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Publication Is the Growing Burden of Non-Communicable Diseases in India Preventable?(2024-06-19) Gaiha, Raghav; Kulkarni, Vani S.; Unnikrishnan, VidhyaNon-Communicable Disease (NCD) morbidity and mortality as shares of total morbidity and mortality have risen steadily in India and projected to surge rapidly. In 1990, NCDs accounted for 40% of all Indian mortality and are now projected to account for three quarters of all deaths by 2030. Currently, cardiovascular diseases, cancer, respiratory illness, and diabetes are the leading causes of death in India, accounting for almost 50% of all deaths. Underlying these rising shares are growing risks that are common to several NCDs. NCDs are chronic in nature and take a long time to develop. They are linked to aging and affluence and have replaced infectious diseases and malnutrition as the dominant causes of ill health and death in much of the world including India. Some NCDs cause others and create clusters of co-morbid conditions (e.g., diabetes can lead to kidney failure and blindness). Old-age morbidity is a rapidly worsening curse in India. The swift descent of the elderly in India (60 years +) into non-communicable diseases (e.g., cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes) could have disastrous consequences in terms of impoverishment of families, excess mortality, lowering of investment and deceleration of economic growth. Indeed, the government must deal simultaneously with the rising fiscal burden of NCDs and substantial burden of infectious diseases. The present study seeks to answer three questions: Why has the prevalence of two NCDs, diabetes and heart diseases risen in recent years? Given the surge in these diseases, whether social protection policies and restructuring of medical services can mitigate such surges in the near future? A related but equally important concern is whether lifestyle and dietary changes could be induced to further prevent the rising burden of these NCDs. Our analysis is based on the only all-India panel survey-India Human Development survey that covers 2005 and 2012. This survey was conducted jointly by University of Maryland and National Council of Applied Economic Research, New Delhi. A robust econometric methodology-specifically, 2SLS- is used to address the endogeneity of key explanatory variables. The results here stress the need to make sure that pension and healthcare reforms are accompanied by greater awareness, expansion of old age pensions and public hospitals, and effective regulation of both public and private hospitals. Key words: NCDs, Diabetes, Heart diseases, Old age and other pensions, Hospitals, IndiaPublication Infant Mortality Expectation and Fertility Choice in Rural Malawi(2024-06) Delavande, Adeline; Kohler, Hans-Peter; Vergili, AliFor decades, population research has been interested in the complex relationship between child mortality and fertility, with a key focus on identifying replacement behavior (fertility response to experienced child mortality) and hoarding behavior (fertility response to expected child mortality). Using unique data from the Malawi Longitudinal Study of Families and Health (MLSFH), we investigate the impact of individual-specific subjective infant mortality expectations on fertility choice. We instrument the potentially endogenous infant mortality expectations with the average of parents’ ratings of children’s health to address a potentially omitted variable bias such as parental taste for health. Consistent with the hoarding mechanism, we find that a 10 percentage point decrease in infant mortality expectations leads to a 14 percentage point decrease in the propensity to have a child in the next 2 years from a baseline propensity of 43%.Publication Food Coma is Real: The Effect of Digestive Fatigue on Adolescents' Cognitive Performance(2024-04-12) Hervé, Justine; Mani, Subha; Behrman, Jere; Laxminarayan, Ramanan; Arindam, NandiFood coma, also known as postprandial somnolence, is a commonly cited reason for experiencing reduced alertness during mid-afternoon worldwide. By using exogenous variation in the timing of tests and, hence, by extension, plausibly exogenous variation in the temporal distance between an individual’s last meal and the time of test, we examine the causal impact of postprandial somnolence on cognitive capacities. Analyzing novel time use data on ∼ 4,600 Indian adolescents and young adults, we find that testing within an hour after a meal reduces test-takers’ scores on English, native language, math, and Raven’s tests by 8, 8, 8, and 16 percent, respectively, compared to test-takers who took the tests more than an hour after their meal. We further find that the negative effect of postprandial somnolence on cognition operates through increased feelings of fatigue and depletion of cognitive resources that become more pronounced while dealing with more challenging test questions.Publication Communication with Kin in the Wake of the COVID-19 Pandemic(2023-09-06) Reed, Megan N.; Li, Linda; Pesando, Luca Maria; Harris, Lauren E.; Furstenberg, Frank F.; Teitler, Julien O.This study investigates patterns of communication among non-coresident kin in the aftermath of a crisis – the COVID-19 pandemic – focusing on a representative sample