Background: Africa will double its population by 2050 and more than half will be below age 25. Th... more Background: Africa will double its population by 2050 and more than half will be below age 25. The continent has a unique opportunity to boost its socioeconomic welfare. This systematic literature review aims to develop a conceptual framework that identifies policies and programs that have provided a favorable environment for generating and harnessing a demographic dividend. This framework can facilitate sub-Saharan African countries’ understanding of needed actions to accelerate their demographic transition and capitalize on their demographic dividend potential. Methods: The search strategy was structured around three concepts: economic development, fertility, and sub-Saharan Africa. Databases used included PubMed and EconLit. An inductive approach was employed to expand the reference base further. Data were extracted using literature records following a checklist of items to include when reporting a systematic review suggested in the Preferred Reporting Items for Systematic Review...
Successive waves of the COVID-19 pandemic are a Sisyphean nightmare proving that we do not have a... more Successive waves of the COVID-19 pandemic are a Sisyphean nightmare proving that we do not have a public health system that has the capacity to learn and improve through time and experience. Budget data and workforce capability assessments from local public health agencies do not allow for a detailed assessment of public health capabilities. Top-down efforts to gather these assessments have to date not resulted in robust data to assess and track the capabilities of our public health system. Public health's intransigent unreadiness stems in part from chronic underfunding. State and local health departments have seen little to no real growth in per capita spending for decades. 2,3 Underfunding has led to capability gaps at both state and county levels. This article highlights past spending levels on foundational capabilities in state and county public health departments to inform efforts to rebuild a responsive and accountable public health system.
South Asian nations are at the crossroads of economic and political progress but still face sever... more South Asian nations are at the crossroads of economic and political progress but still face severe problems of under-development. Available data illustrates that while some macroeconomic indicators have improved over the years, disparities between rich and poor have increased manifold. Although infectious diseases remain a formidable enemy, noncommunicable diseases and injuries are increasing the health challenges facing the countries of the region. While it is widely recognized and accepted that infectious diseases predominantly affect the poor, there is insufficient evidence documenting the burden of RTI on the lower socioeconomic groups in developing countries. Low educational level, poorly paid occupations and poverty have all been found to be risk factors for road traffic injuries. This paper review available data from South Asia to show that RTI disproportionately affect the poor in terms of mortality, morbidity and disability, and presents a persuasive argument to policy make...
Background: This study estimates the potential loss of life in children under five years old attr... more Background: This study estimates the potential loss of life in children under five years old attributable to the economic recessions of 2020. Multiple prior studies have shown a strong and independent effect of GDP per capita on child mortality in developing countries after controlling for health system effects, demography, politics, environment, and literacy. Methods: Data were retrieved from the World Bank World Development Indicators database and the United Nations World Populations Prospects estimates for the years 1990-2020 for 129 countries with GDP per capita below 12,375 US$ (defined as low, lower-middle, and upper-middle income countries; LMICs). We used a multi-level, mixed effects, multivariate model to estimate the adjusted relationship between GDP per capita and the under-5 mortality rate (U5MR) specific to each country. The model’s country-specific parameters were used to simulate the impact on U5MR due to reductions in GDP per capita of 5%, 10%, and 15%. Findings: In a conservative scenario, a 5% reduction in GDP per capita in 2020 is estimated to cause an additional 282,996 deaths in children under 5 in one year compared to a baseline of no economic recession. Recessions at 10% and 15% lead to higher losses of under-5 lives, increasing to 585,802 and 911,026 additional deaths, respectively. We estimate that nearly half of all the potential under-5 lives lost from economic recessions in LMICs are estimated to occur in Sub-Saharan Africa. Interpretation: In developing countries, under-5 mortality rates are closely tied to national income. We estimate that the recessions of 2020 will lead to around 300,000 deaths in the under-5 population. Our results do not take into account the irreparable effects of economic deprivation on child development. We expect to see similar trends of child mortality in the next few years in the absence of sufficient SARS-CoV-2 vaccination or herd immunity. Funding Statement: A grant from Big Win Philanthropy partially funded this study. Declaration of Interests: The authors declare no conflicts of interest.
