Work-related stress is a major occupational health and safety (OHS) issue that has industrial relations origins. Aside from the moral and human rights imperatives to improve the corporate climate for worker psychological health (as per psychosocial safety climate, PSC), there are strong economic costs for not doing so. PSC refers to worker perceptions of the corporate safety system to protect and promote workers’ psychological health and wellbeing. It is a leading indicator of working conditions, which in turn affect workers’ health and work engagement. In this study, we estimate the attributable economic cost of low PSC due to sickness absence and turnover. Data were collected from a multinational company using survey at Time 1 (T1) and objective company data (i.e., sickness absence and turnover) after one year (T2). Using regression analysis and a matched sample of 617 responses, PSC was negatively related to future sickness absence. A binomial logistic regression with 1268 respondents (i.e., all responses at T1) showed that PSC was negatively related to future voluntary turnover. An economic analysis suggests that improving OHS via PSC could save an organisation with 5000 employees USD 0.6–2.7 million per year. Building PSC to protect and promote workers’ psychological health is a likely economic saving on organisational productivity.

We use Benford's law to examine the non-random elements of health care costs. We find that as health care expenditures increase, the conformity to the expected distribution of naturally occurring numbers worsens, indicating a tendency towards inefficient treatment. Government insurers follow Benford's law better than private insurers indicating more efficient treatment. Surprisingly, self-insured patients suffer the most from non-clinical cost factors. We suggest that cost saving efforts to reduce non-clinical expenses should be focused on more severe, costly encounters. Doing so focuses cost reduction efforts on less than 10% of encounters that constitute over 70% of dollars spent on health care treatment.

This study examines disparities in health and nutrition among native and Syrian refugee children in Turkey. To understand the need for targeted programs addressing child well-being among the refugee population, we analyze the Turkey Demographic and Health Survey (TDHS) – which provides representative data for a large refugee and native population. We find no evidence of a difference in infant or child mortality between refugee children born in Turkey and native children. However, refugee infants born in Turkey have lower birthweight and age-adjusted weight and height than native infants. When we account for a rich set of birth and socioeconomic characteristics that display substantial differences between natives and refugees, the gaps in birthweight and age-adjusted height persist, but the gap in age-adjusted weight disappears. Moreover, the remaining gaps in birthweight and anthropometric outcomes are limited to the lower end of the distribution. The observed gaps are even larger for refugee infants born before migrating to Turkey, suggesting that the remaining deficits reflect conditions in the source country before migration rather than deficits in access to health services within Turkey. Finally, comparing children by the country of their first trimester, we find evidence of the detrimental effects of stress exposure during pregnancy.

This article discusses the difference between benefit–cost analysis (BCA) and social welfare analysis in the evaluation of pandemic preparedness policies. Two social welfare approaches are considered: utilitarianism and prioritarianism. BCA sums the individuals’ monetary equivalents of the pandemic impacts. Social welfare analysis aggregates individuals’ well-being impacts. The aggregation rule identifies the normative judgments about what is fair. This article shows that the two methods yield very different estimates of the value of avoiding a future pandemic similar to the COVID-19 one. Compared to BCA, considerations about the distribution of the costs of the hypothetical intervention play a major role in the estimate of both utilitarian and prioritarian pandemic burdens: The more progressive the distribution of the costs is, the larger the net benefits of preventing the pandemic. In contrast, the BCA pandemic burden is indifferent to the distribution of the intervention costs. In addition, BCA tends to underestimate the burden suffered by low-income countries compared to social welfare analysis.

