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12. Empirical Investigation of Declining Childbirth: Psychosocial and Economic Conditions in Japan
- Author:
- Tetsuji Yamada, Chia-Ching Chen, Chie Hanaoka, and Seiritsu Ogura
- Publication Date:
- 08-2013
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Background: For the past two decades, more and more women in certain European countries, Japan, and the United States are giving birth to their first child at a considerably later age than ever before. It remains unclear as to what extent this age-related general fertility decline is affected by changing social and cultural norms. Method: The Global Centers of Excellence Survey was conducted by Osaka University in Japan (n=5313) in 2009. Multivariate regression analyses were conducted to examine the impact of psychosocial norms, cultural differences, and economic conditions on the perception of childbearing. Results: The findings suggest that a subjective measure of happiness has a significant influence on childbearing. A society with income inequalities between classes discourages childbearing. It is observed that women's higher labor force participation generates a negative impact on motherchild relations which causes discouragement of childbearing. A higher female labor force participation stemmed from a transition of a traditional society into a modern and marketoriented society discourages childbearing. Conclusions/implications: A woman's decision to delay childbearing is based on her perception of psychosocial norms with surrounding economic environment and her own value of opportunity in the market oriented society. Childbearing also imposes psycho-economic burdens on the working population under mix of a traditional, patriarchal society, and a modern market oriented framework. Childbearing incentives could be a strategic policy to encourage positive attitudes of childbearing in general and proper welfare policy, labor law(s), employment conditions, and social security system for a working mother with a child or children.
- Topic:
- Economics, Gender Issues, Health, Poverty, Social Stratification, and Labor Issues
- Political Geography:
- United States, Japan, Europe, Israel, and Asia
13. Emerging Infectious Disease Surveillance in Southeast Asia: Cambodia, Indonesia, and the Naval Area Medical Research Unit 2
- Author:
- Sophal Ear
- Publication Date:
- 02-2012
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- 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 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.
- Topic:
- Agriculture, Economics, Health, Human Welfare, and Infrastructure
- Political Geography:
- Indonesia, Cambodia, and Southeast Asia
14. Pharmaceutical Price Regulation: Macro-Level Evidence from China between 1997 and 2008
- Author:
- Qiong Zhang, Binzhen Wu, and Xue Qiao
- Publication Date:
- 01-2012
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- This paper uses macro-level data between 1997 and 2008 to evaluate the effects of China's pharmaceutical price regulations. We find that these regulations had short-run effects on medicine price indexes, reducing them by less than 0.5 percentage points. The effects could have been slightly reinforced when these regulations were imposed on more medicines. However, these regulations failed to reduce household health expenditures and the average profitability of the pharmaceutical industry, and firms on the break-even edge were worse off. Finally, although these regulations have no significant effects on the price of substitutes or complements for medicines, they increased expensive medicine imports.
- Topic:
- Economics, Health, Human Welfare, Industrial Policy, International Trade and Finance, and Markets
- Political Geography:
- China
15. Recalibration of the Framingham Equations in the Thai Population
- Author:
- Panrasri Khonputsa, JL Veerman, M Bertram, S Yamwong, P Vathesatogkit, SS Lim, and T Vos
- Publication Date:
- 04-2011
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- We derived equations for predicting cardiovascular disease (CVD) risks for Thai men and women, separately, over a specific time period using associations between risk factors and CVD events from the Framingham cohort study. The equations were recalibrated against the cumulative risks estimated for Thailand. Equations were developed separately for predicting risks of ischemic heart disease (IHD) and stroke. Recalibration of the Framingham equations reduced the CVD risks predicted for Thai men by 97% and for Thai women by 10%. The correction was largest at younger ages. In older women, recalibration increased the predicted risk. When compared with an existing equation for Thai men our recalibrated Framingham equation produced similar predictions for CVD risks over 8 years. However, the recalibrated Framingham equations are more flexible because they can be used for predicting risks over any time span and for women and men.
- Topic:
- Demographics and Health
- Political Geography:
- Thailand and Southeast Asia
16. Prevention and Control of Chronic Non-communicable Disease in Nine Pacific Rim Cities
- Author:
- Karen Eggleston, Meng Kin Lin, Kun Chen, Yunxian Yu, Sung-Il Cho, Sian Griffiths, EK Yeoh, Jamal Hisham Hashim, Masamine Jimba, Carl Anderson Johnson, Paula Palmer, Vu-Anh Le, Huu-Bich Tran, Ngoc-Quang La, and Bambang Wispriyono
- Publication Date:
- 12-2010
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Populous, economically dynamic, and rapidly urbanizing, the Asia Pacific both reflects and strongly shapes trends in global public health. A comparative assessment of chronic disease prevalence, risk factors, and policy responses in nine Pacific Rim cities shows that chronic diseases are rapidly becoming the leading cause of morbidity and mortality even in the lower income cities of the Pacific Rim. Policy responses are heterogeneous, with few sufficiently funded or adequately informed by evidence. Much could be learned from comparative research and rigorous evaluation of prevention and control initiatives in this region.