This study assessed the relationship of bride price to sexual risk taking based on a large, popul... more This study assessed the relationship of bride price to sexual risk taking based on a large, population-based survey. Data were collected on bride prices for 592 married women in 12 districts in Uganda in 2001. Controlling for covariates, we found that having had a bride price significantly lowered the wife’s odds of sexual intercourse with a partner other than the spouse (OR = 0.222; 95 % CI = 0.067, 0.737). Controlling for covariates, bride price increased the husband’s odds of non-spousal sexual intercourse (OR=1.489; 95 % CI = 0.746, 2.972), although this finding is not statistically significant. Bride price payment is statistically significantly associated with lower rates of non-spousal sexual contact in women, but is not statistically significantly associated with higher rates in men (Afr J Reprod Health 2009; 13[1]:147-158). RĖSUMĖ La dot et la prise de risque sexuel. Cette étude a évalué le rapport entre la dot et la prise de risque sexuel, en se fondant sur une grande enquê...
Fifty pediatric offices and clinics in the metropolitan Los Angeles area were visited to assess v... more Fifty pediatric offices and clinics in the metropolitan Los Angeles area were visited to assess vaccine storage practices. Questionnaires were administered to the personnel responsible for vaccine storage and the vaccine refrigerators were inspected. Only 16% of vaccine storage coordinators could cite appropriate storage temperatures for vaccines and 18% were unaware that heat can harm certain vaccines. Refrigerator thermometers were checked at least weekly in only 20% of offices, and 22% of the refrigerators had inappropriately high temperatures. Vaccines were routinely stored outside of the refrigerator uninsulated during the practice day in 16% of the offices visited. It is concluded that vaccine storage errors occur in pediatric offices at an unacceptably high frequency. Pediatricians should familiarize themselves with the guidelines for optimal vaccine storage in order to minimize the potential for vaccine failure in primary care practice.
Background: Africa will double its population by 2050 and more than half will be below age 25. Th... more Background: Africa will double its population by 2050 and more than half will be below age 25. The continent has a unique opportunity to boost its socioeconomic welfare. This systematic literature review aims to develop a conceptual framework that identifies policies and programs that have provided a favorable environment for generating and harnessing a demographic dividend. This framework can facilitate sub-Saharan African countries’ understanding of needed actions to accelerate their demographic transition and capitalize on their demographic dividend potential. Methods: The search strategy was structured around three concepts: economic development, fertility, and sub-Saharan Africa. Databases used included PubMed and EconLit. An inductive approach was employed to expand the reference base further. Data were extracted using literature records following a checklist of items to include when reporting a systematic review suggested in the Preferred Reporting Items for Systematic Review...
Successive waves of the COVID-19 pandemic are a Sisyphean nightmare proving that we do not have a... more Successive waves of the COVID-19 pandemic are a Sisyphean nightmare proving that we do not have a public health system that has the capacity to learn and improve through time and experience. Budget data and workforce capability assessments from local public health agencies do not allow for a detailed assessment of public health capabilities. Top-down efforts to gather these assessments have to date not resulted in robust data to assess and track the capabilities of our public health system. Public health's intransigent unreadiness stems in part from chronic underfunding. State and local health departments have seen little to no real growth in per capita spending for decades. 2,3 Underfunding has led to capability gaps at both state and county levels. This article highlights past spending levels on foundational capabilities in state and county public health departments to inform efforts to rebuild a responsive and accountable public health system.
Using COVID-19 Case Surveillance Public Use Data by the Centers for Disease Control and Preventio... more Using COVID-19 Case Surveillance Public Use Data by the Centers for Disease Control and Prevention, we estimate monthly age-adjusted case fatality rates (CFR) for four major groups: non-Hispanic (NH) whites, NH Blacks, NH Asians, and Hispanics. Available data show that CFRs across race/ethnic groups have become more equal over time. Nevertheless, racial and ethnic disparities persist. NH whites consistently experience lower CFRs; NH Blacks generally experience higher case fatality among younger patients; and NH Asians generally experience higher case fatality among older patients. Age-adjusted CFRs reveal dramatically different racial and ethnic disparities that are hidden by crude CFRs. Such adjustment is imperative for understanding COVID-19’s toll.
