Ill-health as a household norm: Evidence from other people's health problems

This paper proposes that an individual's self-assessed health (SAH) does not only suffer from systematic reporting bias and adaptation bias but is also biased owing to confounding health norm effects. Using 13 waves of the British Household Panel Survey covering the period 1991–2005, I show that, while there is a negative and statistically significant correlation between SAH and individuals' own health problem index, this negative effect reduces with the average number of health problems per (other) family member. The relative health bias is small, however, which implies that measures of SAH may not suffer seriously from systematic health norm bias. This is an important finding for researchers working with SAH data as it indicates that we do not have to worry too much about controlling for confounding influences from the health of other household members when estimating SAH regression equations.     

Investigating the relationship between formal and informal care: An application using panel data for people living together

There is limited evidence on the relationship between formal and informal care using panel data in a U.K. setting and focused specifically on people living together (co‐residents). Using all 18 waves of the British Household Panel Survey (1991–2009), we analyse the effect of informal care given by co‐residents on the use of formal home care and health care services more generally. To account for endogeneity, we estimate models using random effects instrumental variable regression using the number of daughters as a source of exogenous variation. We find that a 10% increase in the monthly provision of informal care hours decreases the probability of using home help (formal home care) by 1.02 percentage points (p < .05), equivalent to a 15.62% relative reduction. This effect was larger for home help provided by the state (β = ?.117) compared with non‐state home help (β = ?.044). These results provide evidence that significant increases in the supply of informal care would reduce the demand for home‐help provision.     

Do Public Smoking Bans have an Impact on Active Smoking? Evidence from the UK

The literature on the effects of public smoking bans on smoking behaviour presents conflicting results and there is limited evidence on their impact on active smoking. This paper evaluates the impact of smoking bans on active smoking using data from the British Household Panel Survey and exploiting the policy experiment provided by the differential timing of the introduction of the bans in Scotland and England. We assess the short‐term impact of the smoking bans by employing a series of flexible difference‐in‐differences fixed effects panel data models. We find that the introduction of the public smoking bans in England and Scotland had limited short‐run effects on both smoking prevalence and the total level of smoking. Although we identify significant differences in trends in smoking consumption across the survey period by population sub‐groups, we find insufficient evidence to conclude that these were affected by the introduction of the smoking bans. These results challenge those found in the public health literature but are in line with the most recent strand of economic literature indicating that there is no firm evidence on the effects of smoking bans on smoking. Copyright © 2013 John Wiley & Sons, Ltd.     

“I'm afraid I have bad news for you…” Estimating the impact of different health impairments on subjective well-being

Bad health decreases individuals' happiness, but few studies measure the impact of specific illnesses. We apply matching estimators to examine how changes in different (objective) conditions of bad health affect subjective well-being for a sample of 100,265 observations from the British Household Panel Survey (BHPS) database (1996–2006). The strongest effect is for alcohol and drug abuse, followed by anxiety, depression and other mental illnesses, stroke and cancer. Adaptation to health impairments varies across health impairments. There is also a puzzling asymmetry: strong adverse reactions to deteriorations in health appear alongside weak increases in well-being after health improvements. In conclusion, our analysis offers a more detailed account of how bad health influences happiness than accounts focusing on how bad self-assessed health affects individual well-being.     

Measurement and explanation of socioeconomic inequality in health with longitudinal data

This paper presents a method to compare indices of inequality in health that are based on short-run and long-run measures of health and income. For pure health inequality (as measured by the Gini coefficient) and income-related health inequality (as measured by the concentration index), we show how measures derived from longitudinal data can be related to cross section Gini and concentration indices that have been typically reported in the literature to date, along with measures of health mobility inspired by the literature on income mobility. We also show how these measures of mobility can be usefully decomposed into the contributions of different factors. We apply these methods to investigate the degree of income-related mobility in the GHQ measure of psychological well-being in the first nine waves of the British Household Panel Survey (BHPS). This reveals that dynamics increase the absolute value of the concentration index of GHQ on income by 15%, or 1.7% per year on average, for men, and 5%, or 0.6% per year, for women.     

