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Die Fortpflanzungsmedizin stellt medizinisch-technische Optionen bei unerfülltem Kinderwunsch bereit. Dazu zählen alle Behandlungen und Verfahren, die den Umgang mit menschlichen Eizellen, Spermien oder Embryonen mit dem Ziel umfassen, eine Schwangerschaft und die Geburt eines Kindes herbeizuführen. Dieses Buch skizziert Art, Häufigkeiten und Ursachen von Fruchtbarkeitsstörungen. Die Autoren beschreiben alle aktuellen Lösungsansätze, die durch die Reproduktionsmedizin zur Herbeiführung einer Schwangerschaft und der Geburt eines Kindes bereitgestellt werden. Sie thematisieren ausführlich, welche gesundheitlichen Folgen und Risiken sowie psychischen Belastungen mit reproduktionsmedizinischen Behandlungen assoziiert sind und inwieweit sie verringert bzw. vermieden werden können. Erstmals werden die Wirksamkeit und die Erfolgsraten der Verfahren in der klinischen Praxis in Deutschland, in Europa sowie in weiteren Ländern vergleichend analysiert und diskutiert. Die Erörterung einer möglichen Weiterentwicklung des gesetzlichen Rahmens in Deutschland sowie ein Ausblick auf Handlungsoptionen für die deutsche Politik und auf notwendigen gesellschaftlichen Klärungsbedarf runden die Analyse ab. INHALT ZUSAMMENFASSUNG 5 I. EINLEITUNG 17 1. Beauftragung und Anliegen des Berichts 19 2. Gutachter und Danksagung 22 II. FERTILITÄTSSTÖRUNGEN UND ART-VERFAHREN 23 1. Fertilität, Infertilität und Sterilität 23 2. Diagnostik von Fruchtbarkeitsstörungen 26 2.1 Medizinische Diagnostik weiblicher Fertilitätsstörungen 28 2.2 Medizinische Diagnostik männlicher Fertilitätsstörungen 30 2.3 Psychosomatische Diagnostik 31 2.4 Molekulare Faktoren der Fertilitätsbeeinflussung 32 2.5 Indikationen für reproduktionsmedizinische Behandlungen 33 3. Reproduktionsmedizinische Verfahren 36 3.1 Chirurgische Eingriffe 36 3.2 In-vitro-Fertilisation (IVF) 37 3.3 Intracytoplasmatische Spermieninjektion (ICSI) 39 3.4 Qualitätsbeurteilung von Gameten, imprägnierten Eizellen und Embryonen 40 3.5 Kryokonservierung 43 III. ASSISTIERTE REPRODUKTION IN DER KLINISCHEN PRAXIS 45 1. Assistierte Reproduktion in Deutschland 48 1.1 Versorgung mit ART 48 1.2 Erfolgsraten der ART 52 1.3 Mehrlingsschwangerschaften und -geburten 59 2. Assistierte Reproduktion in Europa 62 2.1 Versorgung mit ART 63 2.2 Erfolgsraten der ART 68 2.3 Mehrlingsschwangerschaften und -geburten 72 3. Assistierte Reproduktion in den USA 78 3.1 Versorgung mit ART 78 3.2 Erfolgsraten der ART 80 3.3 Mehrlingsschwangerschaften und -geburten 83 4. Assistierte Reproduktion weltweit 85 4.1 Versorgung mit ART 85 4.2 Erfolgsraten der ART 88 4.3 Mehrlingsschwangerschaften und -geburten 89 5. Datenkritik 90 5.1 Vollständigkeit, Qualität, Vergleichbarkeit 90 5.2 Indikatoren für den »Erfolg« einer ART-Behandlung 91 6. Diskussion 94 IV. FOLGEN UND RISIKEN REPRODUKTIONSMEDIZINISCHER VERFAHREN 101 1. Gesundheitliche Risiken für Frauen 104 1.1 Ovarielle Stimulation 105 1.2 Eizellentnahme 110 1.3 Extrauteringravidität 110 1.4 Spontanabort 111 1.5 Bluthochdruck, Präeklampsie, Placenta praevia 112 1.6 Beckenendlage, Steißgeburt, Kaiserschnitt 113 1.7 Totgeburten 114 2. Gesundheitliche Risiken für Kinder 114 2.1 Angeborene Fehlbildungen 115 2.2 Fehlerhaftes Imprinting 117 2.3 Gesundheitszustand in der Perinatalphase 118 2.4 Gesundheitszustand im Kindesalter 119 3. Mehrlingsschwangerschaften und -geburten 125 3.1 Häufigkeiten 125 3.2 Gesundheitliche Risiken 128 3.3 Präventionsmaßnahmen 131 4. Diskussion 136 V. PSYCHOSOZIALE ASPEKTE 145 1. Erleben von Sub- und Infertilität sowie der reproduktionsmedizinischen Behandlungen 145 1.1 Lebenssituation ungewollt kinderloser Paare 147 1.2 Entscheidungsmotive für bzw. gegen reproduktionsmedizinische Behandlungen 150 1.3 Erleben der reproduktionsmedizinischen Behandlung 151 1.4 Erleben von Schwangerschaft und Geburt 154 2. Elternschaft und Kindesentwicklung nach reproduktionsmedizinischer Behandlung 155 2.1 Elternschaft und Kindesentwicklung nach IVF und ICSI 156 2.2 Elternschaft und Kindesentwicklung nach donogener Behandlung 157 2.3 Elternschaft nach Embryospende 165 2.4 Elternschaft nach Leihmutterschaft 166 2.5 Reproduktives Reisen 167 3. Organisation der psychosozialen Kinderwunschberatung 170 3.1 Fachliche Empfehlung zur psychosozialen Beratung 171 3.2 Inanspruchnahme und Effekte der psychosozialen Kinderwunschberatung 173 3.3 Integration der psychosozialen Beratung in die medizinische Behandlung 177 3.4 Qualitätssicherung, Probleme, Perspektiven 187 4. Diskussion 188 VI. RECHTLICHE RAHMENBEDINGUNGEN 195 1. Rechtsfragen und Rechtslage 195 2. Das Embryonenschutzgesetz und weitere Regelungen 198 2.1 Gametenspenden 199 2.2 Befruchtung und Konservierung 202 2.3 Elektive Maßnahmen 204 2.4 Organisation der Reproduktionsmedizin und rechtliche Anforderungen an die Einrichtungen 207 3. Regulierungen im europäischen Vergleich 212 4. Diskussion 219 VII. SCHLUSSFOLGERUNGEN UND HANDLUNGSOPTIONEN 225 1. Erfolge und Probleme der ART 226 2. Psychosoziale Aspekte 229 3. Rechtliche Aspekte 233 LITERATUR 235 1. In Auftrag gegebene Gutachten 235 2. Weitere Literatur 235 3. Internetlinks 256