South Asian nations are at the crossroads of economic and political progress but still face sever... more South Asian nations are at the crossroads of economic and political progress but still face severe problems of under-development. Available data illustrates that while some macroeconomic indicators have improved over the years, disparities between rich and poor have increased manifold. Although infectious diseases remain a formidable enemy, noncommunicable diseases and injuries are increasing the health challenges facing the countries of the region. While it is widely recognized and accepted that infectious diseases predominantly affect the poor, there is insufficient evidence documenting the burden of RTI on the lower socioeconomic groups in developing countries. Low educational level, poorly paid occupations and poverty have all been found to be risk factors for road traffic injuries. This paper review available data from South Asia to show that RTI disproportionately affect the poor in terms of mortality, morbidity and disability, and presents a persuasive argument to policy make...
Background: This study estimates the potential loss of life in children under five years old attr... more Background: This study estimates the potential loss of life in children under five years old attributable to the economic recessions of 2020. Multiple prior studies have shown a strong and independent effect of GDP per capita on child mortality in developing countries after controlling for health system effects, demography, politics, environment, and literacy. Methods: Data were retrieved from the World Bank World Development Indicators database and the United Nations World Populations Prospects estimates for the years 1990-2020 for 129 countries with GDP per capita below 12,375 US$ (defined as low, lower-middle, and upper-middle income countries; LMICs). We used a multi-level, mixed effects, multivariate model to estimate the adjusted relationship between GDP per capita and the under-5 mortality rate (U5MR) specific to each country. The model’s country-specific parameters were used to simulate the impact on U5MR due to reductions in GDP per capita of 5%, 10%, and 15%. Findings: In a conservative scenario, a 5% reduction in GDP per capita in 2020 is estimated to cause an additional 282,996 deaths in children under 5 in one year compared to a baseline of no economic recession. Recessions at 10% and 15% lead to higher losses of under-5 lives, increasing to 585,802 and 911,026 additional deaths, respectively. We estimate that nearly half of all the potential under-5 lives lost from economic recessions in LMICs are estimated to occur in Sub-Saharan Africa. Interpretation: In developing countries, under-5 mortality rates are closely tied to national income. We estimate that the recessions of 2020 will lead to around 300,000 deaths in the under-5 population. Our results do not take into account the irreparable effects of economic deprivation on child development. We expect to see similar trends of child mortality in the next few years in the absence of sufficient SARS-CoV-2 vaccination or herd immunity. Funding Statement: A grant from Big Win Philanthropy partially funded this study. Declaration of Interests: The authors declare no conflicts of interest.
The geographical spread of COVID-19 across China's provinces provides the opportunity for ret... more The geographical spread of COVID-19 across China's provinces provides the opportunity for retrospective analysis on contributors to the timing of the spread. Highly contagious diseases need to be seeded into populations and we hypothesized that greater distance from the epicenter in Wuhan, as well as higher province-level GDP per capita, would delay the time until a province detected COVID-19 cases. To test this hypothesis, we used province-level socioeconomic data such as GDP per capita and percentage of the population aged over 65, distance from the Wuhan epicenter, and health systems capacity in a Cox proportional hazards analysis of the determinants of each province's time until epidemic start. The start was defined by the number of days it took for each province to reach thresholds of 3, 5, 10, or 100 cases. We controlled for the number of hospital beds and physicians as these could influence the speed of case detection. Surprisingly, none of the explanatory variables h...
This study assessed the relationship of bride price to sexual risk taking based on a large, popul... more This study assessed the relationship of bride price to sexual risk taking based on a large, population-based survey. Data were collected on bride prices for 592 married women in 12 districts in Uganda in 2001. Controlling for covariates, we found that having had a bride price significantly lowered the wife’s odds of sexual intercourse with a partner other than the spouse (OR = 0.222; 95 % CI = 0.067, 0.737). Controlling for covariates, bride price increased the husband’s odds of non-spousal sexual intercourse (OR=1.489; 95 % CI = 0.746, 2.972), although this finding is not statistically significant. Bride price payment is statistically significantly associated with lower rates of non-spousal sexual contact in women, but is not statistically significantly associated with higher rates in men (Afr J Reprod Health 2009; 13[1]:147-158). RĖSUMĖ La dot et la prise de risque sexuel. Cette étude a évalué le rapport entre la dot et la prise de risque sexuel, en se fondant sur une grande enquê...
