trainee with the Royal Norwegian Embassy in Pretoria, South Africa, writes to us:

At my workplace, smoking is prohibited –- as in a substantial number of other indoor workplaces. In order for me to have a smoke, I have to walk about 10 meters, get down 2 flights of stairs (a total of nineteen steps), and then walk 15 meters to the nearest terrace. In one workday, I have about 4-5 cigarettes, which means I cover a distance of about 200-250 meters and between 144 and 180 steps every day with regard to my smoking. Many people obviously smoke more and have to cover an even greater distance in order to have a cigarette. As a result of continuous bans on smoking around the world, people (who don’t quit) in many cases have to go through physical exertion numerous times a day to have a smoke. My question is whether or not this (in any sense or form) can be considered beneficial (especially for people who otherwise wouldn’t get this exercise)?

An interesting question but my sense is that the amount of exercise Aras describes — or even 5x that amount — is so minimal that it wouldn’t come close to offsetting the downsides of smoking. There are certain reported “health benefits of smoking,” including weight loss, but even for someone who likes finding counterintuitive trends, I have a hard time buying Aras’s wishful thinking. Am I wrong?


Do Synthetic Fat Substitutes Make You Fat? Ask the Rats Who Ate Pringles

In a whopper of counterintuitive research, and another reason to look askance at that supposed wonder of modern food science olestra (Olean), a study published by the American Psychological Association shows that synthetic fat substitutes used in low-calorie potato chips can backfire and contribute to weight gain more so than their fatty counterparts. How do we know? Researchers at Purdue fed Pringles to lab rats. Yes, the mathematically perfect, Einstein-inspired Pringles. Here’s how it worked:


Today in Sports-Induced Violence

So, yesterday I wrote about the handful of studies that have been done showing that large sporting events do not lead to higher rates of hospital visits, or for that matter, deaths or public violence. The latest study comes from Canada, and showed that during the 2010 Olympic gold medal ice hockey match between the U.S. and Canada, that emergency room visits declined by 17 percent in Canada. I thought it was a pretty good indication of how much Canadians love ice hockey, and also of the tranquility with which they seem to consume it. I imagined an entire country transfixed by the game on their TV sets, peacefully watching their countrymen beat the world in their most-beloved sport.
But then I saw this: “Vancouver Fans Riot After Stanley Cup Loss” And read this:

Rioting hockey fans clashed with police officers, set vehicles ablaze, smashed windows and looted stores and set several fires in downtown areas here on Wednesday night moments after the Vancouver Canucks lost Game 7 of the Stanley Cup finals to the Boston Bruins.
Local hospitals reported eight people treated for stab wounds, according to Alyssa Polinsky, a spokeswoman for Vancouver Coastal Health, the regional hospital authority.


Need to Go to the ER? Not Until the Game's Over!

Sports fans are nuts, right? Prone to erratic, irrational behavior when their team is playing. You’d think that during the Big Game, violent behavior would spike, and maybe lead to higher rates of emergency room visits and even deaths? Not true. A number of studies show that big sporting events do not increase the number of patients admitted to emergency rooms, and in some cases, hospital visits and even heart attack rates have been shown to decrease during a major sporting event. Unless, of course, your team is losing.
The latest study in this vein, published this week in the Journal of Open Medicine, comes from Canada, where researchers examined emergency room visits during the 2010 Olympic gold medal ice hockey game between the U.S. and Canada. The game ended in a 3-2 overtime win by Canada and was seen by roughly half the country, some 16.6 million people, making it the most popular TV broadcast in Canadian history. The study found that the rate of total emergency room visits during the game decreased by 17 percent, compared with corresponding hours for 6 control days.

This effect extended throughout Canada’s largest province, amounted to a decrease of about 136 fewer patients per hour, appeared accentuated for adult men living in rural locations, and was most evident for those with milder triage severity scores presenting with abdominal pain, musculoskeletal disorders, or traumatic injuries.


The Economics of Gym-Going, Part 1

A new study finds that unemployment “increases the risk of premature mortality by 63 percent.”  Eran Shor, one of the study’s authors, believes there’s a causal relationship: “In past research on the topic, Shor said it was hard to distinguish whether pre-existing health conditions, such as diabetes or heart problems, or behaviors such as smoking, drinking or drug use, lead to both unemployment and a greater risk of death. In the new study, controls were included to account for those factors.”


The Rational War on Fat

Is it likely that we’ll follow the perfectly rational incentives designed by benevolent governmental guardians to reduce obesity? Fat chance.