The social value of health: A frontier analysis of life expectancy gaps across 33 European countries.

We estimate the life expectancy gaps that can be bridged by improving the quality of public health and health care policies at the country level. Our model calculates the net effect of amenable deaths on life expectancy after controlling for time effects and factors affecting amenable deaths related to education, health policies (health expenditure to GDP and waiting lists), and per capita income in a two equation system. We further estimate the life expectancy gap that countries with lower quality health systems can bridge by catching up and reaching the existing health quality frontier and compute the social value of that upside potential.

Excess mortality and protected areas during the COVID-19 pandemic: Evidence from Italian municipalities.

There is widespread debate on the drivers of heterogeneity of adverse COVID-19 pandemic outcomes and, more specifically, on the role played by context-specific factors. We contribute to this literature by testing the role of environmental factors as measured by environmentally protected areas. We test our research hypothesis by showing that the difference between the number of daily deaths per 1,000 inhabitants in 2020 and the 2018-19 average during the pandemic period is significantly lower in Italian municipalities located in environmentally protected areas such as national parks, regional parks, or Environmentally Protected Zones. After controlling for fixed effects and various concurring factors, municipalities with higher share of environmentally protected areas show significantly lower mortality during the pandemic than municipalities that do not benefit from such environmental amenities.

Reconciling human health with the environment while struggling against the COVID-19 pandemic through improved face mask eco-design.

Surgical masks have become critical for protecting human health against the COVID-19 pandemic, even though their environmental burden is a matter of ongoing debate. This study aimed at shedding light on the environmental impacts of single-use (i.e., MD-Type I) versus reusable (i.e., MD-Type IIR) face masks via a comparative life cycle assessment with a cradle-to-grave system boundary. We adopted a two-level analysis using the ReCiPe (H) method, considering both midpoint and endpoint categories. The results showed that reusable face masks created fewer impacts for most midpoint categories. At the endpoint level, reusable face masks were superior to single-use masks, producing scores of 16.16 and 84.20 MPt, respectively. The main environmental impacts of single-use masks were linked to raw material consumption, energy requirements and waste disposal, while the use phase and raw material consumption made the most significant contribution for reusable type. However, our results showed that lower environmental impacts of reusable face masks strongly depend on the use phase since reusable face masks lost their superior performance when the hand wash scenario was tested. Improvement of mask eco-design emerged as another key factor such as using more sustainable raw materials and designing better waste disposal scenarios could significantly lower the environmental impacts.

Particulate matter and COVID-19 excess deaths: Decomposing long-term exposure and short-term effects.

We investigate the time-varying effect of particulate matter (PM) on COVID-19 deaths in Italian municipalities. We find that the lagged moving averages of PM2.5 and PM10 are significantly related to higher excess deceases during the first wave of the disease, after controlling, among other factors, for time-varying mobility, regional and municipality fixed effects, the nonlinear contagion trend, and lockdown effects. Our findings are confirmed after accounting for potential endogeneity, heterogeneous pandemic dynamics, and spatial correlation through pooled and fixed-effect instrumental variable estimates using municipal and provincial data. In addition, we decompose the overall PM effect and find that both pre-COVID long-term exposure and short-term variation during the pandemic matter. In terms of magnitude, we observe that a 1 µg/m3 increase in PM2.5 can lead to up to 20% more deaths in Italian municipalities, which is equivalent to a 5.9% increase in mortality rate.

Understanding the heterogeneity of COVID-19 deaths and contagions: The role of air pollution and lockdown decisions.

The uneven geographical distribution of the novel coronavirus epidemic (COVID-19) in Italy is a puzzle given the intense flow of movements among the different geographical areas before lockdown decisions. To shed light on it, we test the effect of the quality of air (as measured by particulate matter and nitrogen dioxide) and lockdown restrictions on daily adverse COVID-19 outcomes during the first pandemic wave in the country. We find that air pollution is positively correlated with adverse outcomes of the pandemic, with lockdown being strongly significant and more effective in reducing deceases in more polluted areas. Results are robust to different methods including cross-section, pooled and fixed-effect panel regressions (controlling for spatial correlation), instrumental variable regressions, and difference-in-differences estimates of lockdown decisions through predicted counterfactual trends. They are consistent with the consolidated body of literature in previous medical studies suggesting that poor quality of air creates chronic exposure to adverse outcomes from respiratory diseases. The estimated correlation does not change when accounting for other factors such as temperature, commuting flows, quality of regional health systems, share of public transport users, population density, the presence of Chinese community, and proxies for industry breakdown such as the share of small (artisan) firms. Our findings provide suggestions for investigating uneven geographical distribution patterns in other countries, and have implications for environmental and lockdown policies.