Background This paper estimates the impact on childhood drowning rates of community-based introdu... more Background This paper estimates the impact on childhood drowning rates of community-based introduction of crèches or playpens or both in rural Bangladesh for children aged 0–47 months. Methods A baseline census of the whole population of 270,387 households in 51 unions, 451 villages from 7 rural sub-districts in Bangladesh was conducted in 2013. The baseline census determined retrospective, age-specific, and cumulative drowning incidence rates (IR) experienced in the target households in the 12 months prior to the intervention. Beginning in late 2013, creches for drowning prevention were established across the study area. Acceptance into creches was provided and written assent to attend a creche was obtained for all children aged 9–47 months in all participating unions. Playpens were provided to 45,460 of these children, of which 5981 children received only the playpens. All children were followed-up until their 48-month birthday or administrative censoring (fixed timepoint to stop ...
Health economics is driven by its applications to improve the health and well-being of individual... more Health economics is driven by its applications to improve the health and well-being of individuals, people, and places. Health economists are intellectual descendants of 19 th century meliorists (Bentham & Bowring, 1843) who believed that: (1) coordinated human activity could improve well-being and (2) scientific research to find causal connections between policies and human well-being is an important ingredient in ameliorative policy change. Although classical economists like Malthus, Marx, and Ricardo described equilibria of near perpetual suffering, health economists have observed and documented multiple pathways to escape from despair and early death (Deaton, 2013). Since World War II, the explosion of biomedical innovation and health spending has multiplied opportunities to invest in human health on both an individual and a population-wide scale. Being part of the cycle that moves innovation from bench to bedside and street-side is a motivating feature of health economics. Studies also help to flag wasteful policies and technologies as well as improve understanding of the systematic perpetuation of disparities in health. Health economists bring evidence to bear that can help close the gap between possible and actual well-being. Gaps remain primarily for three reasons: 1) political differences block reform; 2) relevant evidence does not yet exist; 3) economic evidence is not considered or not believed. Problems of the first kind will seldom yield to more research in the short term. It is not a failure of economic scholarship when an enlightened policy-maker considers and understands a proposed evidence-backed reform and then partially (or fully) rejects it based on political or other criteria. Problems of the second kind, where evidence is lacking, are addressed in the daily practice of scholarship, grant-writing, and teaching in health economics. Despite its growth, the profession needs more scholars and there are critical regional shortages. Type three problems represent the commonplace tragedy of failed communication and translation of relevant scholarship to policy-makers. The problem where excellent health economics research exists but is not brought to bear should concern everyone. Squandered health economics research is a waste of research resources that can also waste lives and livelihoods. The problem is not that health economists do not concern themselves with policies and applied work. The profession makes myriad important contributions in technology assessment and in identifying systemic inefficiencies. But policy change takes more than applied research, it involves politics, and power, and social consensus. The professional training and toolkits of most health economists do not include methods for shepherding the policy process through contested political waters. While some economists have the good fortune to be in quasi-governmental positions of influence, many others are not. The research and teaching incentive systems of many academic economists do not reward effort to contribute to policy implementation in the political arena. Although there are multiple barriers to implementing policy change, there are many in the profession who succeed despite the obstacles. This essay will consider here two mirror questions: What approaches improve the success of health economists engaged in policy translation? How can we normalize policy implementation work as part of professional expectations in more settings? 2 | IMPROVING THE INTERFACE Although economics is defined as the 'science of choice', it is, surprisingly, not systematically called upon whenever policy choices are made. To investigate this paradox in the health care field, a study was carried out, based on questionnaires sent to about 50 senior health economists from 17 different countries, followed by telephone interviews for half of the sample (Rochaix & Beaufret, 2014). Several respondents raised the common misperception by decisionmakers, patients, and professionals that health economics is mostly about costing, as one possible explanation for the
Background: Africa will double its population by 2050 and more than half will be below age 25. Th... more Background: Africa will double its population by 2050 and more than half will be below age 25. The continent has a unique opportunity to boost its socioeconomic welfare. This systematic literature review aims to develop a conceptual framework that identifies policies and programs that have provided a favorable environment for generating and harnessing a demographic dividend. This framework can facilitate sub-Saharan African countries’ understanding of needed actions to accelerate their demographic transition and capitalize on their demographic dividend potential. Methods: The search strategy was structured around three concepts: economic development, fertility, and sub-Saharan Africa. Databases used included PubMed and EconLit. An inductive approach was employed to expand the reference base further. Data were extracted using literature records following a checklist of items to include when reporting a systematic review suggested in the Preferred Reporting Items for Systematic Review...