- Topic:
- Globalization and Health
- Political Geography:
- Asia and Australia/Pacific
17. The Effect of Coresidence with an Adult Child on Depressive Symptoms among Older Widowed Women in South Korea: An Instrumental Variable Estimation
- Author:
- Young Kyung Do and Chetna Malhotra
- Publication Date:
- 11-2010
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- The objective of this paper is to estimate the causal effect of coresidence with an adult child on depressive symptoms among older widowed women in South Korea. Data from the first and second waves of the Korea Longitudinal Study of Aging were used. Analysis was restricted to widowed women aged ? 65 years with at least one living child (N=2,449). We use an instrumental variable approach that exploits the cultural setting where number of sons predicts the probability of an elderly woman's coresidence with an adult child but is not directly correlated with the mother's depressive symptoms. Our models adjust for age, education, total assets, residence, functional limitations, self-rated health, and various illnesses. Our robust estimation results indicate that, among older widowed women, coresidence with an adult child has a significant protective effect on depressive symptoms, but that this effect does not necessarily benefit those with clinically relevant depressive symptoms. Future demographic and social transitions in South Korea portend that older women's increasing vulnerability to poor mental health is an important though less visible public health challenge.
- Topic:
- Demographics, Gender Issues, and Health
- Political Geography:
- Israel and South Korea
18. Perverse Incentives in the Chinese Health System and Assessment of the April 2009 Reform
- Author:
- Meghan Bruce
- Publication Date:
- 10-2010
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Since 1978, China has been primarily market-focused in its provision of health care and social services. The market-driven health care system has been characterized by perverse incentives for individual providers, patients, and hospitals that are inducing improper provision of care: overprescription of pharmaceuticals and hightech testing, lack of effective primary care and gatekeeping, and competition for patients instead of referral. The national health care reform document that was made public in April 2009 recognizes this failure of the market in health care in China. The document suggests potential policies for improvement on the current system that are focused primarily on a targeted increase in government funding and an increased, changing role for the government. We assess the potential of this national health care reform to achieve the stated goals, and conclude that the reform as designed is necessary but insufficient. For the reform to meet its goals, the promised increase in funding should be accompanied by improved data collection, regional piloting, and a strong regulatory and purchasing role for the government in aligning incentives for individual and institutional payers, providers, and patients.
- Topic:
- Health and Markets
- Political Geography:
- China and Israel
19. Longevity, Capital Formation and Economic Development
- Author:
- Qiong Zhang
- Publication Date:
- 07-2010
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Many researchers have concluded that longer life expectancies prompt increased investment in education, as a prolonged labor supply raises the rate of return on education. Besides explaining the empirical evidence behind this conclusion (at an absolute level), there is another issue to be discussed: does time spent in studying and working increase proportionally with higher longevity? Building on an extended life-cycle model with an assumption on a more realistic distribution of life cycle mortality rates, this article considers dynamic effects of prolonging longevity on economic development by directly introducing changes in longevity into the economy, which is more preferable than comparative static analysis that relies on changes in relevant parameters. It shows that prolonged life expectancy will cause individuals to increase their time in education but may not warrant rises in labor input. Later we show that higher improvement rate of longevity will also promote economic growth, even we exclude the mechanism of human capital formation, and only consider growth effects of higher improvement rate of life expectancy from physical capital investment.
- Topic:
- Development, Economics, Education, Health, and Labor Issues
- Political Geography:
- United States and United Kingdom
20. Catastrophic Payments and Impoverishment Due to Out-of-Pocket Health Spending: The Effects of Recent Health Sector Reforms in India
- Author:
- Soumitra Ghosh
- Publication Date:
- 07-2010
- Content Type:
- Working Paper
- Institution:
- Walter H. Shorenstein Asia-Pacific Research Center
- Abstract:
- Out-of-pocket payments are the principal source of health care finance in most Asian countries, and India is no exception. This fact has important consequences for household living standards. In this paper the author explores significant changes in the 1990s and early 2000s that appear to have occurred as a result of out-of-pocket spending on health care in 16 Indian states. Using data from the National Sample Survey on consumption expenditure undertaken in 1993-94 and 2004-05, the author measures catastrophic payments and impoverishment due to out-of-pocket payments for health care. Considerable data on the magnitude, distribution and economic consequences of out-of-pocket payments in India are provided; when compared over the study period, these indicate that new policies have significantly increased both catastrophic expenditure and impoverishment.
- Topic:
- Economics, Health, and Social Stratification
- Political Geography:
- India
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