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Elomaa-Krapu M, Kaunonen M. Shattered childhood: Experiences of polio survivors in Finland 1950s and 1960s. J Adv Nurs 2024; 80:2860-2868. [PMID: 37849063 DOI: 10.1111/jan.15903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
AIM To describe the childhood experiences of patients with polio from the acute phase of the disease during post-war Finland in the 1950s and 1960s. DESIGN Qualitative empirical study based on self-reported history of nursing rooted in the past, a history of experiences. METHODOLOGY Interview materials were gathered in the form of themes (45) and written interviews (4) (29 September 2018 to 30 June 2019). Data were analysed by reflexive thematic analysis to highlight hidden and latent experiences. This approach generated the study's main theme, themes and subthemes. RESULTS The main theme, 'shattered childhood', generated from the study results and was then divided into two themes, both of which were influenced in part by the loss of a familiar childhood, the changed environment, the breakdown of the body and the absence of control. Through their childhood memories, polio survivors described their broken childhoods using the following themes: 'betrayal by their bodies' and 'isolation'. In the narratives, the theme 'betrayal by one's own body' was generated by the following subthemes: 'suddenness of the affliction', 'paralysis' and 'being moved to the hospital'. The 'isolation' theme developed from the subthemes 'isolation from the body and surroundings' and 'emotional and social loneliness'. CONCLUSION Polio survivors' experiences during the acute stage of the disease were traumatic and demonstrated children's inferior nursing position in Finland in the 1950s and 1960s. IMPACT The study increases our understanding of the history of caring for children and families who were affected and disabled by polio and the importance of their experiences in society and healthcare settings. PATIENT OR PUBLIC CONTRIBUTION The authors collaborated with the Finnish Polio Association to recruit study participants and plan the study. Patients with polio during childhood underwent interviews, and their experiences formulated the data, which were analysed and the basis of the results. REPORTING METHOD Consolidated criteria for reporting qualitative research (COREQ), a 32-item checklist for interviews and focus groups, have been used as a reporting and checklist tool. All authors have agreed on the final version and the use of the COREQ criteria, relationship with participants, theoretical framework, setting, data collection and data analysis and report.
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Affiliation(s)
- Minna Elomaa-Krapu
- Faculty of Social Sciences, Nursing Science, Tampere University, Tampere, Finland
- Metropolia University of Applied Sciences, Helsinki, Finland
| | - Marja Kaunonen
- Faculty of Social Sciences, Nursing Science, Tampere University, Tampere, Finland
- General Administration, Wellbeing services county of Pirkanmaa, Finland
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2
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O'Donnell O. Health and health system effects on poverty: A narrative review of global evidence. Health Policy 2024; 142:105018. [PMID: 38382426 DOI: 10.1016/j.healthpol.2024.105018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024]
Abstract
Ill-health causes poverty. The effect runs through multiple mechanisms that span lifetimes and cross generations. Health systems can reduce poverty by improving health and weakening links from ill-health to poverty. This paper maps routes through which ill-health can cause poverty and identifies those that are potentially amenable to health policy. The review confirms that ill-health is an important contributor to poverty and it finds that the effect through health-related loss of earnings is often larger than that through medical expenses. Both effects are smaller in countries that are closer to universal health coverage and have higher social safety nets. The paper also reviews evidence from low- and middle-income countries (LMICs) and the United States (US) on the poverty-reduction effectiveness of public health insurance (PubHI) for low-income households. This reveals that PubHI does not always deliver financial protection to its targeted population in LMICs. Countries that have succeeded in achieving this goal often combine extension of coverage with supply-side interventions to build capacity and avoid perverse provider incentives in response to insurance. In the US, PubHI is effective in reducing poverty by shielding low-income households with children from healthcare costs and, consequently, generating long-run improvements in health that increase lifetime earnings. Poverty reduction is a potentially important co-benefit of health systems.
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Affiliation(s)
- Owen O'Donnell
- Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands.