There is a need to value health technologies in a way that accommodates their broader economic impacts and competing approaches for doing so have emerged. The Pareto principle (PP) requires policymakers to resolve intrapersonal trade-offs by deferring to the preferences of the individuals facing those trade-offs. Many broad value frameworks such as cost-utility analysis and its extensions, health-centric multicriteria decision analysis, and poverty-free life expectancy are not sufficiently deferential to these preferences, violating PP. I propose using the health-augmented lifecycle model (HALM) to value health technologies in a way that flexibly incorporates the interactions among health and economic factors – specifically mortality and morbidity risks, paid and unpaid work, consumption, leisure, and public and private transfer inflows and outflows--over the life course. It relies on individual preferences, satisfying PP. It is compatible with cost-benefit analysis, social welfare functions, and equivalent income approaches. I calibrate the HALM for the US setting and apply it to a pediatric vaccine.

Compromised kidney function is associated with an array of environmental contaminants and pathogens that may be considered for regulation. However, there are few valuation estimates for kidney effects for use in benefit–cost analyses, particularly willingness-to-pay estimates. This paper is one of several surveys valuing morbidity developed by the OECD Surveys to elicit Willingness-to-pay to Avoid Chemicals-related negative Health Effects project, which aims to improve the basis for benefit–cost analyses. We report the results of a stated preference survey valuing reduced the risk of symptomatic chronic kidney disease, filling an important gap in the valuation literature and addressing a need for applied benefits analysis of chemical regulation. The survey was administered to representative samples in each of 10 countries: Canada, Chile, China, Denmark, Germany, Italy, Norway, Türkiye, the United Kingdom, and the United States. The mean (median) WTP for an average reduction of 3.5 in 1,000 of the risk of serious kidney disease over 5 years is $2,609 ($764), corresponding to a mean (median) value per statistical case (VSC) of chronic kidney disease of $805,000 ($224,000). The mean VSC varies between $700,000 for Canada and $1,200,000 for Türkiye.

Asthma is a non-communicable and non-curable lung disease that affects 10% of children and 4% of adults worldwide and is associated with an array of environmental contaminants and chemicals. This article offers values suitable for use in cost–benefit analyses of the willingness to pay (WTP) for reduced severity of asthma in adults and children and in reduced probability of getting asthma for these two population groups, all in the context of reducing chemical exposures. To this end, an online survey was administered between November 2021 and May 2022 to 12 727 respondents from seven countries of the Organisation for Economic Co-operation and Development (OECD). This article applies two stated preference methods for eliciting WTP: the contingent valuation method for reduced asthma severity and choice experiments for reduced probability of getting asthma of various severities. The context for such elicitations was a set of household products that contain fewer hazardous chemicals than what is currently available in supermarkets but are more expensive. The study finds that the WTP for reducing asthma severity in adults by one step, e.g. from “moderate plus” to “moderate”, is USD2022 529 per year on average. The parental WTP for reducing asthma severity in their children is USD2022 PPP 948 per year and is on average 1.8 times higher than their WTP for themselves. The mean value of a statistical case (VSC) of adult asthma which would be applied to predictions of new cases of asthma avoided by a regulation equals USD2022 280 000, while the mean VSC of childhood asthma equals USD2022 430 000.

The consequences of legal access to medical marijuana for individuals' well-being are controversially assessed. We contribute to the discussion by evaluating the impact of the introduction of medical marijuana laws across US states on self-reported mental health considering different motives for cannabis consumption. Our analysis is based on BRFSS survey data from close to eight million respondents between 1993 and 2018 that we combine with information from the NSDUH to estimate individual consumption propensities. We find that eased access to marijuana through medical marijuana laws reduce the reported number of days with poor mental health for individuals with a high propensity to consume marijuana for medical purposes and for those individuals who likely suffer from frequent pain.

Using virtual reality (VR) in an experimental setting, we analyse how communicating more openly about a medical incident influences patients' feelings and behavioural intentions. Using VR headsets, participants were immersed in an actual hospital room where they were told by a physician that a medical incident had occurred. In a given scenario, half of the participants were confronted by a physician who communicated openly about the medical incident, while the other half were confronted with the exact same scenario except that the physician employed a very defensive communication strategy. The employed technology allowed us to keep everything else in the environment constant. Participants exposed to open disclosure were significantly more likely to take further steps (such as contacting a lawyer to discuss options and filing a complaint against the hospital) and express more feelings of blame against the physician. At the same time, these participants rated the physician's communication skills and general impression more highly than those who were confronted with a defensive physician. Nevertheless, communicating openly about the medical incident does not affect trust in the physician and his competence, perceived incident severity and likelihood of changing physician and filing suit.