Die massiven Gesundheitsschäden, die Rauchen verursacht, sind allseits bekannt. Die Gründe, warum Menschen zu Rauchern werden, sind hingegen nicht so offenkundig. Der vorliegende Bericht untersucht den Zusammenhang von Familienform und Rauchverhalten von jungen Menschen in Deutschland auf Basis der Daten des Sozio-oekonomischen Panels (SOEP). Eines der zentralen Ergebnisse: Jugendliche und junge Erwachsene aus Alleinerzieher-Haushalten haben ein deutlich höheres Risiko, Raucher zu werden sowie früher mit dem Rauchen anzufangen als solche aus sogenannten traditionellen Familien. Auch die Intensität des Tabakkonsums hängt von der Familienform ab - Personen, die in Alleinerzieher-Haushalten aufwachsen, rauchen im Durchschnitt mehr Zigaretten pro Tag. Besonders wichtig ist dabei, wie die Alleinerziehung zustande kam und in welchem Alter sie einsetzte: Eine Scheidung der Eltern erhöht das Risiko zu rauchen am stärksten, wohingegen das Aufwachsen mit einer alleinerziehenden Mutter oder der Tod des Vaters während der Kindheit keine statistisch signifikante Rolle spielen.

Background: The trend in the BMI values of the US population has not been estimated accurately because time series data are unavailable and because the focus has been on calculating period effects. Object: To estimate the trend and rate of change of BMI values by birth cohorts stratified by gender and ethnicity born 1882-1986. Methods: We use loess additive regression models to estimate age and trend effects of BMI values of US-born black and white adults measured between 1959 and 2006. We use all the NHES and NHANES survey data. Results: The increase in BMI was already underway among the birth cohorts of the early 20th century. The rate of increase was fastest among black females; for the three other groups under consideration, the rates of increase were similar. The generally persistent upward trend was punctuated by upsurges, particularly after each of the two World Wars. That the estimated rate of change of BMI values increased by 71% among black females between the birth cohorts 1955 and those of 1965 is indicative of the rapid increases in their weight. Conclusion: We inference that transition to post-industrial weights was a gradual process and began considerably earlier than hitherto supposed.

The negative association between obesity and labor market outcomes has been widely documented, yet little is known about the mechanisms through which the association arises. Using rich and unique data on 450,000 Swedish men enlisting for the military, we find that the crude obesity penalty in earnings, which amounts to about 18 percent, is linked to supply-side characteristics that are associated with both earnings and obesity. In particular, we show that the penalty reflects negative associations between obesity, on the one hand, and cognitive skills, non-cognitive skills, and physical fitness, on the other. Our results suggest that employers use obesity as a marker for skill limitations in order to statistically discriminate.

We use the compulsory school reforms implemented in European countries after the II World War to investigate the causal effect of education on the Body Mass Index (BMI) and the incidence of overweight and obesity among European females. Our IV estimates suggest that years of schooling have a protective effect on BMI. The size of the estimated effect is not negligible but smaller than the one found in comparable recent work for the US. We depart from the current empirical literature in three main directions. First, we use a multi-country approach. Second, we complement the standard analysis of the causal impact of years of schooling on BMI with one relying on a broader measure of education, i.e. individual standardized cognitive tests, and show that the current focus in the literature on years of schooling as the measure of education is not misplaced. Last, we evaluate whether the current focus on conditional mean effects should be integrated with an approach which allows for heterogeneous responses to changes in compulsory education. Although our evidence based on quantile regressions is mixed, there is some indication that the protective effect of schooling does not increase monotonically from the lower to the upper quantile of the distribution of BMI. Rather, the marginal effect is stronger among overweight (but not obese) females than among females with BMI above 30.