Economic Evaluation of the effect of Quitting Smoking on Weight Gains: Evidence from the United Kingdom

ObjectiveThis article estimated the causal effect of quitting smoking on body weight gains in the United Kingdom to evaluate whether savings in health costs deriving from smoking prevention and its related diseases are greater than the costs associated with increased obesity.MethodsWe used a longitudinal data set extracted from two waves (2004–2006) of the British Household Panel Survey, which includes information on smoking and a large number of sociodemographic variables. We modeled the effect of quitting smoking on body weight accounting for heterogeneous responses from individuals belonging to different clinical classes of body mass index (BMI) (i.e., overweight and obese individuals). National Health Service costs associated with smoking were then used to implement a cost-benefit analysis, comparing the advantages of smoking reductions with the costs associated with increased obesity.ResultsThe BMI was found to increase by 0.26 points for quitters compared with those who continued to smoke. The estimated BMI increase was larger for overweight (0.49 points) and obese (0.76 points) people. This result does not change when different control groups are examined. From an economic perspective, the National Health Service cost reductions attributable to quitting smoking were £156.81 million whereas the lost benefit for unintended increases in body weight was £24.07 million.ConclusionsThis article found that the health benefits associated with quitting smoking are greater than the costs associated with increased overweight and obesity.     

EX‐ANTE AND EX‐POST MEASUREMENT OF EQUALITY OF OPPORTUNITY IN HEALTH: A NORMATIVE DECOMPOSITION

This paper proposes and discusses two different approaches to the definition of inequality in health: the ex‐ante and the ex‐post approach. It proposes strategies for measuring inequality of opportunity in health based on the path‐independent Atkinson equality index. The proposed methodology is illustrated using data from the British Household Panel Survey; the results suggest that in the period 2000–2005, at least one‐third of the observed health equalities in the UK were equalities of opportunity. Copyright © 2013 John Wiley & Sons, Ltd.     

Variations in preventive care utilisation in Europe

Prevention has been identified as an effective strategy to lead healthy, active and independent lives in old age. Developing effective prevention programs requires understanding the influence of both individual and health system level factors on utilisation of specific services. This study examines the variations in utilisation of preventive services by the population aged 50 and over in 14 European countries, pooling data from the two waves of Survey of Health Ageing and Retirement in Europe and the British Household Panel Survey. The models used allow for the impact of individual level demand-side characteristics and supply-side health systems features to be separately identified. The analysis shows significant variations in preventive care utilisation both within and across European countries. In all countries, controlling for individual health status and country-level systemic differences, higher educated and higher income groups use more preventive services. At the health system level, high public health expenditures and high GP density is associated with a high level of preventive care use, but specialist density does not appear to have any effect. Moreover, payment schemes for GPs and specialists appear to significantly affect the incentives to provide preventive health care. In systems where doctors are paid by fee-for-service the utilisation of all health services, including cancer screening, are higher.     

What happens to people before and after disability? Focusing effects,lead effects,and adaptation in different areas of life

This paper addresses the question of when and to what extent different areas of a person's life are affected by mild and severe disability. We use a nationally representative longitudinal dataset of British individuals to examine what happens to seven different areas of life – health, income, housing, partner, social life, amount of leisure time, and use of leisure time – before and after disability. We found that although there is some evidence of lead effects to becoming disabled in more than one aspects of life, the strongest lead effects are found in the health domain. Disability has a negative impact on satisfactions with income, social life, and use of leisure time, but is positively associated with the levels of satisfaction with amount of leisure time. Adaptation takes place in almost all of the affected life domains for both disabled groups, but is often incomplete for the severely disabled. Finally, this paper proposes a two-layer model to study leads and lags in life satisfaction to different life events.     

What is the relationship between income inequality and health? Evidence from the BHPS

Income inequality hypotheses propose that income differentials and/or income distributions have a detrimental effect on health. This previously well accepted relationship between inequality and health has recently come under scrutiny; some claim that it is a statistical artefact, arguing that aggregate level data are not sophisticated enough to adequately test for (and discriminate between) their existence. Supporters argue that it is a question of estimating the relationship using, amongst other things, an appropriate geographical scale. This paper adds to the debate by estimating the relationship between income inequality and health using individual panel data, exploring the relationship at the regional as well as the national level, while attempting to discriminate between the competing hypotheses. Pooled, random and fixed effects ordered probit models are exploited to estimate the relationship between self-reported health and household income, income inequality and relative income. While the estimating regressions find support for the absolute income hypothesis, there is no support for the income inequality hypothesis or relative income hypothesis, and as such we argue that there is limited evidence of an effect of income inequality on health within Britain.