This note updates a measure of lockdown regulatory freedom for 2021 and then uses it to adjust countries' 2021 economic freedom scores to account for pandemic regulations that impact economic freedom but otherwise would go unmeasured. We directly follow Miozzi and Powell's (2023a, Journal of Institutional Economics 19(2), 229–250) methods to measure lockdown regulations and adjust 2020 economic freedom scores. Thus, when paired with those findings we provide a data set that consistently measures coronavirus disease 2019 regulations and economic freedom over the course of the pandemic that can be used in other research. We find that lockdown regulatory freedom increased as countries scaled back pandemic regulations, while other areas of economic freedom continued declining. We also find that adjusting for lockdown regulatory freedom continues to significantly impact countries' relative ranking in economic freedom.

This report presents a cost–benefit analysis of increased spending on tuberculosis (TB) using impacts and costs drawn from the Global Plan to End Tuberculosis, 2023–2030. The analysis indicates that the return on TB spending is substantial with a centrally estimated benefit–cost ratio (BCR) of 46, meaning every US$ 1 invested in TB yields US$ 46 in benefits. Alternative specifications using different baselines, interventions, cost profiles, and discount rates still yield robustly high BCRs, in the range of 28–84. This report also shows that TB investment would avert substantial mortality, estimated at 27.3 million averted deaths over the 28-year period between 2023 and 2050 inclusive: almost 1 million averted deaths per year on average. Accounting for all estimated direct and indirect costs, the cost per averted death is slightly over US$ 2000. Interventions to address TB represent exceptional value-for-money.

Studies of health care expenditure often exclude explanatory variables measuring wealth, despite the intuitive importance and policy relevance. We use the Household, Income and Labour Dynamics in Australia Survey to assess impacts of income and wealth on health expenditure. We investigate four different dependent variables related to health expenditure and use three main methodological approaches. These approaches include a first difference model and introduction of a lagged dependent variable into a cross-sectional context. The key findings include that wealth tends to be more important than income in identifying variation in health expenditure. This applies for health variables which are not directly linked to means testing, such as spending on health practitioners and for being unable to afford required medical treatment. In contrast, the paper includes no evidence of different impacts of income and wealth on spending on medicines, prescriptions or pharmaceuticals. The results motivate two novel policy innovations. One is the introduction of an asset test for determining rebate eligibility for private health insurance. The second is greater focus on asset testing, rather than income tests, for a wide range of general welfare payments that can be used for health expenditure. Australia's world-leading use of means testing can provide a test case for many countries.

Exposure to (a liberal) democracy can have an impact on both the political attention and visibility of the needs of marginalized populations, as well as the design of health policies that can influence the distribution of population health. This paper investigates the effect of exposure to democracy, that is, the number of years spent in a democracy as measured by democracy indexes, on various measures of inequality in self-reported health across European countries. We use an instrumental variable strategy to leverage the potential endogeneity of a country’s exposure to democracy, drawing on both bivariate (socioeconomic) and univariate health inequality measures. Our estimates provide evidence that an additional year in a democracy reduces both bivariate (income-related) health inequality and overall (univariate) health inequality. Our preferred specification suggests a two-point rank reduction in inequality with an additional year under a democracy. The effect is mainly driven by a reduction of “health poverty” alongside other effects.