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Jeon SH, Park J, Kohen D. Childhood-onset disabilities and lifetime earnings growth: A longitudinal analysis. HEALTH ECONOMICS 2023; 32:1749-1766. [PMID: 37072904 DOI: 10.1002/hec.4687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/18/2023] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
This study offers insights into lifetime earnings growth differences between individuals with and without childhood-onset disabilities (COD) defined as disabilities whose onset occurred before an individual's 16th birthday. We use a newly available database linking data from the 2017 Canadian Survey of Disability with individual income tax records covering a period of over 3 decades. We estimate the average earnings growth profiles of individuals with COD from the age when individuals generally enter the labor market to the age when most retire. The main finding of our study is that individuals with COD experience very little earnings growth when they are in their mid-30 and 40s while the earnings of those without COD grow steadily until they reach their late 40s and early 50s. The largest earnings growth differences between individuals with and without COD are observed for male university graduates.
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Affiliation(s)
- Sung-Hee Jeon
- Social Analysis and Modelling Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Jungwee Park
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Dafna Kohen
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
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Houeninvo HG, Quenum VCC, Senou MM. Out- Of- Pocket health expenditure and household consumption patterns in Benin: Is there a crowding out effect? HEALTH ECONOMICS REVIEW 2023; 13:19. [PMID: 36971878 PMCID: PMC10041797 DOI: 10.1186/s13561-023-00429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Health shocks are common and have serious consequences for households in developing countries where health insurance is lacking. In this study, we examine whether out-of-pocket health expenditures crowd out household consumption of non-healthcare necessities, such as education items in Benin using a sample of 14,952 households from the global vulnerability and food security analysis survey. We estimated a system of conditional Engel curves with three stage least squared (3SLS) and seemingly unrelated regression (SURE) for seven categories of goods using the Quadratic Almost Ideal Demand System (QUAIDS) in the form of budget shares corresponding to proportions of total non-health expenditure. Findings show that out of pocket health expenditure leads households to spend more on health care that in fine crowd out expenditure in other necessity goods such as education item. These findings highlight the need for social protection programs to mitigate the impact of health shocks on vulnerable households in Benin.
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Affiliation(s)
| | | | - Melain Modeste Senou
- University of Abomey Calavi, Calavi, Benin.
- African Economic Research Consortium, Nairobi, Kenya.
- Economics, African Centre of Excellence for Inequality Research, Cape Town, South Africa.
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Chen Y, Zhao Y. Widening or convergence, the trajectories of health inequalities induced by childhood SES across the life course: Evidence from China. SSM Popul Health 2022; 21:101324. [PMID: 36632049 PMCID: PMC9827053 DOI: 10.1016/j.ssmph.2022.101324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/30/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
This study aims to explore the trajectories of health inequalities induced by childhood SES across the life course in China. There are two competing theories on this subject. Cumulative disadvantage theory contends that health gaps induced by childhood SES tend to widen across the life course as adulthood SES compound or multiply the negative effects of early SES disadvantage. Age-neutral theory draws the opposite inference that the physiological decline due to aging offsets the health gaps at older ages. Based on the data of the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, a two-level mixed-effects model was used to analyze the trajectories of health inequalities induced by childhood SES among Chinese individuals aged 45 and above and further distinguished the age and cohort effects in the overall trajectories. Unlike previous studies that unilaterally supported one of these theories, our findings support both of them. In this study, health gaps induced by childhood SES gradually widened before entering old age, which supports the cumulative disadvantage theory. In contrast, the health gaps in older adults gradually converged with age, thus supporting the age-neutral theory. The age effect shows that in the same birth cohort, health gaps induced by childhood SES first increased and then decreased during the survey time. The cohort effect shows that, at the same age, childhood SES has a greater impact on the health of those with later birth cohorts than on those with earlier birth cohorts. The findings of this study support the importance of policy and practices to reduce health inequalities among adolescents for long-term healthy aging in China.
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Affiliation(s)
- Yucheng Chen
- School of Political Science and Law in University of Jinan, 250000, Jinan, China
| | - Yuxiao Zhao
- School of Medical Management in Shandong First Medical University & Shandong Academy of Medical Sciences, 250000, Jinan, China,Corresponding author.
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Alfano M. Islamic law and investments in children: Evidence from the Sharia introduction in Nigeria. JOURNAL OF HEALTH ECONOMICS 2022; 85:102660. [PMID: 35926253 DOI: 10.1016/j.jhealeco.2022.102660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/29/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Islamic law lays down detailed rules regulating children's upbringing. This study examines the effect of such rules on investments in children by analysing the introduction of Sharia law in northern Nigeria. Triple-differences estimates using temporal, geographical and religious variation together with large, representative survey data show decreases in infant mortality. Official government statistics further confirm improvements in survival. Findings also show that Sharia increased vaccination rates, duration of breastfeeding and prenatal health care. Evidence suggests that Sharia improved survival by specifying strict child protection laws and by formalising children's duty to maintain their parents in old age or in sickness.
