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Health Concerns and Socio-Economic Determinants: Analysis and Evaluation in Italy and England
Full text linkLo scopo di questa tesi è di analizzare le differenti determinanti socio-economiche dell’obesità in due nazioni europee, Italia e Inghilterra. Queste nazioni sono interessanti da studiare per motivi molto diversi. Sebbene in notevole ritardo rispetto agli Stati Uniti e ad altre nazioni europee anche in Italia si è verificata una notevole crescita nei livelli di obesità. Difatti nel 2005 il 34.2% della popolazione è stata classificata come sovrappeso e il 9.8% come obesa. Queste percentuali inoltre variano notevolmente per individui con differente età, genere, educazione e reddito. Inoltre dati di fonte ISTAT mostrano come gli adulti classificati come obesi siano aumentati del 4% nell’ultimo decennio. Tale misura diventa ancora più rilevante se consideriamo l’ulteriore crescita registrata nella categoria dei sovrappeso. Nel Regno Unito il trend seguito dall’obesità è molto simile a quello registrato negli Stati Uniti. Nel 2007 la percentuale di obesi risultava pari al 24% della popolazione e si poneva come una tra le più alte in Europa. Il trend dell’obesità sia maschile che femminile è stato inoltre in notevole aumento negli ultimi 15 anni (con una crescita del 15% dal 1993). Questa crescita così persistente indica che alcune delle cause dell’obesità potrebbero essere divenute strutturali nella determinazione del livello di obesità sia nel Regno Unito che in Italia.
Le ragioni di questo incremento significativo nei livelli di obesità per le due nazioni considerate nell’analisi potrebbero essere di varia natura. Abbiamo quindi deciso di focalizzare la nostra attenzione sul ruolo dei prezzi degli alimenti in Italia, dove le proprietà benefiche della dieta Mediterranea hanno finora determinato i bassi livelli di obesità. Per questo motivo risulta di cruciale importanza documentare qualsiasi variazione nei comportamenti di consumo di alimenti che potrebbero essere responsabili per l’aumento nei tassi di obesità e sovrappeso. Invece, per quanto riguarda il Regno Unito questo lavoro fa riferimento ad un vasto numero di articoli empirici che testano l’influenza di differenti cambiamenti socio-economici che potrebbero aver alterato le abitudini degli individui. In particolare è stato analizzato il ruolo del prezzo di alimenti sani (come frutta e verdura) e la densità di fast-food e ristoranti, come anche mutamenti nel consumo di sigarette. Ci riferiamo inoltre anche agli effetti collegati a cambiamenti tecnologici, che sono responsabili di variazioni nell’occupazione da settori agricoli e industriali ai servizi, implicando una notevole diminuzione nell’intensità dell’attività fisica destinata al lavoro. Innovazioni in agricoltura sono inoltre responsabili per riduzioni nei prezzi del cibo e conseguentemente anche nella quantità di calorie assunte.
Un ulteriore importante determinante dell’obesità individuata dalla letteratura economica e medica è la recente diminuzione registrata nei consumi di sigarette. Molti studi hanno infatti determinato una inversione netta tra i trend della percentuale di fumatori, in costante riduzione negli ultimi decenni e la percentuale di obesi, che invece risulta in netta crescita. Tuttavia tutti i precedenti lavori non sono stati in grado di stimare in maniera precisa e unanime il segno e l’intensità di tale relazione. Per sorpassare queste limitazioni questo lavoro sfrutta l’introduzione della recente riforma anti fumo in Italia, che dal 2005 proibisce di fumare nei luoghi pubblici. Per identificare l’effetto della riduzione nel consumo di nicotina sul peso viene utilizzata la discontinuità introdotta dalla riforma come misura di una variazione esogena nei consumi di sigarette. Nel caso del Regno Unito è stata invece sfruttata la natura longitudinale dei dati a disposizione, che raccolgono informazioni in differenti istanti temporali per lo stesso individuo. In questo modo siamo in grado di tenere conto propriamente delle differenti attitudini che ciascuno potrebbe avere nei confronti della propria salute. In più vengono utilizzati un elevato numero di gruppi di controllo per eliminare distorsioni nella stima legate al problema dell’endogeneità.This thesis analyses various aspects related to the economic determinants of obesity in two EU countries, Italy and the UK, which are of interest for different reasons. Although much later with respect to the United States and some continental European countries, the issue of the rise of weight has also become significant in Italy, where, 34.2% of adults were classified as overweight and 9.8% as obese in 2005. These percentages were found to differ greatly according to age, gender, years of education and income level. Moreover, the percentage of adults classified as obese has risen by 4 percentage points in the last
decade as shown by ISTAT. This measure becomes more relevant when we consider that the obesity and overweight rate increased in the same period by 9 percentage points. In the UK, the increase in obesity is found to be similar to that of the United States although it started from a lower level. The percentage of obese individuals is about 24% in 2007 and is among the highest in Europe. The trends of obesity in aggregate have constantly