of New York City residents from the Poverty Tracker survey. Over half of New Yorkers spoke to their non-coresident family members several times a week during the pandemic and nearly half reported that their communication with non-coresident kin increased since March 2020. Extended kin proved to be important with 27.57% of respondents reporting that they increased communication with at least one extended family member. However, the kin type that New Yorkers were most likely to report increased communication with were siblings, revealing the importance of these ties during times of crisis. Communication with kin varied by sociodemographic characteristics. Women spoke with family members outside of their household more frequently and had higher odds of reporting that their communication increased. There was little support for the oft-stated premise that disadvantaged families by race or social class display greater patterns of kin engagement. In fact, the findings point to the opposite conclusion that families with greater economic resources generally engage with both their nuclear and extended kin more frequently, illuminating patterns of inequality in access to kin resources that may extend well beyond the COVID-19 pandemic. Overall, this study sheds light on an important yet oft-neglected driver of intra- and inter-generational inequalities, namely access to kin ties as a form of social capital to be activated and leveraged when need arises.Publication Financial Literacy, Portfolio Choice and Wealth Inequality: A General Equilibrium Approach(2024-02-07) Kim, MinI develop a general equilibrium model in which households allocate their wealth to safe and risky assets (“bonds” and “stocks”) and accumulate financial literacy to raise their risk-adjusted stock returns. Calibrated to match financial literacy and stock market participation rate of U.S. households, the model demonstrates that a policy subsidizing financial literacy acquisition increases short-run stock investments. In equilibrium, however, the resulting aggregate capital growth lowers the average equity premium, thereby moderating the subsidy’s impact. The policy mitigates wealth inequality by inducing heterogeneous portfolio adjustments across the wealth distribution. With the subsidy, the middle wealth quartiles acquire more financial literacy and shift their portfolios toward stocks. The top quartile attains its maximum literacy level prior to the subsidy and shifts toward bonds to compensate for lower stock returns. The ratio of total wealth held by the top quartile versus the rest of the population decreases.Publication Understanding Gender Disparities in STEM Major and Occupation Choices: A Random Forest Approach(2024-02-06) Todd, Petra; Wang, ShashaIn the US, women for decades have gone to college at higher rates than men, but they are less likely to choose applied-STEM college majors or occupations. Using the NLSY79 and 97 datasets, this paper assesses the importance of adolescent skills and high school course-taking in explaining gender disparities in four-year college completion, college major, and occupational choice. It considers five cognitive skill areas (math, verbal, science, administrative, and mechanical) and one non-cognitive measure and examines how gender skill gaps evolve over a twenty-year time span. Logistic, CART and nonparametric random forest models are estimated to identify the skill sets, course-taking and family background characteristics that best predict educational and occupational choices. Results show that women are on average on par with men in mathematics skills and exceed men in verbal and noncognitive skills, but they lag behind in mechanical and, to a lesser extent, science skills. Estimates show that a combination of mathematics and mechanical skills along with intensive high school exposure to science and math courses are key predictors of choosing applied-STEM majors and careers. This paper also develops and implements a nonparametric decomposition approach to quantify how eliminating adolescent gender skill disparities would affect women’s and men’s entry into STEM fields.Publication Surviving Bad News: Health Information Without Treatment Options(2024-01-10) Ciancio, Alberto; Kampfen, Fabrice; Kohler, Hans-Peter; Thornton, RebeccaProviding personal health information allows individuals to take action to improve their health. If treatment is not available, however, being informed about having a life-threatening disease could lead to feelings of despair or fatalistic behaviors resulting in negative health outcomes. We document this possibility utilizing an experiment in Malawi that randomized incentives to learn HIV testing results in a context where anti-retroviral treatment (ART) was not yet available. Six years after the experiment, receiving an HIV+ diagnosis reduced survival rates by 23% points and this effect persists after 15 years. We show that HIV+ persons who learned they were HIV+ engaged in more risky health behaviors, have greater anxiety and a higher discount rate. We do not find any effects of receiving an HIV - diagnosis on survival.Publication Social Protection and Foundational Cognitive Skills During Adolescence: Evidence from a Large Public Works Programme(2022-09-09) Freund, Richard; Favara, Marta; Porter, Catherine; Behrman, Jere