Economic evaluation of vaccination: capturing the full benefits, with an application to human papillomavirus.

Vaccination has been among the greatest contributors to the past century's dramatic improvements in health and life expectancy. Recent advances in vaccinology have resulted in new vaccines that will likely lead to substantial future health gains. However, the high cost of these new vaccines, such as the human papillomavirus (HPV) vaccine, poses an obstacle to their widespread adoption in many countries. Economic evaluation can help to determine if investment in vaccine introduction is worthwhile. However, existing economic evaluations usually focus on a narrow set of vaccination-mediated benefits-most notably avoided medical-care costs-and fail to account for several categories of potentially important gains. We consider three sources of such benefit and discuss them with respect to HPV vaccination: (i) outcome-related productivity gains, (ii) behaviour-related productivity gains, and (iii) externalities. We also highlight that HPV vaccination protects against more than just cervical cancer and that these other health gains should be taken into account. Failing to account for these broader benefits of HPV vaccination could result in substantial underestimation of the value of HPV vaccination, thereby leading to ill-founded decisions regarding its introduction into national immunization programmes.

Prevalence estimate of intimate partner violence in Jordan.

This study examined the prevalence of intimate partner violence in Jordan among a sample of 517 reproductive health clinic attendees. Intimate partner violence was measured using the World Health Organization's domestic violence questionnaire which was modified by the results of focus group discussions conducted in Amman. The percentages of women experiencing at least 1 form of control or violence since marriage were: control, 97.2%; psychological violence, 73.4%; physical violence, 31.2%; and sexual violence, 18.8%. Modifications of the WHO questionnaire were needed to measure control and psychological violence in Jordan. Similar modifications might be required when conducting research in the Region.

Prevalence estimate of intimate partner violence in Jordan

This study examined the prevalence of intimate partner violence in Jordan among a sample of 517 reproductive health clinic attendees. Intimate partner violence was measured using the World Health Organization's domestic violence questionnaire which was modified by the results of focus group discussions conducted in Amman. The percentages of women experiencing at least 1 form of control or violence since marriage were: control, 97.2%; psychological violence, 73.4%; physical violence, 31.2%; and sexual violence, 18.8%. Modifications of the WHO questionnaire were needed to measure control and psychological violence in Jordan. Similar modifications might be required when conducting research in the Region

A moment in time: AIDS and business.

Business has transformed the planet. But this gives it new responsibilities. People now expect business leaders to lead--and not just respond when things go wrong. HIV/AIDS is a global problem, with over 16.3 million people now thought to have died of the disease (Global Summary of HIV/AIDS Epidemic, UNAIDS, December 1999). Without action now, the pandemic will worsen, health services will come under relentless pressure and the number of people dying will increase exponentially. So why should business sit up and take notice? First: money. AIDS is slowly strangling many businesses and economies--and in a global market, everyone eventually suffers. Without profit, there is no business--so the business community needs to act to protect its bottom line. Second: people. Over 80% of those dying are in their 20s, 30s, and 40s. Businesses are losing workers and customers, and human networks that have taken decades to build. Third: imagination. Business is inventive, creative and fast-moving. It has the opportunity to use these strengths for the benefit of the wider community. It's time to pit business ideas (and some money, too) against the threat of AIDS. The course of the AIDS epidemic is not inevitable. The world's businesses have the skills and intensity to make a measurable difference, especially if they find public sector and NGO partners with whom they share a vision. A focused, coordinated, results-driven effort will hit AIDS hard. The HIV virus moves fast (and is mutating all the time). Business has the opportunity to make a difference. It must grasp this opportunity. And grasp if fast.

Something to be done: treating HIV/AIDS. River Path Associates.

Largely because of disparities in access to drug treatment and care, AIDS morbidity and mortality have fallen in the developed world but continue to rise among developing countries. Achieving more equitable access to AIDS drugs is hindered by high drug prices, technical complexities related to the provision of health care, and conflict among stakeholders. Recognition that health is vital to the prospects of the emerging global society must be combined with new mechanisms to help all stakeholders work together cooperatively. Tiered drugs pricing should be coupled with investment in health services. An independent "Global Task Force," able to act as an "active think tank," could build consensus about the way forward.

Geography, demography, and economic growth in Africa.