Successive waves of the COVID-19 pandemic are a Sisyphean nightmare proving that we do not have a... more Successive waves of the COVID-19 pandemic are a Sisyphean nightmare proving that we do not have a public health system that has the capacity to learn and improve through time and experience. Budget data and workforce capability assessments from local public health agencies do not allow for a detailed assessment of public health capabilities. Top-down efforts to gather these assessments have to date not resulted in robust data to assess and track the capabilities of our public health system. Public health's intransigent unreadiness stems in part from chronic underfunding. State and local health departments have seen little to no real growth in per capita spending for decades. 2,3 Underfunding has led to capability gaps at both state and county levels. This article highlights past spending levels on foundational capabilities in state and county public health departments to inform efforts to rebuild a responsive and accountable public health system.
South Asian nations are at the crossroads of economic and political progress but still face sever... more South Asian nations are at the crossroads of economic and political progress but still face severe problems of under-development. Available data illustrates that while some macroeconomic indicators have improved over the years, disparities between rich and poor have increased manifold. Although infectious diseases remain a formidable enemy, noncommunicable diseases and injuries are increasing the health challenges facing the countries of the region. While it is widely recognized and accepted that infectious diseases predominantly affect the poor, there is insufficient evidence documenting the burden of RTI on the lower socioeconomic groups in developing countries. Low educational level, poorly paid occupations and poverty have all been found to be risk factors for road traffic injuries. This paper review available data from South Asia to show that RTI disproportionately affect the poor in terms of mortality, morbidity and disability, and presents a persuasive argument to policy make...
Background: This study estimates the potential loss of life in children under five years old attr... more Background: This study estimates the potential loss of life in children under five years old attributable to the economic recessions of 2020. Multiple prior studies have shown a strong and independent effect of GDP per capita on child mortality in developing countries after controlling for health system effects, demography, politics, environment, and literacy. Methods: Data were retrieved from the World Bank World Development Indicators database and the United Nations World Populations Prospects estimates for the years 1990-2020 for 129 countries with GDP per capita below 12,375 US$ (defined as low, lower-middle, and upper-middle income countries; LMICs). We used a multi-level, mixed effects, multivariate model to estimate the adjusted relationship between GDP per capita and the under-5 mortality rate (U5MR) specific to each country. The model’s country-specific parameters were used to simulate the impact on U5MR due to reductions in GDP per capita of 5%, 10%, and 15%. Findings: In a conservative scenario, a 5% reduction in GDP per capita in 2020 is estimated to cause an additional 282,996 deaths in children under 5 in one year compared to a baseline of no economic recession. Recessions at 10% and 15% lead to higher losses of under-5 lives, increasing to 585,802 and 911,026 additional deaths, respectively. We estimate that nearly half of all the potential under-5 lives lost from economic recessions in LMICs are estimated to occur in Sub-Saharan Africa. Interpretation: In developing countries, under-5 mortality rates are closely tied to national income. We estimate that the recessions of 2020 will lead to around 300,000 deaths in the under-5 population. Our results do not take into account the irreparable effects of economic deprivation on child development. We expect to see similar trends of child mortality in the next few years in the absence of sufficient SARS-CoV-2 vaccination or herd immunity. Funding Statement: A grant from Big Win Philanthropy partially funded this study. Declaration of Interests: The authors declare no conflicts of interest.