Using the 2006-07 American Time Use Survey and its Eating and Health Module, I show that over half of adult Americans report grazing (secondary eating/drinking) on a typical day, with grazing time almost equaling primary eating/drinking time. An economic model predicts that higher wage rates (price of time) will lead to substitution of grazing for primary eating/drinking, especially by raising the number of grazing incidents relative to meals. This prediction is confirmed in these data. Eating meals more frequently is associated with lower BMI and better self-reported health, as is grazing more frequently. Food purchases are positively related to time spent eating - substitution of goods for time is difficult - but are lower when eating time is spread over more meals.

Child care subsidies play a critical role in facilitating the transition of disadvantaged mothers from welfare to work. However, little is known about the influence of these policies on children's health and well-being. In this paper, we study the impact of subsidy receipt on low-income children's weight outcomes in the fall and spring of kindergarten. The goals of our empirical analysis are twofold. We first utilize standard OLS and fixed effects methods to explore body mass index as well as measures of overweight and obesity. We then turn to quantile regression to address the possibility that subsidy receipt has heterogeneous effects on children's weight at different points in the BMI distribution. Results suggest that subsidy receipt is associated with increases in BMI and a greater likelihood of being overweight and obese. We also find substantial variation in subsidy effects across the BMI distribution. In particular, child care subsidies have no effect on BMI at the lower end of the distribution, inconsistent effects in the middle of the distribution, and large effects at the top of the distribution. Our results point to the use of non-parental child care, particularly centerbased services, as the key mechanism through which subsidies influence children's weight outcomes.

We analyze the effect of growing up on welfare on young people's involvement in a variety of social and health risks. Young people in welfare families are much more likely to take both social and health risks. Much of the apparent link between family welfare history and risk taking disappears, however, once we account for family structure and mothers' decisions regarding their own risk taking and investment in their children. Interestingly, we find no significant effect of socio-economic status per se. Overall, we find no evidence that growing up on welfare causes young people to engage in risky behavior.

Besonders jene Menschen, die für die Gesundheit anderer Menschen arbeiten, sind von gesundheitlichen Belastungen in ihrer Arbeit betroffen. Dazu gehören sowohl physische, z.T.l extrem hohe Belastungen durch Heben und Stützen, als auch psychische Belastungen, die die direkte Arbeit mit kranken Menschen mit sich bringt. Zeitdruck und administrativer und organisatorischer Aufwand in der mobilen Pflege, Schichtdienst in der stationären Pflege und relativ wenig Gestaltungsmöglichkeiten der eigenen Karriere belasten gerade eine Berufsgruppe, die in Zukunft noch viel stärker gefragt sein wird. Welche Möglichkeiten gibt es für das Pflegepersonal, die gesundheitlichen Belastungen in der Arbeit zu reduzieren und die Ressourcen der einzelnen Beschäftigten zu stärken? Betriebliche Gesundheitsförderung (BGF) könnte eine Antwort sein. Am 20. Mai 2008 fand im Kardinal-König-Haus in Wien die Fachtagung 'Gesund pflegen und gesund bleiben! - Betriebliche Gesundheitsförderung in der mobilen und stationären Pflege' statt. Veranstaltet wurde diese Fachtagung von der Abt. Arbeitsmarktforschung und Berufsinformation des AMS Österreich (www.ams.at), von der Caritas Österreich (www.caritas.at) und vom sozialwissenschaftlichen Forschungs- und Beratungsinstitut abif (www.abif.at). Der Tagungsband enthält Artikel der Vortragenden und eine Zusammenfassung der Podiumsdiskussion dieser Veranstaltung. Präsentationen verschiedener Projekte zur Betrieblichen Gesundheitsförderung (BGF) schließen den Band ab.

Exploiting DHS data from 235 regions in 29 Sub-Saharan Africa countries, we find that the combination of low levels of malnutrition together with dramatically high rates of mortality, encountered in Kenya\'s Lake Victoria territory, is unique for Sub-Saharan Africa. This paper explores the causes of this paradox for the Kenyan context. Our identification strategy consists of two parts. First of all, we apply multilevel regression models to control simultaneously for family and community clustering of the observed malnutrition and mortality outcomes. Secondly, to address unobserved but correlated factors, we exploit information from GIS and malaria databases to construct variables that capture additional components of children\'s geographic, political and cultural environment. Our analysis reveals that beneficial agricultural conditions and feeding practices lead to the observed sound anthropometric outcomes around Lake Victoria. In contrast, high mortality rates rest upon an adverse disease environment (malaria prevalence, water pollution, HIV rates) and a policy neglect (underprovision of health care services). Nonetheless, a significant effect of the local ethnic group, the Luo, on mortality remains.