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Affiliation(s)
- Marco Alfano
- Department of Economics, Lancaster University and Centre for Research and Analysis of Migration, University College London, United kingdom.
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COVID-19: Faustos y Mefistófeles. ACTA COLOMBIANA DE CUIDADO INTENSIVO 2022. [PMCID: PMC8685195 DOI: 10.1016/j.acci.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Araújo D, Carrillo B, Sampaio B. The Long-Run Economic Consequences of Iodine Supplementation. JOURNAL OF HEALTH ECONOMICS 2021; 79:102490. [PMID: 34247127 DOI: 10.1016/j.jhealeco.2021.102490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
We present evidence on the impacts of a large-scale iodine supplementation program in Tanzania on individuals' long-term economic outcomes. Exploiting the timing and location of the intervention, we document that in utero exposure to the program increased completed years of education and income scores in adulthood. We find no increase in total employment, but a significant change in the occupational structure. Cohorts exposed to the program are less likely to work in agricultural self-employment and more likely to hold skilled jobs that typically demand higher levels of education. Together, these results demonstrate that iodine deficiency can have long-run implications for occupational choices and labor market incomes in low-income regions.
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Affiliation(s)
- Daniel Araújo
- Department of Economics, Universidade Federal de Pernambuco, AV. Prof. Moraes Rego, 1235 - Cidade Universitaria, Recife - PE, 50670-420 Brazil.
| | - Bladimir Carrillo
- Department of Economics, Universidade Federal de Pernambuco, AV. Prof. Moraes Rego, 1235 - Cidade Universitaria, Recife - PE, 50670-420 Brazil.
| | - Breno Sampaio
- Department of Economics, Universidade Federal de Pernambuco, AV. Prof. Moraes Rego, 1235 - Cidade Universitaria, Recife - PE, 50670-420 Brazil.
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Hirani JLJ. Inattention or reluctance? Parental responses to vaccination reminder letters. JOURNAL OF HEALTH ECONOMICS 2021; 76:102439. [PMID: 33601095 DOI: 10.1016/j.jhealeco.2021.102439] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 06/12/2023]
Abstract
This paper studies non-adherence in the Danish Childhood Vaccination Program using a nationwide introduction of a vaccination reminder letter policy and administrative data from 2011-2017. First, I provide causal estimates of how the reminder letter policy affects vaccination adherence using a Regression Discontinuity Design (RDD). Second, I link parental responses to the reminder letter to parents' causes for being non-adherent. I find that the reminder letter policy positively affects adherence. However, 72% of non-adherent parents are non-responsive to the reminder letter indicating that reluctance and not inattention is the leading cause for non-adherence. Thus, other policies beyond reminder letters - such as mandatory vaccination laws - are necessary to substantially increase vaccination coverage.
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Affiliation(s)
- Jonas Lau-Jensen Hirani
- The Danish Center for Social Science Research (VIVE), Herluf Trolles Gade 11, 1052 Copenhagen, Denmark.
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Meyers K, Thomasson MA. Can pandemics affect educational attainment? Evidence from the polio epidemic of 1916. CLIOMETRICA 2021; 15:231-265. [PMID: 32837578 PMCID: PMC7384283 DOI: 10.1007/s11698-020-00212-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/11/2020] [Indexed: 05/20/2023]
Abstract
We leverage the largest polio outbreak in US history, the 1916 polio epidemic, to study how epidemic-related school interruptions affect educational attainment. Using polio morbidity as a proxy for epidemic exposure, we find that children aged 10 and under, and school-aged children of legal working age with greater exposure to the epidemic experienced reduced educational attainment compared to their slightly older peers. These reductions in observed educational attainment persist even after accounting for the influenza epidemic of 1918.
