期刊-NBER美国国民经济研究局-2015number1_19页_3mb

NBER Reporter Summary: Health Economics Research (2015 Number 1)

Core Content

The NBER Health Economics Program has been examining the determinants and consequences of health outcomes through various lenses, including the effects of economic conditions, pollution, and policy interventions on health. This report highlights key findings from studies conducted between 2010 and 2014, focusing on how macroeconomic changes, environmental factors, and public policies influence health behaviors and outcomes.

Main Topics and Key Findings

1. The Great Recession and Health

• Unemployment and Health: Christopher Ruhm's research indicates that during the Great Recession, health outcomes in the U.S. were less favorable than previously observed. A 1 percentage point rise in unemployment led to a 0.5 percent decline in the death rate.
• Mortality Trends: Total mortality became less correlated with macroeconomic conditions, with cardiovascular disease and motor vehicle accidents remaining procyclical, while cancer and accidental poisonings became countercyclical.
• Leisure and Physical Activity: Unemployment was associated with increased leisure-time exercise but a substantial decline in total physical activity due to job losses in manual labor, leading to weight gain and long-term health impacts.
• Health Differentials: The recession may have worsened health disparities between high and low socioeconomic status groups.
• Housing Crisis: The housing crisis in the U.S. during the Great Recession was linked to increased mental health visits and preventable conditions, with larger effects observed in African-American and Hispanic populations.
• Iceland Case Study: In Iceland, the recession led to a reduction in health-compromising behaviors and mixed changes in health-promoting behaviors, influenced by the real exchange rate.

2. Pollution and Health

• Outdoor Air Pollution: PM2.5 (fine particulate matter) had a significant negative impact on worker productivity at a pear-packing factory, even at levels below current air quality standards.
• Ozone and Productivity: A 10 parts per billion decrease in ozone levels increased worker productivity by 4.2 percent.
• Birth Outcomes and Pollution: A reduction in sulfur dioxide levels during a French refinery strike improved newborn health, including higher birth weight and gestational age.
• Infant Mortality and Natural Gas: In Turkey, the adoption of natural gas led to a 4 percent decline in infant mortality for every 1 percentage point increase in subscriptions.
• Avoidance Behavior: The cost of pollution includes both health reductions and the cost of avoidance behaviors, such as spending on bottled water to avoid contaminated water.

3. Health of Returning Veterans

• Combat Exposure and Health: Ryan Edwards found that deployment to combat zones had a negative impact on self-reported health, even if socioeconomic well-being was not significantly affected.
• Mental Health and Deployment: Cesur, Sabia, and Tekin showed that soldiers deployed to high-risk combat zones had a significantly higher risk of suicidal ideation and PTSD, with estimated healthcare costs ranging from $1.5 to $2.7 billion.

4. Unhealthy Behaviors

• Leading Causes of Premature Mortality: Tobacco use, poor diet/inactivity, and alcohol consumption are the top three causes of premature mortality in the U.S.
• Time Preference and Self-Regulation: Individuals with higher time preference (discounting future consequences) are more likely to engage in harmful behaviors.
• Self-Regulation Correlation: Self-regulation is highly correlated across smoking, drinking, drug use, and crime, but less so for BMI and obesity.
• Tobacco Tax Impact: The 2009 federal tobacco tax increase reduced youth smoking and smokeless tobacco use, with potential long-term benefits.
• Magazine Advertising and Smokeless Tobacco: Dave and Saffer found that exposure to smokeless tobacco ads in magazines increases use, especially among males, and that both ST and cigarette taxes can reduce ST use.

5. Alcohol Use and Policy Impact

• Alcohol Tax Hikes: The 1991 U.S. federal excise tax hikes on alcohol reduced crash-related deaths and crime.
• Drunk Driving Penalties: Hansen found that increasing penalties for drunk driving is more effective in deterring behavior than lowering the BAC threshold for conviction.
• Alcohol and Crime: Alcohol consumption is positively related to assault, rape, and larceny, but not to murder or robbery.

6. Illegal Drug Use

• Medical Marijuana Laws: These laws reduced the price of marijuana, potentially increasing its use. The effects on alcohol use and motor vehicle accident mortality are mixed, depending on whether the substances are substitutes or complements.
• Youth Use and Laws: Some studies found an increase in youth marijuana use following the enactment of medical marijuana laws, though results are inconsistent and require more long-term data.

7. Obesity and Health Outcomes

• Food Prices and Obesity: A 10 percent increase in the real price per calorie of food reduced body fat percentage among youth, while fast-food price increases led to greater reductions.
• Fruit and Vegetable Prices: Increases in the real price of fruits and vegetables were associated with higher body fat.
• Nonwhite Youth Sensitivity: Nonwhite youths showed greater sensitivity to fast-food prices.
• Genetic Variation and Obesity Costs: Cawley and Meyerhoefer found that the impact of obesity on medical costs is about four times greater when controlling for endogeneity, with an estimated annual cost of $168 billion.

8. Schooling and Health

• Fetal Origins Hypothesis: Lin and Liu tested the hypothesis that in utero conditions affect long-term health and educational outcomes, using the 1918 influenza pandemic as a natural experiment.
• Health and Education: Individuals born during the pandemic were shorter, less educated, and more likely to suffer from chronic health conditions.

Conclusion

The NBER Health Economics Program has provided a wealth of insights into how various economic and environmental factors influence health outcomes. From the effects of the Great Recession on mortality and mental health, to the role of pollution in reducing productivity and improving birth outcomes, and the impact of policy interventions on tobacco, alcohol, and drug use, the research underscores the complex interplay between economic conditions and health. The findings also highlight the importance of considering behavioral responses and long-term consequences in health policy design.