In this paper, we focus on the causes and consequences of adolescent obesity from an economic perspective. The paper examines the determinants of obesity and its role in influencing early school leaving amongst adolescents in the province of Salerno in Southern Italy. A simple human capital investment model is employed and this provides a framework within which to analyse the interrelated 'decisions' regarding schooling and overeating, taking into account the importance of time preference and the differential effects of adolescent obesity for males and females. We find that: a) there is a strong and robust positive effect of obesity on early school leaving; b) there are significant gender differences in the nature of this relationship; and, c) although not statistically significant, there is support for the idea that contextual factors - such as the type of school attended - are important in determining the effects of obesity on early school leaving. These findings have important policy implications. In particular, evidence on the positive causal link running from obesity to early school leaving suggests: i) that action aimed at reducing obesity - such as the encouragement of sporting activity - may also have beneficial effects in terms of reducing early school leaving rates; ii) the introduction of financial incentives to encourage educational participation; and, iii) the significant differences identified between young men and young women suggest the adoption of some gender- specific policy measures.

The US and the EU recently introduced regulation to curb the extent of risky off-label drug use. It offers manufacturers a prolongation of patent protection or exclusivity if they invest in pediatric clinical tests. This paper shows that a reinforcement of physician liability for off-label use may be the preferred instrument for achieving dynamic efficiency. The liability threat reduces the demand for off-label use, giving manufacturers an appropriate incentive to invest in extended approval. By contrast, patent prolongation does not affect physicians' prescription decisions and increases the likelihood of investments in cases where the induced additional benefit falls short of testing costs.

We construct a matching model on the marriage market along more than one characteristic, where individuals have preferences over physical attractiveness (proxied by anthropometric characteristics) and market and household productivity of potential mates (proxied by socioeconomic characteristics), with a certain degree of substitutability between them. Men and women assess each other through an index combining these various attributes, so the matching is one-dimensional. We estimate the trade-offs among these characteristics using data from the PSID and the ECHP, finding evidence of compensation between anthropometric and socioeconomic characteristics. An additional unit of husband's (wife's) BMI can be compensated by a 0.3%-increase (0.15%-increase) in husband's (wife's) average (predicted) wage. Interestingly, these findings suggest that female physical attractiveness plays a larger role in men's assessment of a woman than male physical attractiveness does for women

A recent debate in the medical literature has arisen around the mortality effects of obesity. Whereas it has been argued that the obese die younger, the data that have become available do not immediately support this. This potentially undermines the hypothesis that modern life with its physical ease and cheap food would eventually make us die younger, and undermines the notion that economic growth comes with health warnings. We revisit this debate going over the mortality effects of obesity, using the US Health and Retirement Study. Whilst we find that obesity leads to chronic diseases that reduce length of life, we also find that the obese survive strokes and lung disease more often than the non-obese. A possible explanation is that the obese are under greater medical scrutiny, meaning that lung disease is more quickly diagnosed. This result holds when controlling for smoking and the long-term effects of obesity.

We study the effect of obesity on wages and employment, using data from the British NCDS. The results show a significant negative association between obesity and labor market outcomes even after controlling for a rich set of demographic, socioeconomic, environmental and behavioral variables. After instrumenting with parental obesity the associations are no longer significant. We show that the intergenerational correlation in obesity is mainly due to genetic variation. However, the instruments do not always pass the overidentification tests and are sometimes weak. We are therefore somewhat sceptical about using parental obesity as an instrument.

During the postwar period German states pursued policies to increase the share of young Germans obtaining a university entrance diploma (Abitur) by building more academic track schools, but the timing of educational expansion differed between states. This creates exogenous variation in the availability of higher education, which allows estimating the causal effect of education on health behaviors. Using the number of academic track schools in a state as an instrumental variable for years of schooling, we investigate the causal effect of schooling on health behavior such as smoking and related outcomes such as obesity. We find large negative effects of education on smoking. These effects can mostly be attributed to reductions in starting rates rather than increases in quitting rates. We find no causal effect of education on reduced overweight and obesity.

The prevalence and importance of children's physical health problems have been increasingly recognized in recent years. Physical health problems of children such as obesity, motor impairment and chronic diseases cause social costs. Further, they can lead directly to adult physical health problems, which cause additional social costs. This paper examines the intergenerational link and transmission of both maternal and paternal health on children's health in Germany. We investigate this issue using data from the German Socio-Economic Panel (SOEP), making particular use of the mother and child questionnaires. These data allow us to capture a broad set of health measures: anthropometric, self-rated health and "more objective" health measures. The results indicate significant relationships between parental and child health in the first and third year of life. In order to take into account the endogeneity of parental health, we estimate fixed effect models. Overall, we find, controlling for parental income, education and family composition, that parents who experience poor health have children with significantly poorer health. For example, the father's body mass index (BMI) is a predictor for their children's BMI. Mothers who consider their health as good, have also healthier children.

We characterize the bias of propensity score based estimators of common average treatment effect parameters in the case of selection on unobservables. We then propose a new minimum biased estimator of the average treatment effect. We assess the finite sample performance of our estimator using simulated data, as well as a timely application examining the causal effect of the School Breakfast Program on childhood obesity. We find our new estimator to be quite advantageous in many situations, even when selection is only on observables.

Global climate change will increase outdoor and indoor heat loads, and may impair health and productivity for millions of working people. This study applies physiological evidence about effects of heat, climate guidelines for safe work environments, climate modelling and global distributions of working populations, to estimate the impact of two climate scenarios on future labour productivity. In most regions, climate change will decrease labour productivity, under the simple assumption of no specific adaptation. By the 2080s, the greatest absolute losses of population based labour work ability as compared with a situation of no heat impact (11-27%) are seen under the A2 scenario in South-East Asia, Andean and Central America, and the Caribbean. Climate change will significantly impact on labour productivity unless farmers, self-employed and employers invest in adaptive measures. Workers may need to work longer hours to achieve the same output and there will be economic costs of occupational health interventions against heat exposures.

