Long-Term Outcomes and Heterogeneity of Effects of Health Interventions in Matlab, Bangladesh
This research aims to better understand the impact of the Matlab health interventions by using panel data to control for unobservables and understand the dynamics and long-term effects of these programs. Heterogeneity in the fertility response to the family planning program is analyzed, using sequential fertility to isolate the family planning program from other interventions and examine heterogeneity based on time-varying characteristics. The link between childhood measles vaccination and school enrollment is examined using instrumental variables, and is motivated by the hypothesis that by avoiding the long-term health effects of a disease, vaccinated children are higher-achieving. Both analyses generate interesting findings that are not captured using the traditional methodologies and outcomes of program evaluation.
Julia Driessen, PhD, is an assistant professor of health policy and management in the Graduate School of Public Health at the University of Pittsburgh. She has a secondary appointment in the Department of Economics. In 2011 Dr. Driessen received her PhD in Economics from Johns Hopkins University. Her research interests include program evaluation and the links between health interventions and socioeconomic status, with an emphasis on heterogeneity of program effects as well as long-term outcomes. Recent research has analyzed the schooling effects of childhood measles vaccination and variation in the fertility response to a family planning program in Bangladesh. Her primary new interest since arriving at Pitt is the clinical and financial effects of electronic medical records in developing countries.
Daniel and Nancy Okimoto Conference Room
Intergenerational Living Arrangements in South Korea: Health and Economic Implications
Population aging in Asian societies is accompanied by changes in intergenerational living arrangements, which can have substantial health and economic implications for the elderly parents and their adult children. Dr. Young Kyung Do will present some of his recent works related to elderly living arrangements in South Korea. These works include the effect of coresidence with an adult child on depressive symptoms among older widowed women; the relationship between adult children's coresidence with parents and their labor force participation; and interrelations between expectations about bequests and informal care with special emphasis on the role of intergenerational coresidence. In these studies, Dr. Do attempted to account for a common methodological issue: living arrangements are not always randomly assigned but may be jointly decided with the outcome of interest taken into account by either the elderly parents or their adult children. While this seminar will focus on the South Korean context, the significance and implications apply to many other Asian societies undergoing population aging and marked transitions in elderly living arrangements.
Dr. Young Kyung Do is an assistant professor at the Duke-National University of Singapore Graduate Medical School (Duke-NUS), Program in Health Services and Systems Research. His research interests include the economic and health system impact of population aging and noncommunicable disease; interactions between self-care, informal care, and formal care interfaces; and health, education, and labor market outcomes over the life course. He received his MD (1997) and master of public health (2003) degrees from Seoul National University, subsequently completing his PhD in Health Policy and Management (2008) at the University of North Carolina at Chapel Hill. He was the inaugural Asia Health Policy postdoctoral fellow at the Shorenstein Asia-Pacific Research Center,(2008−9).
Daniel and Nancy Okimoto Conference Room
Young Kyung Do
Young Kyung Do is the inaugural Postdoctoral Fellow in the Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center. He completed his Ph.D. in health policy and administration at the University of North Carolina at Chapel Hill School of Public Health in August 2008. He has also earned M.D. and Master of Public Health degrees from Seoul National University (in 1997 and 2003, respectively). He earned board certification in preventive medicine from the Korean Medical Association in 2004. His research interests include population aging and health care, comparative health policy, health and development, quality of care, program evaluation, and quantitative methods in health research.
He received the First Prize Award in the Graduate Student Paper Competition in the Korea Labor and Income Panel Study Conference in 2007. He also is the recipient of the Harry T. Phillips Award for Outstanding Teaching by a Doctoral Student from the UNC Department of Health Policy and Administration in 2007. In May 2008, he was selected as a New Investigator in Global Health by the Global Health Council.