The Gender Life Satisfaction/Depression Paradox.

According to the gender life satisfaction/depression paradox women are significantly more likely to report higher levels of life satisfaction than men after controlling for all relevant socio-demographic factors, but also significantly more likely to declare they are depressed. We find that the paradox holds in the cross-country sample of the European Social Survey and is stable across age, education, self-assessed health, macroregion and survey round splits. We find support for the affect intensity rationale showing that women are relatively more affected in their satisfaction about life by the good or bad events or achievements occurring during their existence and less resilient (less likely to revert to their standard levels of happiness after a shock). We as well discuss biological, genetic, cultural, personality rationales advocated in the literature that can explain our findings.

Vaccine uptake and constrained decision making: The case of Covid-19.

Policy makers require support in conceptualizing and assessing the impact that vaccination policies can have on the proportion of the population being vaccinated against COVID-19. To this purpose, we propose a behavioural economics-based framework to model vaccination choices. We calibrate our model using up-to-date surveys on people attitudes toward vaccination as well as estimates of COVID-19 infection and mortality rates and vaccine efficacy for the UK population. Our findings show that vaccine campaigns hardly reach herd immunity if the sceptics have real-time information on the proportion of the population being vaccinated and the negationists do not change their attitudes toward vaccination. Based on our results, we discuss the main implications of the model's application in the context of nudging and voluntariness versus mandatory rule-based policies.

Air quality and COVID-19 adverse outcomes: Divergent views and experimental findings.

BACKGROUND: The questioned link between air pollution and coronavirus disease 2019 (COVID-19) spreading or related mortality represents a hot topic that has immediately been regarded in the light of divergent views. A first "school of thought" advocates that what matters are only standard epidemiological variables (i.e. frequency of interactions in proportion of the viral charge). A second school of thought argues that co-factors such as quality of air play an important role too. METHODS: We analyzed available literature concerning the link between air quality, as measured by different pollutants and a number of COVID-19 outcomes, such as number of positive cases, deaths, and excess mortality rates. We reviewed several studies conducted worldwide and discussing many different methodological approaches aimed at investigating causality associations. RESULTS: Our paper reviewed the most recent empirical researches documenting the existence of a huge evidence produced worldwide concerning the role played by air pollution on health in general and on COVID-19 outcomes in particular. These results support both research hypotheses, i.e. long-term exposure effects and short-term consequences (including the hypothesis of particulate matter acting as viral "carrier") according to the two schools of thought, respectively. CONCLUSIONS: The link between air pollution and COVID-19 outcomes is strong and robust as resulting from many different research methodologies. Policy implications should be drawn from a "rational" assessment of these findings as "not taking any action" represents an action itself.

Not feeling well true or exaggerated? Self-assessed health as a leading health indicator.

We provide original, international evidence documenting that self-assessed health (SAH) is a leading health indicator, that is, a significant predictor of future changes in health conditions, in a large sample of Europeans aged above 50 and living in 13 different countries. We find that, after controlling for attrition bias, lagged SAH is significantly and negatively correlated with changes in the number of chronic diseases, net of the correlations with levels, and changes in sociodemographic factors and health styles, country and regional health system effects, and declared symptoms. Illness-specific estimates document that lagged SAH significantly correlates with arthritis, cholesterol, and lung diseases (and weakly so with ulcer, hypertension, and cataracts) and has a significant correlation with the probability of contracting cancer. Interpretations and policy implications of our findings are discussed in the paper.

The impact of health expenditure on the number of chronic diseases.

We investigate the impact of health expenditure on health outcomes on a large sample of Europeans aged above 50 using individual and regional level data. We find a negative and significant effect of lagged health expenditure on subsequent changes in the number of chronic diseases. This effect varies according to age, health behavior, gender, income, and education. Our empirical findings are confirmed also when health expenditure is instrumented with parliament political composition.