We provide comparable evidence on the patterns and trends in obesity across the Atlantic and analyse whether there are economic rationales for public intervention to control obesity. We take into account equity issues as well as efficiency considerations, which are organized around three categories of market failures: productive inefficiencies, lack of information or rationality and health insurance externalities. We also calculate the long term financial consequences of current US and European obesity trends, and conclude with a brief review of current policies to reduce and prevent excessive body weight both in Europe and the US.

Despite the urgent public health implications, relatively little is yet known about the effect of peers on adolescent weight gain. We describe trends and features of adolescent BMI in a nationally representative dataset and document correlations in weight gain among peers. We find strong correlations between own body mass index (BMI) and peers' BMI's. Though the correlations are especially strong in the upper ends of the BMI distribution, the relationship is smooth and holds over almost the entire range of adolescent BMI. Furthermore, the results are robust to the inclusion of school fixed effects and basic controls for other confounding factors such as race, sex, and age. Some recent research in this area asks whether or not adolescent weight gain is caused by peers. We discuss the econometric difficulties in plausibly estimating such effects. Our results do not rule out the existence of these types of social network effects.

1. Gegenstand dieser Studie ist eine Analyse der Daten zur HIV-Inzidenz und -Prävalenz in Deutschland. Anlass für die Studie ist zum einen, dass das Robert Koch-Institut die Schätzungen zur HIV-Inzidenz und zur HIV-Prävalenz in 2005 deutlich heraufgesetzt hat; hier soll das Verfahren der Ermittlung dieser Schätzwerte einer kritischen Analyse unterzogen werden. Zum anderen wird seit längerem interessiert festgestellt, dass die Be-richte der PKV zu den HIV-Infizierten in ihren Reihen im Vergleich zu den nach Infenk-tionschutzgesetz an das RKI gemeldeten HIV-Erstdiagnosen überproportional hoch ist: Während die von der PKV kommunizierten Erstberichte von HIV-Fällen rd. 30 % aller an das RKI gemeldeten HIV-Erstdiagnosen ausmachen, liegt der Anteil der HIV-Bestände der PKV bei etwas über 10 Prozent der vom RKI geschätzten HIV-Prävalenz. Daher wird in dieser Studie auch eine Analyse der Daten zu den HIV-Versicherten in den Unternehmen der privaten Krankenversicherung vorgenommen. 2. In Bezug auf die Erfassung der HIV-Zahlen im RKI ist festzustellen, dass das RKI im Laufe der Jahre die Methodik mehrfach leicht modifiziert hat. Dies trägt insbesondere der Tatsache Rechnung, dass sich die Datengrundlagen für die Feststellung gesicherter Erst-diagnosen verbessert haben. So konnte mit dem Inkrafttreten des Infektionsschutzgeset-zes im Jahr 2001 und der damit bewirkten Einführung der fallbezogenen Verschlüsselung das Auffinden von Mehrfachdiagnosen aus dem Umfang der gesicherten HIV-Erstdiagnosen deutlich verbessert werden, wenn auch eine gewisse Untererfassung von HIV-Erstdiagnosen dadurch nach wie vor nicht ausgeschlossen ist.

We connect the recent medical and economic literatures on the long-run effects of early-life conditions, by analyzing the effects of economic conditions on the individual cardiovascular (CV) mortality rate later in life, using individual data records from the Danish Twin Registry covering births since the 1870s and including the cause of death. To capture exogenous variation of conditions early in life we use the state of the business cycle around birth. We find a significant negative effect of economic conditions early in life on the individual CV mortality rate at higher ages. There is no effect on the cancer-specific mortality rate. From variation within and between monozygotic and dizygotic twin pairs born under different conditions we conclude that the fate of an individual is more strongly determined by genetic and household-environmental factors if early-life conditions are poor. Individual-specific qualities come more to fruition if the starting position in life is better.

This study provides empirical support for automatically activated associations inducing unequal treatment against the obese among recruiters in a real-life hiring situation. A field experiment on differential treatment against obese job applicants in hiring is combined with a measure of employers' automatic/implicit performance stereotype toward obese relative to normal weight using the implicit association test. We find a strong and statistically significant obesity difference in the correlation between the automatic stereotype of obese as being less productive and the callback rate for an interview. This suggests that automatic processes may exert a significant impact on employers' hiring decisions, offering new insights into labor market discrimination.

We connect the recent medical and economic literatures on the long-run effects of early-life conditions, by analyzing the effects of economic conditions on the individual cardiovascular (CV) mortality rate later in life, using individual data records from the Danish Twin Registry covering births since the 1870s and including the cause of death. To capture exogenous variation of conditions early in life we use the state of the business cycle around birth. We find a significant negative effect of economic conditions early in life on the individual CV mortality rate at higher ages. There is no effect on the cancer-specific mortality rate. From variation within and between monozygotic and dizygotic twin pairs born under different conditions we conclude that the fate of an individual is more strongly determined by genetic and household-environmental factors if early-life conditions are poor. Individual-specific qualities come more to fruition if the starting position in life is better.

