Health insurance and child mortality: Evidence from India.

Although less than a third of the population in developing countries is covered by health insurance, the number has been on the rise. Many countries have implemented national insurance policies in the past decade. However, there is limited evidence on their impact on child mortality in low- and middle-income contexts. Here we document the child mortality reducing effects of an at-scale national level health insurance policy in India. The Rashtriya Swasthya Bima Yojana (RSBY), was rolled out across India between 2008 and 2013. Leveraging the temporal and spatial variation in program implementation, we demonstrate that it lowered infant mortality by 6% and child under five mortality by 5%. The effects are largely concentrated among urban poor households. In terms of mechanisms, we find that the program effects seem to be driven by increased usage of reproductive health services by mothers. We also demonstrate a rise in usage of complementary health services that were were not covered under the policy (such as child immunizations), which suggests that RSBY had significant positive spillover effects on health care usage.

Transitioning to an obese India: Demographic and structural determinants of the rapid rise in overweight incidence.

India, which has long suffered from undernutrition, has seen a rapid rise in overweight incidence in the last decade and a half. These changes are characterized by significant within-country differences in overweight incidence that vary by gender and regional development levels. In this paper, we provide an integrative framework, linking the income-gradient hypothesis of obesity with biological, obesogenic, and environmental factors to provide an explanation on the emergence of within-country differences in overweight patterns. We utilize measured body mass index (BMI), along with individual- and household-level data of over 800,000 men and women surveyed in the National Family Health Surveys of 2005-06 and 2015-16 to identify correlates of within-country differences in overweight incidence. A decomposition analysis reveals that among women, in addition to increasing access to obesogenic technologies, biological factors are associated with overweight incidence. Among men, obesogenic factors related to technology use and health behaviors are associated with the rise in overweight incidence, but biological factors are not. At lower levels of regional development, overweight incidence is associated with greater access to obesogenic technology such as motorized transport, which reduces physical activity among men at higher rates than women. At higher levels of economic development, obesogenic behaviors, such as watching more television and reducing smoking, are associated with overweight incidence. Our results corroborate the call by public health experts for group-specific policies to stem the rise of overweight incidence in developing countries.

Pandemics and food systems - towards a proactive food safety approach to disease prevention & management.

Recent large-scale pandemics such as the covid19, H1N1, Swine flu, Ebola and the Nipah virus, which impacted human health and livelihoods, have come about due to inadequate food systems safeguards to detect, trace and eliminate threats arising from zoonotic diseases. Such diseases are transmitted to humans through their interaction with animals in the food value chain including through the consumption of bush meat. Climate change has also facilitated the emergence of new zoonotic diseases. The lack of adequately enforced food-safety standards in managed agricultural production systems creates the necessary conditions for diseases to mutate into highly contagious strains. The lack of food safety measures in handling, packaging and sales of food increases risks of cross-species contamination. Finally, increasing anti-microbial resistance, combined with rapid urbanization and global interconnectedness allows diseases to spread rapidly among humans. Thus, part of the reconstruction efforts, post covid19, should include prioritizing proactive investments in food safety. The key to stave off another such pandemic lies in integrating one-health knowledge on zoonotic diseases along with food safety measures along the food value chain. Refocusing policy priorities from disease control to prevention will improve international coordination efforts in pandemic prevention. Implementing such proactive actions will cost a very small fraction of the reconstruction budgets. However, the expected benefits of the food-safety approach will include preventing global economic losses due to pandemics.