PIP: This paper presents the effects of climate, topography, and natural ecology on public health, nutrition, demographics, technological diffusion, international trade and other determinants of economic development in Africa. The goal of this paper is to emphasize the need for intensified research on the issues at the intersection of ecology and human society. Geography was given emphasis because of three reasons: the minimal gain from another recitation of the damage caused by statism, protectionism and corruption to African economic performance; negligence of the role of natural forces in shaping economic performance; and tailoring of policies to geographical realities. The paper also discusses the general problems of tropical development and the focus of Africa's problems in worldwide tropical perspectives; demographic trends in Africa; use of standard cross-country growth equations with demographic and geographic variables, to account for the relative roles of geography; and the future growth strategies and the need for urban-based export growth in manufacturing and services. Lastly, the authors provide a summary of conclusions and discuss the agenda for future research.^ieng

The changing labour market position of Canadian immigrants.

"This paper uses pooled 1971, 1981, and 1986 Canadian census data to evaluate the extent to which (1) the earnings of Canadian immigrants at the time of immigration fall short of the earnings of comparable Canadian-born individuals, and (2) immigrants' earnings grow more rapidly over time than those of the Canadian born. Variations in the labour market assimilation of immigrants according to their gender and country of origin are also analysed. The results suggest that recent immigrant cohorts have had more difficulty being assimilated into the Canadian labour market than earlier ones, an apparent consequence of recent changes in Canadian immigration policy, labour market discrimination against visible minorities, and the prolonged recession of the early 1980s." (SUMMARY IN FRE)

International public opinion on the environment.

This article analyzes public opinion data on environmental issues collected in two major surveys. The data reveal substantial concern about the environment in both developing and industrial countries along with perceptions that the quality of the environment has declined and will continue to decline. Developing country respondents rate their local and national environmental quality lower than do industrial country respondents, whereas both groups rate global environmental quality about the same. The data also reveal considerable willingness among the developing and industrial countries to accept responsibility for the world's environmental problems and recognition of the importance of governments in addressing local and national environmental issues and of strong international agencies in addressing transnational issues.

The influence of nonmarital childbearing on the formation of first marriages.

We document a negative association between nonmarital childbearing and the subsequent likelihood of first marriage in the United States, controlling for a variety of potentially confounding influences. Nonmarital childbearing does not appear to be driven by low expectations of future marriage. Rather, it tends to be an unexpected and unwanted event, whose effects on a woman's subsequent likelihood of first marriage are negative on balance. We find that women who bear a child outside marriage and who receive welfare have a particularly low probability of marrying subsequently, although there is no evidence that AFDC recipients have lower expectations of marriage. In addition, we find no evidence that stigma associated with nonmarital childbearing plays an important role in this process or that the demands of children significantly reduce unmarried mothers' time for marriage market activities.

Fertility timing, wages, and human capital.

PIP: This theoretical model posits that women who delay child bearing will be more likely to invest in human capital (training that enhances productivity but is costly). This investment is conditioned by a greater discount rate than an economy-wide growth rate of wages for non-human capital investor women. The aim of the model is to present a more unified view of relationships between wages and fertility timing identified in earlier research. The empirical analyses, using ordinary least squares techniques, was based on data from the National Longitudinal Survey of Young Women, 1968-82 annually, for a sample of 1817 White working women aged 28-38 in 1982. Data were available for wages, education, work experience, age, number of children, and the percentage in occupations (manager, professional, administrative, service, and blue collar). First wages of women not in school and without a first birth were obtained for 991 women in the sample. Descriptive statistics revealed that the average early wage of late child bearers was 37% higher than the average early wage of early child bearers and 43% higher for 1982 wages. Childless women, compared to early child bearers, experienced a growth in wages from 31-38%. The assumptions in the theoretical model were 1) that all women were equally productive in the labor market in the beginning; 2) that women bore only one child; 3) that women worked continuously for a period of time, except for time out for child bearing; 4) that all women had the option of investing in one type of human capital, which cost the same for all women; 5) that the only source of income was the woman's own earnings; and 6) that a woman's lifetime utility was a function of the present value of her lifetime income and the intervening time period for child birth. Differences in education, experience, tenure, and wages were strongly associated with differences in fertility timing. The results revealed that wages were higher for delayed child bearers, primarily because of larger accumulations of human capital, assuming joint human capital and fertility timing decisions. The interpretation of regressions to test family influence was that unobserved heterogeneity partly explained the empirical relationship. Wages were affected by education, experience, and tenure, as proxies for human capital. Results were consistent with the hypothesis but did not confirm the theory.^ieng

Projecting the number of new AIDS cases in the United States.