The general objective of this study was to analyze the impact of wastewater use in agriculture. It mainly focused on three aspects of wastewater use for irrigation and their policy implications: impact on crop production and productivity; its impact on the health of farmers; and the value attached to its safe use for irrigation. The main objectives of the study were, therefore, 1) to define the farming system of wastewater farmers and to analyze the impact of wastewater on crop productivity; 2) to analyze the prevalence of the actual health risks to farmers and estimate the health costs associated with the use of wastewater in irrigation; and 3) to estimate the farmer?s willingness to pay for improved or safe use of wastewater for crop production. This study used mainly primary data collected from a household survey conducted on 415 wastewater and freshwater farm households operating irrigated agricultural activities within and around Addis Ababa, a central region of Ethiopia. A Cobb Douglas production function is specified to analyze the impact of wastewater on crop productivity. The production function was estimated using a Censored Least Absolute Deviation (CLAD) econometric model. To analyze the health impact of wastewater, the probability of illness was estimated based on the theory of the utility maximizing behavior of households subject to the conventional farm household production model modified by adding a health production function. The economic value of safe use of wastewater is estimated from data obtained from a contingent valuation survey administered by in-person interviews. A dichotomous choice model is used to elicit the farmers? willingness to pay. Bivariate probit and interval regression models are used to analyze the factors determining the farmers? willingness to pay for safe use of wastewater for crop production. The study shows that the livelihoods of wastewater farm households depend on the wastewater farm. Income from a wastewater farm accounts for 62% of total annual household income, ranging from 27% to 97%. About 61% of the vegetable market of Addis Ababa, the capital city of Ethiopia with more than five million people, is produced from the wastewater farms. Leafy vegetables, which are eaten raw, are mainly produced in less polluted wastewater farms and root vegetables are produced in more polluted wastewater farms. The study revealed that wastewater farm households use significantly less doses of chemical fertilizer compared to the freshwater irrigators. However, they spend three times more on seed and five times more on farm labor. Net farm return per hectare of plots irrigated with wastewater is significantly higher than for plots irrigated with freshwater. The results also indicate that the predicted median output value per hectare is significantly higher in wastewater irrigated plots compared to plots irrigated with freshwater. The CLAD estimation result shows that higher productivity of wastewater plots is explained by investments in inputs (organic fertilizer, improved seed and agricultural extension services), ownership of plots and levels of pollution of the irrigation water. The overall effect of wastewater on crop productivity is negative and insignificant (compared to freshwater). Plots irrigated with less polluted wastewater are more productive than plots irrigated with more polluted wastewater. The implication of the result is that even if wastewater is a reliable source of irrigation water and contains essential plant nutrients such as NPK, the nutrient content exceeds the recommended level of the plant requirement (e.g. nitrogen) or it contains toxic elements (e.g. nickel, zinc) above the recommended limit, and thereby reduce yield. Due to unsafe wastewater irrigation systems, wastewater use in irrigation actually poses health risks to farmers. Apart from working on wastewater farms, different risk factors prevail that can cause wastewater-related diseases in the studied areas. This study shows that major risk factors causing illness are household demographic characteristics, hygienic behavior of farm families and poor access to sanitation services. Lack of awareness on health risk of wastewater as well as working without protective clothing on the farm are also important risk factors in the study area. The distribution of these risk factors varies between the wastewater and freshwater irrigation areas. The most common incidence of illness reported by farm households are intestinal infection due to hookworm and Ascaris, diarrhea and skin diseases, which also varies between the two groups of farmers as well as within the different areas of wastewater. The findings of this study show that the prevalence of illness is not only significantly higher in farmers working on wastewater farms compared to freshwater irrigators, but is also significantly higher in wastewater areas where the pollution level is higher. The probability of being sick with an intestinal illness is 15% higher for wastewater farmers than for freshwater farmers. Use of protective clothing during farm work and awareness of health risks in working on wastewater farms significantly reduce illness prevalence. In addition, hygienic behavior of farm families including eating safe raw vegetables, compound sweeping, and washing hands before a meal are important determinants of illness prevalence in wastewater irrigation