This study assessed the relationship of bride price to sexual risk taking based on a large, popul... more This study assessed the relationship of bride price to sexual risk taking based on a large, population-based survey. Data were collected on bride prices for 592 married women in 12 districts in Uganda in 2001. Controlling for covariates, we found that having had a bride price significantly lowered the wife’s odds of sexual intercourse with a partner other than the spouse (OR = 0.222; 95 % CI = 0.067, 0.737). Controlling for covariates, bride price increased the husband’s odds of non-spousal sexual intercourse (OR=1.489; 95 % CI = 0.746, 2.972), although this finding is not statistically significant. Bride price payment is statistically significantly associated with lower rates of non-spousal sexual contact in women, but is not statistically significantly associated with higher rates in men (Afr J Reprod Health 2009; 13[1]:147-158). RĖSUMĖ La dot et la prise de risque sexuel. Cette étude a évalué le rapport entre la dot et la prise de risque sexuel, en se fondant sur une grande enquê...
Fifty pediatric offices and clinics in the metropolitan Los Angeles area were visited to assess v... more Fifty pediatric offices and clinics in the metropolitan Los Angeles area were visited to assess vaccine storage practices. Questionnaires were administered to the personnel responsible for vaccine storage and the vaccine refrigerators were inspected. Only 16% of vaccine storage coordinators could cite appropriate storage temperatures for vaccines and 18% were unaware that heat can harm certain vaccines. Refrigerator thermometers were checked at least weekly in only 20% of offices, and 22% of the refrigerators had inappropriately high temperatures. Vaccines were routinely stored outside of the refrigerator uninsulated during the practice day in 16% of the offices visited. It is concluded that vaccine storage errors occur in pediatric offices at an unacceptably high frequency. Pediatricians should familiarize themselves with the guidelines for optimal vaccine storage in order to minimize the potential for vaccine failure in primary care practice.
Background: Africa will double its population by 2050 and more than half will be below age 25. Th... more Background: Africa will double its population by 2050 and more than half will be below age 25. The continent has a unique opportunity to boost its socioeconomic welfare. This systematic literature review aims to develop a conceptual framework that identifies policies and programs that have provided a favorable environment for generating and harnessing a demographic dividend. This framework can facilitate sub-Saharan African countries’ understanding of needed actions to accelerate their demographic transition and capitalize on their demographic dividend potential. Methods: The search strategy was structured around three concepts: economic development, fertility, and sub-Saharan Africa. Databases used included PubMed and EconLit. An inductive approach was employed to expand the reference base further. Data were extracted using literature records following a checklist of items to include when reporting a systematic review suggested in the Preferred Reporting Items for Systematic Review...
Successive waves of the COVID-19 pandemic are a Sisyphean nightmare proving that we do not have a... more Successive waves of the COVID-19 pandemic are a Sisyphean nightmare proving that we do not have a public health system that has the capacity to learn and improve through time and experience. Budget data and workforce capability assessments from local public health agencies do not allow for a detailed assessment of public health capabilities. Top-down efforts to gather these assessments have to date not resulted in robust data to assess and track the capabilities of our public health system. Public health's intransigent unreadiness stems in part from chronic underfunding. State and local health departments have seen little to no real growth in per capita spending for decades. 2,3 Underfunding has led to capability gaps at both state and county levels. This article highlights past spending levels on foundational capabilities in state and county public health departments to inform efforts to rebuild a responsive and accountable public health system.
Using COVID-19 Case Surveillance Public Use Data by the Centers for Disease Control and Preventio... more Using COVID-19 Case Surveillance Public Use Data by the Centers for Disease Control and Prevention, we estimate monthly age-adjusted case fatality rates (CFR) for four major groups: non-Hispanic (NH) whites, NH Blacks, NH Asians, and Hispanics. Available data show that CFRs across race/ethnic groups have become more equal over time. Nevertheless, racial and ethnic disparities persist. NH whites consistently experience lower CFRs; NH Blacks generally experience higher case fatality among younger patients; and NH Asians generally experience higher case fatality among older patients. Age-adjusted CFRs reveal dramatically different racial and ethnic disparities that are hidden by crude CFRs. Such adjustment is imperative for understanding COVID-19’s toll.