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Affiliation(s)
- Keith Meyers
- Department of Business and Economics, Danish Institute of Advanced Studies, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
| | - Melissa A. Thomasson
- Julian Lange Professor of Economics, Miami University and Research Associate, NBER. FSB 2054, MSC 1035 800 E. High St., Oxford, OH 45056 USA
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11
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Serratos-Sotelo L. Were there long-term economic effects of exposure to polio vaccination? An analysis of migrants to Sweden 1946-2003. SSM Popul Health 2020; 11:100589. [PMID: 32577493 PMCID: PMC7305338 DOI: 10.1016/j.ssmph.2020.100589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 11/27/2022] Open
Abstract
Recent research showed that exposure to the vaccine against polio in early life had no long-term economic benefits among native Swedes. However, whether this result holds for individuals from other countries remains unexplored. This study explores the relationship between exposure to the vaccine and later-life outcomes, but focuses on individuals who migrated to Sweden (birth cohorts 1946-1971), and constitute a diverse sample in terms of national origin. Using a differences-in-differences approach and register data from the Swedish Longitudinal Immigrant Database, this study explores if being exposed to the vaccine against polio in the year of birth in the country of origin has any impact on adult income, educational achievement, or days or number of hospitalizations. The results are in line with the previous research in showing that there are no statistically significant effects on adult income, education, or health from exposure to the vaccine against polio, regardless of national origin. Furthermore, no scarring effects of exposure to polio epidemics were found on any of the outcomes, reinforcing the hypothesis that polio did not scar individuals in the same way as other contemporary epidemic diseases did, and that the lack of scarring could explain the absence of long-term impact from vaccine exposure.
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Nandi A, Shet A, Behrman JR, Black MM, Bloom DE, Laxminarayan R. Anthropometric, cognitive, and schooling benefits of measles vaccination: Longitudinal cohort analysis in Ethiopia, India, and Vietnam. Vaccine 2019; 37:4336-4343. [PMID: 31227354 PMCID: PMC6620502 DOI: 10.1016/j.vaccine.2019.06.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/28/2019] [Accepted: 06/13/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate the associations between measles vaccination and child anthropometry, cognition, and schooling outcomes in Ethiopia, India, and Vietnam. METHODS Longitudinal survey data from Young Lives were used to compare outcomes at ages 7-8 and 11-12 years between children who reported receipt or non-receipt of measles vaccine at 6-18 months-of-life (n = ∼2000/country). Z-scores of height-for-age (HAZ), BMI-for-age (BMIZ), weight-for-age (WAZ), Peabody Picture Vocabulary Test (PPVT), early grade reading assessment (EGRA), language and mathematics tests, and attained schooling grade were examined. Propensity score matching was used to control for systematic differences between measles-vaccinated and measles-unvaccinated children. FINDINGS Using age- and country-matched measles-unvaccinated children as comparisons, measles-vaccinated children had better anthropometrics, cognition, and schooling. Measles-vaccinated children had 0.1 higher HAZ in India and 0.2 higher BMIZ and WAZ in Vietnam at age 7-8 years, and 0.2 higher BMIZ at age 11-12 years in Vietnam. At ages 7-8 years, they scored 4.5 and 2.9 percentage points (pp) more on PPVT and mathematics, and 2.3 points more on EGRA in Ethiopia, 2.5 points more on EGRA in India, and 2.6 pp, 4 pp, and 2.7 points more respectively on PPVT, mathematics, and EGRA in Vietnam. At ages 11-12 years, they scored 3 pp more on English and PPVT in India, and 1.7 pp more on PPVT in Vietnam. They also attained 0.2-0.3 additional schooling grades across all ages and countries. CONCLUSION Our findings suggest that measles vaccination may have benefits on cognitive gains and school-grade attainment that can have broad educational and economic consequences which extend beyond early childhood.
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Affiliation(s)
- Arindam Nandi
- Center for Disease Dynamics, Economics & Policy, 1400 Eye St. NW, Suite 500, Washington, DC 20005, USA.
| | - Anita Shet
- Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Baltimore, MD 21231, USA.
| | - Jere R Behrman
- Economics Department, Perelman Center for Political Science and Economics, University of Pennsylvania, 133 South 36th Street, Philadelphia, PA 19104-6297, USA.
| | - Maureen M Black
- RTI International, Research Triangle Park, NC 27709, USA; Department of Pediatrics, University of Maryland School of Medicine, 737 W. Lombard Street, Suite 161, Baltimore, MD 21201, USA.
| | - David E Bloom
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building I 12th Floor, Suite 1202, Boston, MA 02115, USA.
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, B-25, Lajpat Nagar II, New Delhi, Delhi 110024, India; Princeton Environmental Institute, Princeton University, Princeton, NJ 08544, USA.
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