areas. Therefore, use and provision of protective clothing at affordable prices, creating awareness for safe use of wastewater, and reducing the pollution level of irrigation water can significantly decrease the health risk of wastewater use in irrigation. While each of these policy interventions has a significant effect in reducing health risks, combining these measures will result in more significant reduction of health risks to farmers, and thereby maximize the benefit from the wastewater resource as a source of livelihood and vegetable supply to the residents of nearby cities. Farmers are willing to contribute money to improve the existing unsafe irrigation system. Two options were suggested by farmers to improve the existing situation: enforcing laws against polluters who discharge their wastewater without any kind of treatment, and awareness creation of safe use of wastewater for irrigation. Farmers are willing to pay for the improvement programs and there is a welfare gain to the society from safe use of wastewater for crop production. The benefit from irrigated-farming, membership to water users? association, yield value, off-farm income and working on a wastewater farm all significantly determine the farmers? probability of accepting offered bids for the improvement program. In addition to these variables, multi-purpose uses of irrigation water as well as education level determines the farmers? willingness to pay. Irrigation method has no significant effect on the farmers? willingness to pay, implying that introducing water saving and improved irrigation techniques has an important role in improving the situation without affecting the farmers? willingness to pay. Overall, this study shows that wastewater is a means of livelihood for many poor households, but the existing use of wastewater for crop production actually causes health risks both to farmers and consumers. Farmers are willing to contribute to programs designed to improve the existing situation so that it is possible to maximize the livelihood benefit at minimum health risks. However, the results do not necessarily imply that the cost of improving the situation has to be borne by the farmers only. Although the study focuses on the central region of Ethiopia, most conclusions can have a wider application in other parts of the country and in many sub-Saharan African countries where wastewater is used for irrigation. Ziel der Studie ist es, die Auswirkungen von Abwassernutzung in der Landwirtschaft zu analysieren. Die Arbeit richtet ihren Focus dabei hauptsächlich auf drei Aspekte der Auswirkungen von Abwassernutzung: die Auswirkungen auf die Pflanzenproduktion und deren Produktivität, die Auswirkungen auf die Gesundheit der Landwirte, sowie auf den Wert einer sicheren Nutzung des Abwassers zur Bewässerung. Die spezifischen Ziele der Studie sind 1) die Abwasser nutzenden Anbausysteme zu definieren und die Auswirkungen der Abwassernutzung auf die Produktivität zu analysieren; 2) die Auswirkungen der Abwassernutzung auf die Gesundheitsrisiken der Landwirte zu analysieren und die dadurch anfallenden Kosten abzuschätzen; und 3) die Zahlungsbereitschaft der Landwirte für eine verbesserte oder sichere Nutzung von Abwässern in der Pflanzenproduktion abzuschätzen. Die Studie nutzt im Wesentlichen Primärdaten aus einer Haushaltserhebung von 415 landwirtschaftlichen Haushalten bei Addis Ababa (Zentral-Äthiopien), die Abwasser und Frischwasser zur Bewässerung verwenden. Eine Cobb-Douglas-Produktionsfunktion wurde spezifiziert, um die Auswirkungen der Abwassernutzung auf die Produktivität zu analysieren, sie wurde mit Hilfe eines ökonometrischen Censored Least Absolute Deviation (CLAD) Modells geschätzt. Um Auswirkungen auf die Gesundheit abzuschätzen, wurde die Wahrscheinlichkeit für eine Erkrankung unter Verwendung einer erweiterten Theorie des nutzenmaximierenden Haushalts durch eine Gesundheitsproduktionsfunktion geschätzt. Der ökonomische Wert der sichereren Nutzung von Abwässern wurde über eine Contingent Value-Analyse von Daten aus persönlichen Interviews geschätzt. Ein Double-Bounded Dichotomes Choice Modell wurde genutzt, um die Zahlungsbereitschaft der Landwirte festzustellen. Bivariate Probit- und Intervall-Regressionsmodelle wurde genutzt, um die Einflussfaktoren auf Zahlungsbereitschaft der Landwirte für eine sichere Nutzung von Abwässern zur Pflanzenproduktion zu ermitteln. Die Studie zeigt, dass das Haushaltseinkommen zu wesentlichen Teilen aus der Landwirtschaft stammt. Für die Haushalte, die Abwasser für die landwirtschaftliche Produktion nutzen, beträgt das aus landwirtschaftlichen Quellen stammende Einkommen ca. 61 % des Gesamteinkommens, mit einer Spannweite zwischen 27% und 97%. Ungefähr 61% des Gemüsemarktes von Addis Ababa, der Hauptstadt Äthiopiens mit mehr als 5 Millionen Einwohnern, werden durch Betriebe bereitgestellt, die Abwässer zur Pflanzenproduktion nutzen. Roh verzehrtes Blattgemüse wird im Gegensatz zu Wurzelgemüse meist in weniger mit Abwasser belasteten Gebieten angebaut. Die Studie ergab, dass Abwasser nutzende Betriebe signifikant geringere Mengen an chemischen Düngern nutzen als Betriebe, die mit Frischwasser bewässern. Jedoch geben sie drei Mal soviel Geld für Saatgut und fünf Mal soviel für Arbeitskräfte aus. Der Nettoertrag pro Hektar auf den mit Abwasser bewässerten Parzellen ist signifikant höher als auf Parzellen, die mit Frischwasser