South Asian nations are at the crossroads of economic and political progress but still face sever... more South Asian nations are at the crossroads of economic and political progress but still face severe problems of under-development. Available data illustrates that while some macroeconomic indicators have improved over the years, disparities between rich and poor have increased manifold. Although infectious diseases remain a formidable enemy, noncommunicable diseases and injuries are increasing the health challenges facing the countries of the region. While it is widely recognized and accepted that infectious diseases predominantly affect the poor, there is insufficient evidence documenting the burden of RTI on the lower socioeconomic groups in developing countries. Low educational level, poorly paid occupations and poverty have all been found to be risk factors for road traffic injuries. This paper review available data from South Asia to show that RTI disproportionately affect the poor in terms of mortality, morbidity and disability, and presents a persuasive argument to policy make...
Background: This study estimates the potential loss of life in children under five years old attr... more Background: This study estimates the potential loss of life in children under five years old attributable to the economic recessions of 2020. Multiple prior studies have shown a strong and independent effect of GDP per capita on child mortality in developing countries after controlling for health system effects, demography, politics, environment, and literacy. Methods: Data were retrieved from the World Bank World Development Indicators database and the United Nations World Populations Prospects estimates for the years 1990-2020 for 129 countries with GDP per capita below 12,375 US$ (defined as low, lower-middle, and upper-middle income countries; LMICs). We used a multi-level, mixed effects, multivariate model to estimate the adjusted relationship between GDP per capita and the under-5 mortality rate (U5MR) specific to each country. The model’s country-specific parameters were used to simulate the impact on U5MR due to reductions in GDP per capita of 5%, 10%, and 15%. Findings: In a conservative scenario, a 5% reduction in GDP per capita in 2020 is estimated to cause an additional 282,996 deaths in children under 5 in one year compared to a baseline of no economic recession. Recessions at 10% and 15% lead to higher losses of under-5 lives, increasing to 585,802 and 911,026 additional deaths, respectively. We estimate that nearly half of all the potential under-5 lives lost from economic recessions in LMICs are estimated to occur in Sub-Saharan Africa. Interpretation: In developing countries, under-5 mortality rates are closely tied to national income. We estimate that the recessions of 2020 will lead to around 300,000 deaths in the under-5 population. Our results do not take into account the irreparable effects of economic deprivation on child development. We expect to see similar trends of child mortality in the next few years in the absence of sufficient SARS-CoV-2 vaccination or herd immunity. Funding Statement: A grant from Big Win Philanthropy partially funded this study. Declaration of Interests: The authors declare no conflicts of interest.
The geographical spread of COVID-19 across China's provinces provides the opportunity for ret... more The geographical spread of COVID-19 across China's provinces provides the opportunity for retrospective analysis on contributors to the timing of the spread. Highly contagious diseases need to be seeded into populations and we hypothesized that greater distance from the epicenter in Wuhan, as well as higher province-level GDP per capita, would delay the time until a province detected COVID-19 cases. To test this hypothesis, we used province-level socioeconomic data such as GDP per capita and percentage of the population aged over 65, distance from the Wuhan epicenter, and health systems capacity in a Cox proportional hazards analysis of the determinants of each province's time until epidemic start. The start was defined by the number of days it took for each province to reach thresholds of 3, 5, 10, or 100 cases. We controlled for the number of hospital beds and physicians as these could influence the speed of case detection. Surprisingly, none of the explanatory variables h...
This study assessed the relationship of bride price to sexual risk taking based on a large, popul... more This study assessed the relationship of bride price to sexual risk taking based on a large, population-based survey. Data were collected on bride prices for 592 married women in 12 districts in Uganda in 2001. Controlling for covariates, we found that having had a bride price significantly lowered the wife’s odds of sexual intercourse with a partner other than the spouse (OR = 0.222; 95 % CI = 0.067, 0.737). Controlling for covariates, bride price increased the husband’s odds of non-spousal sexual intercourse (OR=1.489; 95 % CI = 0.746, 2.972), although this finding is not statistically significant. Bride price payment is statistically significantly associated with lower rates of non-spousal sexual contact in women, but is not statistically significantly associated with higher rates in men (Afr J Reprod Health 2009; 13[1]:147-158). RĖSUMĖ La dot et la prise de risque sexuel. Cette étude a évalué le rapport entre la dot et la prise de risque sexuel, en se fondant sur une grande enquê...
