Essays on the economics of population health

Ferraz Musse, Isabel

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Description

Title

Essays on the economics of population health

Author(s)

Ferraz Musse, Isabel

Issue Date

2020-04-24

Director of Research (if dissertation) or Advisor (if thesis)

Thornton, Rebecca

Doctoral Committee Chair(s)

Thornton, Rebecca

Committee Member(s)

• Miller, Nolan
• Molitor, David
• Borgschulte, Mark

Department of Study

Economics

Discipline

Economics

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

• Economic conditions
• Employment
• Pain relief
• Opioids
• Pregnancy Testing
• Reproductive Health
• Nepal
• Elections
• Risky health behaviors
• Alcohol

Abstract

This dissertation consists of three essays on the economics of population health. In Chapter 2, I study employment shocks and demand for pain medication. Declining economic opportunity is often portrayed as one of the drivers of the opioid epidemic. Better employment conditions can, however, affect opioid use through two channels: increasing physical pain from working or reducing mental distress that can contribute to substance abuse. I use a large dataset of opioid and over-the-counter (OTC) painkiller sales to measure the effect of employment shocks on demand for pain medication. To separate the channels, I contrast the effect of labor demand shocks on the use of opioids with the effect on the use of OTC painkillers---which address pain but not mental health---allowing for the effects to depend on the injury rate of local industries. I find that a 1 percent increase in the employment-to-population ratio decreases the per-capita demand for opioids by 0.20 percent, while it increases the per-capita demand for OTC painkillers by 0.14 percent. To decompose the effect of employment on opioid use in the two channels, I calculate the substitution between these pain medications, exploring the introduction of a policy that increased requirements to prescribe opioids. My findings show that during local economic expansions, the decline in opioid abuse is 40 percent larger than the total effect on use while, at the same time, the demand for pain relief medication increases and is related to jobs in high injury industries. In Chapter 3, I study how women learn they are pregnant and pregnancy uncertainty. The earlier a woman learns about her pregnancy status, the sooner she can make decisions about her own and infant’s health. This paper examines how women learn about their pregnancy status and measures how access to pregnancy tests affects earlier pregnancy knowledge. Using ten years of individual-level monthly panel data in Nepal, we find that, on average, women learn they are pregnant in their 4.6th month of pregnancy. Living approximately a mile further from a clinic offering pregnancy tests increases the time a woman knows she is pregnant by one week (5\% increase) and decreases the likelihood of knowing in the first trimester by 4.5 percentage points (16.1\% decrease). Women with prior pregnancies experience the most substantial effects of distance within the first two trimesters, while, for women experiencing their first pregnancy, distance does not affect knowledge. This difference suggests that access to pregnancy tests is a binding constraint only after women’s beliefs, or symptoms, about being pregnant are strong enough. In Chapter 4, I study how election outcomes affect alcohol drinking. The growing political polarization and the increasing use of social media have been linked to straining social ties worldwide. The 2016 presidential elections in the United States reflected this trend, with reports of fear and anxiety among voters. We examine how election results can be linked to episodes of anxiety and the use of alcohol for self-medication. We analyze a daily dataset of household purchases of alcohol in the weeks following presidential elections. We find that, within 30 days from Election Day, a 10 percentage point increase in support for the losing candidate increases alcohol expenditure by 1.1\%. The effect is driven by counties with more immigrants, higher income, higher unemployment, and higher levels of education. Suggestive evidence shows that the number of fatal car crashes also increases in counties with a higher share of losers. These two effects are present in the 2016 elections and absent in previous years.

Graduation Semester

2020-05

Type of Resource

Thesis

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Copyright and License Information

Copyright 2020 Isabel Ferraz Musse

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