RMany low- and middle-income countries have introduced Public Works Programmes (PWPs) to fight poverty. PWPs provide temporary cash-for-work opportunities to boost poor households’ incomes and to provide better infrastructure to local communities. While PWPs do not target children directly, the increased demand for adult labour may affect children’s development through increasing households’ incomes and changing household members’ time uses. This paper expands on a multidimensional literature showing the relationship between early life circumstances and learning outcomes and provides the first evidence that children from families who benefit from PWPs show increased foundational cognitive skills (FCS). We focus on four child FCS: inhibitory control, working memory, long-term memory, and implicit learning. Our results, based on unique tablet-based data collected as part of a 20-year longitudinal survey, show positive associations of family participation in the Productive Safety Net Programme (PSNP) in Ethiopia during childhood on long-term memory and implicit learning, with weaker evidence for working memory. These associations appear to be strongest for children whose households were still PSNP participants in the year of data collection. We find suggestive evidence that, the association with implicit learning may be operating through children’s time reallocation away from unpaid labour responsibilities, while the association with long-term memory may be due to the programme’s success in remediating nutritional deficits caused by early life rainfall shocks. Our results suggest that policy interventions such as PWPs may be able to mitigate the effects of early poverty on cognitive skills formation and thereby improve children’s potential future outcomes.Publication The Impact of the JUNTOS Conditional Cash Transfer Programme on Foundational Cognitive Skills: Does Age of Enrollment Matter?(2022-09-02) Scott, Douglas; Lopez, Jennifer; Sánchez, Alan; Behrman, Jere RThis paper studies the relationship between the age of enrolment in Peru’s conditional cash transfer programme, JUNTOS, and the foundational cognitive skills of a sample of children aged between 5 and 12 years old. Using a difference-in-differences approach and exploiting within-household variation, we show that younger siblings in recipient households display significantly higher levels of inhibitory control than their older counterparts (0.11 standard deviations), having benefited from the programme for the first time at a relatively earlier age. In high-income countries, this behavioural trait has been linked to later-life outcomes such as job success, physical health, and even reduced risk of criminality. Conversely, we find little evidence that enrolment age is associated with long-term memory, working memory, or implicit learning. Employing a threshold estimator, we show that relative gains in inhibitory control are most clearly defined where a child benefits from the programme before they reach 80 months of age (6.7 years). In an extension to our main results, we then conduct mediation analysis, demonstrating that a small but meaningful proportion of this benefit (6.5%) operates through changes in the probability of the child’s timely entry into primary school.Publication Resilience, Accelerated Aging and Persistently Poor Health: Diverse Trajectories of Health among the Global Poor(2022-08-01) Kohler, Iliana V; Hoang, Cung Truong; Amin, Vikesh; Behrman, Jere R; Kohler, Hans-PeterObjectives: This study is among the first to document lifecourse trajectories of physical and mental health across adult and older ages (20-70 years) for a poor sub-Saharan African population having faced frequent and sustained adversities. Methods: The 2006-19 waves of the Malawi Longitudinal Study of Families and Health (MLSFH) were analyzed using group-based trajectory models (GBTM) to identify trajectories of heath (SF12 mental/physical health and BMI) across the lifecourse. Predictors of trajectory membership were estimated using fractional multinomial logits. Results: Analyses identified three distinct trajectories: (1) good initial mental/physical health that persisted throughout the lifecourse ("resilient aging"); (2) good initial mental and physical health that deteriorated with age ("accelerated aging"); or (3) poor initial mental and physical health with possibly further declines over the lifecourse ("aging with persistently poor health"). Predictors of trajectory group membership included gender, childhood poverty, and schooling. Discussion: Despite lifecourses being characterized by poverty and frequent adversities in this poor population, our analyses identified a sizable group (30%) of resilient individuals who experienced successful aging with good initial health that persisted across the lifecourse and into old age. Accelerated aging was the most common trajectory for SF12 physical and mental health in this poor population, while for BMI, persistently poor health was most common. Men were more likely to enjoy resilient aging than women in terms of physical/mental health, contrary to previous findings from high-income contexts. Other predictors of trajectory membership sometimes confirmed, and sometimes contradicted, hypotheses derived from high-income country studies.