Background This paper estimates the impact on childhood drowning rates of community-based introdu... more Background This paper estimates the impact on childhood drowning rates of community-based introduction of crèches or playpens or both in rural Bangladesh for children aged 0–47 months. Methods A baseline census of the whole population of 270,387 households in 51 unions, 451 villages from 7 rural sub-districts in Bangladesh was conducted in 2013. The baseline census determined retrospective, age-specific, and cumulative drowning incidence rates (IR) experienced in the target households in the 12 months prior to the intervention. Beginning in late 2013, creches for drowning prevention were established across the study area. Acceptance into creches was provided and written assent to attend a creche was obtained for all children aged 9–47 months in all participating unions. Playpens were provided to 45,460 of these children, of which 5981 children received only the playpens. All children were followed-up until their 48-month birthday or administrative censoring (fixed timepoint to stop ...
Health economics is driven by its applications to improve the health and well-being of individual... more Health economics is driven by its applications to improve the health and well-being of individuals, people, and places. Health economists are intellectual descendants of 19 th century meliorists (Bentham & Bowring, 1843) who believed that: (1) coordinated human activity could improve well-being and (2) scientific research to find causal connections between policies and human well-being is an important ingredient in ameliorative policy change. Although classical economists like Malthus, Marx, and Ricardo described equilibria of near perpetual suffering, health economists have observed and documented multiple pathways to escape from despair and early death (Deaton, 2013). Since World War II, the explosion of biomedical innovation and health spending has multiplied opportunities to invest in human health on both an individual and a population-wide scale. Being part of the cycle that moves innovation from bench to bedside and street-side is a motivating feature of health economics. Studies also help to flag wasteful policies and technologies as well as improve understanding of the systematic perpetuation of disparities in health. Health economists bring evidence to bear that can help close the gap between possible and actual well-being. Gaps remain primarily for three reasons: 1) political differences block reform; 2) relevant evidence does not yet exist; 3) economic evidence is not considered or not believed. Problems of the first kind will seldom yield to more research in the short term. It is not a failure of economic scholarship when an enlightened policy-maker considers and understands a proposed evidence-backed reform and then partially (or fully) rejects it based on political or other criteria. Problems of the second kind, where evidence is lacking, are addressed in the daily practice of scholarship, grant-writing, and teaching in health economics. Despite its growth, the profession needs more scholars and there are critical regional shortages. Type three problems represent the commonplace tragedy of failed communication and translation of relevant scholarship to policy-makers. The problem where excellent health economics research exists but is not brought to bear should concern everyone. Squandered health economics research is a waste of research resources that can also waste lives and livelihoods. The problem is not that health economists do not concern themselves with policies and applied work. The profession makes myriad important contributions in technology assessment and in identifying systemic inefficiencies. But policy change takes more than applied research, it involves politics, and power, and social consensus. The professional training and toolkits of most health economists do not include methods for shepherding the policy process through contested political waters. While some economists have the good fortune to be in quasi-governmental positions of influence, many others are not. The research and teaching incentive systems of many academic economists do not reward effort to contribute to policy implementation in the political arena. Although there are multiple barriers to implementing policy change, there are many in the profession who succeed despite the obstacles. This essay will consider here two mirror questions: What approaches improve the success of health economists engaged in policy translation? How can we normalize policy implementation work as part of professional expectations in more settings? 2 | IMPROVING THE INTERFACE Although economics is defined as the 'science of choice', it is, surprisingly, not systematically called upon whenever policy choices are made. To investigate this paradox in the health care field, a study was carried out, based on questionnaires sent to about 50 senior health economists from 17 different countries, followed by telephone interviews for half of the sample (Rochaix & Beaufret, 2014). Several respondents raised the common misperception by decisionmakers, patients, and professionals that health economics is mostly about costing, as one possible explanation for the
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Papers by David Bishai