The Quality of Life and Mortality risk of Elderly People in Rural China: The Role of Family Support
The elderly share of China’s population is projected to grow well beyond the capacity of the nation’s social security system. Meanwhile, family care is being challenged by a decline in fertility and an increase in migration from rural to urban areas. This paper examines the short-, mid-, and long-term effects of family support on elderly well-being in rural China, using four-wave panel data on 1,456 persons aged 60 and above in the Chaohu region of China. Findings showed that compared with living alone, being coresident with others lowered the mortality risk of several chronic diseases; but being coresident with adult children increased the mortality risk of cardiovascular diseases, though it was associated with a higher quality of life in the short and middle term. Children’s educational attainment and financial support increased the quality of life except for an increased risk of new incidence of cardiovascular disease in the middle term.
Patterns of Elderly Life Expectancy in Three Chinese Cities: Hong Kong, Shanghai and Taipei
Life expectancy at aged 65 is remarkably similar in the three Chinese cities of Hong Kong, Shanghai, and Taipei, even though the cities differ in levels of socioeconomic development, health systems, and other factors. Edward Jow-Ching Tu will discuss research that aims to understand this phenomenon. Despite unprecedented increases in life expectancy and attainment of similar current levels of life expectancy, the cities differ in the contributions of changes in major causes of death to the improvements in life expectancy among the elderly. Tu and colleagues have explored several possible determinants of these different patterns and trends in the three cities, including socioeconomic development, health service delivery systems, cause-of-death classification systems, and competing risks from cardiovascular disease and other diseases. Their analysis suggests that the effect of equity of health service delivery has become more important over time.
Edward Jow-Ching Tu is a senior lecturer of demography in the Division of Social Science at Hong Kong University of Science and Technology. His work is focused on the impact of fertility, mortality, and migration on socio-economic changes in East Asia countries with special emphasis on nations experiencing a transition from planned economy to market economy; on causes and impacts of mortality changes and health transition on aging societies; and on the causes of lowest-low fertility in many East Asia countries. He has several active research projects ongoing in China, Japan, Taiwan, Hong Kong, and Singapore. He holds graduate degress from West Virginia University, the University of Pennsylvania, and the University of Tennessee (Knoxville). Tu has worked extensively in Asia, and has served as an adjunct professor and taught in many universities in China, including Peking University, Peoples University, Nankai Univerity, and Fudan University. He had served as a senior research scientist at the New York State Health Department and as a research fellow (full professor) at the Institute for Social Sciences and Philosophy at Academia Sinica. Tu has also taught at the State University of New York in Albany.
Philippines Conference Room
Emerging Infectious Disease Surveillance in Southeast Asia: Cambodia, Indonesia, and the Naval Area Medical Research Unit 2
Emerging infectious diseases (EIDs) pose international security threats because of their potential to inflict harm upon humans, crops, livestock, health infrastructure, and economies. The following questions stimulated the research described in this paper: What infrastructure is necessary to enable EID surveillance in developing countries? What cultural, political, and economic challenges stand in the way of setting up such infrastructure? And are there general principles that might guide engagement with developing countries and support EID surveillance infrastructure?
Using the U.S. Naval Area Medical Research Unit No. 2 as a common denominator, this paper compares barriers to EID surveillance in Cambodia and Indonesia and presents key factors—uncovered through extensive interviews—that constrain disease surveillance systems. In Cambodia, the key factors that emerged were low salaries; poor staff and human resources management; the effect of patronage networks; a culture of donor dependence; contrasting priorities between the government and international donors; and a lack of compensation for animal culling. The Cambodian military has also played a part. The government ceased a merit-based salary supplement scheme for civil servants after the military is alleged to have demanded similar pay incentives that donors had no interest in funding.
In Indonesia the key issues emerging as barriers to effective surveillance include poor host-donor relationships, including differing host-donor priorities and a misunderstanding of NAMRU-2 by Indonesian authorities; low salaries; a decline in the qualifications of personnel in the Ministry of Health; poor compensation for animal culling; and difficulties incentivizing local-level reporting in an era of decentralization.
As the interviews with in-country practitioners revealed, low levels of development in general are the main impediments to building EID surveillance infrastructure and are perhaps beyond the scope of health and scientific agencies at this point. Nevertheless, promoting greater understanding of these issues is a critical first step in mitigating negative outcomes.