Each year, 295,000 women die during and just after pregnancy, and 2.4 million babies die in the first month of their lives. In 2019, 2,160,000 neonatal deaths and 275,000 maternal deaths occurred in low-income and lower-middle-income countries alone, translating to a welfare loss equivalent to $426 billion and $36 billion for neonatal and maternal deaths, respectively. The total loss was $462 billion or almost 6 % of these countries’ combined GDP. In the sustainable development goals pledge, the world promised to reduce maternal deaths to 0.07 % and neonatal mortality to below 1.2 %, saving about 200,000 women and 1.2 million children from dying annually. However, on the current trajectory, maternal mortality is expected to decline to only 0.16 % and neonatal deaths to only 1.5 % by 2030. This article analyses the most cost-effective way to reduce maternal and neonatal deaths – Increase coverage of basic emergency obstetric and newborn care from 68 to 90 % combined with increased family planning services in 55 low-income and lower-middle-income countries which account for around 90 % of the burden of maternal and neonatal mortality globally. The proposed package will require $3.2 billion per year more investment and will deliver benefits worth $278 billion per year in avoided deaths and higher economic growth. It will also yield a demographic dividend benefit equivalent to $25 billion annually. For every $1 invested, the social and economic benefits are estimated to be $87. The benefit-cost ratio is 87.

Another quiet revolution is taking place in the alcoholic beverage markets: a trend toward lower-alcohol and even no-alcohol beverages, especially in the world's higher-income countries. This new trend adds to the long-term consumer trend in affluent countries of substituting quality for quantity in many of their purchases (premiumization), which, in the case of alcoholic beverages, has been driven largely by a desire for a healthier lifestyle. More-affluent consumers also desire a greater variety than is typically available from large producers of regular products, which has led to a craft beverage revolution. Both desires—for lower-alcohol beverages and a greater variety of quality offerings—are driving this so-called low- or no-alcohol revolution. The trend is just beginning to show up in wine (and spirits) markets, but it began developing much earlier in beer markets. The purpose of this paper is to explore the extent of the latter and the consumer forces behind it. Since Australian brewers are leading the way globally in building various Lo-No beer categories, and thereby contributing substantially to lowering that nation's alcohol consumption, its trends are highlighted and compared with global trends. The paper concludes by drawing out lessons and prospects for lower-alcohol beer and wine.

Long-term exposure to extreme temperatures could threaten individuals' mental health and psychological wellbeing. This study aims to investigate the long-term impact of cumulative exposure to extreme temperature. Differently from existing literature, we define extreme temperature exposure in relative terms based on local temperature patterns. Combining the China Health and Retirement Longitudinal Study and environmental data from the U.S. National Oceanic and Atmospheric Administration from 2011 to 2015, this study demonstrates that heat and cold exposure days in the past year significantly increase the measured depression level of adults over age 45 by 1.75 and 3.00 per cent, respectively, controlling for the city, year, and individual fixed effects. The effect is heterogeneous across three components of depression symptoms as well as age, gender, and areas of residency, and air conditioning and heating equipment are effective in alleviating the adverse impact of heat and cold exposure. The estimation is robust and consistent across a variety of temperature measurements and model modifications. Our findings provide evidence on the long-term and accumulative cost of extreme temperature to middle-aged and elderly human capital, contributing to the understanding of the social cost of climate change and the consequent health inequality.

Intentional violence against healthcare workers inflicts a physical and mental toll, motivating legislative proposals to better regulate these occupational risks. This article uses this context to address two novel issues for benefit assessment raised by injuries from assailants: potential heterogeneity in valuation based on the context of the injury risk and possible reductions in self-reported valuations when the exposed population has been trained to feel responsible for the risk. This article presents experimental evidence on workers’ preferences over the form of intervention: protection (risk reduction) or insurance (cost-sharing). The experiment also elicits worker valuations of occupational health care risks, calculating the value of a statistical injury (VSI), based on local wage-risk tradeoffs, in the general range of $200,000. Workers accord a premium to risk reductions that might eliminate the risk of injuries. Both the physical harm and the process by which the injury occurs may affect benefit assessments for the regulation of workplace violence. Non-healthcare participants require a $40,000 premium per expected injury resulting from intentional harm. While health care workers do not generally require such a premium, health care workers in clinical positions require more compensation to face occupational risks. Insurance coverage for monetary losses is more highly valued than protective measures for accidental harms, though there is no significant comparable preference for insurance against intentional harms. The results have important practical implications for addressing the concerning phenomenon of violence against healthcare workers, suggesting that expanding insurance compensation would be desirable, as would assigning an intentionality premium to intentional injuries.