risen over the last fifteen years (15% since 1993), similarly for both men and women. This persistent growth suggests that, at least, some causes may have become structural in determining obesity in the UK, but also in Italy. The reasons for the significant increase in the obesity levels for the two countries analysed may be of various nature. We decided to focus our attention on the role of food prices in Italy, where the healthy properties of the Mediterranean diet have, up to now, mostly influenced the low obesity rates in the country. It becomes then of crucial importance to document any significant variation, in terms of food onsumption, that may be responsible for the general increase in obesity and overweight rates. While for the UK, this research is related to a number of empirical papers testing overweight as the
result of several socio-economic changes which have altered people’s lifestyle choices. In particular, we examined the consequences of changes in relative prices and in the density of different types of restaurants on obesity, as well as the influence of cigarette consumption. We also refer to the effects of technological changes, which are responsible for shifts over time in employment from agricultural and manufacturing to services, implying a decrease in the strenuousness of jobs, and in the number of hours dedicated to physical exercise. Agricultural innovations are also responsible for reductions in the price of food and consequently of calories.
Another very important determinant of the obesity epidemic is related, by the health economic literature, to the recent drastic reduction in smoking habits. Many previous works have documented a very clear inversion between the trends of smoking, which have constantly reduced, and BMI, which documented a sharp increase. However all these works did not provide a general agreement on the sign and the magnitude of these effects, and most importantly they did not provide a clear estimate of these effects on obese individuals. We take advantage of the introduction of the Clean Indoor Air Law, which prohibits smoking in public places, implemented in Italy as from 10 January 2005, to identify the relationship between smoking behavior and body weight within a regression discontinuity design. In the case of the UK, we took advantage of the longitudinal framework of the BHPS and estimate a difference-in-differences (DID) model to account for individual fixed-effects related to individual health concerns and estimate the parameters of the DID model using a battery of control groups. We also performed IV and IVQR estimates for the average treatment effects (ATEs) and quantile treatment effects (QTEs) estimators to take into account properly issues related to endogeneity
Immigration policy and birth weight: Positive externalities in Italian law
No full textA decade ago, the political party of the Italian center-right voted a law restricting immigration. The law became effective in early 2005, when the Italian parliament approved the decree for its application, but one of its articles, granting amnesty for illegal immigrant workers, became immediately effective in July 2002. As a result, 650,000 immigrants were granted the status of foreign nationals in Italy. In this paper, we examine whether the increase in the prevalence of "regular immigrants" has led to an improvement in health outcomes of babies born to migrant women, measured in terms of birth weight. Two hitherto unexploited birth sample surveys published by Italian Institute of Statistics were used for this study. Our estimates show that regularized immigration reduced the probability of low birth weight
The Economic Impact of Smoke-Free Policies on Restaurants, Cafés, and Bars: Panel Data Estimates From European Countries
No full textIn this paper, we investigate the extent to which the economic outcomes of restaurants, bars, and cafés have been affected by the introduction of anti-smoking regulations in Europe. We use an unexploited panel database to collect a comprehensive set of information on financial indicators regarding the balance sheets of private and public companies in various economic sectors. The results show that smoke-free policies did not significantly affect the firms' economic performance, irrespective of the balance sheet indicators analyzed. Moreover, the results are robust to various econometric specifications and suggest that the recent enforcement of anti-smoking legislation in Europe has improved public health without a corresponding negative impact on revenues and employment in the hospitality industry
The effect of smoking habit changes on body weight: Evidence from the UK
No full textThis paper evaluates the causal relationship between smoking and body weight through two waves (2004-2006) of the British Household Panel Survey. We model the effect of changes in smoking habits, such as quitting or reducing, and account for the heterogeneous responses of individuals located at different points of the body mass distribution by quantile regression. We test our results by means of a large set of control groups and investigate their robustness by using the changes-in-changes estimator and accounting for different thresholds to define smoking reductions. Our results reveal the positive effect of quitting smoking on weight changes, which is also found to increase in the highest quantiles, whereas the decision to reduce smoking does not affect body weight
Use of instrumental variables in electronic health record-driven models
No full textPrecision medicine presents various methodological challenges whose assessment requires the
consideration of multiple factors. In particular, the data multitude in the Electronic Health Records
