Good stuff on the net

On December 24, 2008, in links, stuff on the net, by Karen Grepin

Here are links to a few sites that I thought were particularly interesting:

1. The Economist’s Daily Chart picturing the variation in the density of doctors in the world.

2. Coverage of the WHO’s efforts to quantify the health crisis in the DR Congo.

3. A Kenyan choir will perform during Obama’s inauguration in a few weeks.

4. The Lives of Saints: aid works in Sudan.

5. An obituary for Steve Fosset – the Aviator.

6. Paul Chinook’s reporting on the changing epidemiology of Dengue Fever globally.

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Paying our way out of poverty

On December 22, 2008, in economics, poverty, by Karen Grepin

Greetings from sunny Aruba. My husband and I are here for the next few weeks enjoying a few days of much needed sun and relaxation. First on the top of his to-do item: exercise like a maniac, first on mine: catch up on all of the reading I have been meaning to do for months and just have not had the mental capacity to tackle. Fortunately, this island appear to be conducive to both goals…and I am already half ways through my first book.

On the list of things I wanted to read more about this break was the current thinking on conditional cash transfer schemes. I have been reading a lot about these “success” stories but had not had the time to sit down and really go through literature. Fortunately, Tina Rosenberg has just published a frighteningly well written piece in the NYTimes magazine, entitled “A Payoff Out of Poverty“, on these schemes, which is great to help me get started.

Rosenberg chronicles the impact a CCT scheme has had on poor families in Mexico – a scheme known as the Oportunidades program. In the scheme, poor households, receive relatively large sums of cash in exchange for ensuring that women attend educational programs, children remain in school, and household members seek preventive care. The program, which has been thoroughly evaluated at ever step of the way, has been shown to have been very successful.

“In 1994, before the peso crisis [and before the scheme], 21.2 percent of Mexicans lived in extreme poverty. In 1996, just after the crash, 37.4 percent did. But that figure had dropped to 13.8 percent by 2006. Mexico’s economic growth during the decade averaged an unspectacular 3 percent, which would not by itself have produced such gains for the poor. And these statistics underestimate the program’s true influence, as its greatest effects were concentrated on the very poorest.”

The articles goes on to explore whether or not such a scheme, which have now been implemented in dozens of developing countries, could also be successful in the United States. While it is too soon to tell whether this program will work in a city like NYC, where it is currently being evaluated, the early results seem promising. How far might we be able to go with these schemes?

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I recently posted about some research in a small sample of countries which indicated that there had been rapid scale up of insecticide treated nets (ITNs) in sub-Saharan Africa.  I just read a related study published in the Lancet (November 18, 2008) by Noor, Mutheu, Tatem, Hay, and Snow that expands upon these findings.
In this second study, the authors collected data from 40 countries in Africa instead of just a handful.  They also find relatively large increases in coverage – from under 2% of children to nearly 20% by 2007.  I think a nearly 10 fold increase in 7 years is pretty remarkable, although clearly this is still very far from the target level to reach the MDG goal.
What I thought was really interesting in their study, is that they then go on the stratify the countries relative to the actual risk of malaria in those countries.  They find the highest coverage rates in areas that have no risk of malaria transmission, although less than 10% of children do fall into this category.  Coverage rates were the lowest in countries with the highest risk of malaria transmission, suggesting that improved targeting might be needed.
Nearly half of the children in high risk malaria countries not sleeping under nets lived in just 7 countries: Nigeria, Demographic Republic of Congo, Uganda, Sudan, Mozambique, Cote d’Ivoire, and Cameroon.  A quarter lived in  Nigeria alone.
Stepped up targeted efforts in a few countries, such as Nigeria, could go a long way to protecting the proportion of children in Africa sleeping under nets.
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Defeat Malaria? Yes We Can….

On December 19, 2008, in global health, malaria, pharmaceuticals, by Karen Grepin

…or so argues Jean Stephenne, president of the biologicals division of GSK, in a recent editorial in the WSJ. His enthusiastic statements come following the publication earlier this month of some really promising results from trials conducted in Africa for a new malaria vaccine developed by GSK-Biologicals in partnership with many global health organizations. I previously reported about these trials…and must admit am still very, very excited that we might actually have a malaria vaccine as early as 2011 – I might still be working on a post-doc or something by then…that is just around the corner in graduate student time.

He asks:

“Why would a company like ours devote 25 years of research and more than $300 million of shareholders’ capital to develop a malaria vaccine? After all, there has never been a vaccine against any parasitic disease. Moreover, this vaccine is only relevant in some of the world’s poorest countries, leaving little opportunity for profit.”

He replies:

“We did it because it was the right thing to do.”

While I do honestly believe him when he says they are doing it because they believe it to be the right thing to do, I kind of wish he had not stopped there. The global market for this vaccine could be enormous, and drugs for global health can be profitable (supposedly, Coartem is now Novartis leading product). Vaccines historically are small market, low profit products, but newer vaccines (think Prevnar and the new vaccines for cervical cancer) are big business, and this vaccine could be too.

I think it would be great if a pharmaceutical company could develop – in partnership with global health actors – a new vaccine, for use almost exclusively in the developing world, and do well with it. Doing good for the world can also be good business. Then everyone would want to get on board.

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Househusbands and rising fertlity

On December 17, 2008, in fertility, research, by Karen Grepin

Fertility declines in industrialized nations over the past 50 years have been so dramatic that in many countries, including Italy, Spain, Germany, and Japan, total fertility rates are now far below what is known as the replacement rate of a population – or 2.1 children per woman (the replacement rate is basically the sum of how many adults it takes to make a baby – in theory 2 – plus some extra to account for death of the child before it gets the chance to reproduce).  Rising labor participation rates as well as high pay for women have long been thought to be responsible for these trends.  Working women have less time to have children and the rising wages make them  more costly due to the opportunity cost of lost wages.

