Population Health Economics
The HCI’s program on Population Health Economics (PHE) supports research on the linkages between population health, human capital and human well-being. Research in PHE focuses on how structural factors interact with human behavior to shape the health of populations, and how policies, programs and interventions can target these root causes of population health, accounting for behavioral responses.
Key themes that animate this work include: (1) the study of policies, programs and interventions in population health; (2) the economics of health decision-making; and (3) the relationships between health, human capital and longer-term well-being.
1) Interventions in Population Health: Policy interventions, from health systems to social policy to family planning, are an important determinant of population health in low- and middle-income countries. Research in this focus area approaches health systems interventions from a population health paradigm, asking how therapeutics can be delivered for the greatest benefit. Topics include disease management, the role of access and quality, algorithmic treatment guidelines, health systems performance and population health impact, and the use of “treatment-as-prevention” to control chronic infectious diseases such as HIV and TB.
2) Health Decision-Making: People make health decisions in the context of other competing needs, and often with limited information. Research in this focus area examines the role of traditional (prices, information) and non-traditional (choice architecture) factors that shape health behaviors and drive health decision making, particularly in resource-constrained settings.
3) Health and Human Capital: Research in this focus area looks at health as a form of human capital and studies the complementarities between investments in health, education, and other sources of human capital. Topics include the health impacts on productivity and labor market outcomes, the role of population and health on economic development and well-being, survival expectations and human capital investment, and health returns to educational investments.
Interventions in Population Health Featured Project: Networks and Global Health: Evidence from a Field Experiment in Rural India
HCI Associate Director Mahesh Karra is one of the principal investigators on a project that explored the role of women’s social networks on family planning and reproductive health outcomes in rural Uttar Pradesh, India. The project evaluated the impact of a social networks-based family planning intervention by means of a randomized experiment. Women who participated in the study received an informational brochure on the benefits of family planning, healthy birth spacing and timing of pregnancy. Women who were randomly assigned to the family planning intervention group additionally received a voucher for discounted access to family planning services at a high-quality private clinic in Jaunpur, Uttar Pradesh. Among women in the voucher group, a randomly selected subgroup of women was additionally encouraged to bring friends or peers to the clinic who might also be eligible to receive services. Karra and collaborators aimed to evaluate whether enabling women to bring peers to the clinic may allow them to overcome social and structural barriers to accessing family planning and reproductive health services. Findings from this project are explored in the 2020 paper “Curse of the Mummy-ji: The Influence of Mothers-in-law on Women’s Social Networks and Autonomy in Rural India.”
Health Decision Making Featured Project: Integrating U=U into HIV counseling in South Africa
HCI Core Faculty Member Jacob Bor, along with Dr. Dorina Onoya of the Health Economics and Epidemiology Research Office, have been awarded a grant by the National Institute of Mental Health for a project focused on a major HIV policy called undetectable=untransmittable (U=U). In addition to extending the lives of people living with HIV, antiretroviral therapy also prevents sexual transmission of the disease, and U=U refers to the strategy of treating HIV-positive individuals with ART to prevent transmission. Surveys have shown that knowledge of U=U is limited in South Africa. However, evidence also suggests that providing information on U=U can improve wellbeing for people living with HIV. Bor and Onoya’s project, scheduled to run until 2023, aims to develop an app-based educational video intervention that will provide locally-appropriate information on U=U and can be integrated into routine HIV counselling.
Health and Human Capital Featured Project: Investing in Secondary Schooling to Reduce HIV Risk
An additional project spearheaded by Bor centers around the impact of secondary education on HIV rates in Botswana. Previous research by Bor and collaborators found that one additional year of schooling—the result of a 1996 educational reform—reduced the ten-year cumulative incidence of HIV amongst individuals from 25 percent to 18 percent. In this National Institute of Child Health and Human Development-funded project, Bor evaluated how additional schooling shifted individuals’ behaviors and preferences in order to explain the reduction in HIV rates. Bor’s results will inform future interventions that aim to reduce HIV rates through formal education.
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