poses interoperability issues and requires novel inference strategies. A problem, though apparently a
paradox, is that highly specific treatments and a variety of outcomes may hardly match with consistent
observations (i.e., large samples). Why is it the case? Owing to the heterogeneity of Electronic Health
Records, models for the evaluation of treatment effects need to be selected, and in some cases, the use of
instrumental variables might be necessary. We studied the recently defined person-centered treatment
effects in cancer and C-section contexts from Electronic Health Record sources and identified as an
instrument the distance of patients from hospitals. We present first the rationale for using such
instrument and then its model implementation. While for cancer patients consideration of distance
turns out to be a penalty, implying a negative effect on the probability of receiving surgery, a positive
effect is instead found in C-section due to higher propensity of scheduling delivery. Overall, the estimated
person-centered treatment effects reveal a high degree of heterogeneity, whose interpretation remains
context-dependent. With regard to the use of instruments in light of our two case studies, our suggestion
is that this process requires ad hoc variable selection for both covariates and instruments and additional
testing to ensure validit
Immigration policy and birth weight: Positive externalities in Italian law
No full textA decade ago, the political party of the Italian center-right voted a law restricting immigration. The law became effective in early 2005, when the Italian parliament approved the decree for its application, but one of its articles, granting amnesty for illegal immigrant workers, became immediately effective in July 2002. As a result, 650,000 immigrants were granted the status of foreign nationals in Italy. In this paper, we examine whether the increase in the prevalence of "regular immigrants" has led to an improvement in health outcomes of babies born to migrant women, measured in terms of birth weight. Two hitherto unexploited birth sample surveys published by Italian Institute of Statistics were used for this study. Our estimates show that regularized immigration reduced the probability of low birth weight
Multidimensional poverty across Europe
No full textIncome poverty is commonly encountered in developing and developed countries alike, but in the latter case the incidence rate is lower. Beyond income, the health dimension is recalling the attention of a wide number of studies about poverty. A disjoint analysis of the two components could potentially lead to misleading results, especially in developed countries (Madden, 2008). In this framework Sen’s Capability Approach emerged as the leading alternative to standard economic analysis of poverty and human development generally, arguing that poverty is not
just low level of consumption or income, but it is a broader concept related to the inability of reaching an acceptable standard in several dimensions, e.g. health. This paper presents poverty according to the multidimensional approach. The correlation between these two dimensions of poverty is examined using the
Receiver Operating Characteristics curve (ROC). We are interested in comparing the dynamic of multidimensional poverty across European countries for elderly people, therefore we use data from the Survey of Health, Ageing and Retirement in
Europe (SHARE) for the years 2004-2006
Immigrant mothers and access to prenatal care: Evidence from a regional population study in Italy
No full textObjectives: We addressed the question of whether use of adequate prenatal care differs between foreignborn and Italian mothers and estimated the extent to which unobservable characteristics bias results. Setting: This study is on primary care and especially on adequate access to prenatal healthcare services by immigrant mothers. Participants: Approximately 37 000 mothers of both Italian and foreign nationality were studied. Data were obtained from the Standard Certificate of Live Birth between 2005 and 2010 in Umbria. Results: Estimates from the bivariate probit model indicate that immigrant mothers are three times more likely to make fewer than four prenatal visits (OR=3.35) and 1.66 times more likely to make a late first visit (OR=1.66). The effect is found to be strongest for Asian women. Conclusions: Standard probit models lead to underestimation of the probability of inadequate use of prenatal care services by immigrant women, whereas bivariate probit models, which allow us to consider immigrant status as an endogenous variable, estimated ORs to be three times larger than those obtained with univariate models
More Than a Ban on Smoking? Behavioural Spillovers of Smoking Bans in the Workplace
No full textWe study the potential behavioural spillover effects of a workplace smoking ban (WSB) on a variety of health-related behaviours as well as on people who are not directly impacted by the bans. Drawing on quasi-experimental evidence comparing employed and unemployed individuals in Russia, we document that individuals who give up smoking are less likely to drink or cut back on alcohol consumption. Furthermore, we show that as expected the WSB exerts an impact on the health behaviours of those who are not directly exposed to the reform, such as never smokers. Finally, the effects of the WSB are driven by changes among men, 60 percent of whom were smoking before the ban
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