The retirement of old workers increased during the COVID-19 pandemic, and health concerns are considered to be a critical factor. To understand the effect of pure health concerns during the pandemic, we analyze the impact of the aggregate health shock on retirement decisions using a life cycle model. The aggregate health shock changes the economy from the normal state to the pandemic state, where the probability of adverse idiosyncratic health shock increases, especially if agents are working. Simulation results suggest that the shock accelerates the retirement of agents aged over 60. The increase in retirement is significant even though the shock is expected to be temporary. Also, the effect hinges on the assumption that working poses a greater risk of receiving a negative health shock than retiring. Even accounting for the large income and wealth changes that US households experienced in 2020, a counterfactual experiment suggests that the aggregate health shock plays a prominent role in increasing retirement.

The generalized risk-adjusted cost-effectiveness (GRACE) analysis method modifies standard cost-effectiveness analysis (CEA), the primary method currently used worldwide to value health improvements arising from healthcare interventions. Generalizing standard CEA, GRACE allows for decreasing or even increasing returns to health. Previous presentations of GRACE have relied extensively on Taylor Series expansion methods to specify key model parameters, including those that properly adjust for illness severity and preexisting disability, consequences of uncertain treatment outcomes, and the marginal rate of substitution between life expectancy and health-related quality of life. Standard CEA cannot account for these sources of value or cost in its valuation of medical treatments. However, calculations of GRACE measures based on Taylor Series are approximations, which may be poorly behaved in some contexts. This paper provides a new approach for implementing GRACE, using exact utility functions instead of Taylor Series approximations. While any proper utility function will suffice, we illustrate with three well-known functions: constant relative risk aversion (CRRA) utility; hyperbolic absolute risk aversion (HARA) utility, of which CRRA is a special case; and expo-power (EP) utility, of which constant absolute risk aversion (CARA) is a special case. The analysis then extends from two-period to multiperiod models. We discuss methods to estimate parameters of HARA and EP functions using two different types of data, one from discrete choice experiments and the other from “happiness economics” methods. We conclude with some reflections on how this analysis might affect benefit-cost analysis studies of healthcare interventions.

The impact and economic merits of President Biden’s Executive Order 13985 on equity depend on how the executive order is implemented. While policy discussion to date has focused on equitable outcomes, we propose framing risk equity policies in terms of equitable risk tradeoff rates based on six policy guidelines. The starting point for ex ante evaluation of equity for mortality risk policies should be the symmetric application of the value of a statistical life (VSL) to all groups. Because of the substantial heterogeneity in VSLs by income and demographic characteristics, symmetric tradeoff rates generate subsidies and deficits relative to private values of risk. Efforts to provide for distributional preferences should be grounded in an understanding of the differentials already provided through application of a uniform VSL. Targeting government programs to specific groups ex ante should be coupled with estimates of the efficiency loss based on symmetric tradeoff rates and the implicit tradeoff rate ratio relative to the average VSL needed to support the redistributive policy. Here, we propose equity guidance that could be incorporated in a revised version of Office of Management and Budget Circular A-4. We contrast the ex ante equity guidance approach with the ex post risk equity evaluation procedure that is incorporated in the Biden Administration’s recently proposed Justice40 plan, where 40% of the benefits of existing programs must be targeted to certain minority groups without ex post examination of their cost effectiveness either feasible or currently planned.