It appears as though this relationship is not continuously increasing, according to the results of a recent study by authors Bruce Sacerdote, James Feyrer, and Ariel Stern (NBER Working Paper No. w14114). The authors find that in countries where female wages have continued to increase, men appear to be taking on more of household chores, perhaps due to the fact that some women are now earning more than their partners or are viewed more equally within the family unit, thereby making it more feasible for families to have more children.  In these countries total fertility rates have actually seen reversals, including here in the United States.

I guess this could be a upside for any parent whose daughter married “that guy”, the one that will never amount to much in life, at least they may have hope of getting more grandchildren.

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How much does it cost to save the life of a newborn?

On December 16, 2008, in economics, research, by Karen Grepin

Some of my classmates, as well as their co-authors, have recently released a great NBER working paper that gets at a really important question in health economics: how much do we spend to improve health? Specifically, how much is a life worth?

The authors observe the following phenomenon, babies born just below the 1500 g “low birth weight” threshold actually have lower mortality than children born just above the threshold. This discontinuity, they argue, is due to the fact that children born just below the threshold get extra medical services than those who are born just above the threshold. At this threshold, medical care does appear to be effective. They then calculate the additional costs of treating these children to the additional gains in terms of reduce mortality to estimate that saving a life of a newborn is $550,000 in 2006 dollars in the US.

This is really, really great work so I thought it was worth sharing their findings.

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Understanding season of birth outcomes

On December 16, 2008, in economics, research, by Karen Grepin

You’ve probably heard this fact before: children born in the winter tend to do worse than children born at other times of the year. A winter birth translates into lower earnings later in life, poorer health, and a whole host of other outcomes (It remains in my mind because I was born in February…).

There have been lots of theories put forward, most focused on environmental or institutional factors that may help to explain these differences. A common one is that children born in winter tend to be old relative to their classmates and this may affect outcomes, or we get exposed to better food at different times of the year, or women get out and exercise more during the summer, and so on.

Surprisingly (I say this after reading the paper) no one has really properly considered that it may be due to the fact that different women given birth to children at different times of the year. The birthdate has always been sort of assumed to be independent of background, but in retrospect it is not at all clear why this might be the case. Anyone who has been around a university would notice that there are a lots of big bellies as the semester ends.

A recent working paper by Kasey Buckles and Daniel Hungerman finds exactly this fact to be the case. People who give birth in the winter are more likely to have less education and to be of lower socio-economic status than women who give birth at other times of the year. The differences can actually be quite large – up to 10%.

Pretty smart…

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Is cholera a WMD?

On December 15, 2008, in Africa, cholera, politics, by Karen Grepin

“Last week, [Zimbabwe's] government spokesman George Charamba accused Britain of trying to use the cholera epidemic, which has killed close to 1,000 Zimbabweans and affected 16,000 others, as an excuse for the former colonial power to invade Zimbabwe.”

Another week, but still no action from the international community to intervene in Zimbabwe. The numbers infected and killed are inching up. How bad does it have to get before we need to intervene?

The logic for not getting involved, at least from South Africa, to date has largely been based on the logic that Zimbabwe’s problems do not affect anyone beyond its borders. Although those living in communities now housing thousands of Zimbabwean refugees would probably disagree with this claim, the cholera epidemic gives new rationale for intervention as it will spread beyond the country.

Public health crises have usually lead to situations that have caused the termination or pausing of wars (e.g. supposedly the war between Northern and Southern Sudan paused to allow vaccinations, epidemics have decimated armies leading to one side to topple the other) but have they ever been used to provide rationale to initiate one?

Cholera is just the tip of the iceberg. In addition to the thousands who will die from cholera, due to the fact that public health services are basically non-functional means thousands will also die from less visible, but preventable health conditions. Can the international community just sit by while we know thousands of people are dying?

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What a difference a few years makes

On December 12, 2008, in malaria, research, by Karen Grepin

A few years back, it was quite rare to find people owning and using bed nets in Africa. When I first lived with a family in Burkina Faso in 2002 I was the only member of the family unit sleeping under a net (although the kids loved to play with my net). Things are changing for the better, and apparently quite rapidly, throughout the continent.

There is a group called Net Mark, who for the past few years has been collected nationally representative data on net ownership and use throughout Africa. Although DHS also has begun to collect similar data, many countries are now onto their second survey round allowing a longitudinal analysis of the changes in net ownership and use. (By the way, their data is freely available so if you were looking for some data to write a paper, you may wish to check it out).

Some early analysis of the changes in net ownership were recently released in the Malaria Journal. In the four studies they investigated (Nigeria, Senegal, Zambia, and Uganda) awareness of nets increased tremendously in all 4 countries with nearly universal awareness of them by 2004. Net use also increased to nearly half of household using these nets. The last round of data was from 2004, which by malaria standards is actually quite old, so I am sure these numbers would be much higher today.

However, few things caught my eye from this study. While ownership grew a great deal, actual usage lagged behind tremendously (15-20 percentage points). So while I think we should be cautiously optimistic of the results of this study, I think we need to make sure that we realize that a lot remains to be done.

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More on cholera in Zimbabwe

On December 11, 2008, in Africa, cholera, politics, by Karen Grepin

Since I posted last night on the cholera epidemic in Zimbabwe, the following article was posted in the economist. I thought I would add the link in case anyone was interested in reading it as well.

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