"This paper reviews the two leading methods used to project the number of AIDS cases: back calculation and extrapolation. These methods are assessed in light of key features of the HIV/AIDS epidemic and of data on the epidemic; they are also assessed in terms of the quality of the projections they yield. Our analysis shows that both methods have tended to overproject, often by sizable amounts, the number of AIDS cases in the United States....A new method for projecting AIDS cases is proposed that exploits knowledge about the process generating AIDS cases and that incorporates readily available information about rates of new HIV infection.... Relative to the method of extrapolation, this method projects 22,000 fewer new AIDS cases for 1995 (a 36% difference). This method also projects that intravenous drug users will replace homosexual/bisexual men as the dominant transmission category for AIDS."

Benefits and costs of HIV testing.

The benefits and costs of human immunodeficiency virus (HIV) testing in employment settings are examined from two points of view: that of private employers whose profitability may be affected by their testing policies and that of public policy-makers who may affect social welfare through their design of regulations related to HIV testing. The results reveal that HIV testing is clearly not cost-beneficial for most firms, although the benefits of HIV testing may outweigh the costs for some large firms that offer generous fringe-benefit packages and that recruit workers from populations in which the prevalence of HIV infection is high. The analysis also indicates that the testing decisions of unregulated employers are not likely to yield socially optimal economic outcomes and that existing state and federal legislation related to HIV testing in employment settings has been motivated primarily by concerns over social equity.

Modeling American marriage patterns.

"This article investigates the application of the three-parameter, Coale-McNeil marriage model and some related hyperparameterized specifications to data on the first marriage patterns of American women. Because the model is parametric, it can be used to estimate the parameters of the marriage process for cohorts that have yet to complete their first marriage experience. Empirical evidence from three surveys is reported on the ability of the model to replicate and project observed marriage behavior. The results indicate that the model can be a useful tool for analyzing cohort marriage data and that recent cohorts are showing relatively strong proclivities to both delay and forego marriage. Consistent with earlier work, the results also indicate that education is a powerful covariate of the timing of first marriage and that race is a powerful covariate of its incidence." Data are from the U.S. Current Population Survey for 1976 and 1985 and Cycle III of the National Survey of Family Growth for 1982.

The evolution of AIDS economic research.

This paper reviews the progress made by economists in their research on the AIDS epidemic. Three main conclusions are drawn. First, the direct economic impact of AIDS in the U.S. (i.e. personal medical care costs and foregone earnings due to morbidity and premature mortality) is not likely to be large on a national level through the early 1990s, although its impact will be large in certain regions of the country. Second, the large direct impact in certain regions implies that the epidemic may have serious economic repercussions that extend beyond the health sector of the economy. This raises a number of important research issues, many of which economists have not yet begun to address. Third, all of the key ingredients for conducting effective research on several of these important new issues - theory, data, and empirical methods - are currently available. This last conclusion is illustrated by an analysis of the labor market impact of the AIDS epidemic.

The labour-market consequences of generational crowding.

PIP: This paper attempts to distinguish between two alternative views of the labour-market problems faced by young workers in a number of industrialized countries in the 1970s and early 1980s. The first view is that the low relative earnings and high unemployment rates experienced by these cohorts were largely age-related; the second is that they are a consequence of large cohort size. A multi-country empirical analysis indicates that large cohort size tends to have a negative effect on the expected earnings...of a cohort there is, moreover, a marked tradeoff between the relative-earnings effect and the relative-employment effect, with large cohort sizes reducing relative earnings in some countries and relative employment in others. More detailed data for the U.S.A. show that the relatively low wages and high unemployment of the 'unlucky' cohorts have tended to converge to the patterns that would have resulted had the cohorts been more 'normal' in size, but that their lifetime income has been permanently reduced. Finally, baby-boom cohorts in several countries are shown to have been absorbed in a wide range of industries rather than through expansion of the traditionally youth-intensive industries. (author's modified)^ieng