bewässert wurden. Die Ergebnisse zeigen ferner, dass auch der mit Hilfe des ökonometrischen Modells vorausgesagte mediane Ertragswert pro Hektar bei mit Abwässern bewässerten Parzellen signifikant höher ist als auf Parzellen, die mit Frischwasser bewässert wurden. Die Ergebnisse des CLAD-Modells zeigen, dass die höhere Produktivität der Abwässer-Parzellen mit dem Aufwand an Inputs (organischer Dünger, verbessertes Saatgut und landwirtschaftliche Beratungsdienste), mit den Besitzverhältnissen an den Parzellen und der Höhe der Verschmutzung des Wassers erklärt werden kann. Der Gesamteffekt von Abwasser auf die Produktivität ist negativ und nicht signifikant. Parzellen, die mit weniger verschmutztem Wasser bewässert werden sind produktiver als Parzellen mit stärker verschmutzem Abwasser. Daraus lässt sich folgern, dass, auch wenn das Abwasser wichtige Pflanzennährstoffe wie NPK enthält, diese die benötigte Menge jedoch übersteigen (z.B bei Stickstoff) oder, dass toxische Elemente (z.B. Nickel, Zink) oberhalb der empfohlenen Grenzen liegen, so dass das Pflanzenwachstum negativ beeinflusst wird und der Ertrag reduziert wird. Aufgrund gefährlicher Abwasser-Bewässerungssysteme verursacht Abwasser Gesundheitsrisiken für Landwirte. Abgesehen von der Tatsache, dass sie überhaupt auf solchen Betrieben arbeiten, zeigten sich verschiedene andere Risikofaktoren, die mit dem Abwasser zusammenhängende Krankheiten bewirken können. Die Studie zeigt, dass die Hauptrisikofaktoren die demographischen Charakteristika der Haushalte, das Hygieneverhalten der Familien und ein schlechter Zugang zu sanitären Einrichtungen sind. Zudem sind mangelndes Problembewusstsein sowie das Arbeiten ohne Schutzkleidung wichtige Einflussfaktoren im Untersuchungsgebiet. Die Verteilung dieser Faktoren variiert zwischen den Gebieten der Abwasser- und der Frischwassernutzung. Die am meisten auftretenden Erkrankungen sind die durch den Astaris- und den Hakenwurm verursachte intestinale Infektionen, Durchfall- und Hauterkrankungen, die wiederum zwischen den beiden Gruppen der Landwirte sowie den Abwassergebieten variieren. Die Studie zeigt, dass nicht nur Erkrankungen im Bereich abwassernutzender Areale häufiger sind, sondern dass die Zahl der Erkrankungen signifikant höher in Bereichen höherer Verschmutzung ist. Die Wahrscheinlichkeit an intestinalen Infektionen zu erkranken ist bei Abwassernutzern um 15% höher als bei Frischwassernutzern. Schutzkleidung und verbessertes Risikobewusstsein senken die Krankheitswahrscheinlichkeit signifikant. Zudem sind Hygieneverhalten, das Essen von sicherem rohen Gemüse, das Fegen bzw. Reinigen des Hof-Geländes, sowie das Waschen der Hände vor dem Essen, wichtige Determinanten des Gesundheitsrisikos in abwassernutzenden Gebieten. Daher können das Anbieten und Nutzen von erschwinglicher Schutzkleidung, ein verbessertes Risikobewusstsein sowie Maßnahmen zur Reduzierung der Verunreinigung von Bewässerungswasser das Gesundheitsrisiko signifikant verringern. Während schon jede der genannten Maßnahmen selbst eine signifikante Verbesserung darstellt, würde eine Kombination dieser Maßnahmen das Gesundheitsrisiko noch deutlicher reduzieren und somit den Nutzen der Abwasseressource als Quelle des Lebensunterhalts und der Gemüseversorgung für die Anwohner der nahegelegenen Städte verbessern. Die Landwirte äußerten bei der Befragung die Bereitschaft einen finanziellen Beitrag zu einer größeren Sicherheit der Bewässerungssysteme zu leisten. Zwei Optionen wurden von ihnen zur Verbesserung vorgeschlagen: Die vorgeschriebene Abwasserbehandlung durch die Verursacher, und das Schaffen von Bewusstsein für einen sicheren Umgang mit Abwasser. Die Zahlungsbereitschaft der Landwirte für eine sichere Abwassernutzung bedeutet, dass eine Steigerung der Wohlfahrt möglich wäre. Die Höhe des Nutzens aus der Bewässerungslandwirtschaft, die Mitgliedschaft in Wassernutzungsgemeinschaften, der Wert des Ertrages, das Einkommen außerhalb der Landwirtschaft und die Frage, ob es sich um einen Abwasser nutzenden Betrieben handelt bestimmen signifikant die Wahrscheinlichkeit der Annahme der angebotenen Programme durch die Landwirte. Zusätzlich zu diesen Variablen bestimmt die Frage der Mehrfachnutzung des Bewässerungswassers und der Ausbildungsgrad der Landwirte die Zahlungsbereitschaft. Zusammenfassend zeigt die Studie, dass die Nutzung von Abwasser für viele arme Haushalte bedeutend für den Lebensunterhalt ist, dass jedoch die gegenwärtige Abwassernutzung Gesundheitsrisiken für Landwirte und für Konsumenten birgt. Die Landwirte sind bereit, für Programme zu bezahlen, die die Situation verbessern könnten, so dass es möglich wäre die Lebensbedingungen zu verbessern, bei verringertem Gesundheitsrisiko. Jedoch bedeuten die Ergebnisse nicht zwingend, dass die Kosten allein von den Landwirten getragen werden müssen. Obwohl sich die Studie auf Zentral-Äthiopien bezieht, können die meisten Erkenntnisse auf größere Teile des Landes und auf viele afrikanische Sub-Sahara Länder, in denen Abwasser zu Bewässerung genutzt wird, übertragen werden.

The level of violence in the National Hockey League (NHL) reached its highest point in 1987 and has reduced somewhat since then, although to levels much larger than before the first team expansions in 1967. Using publicly available information from several databases 1996-2007, the incentives for violence in North American ice hockey are analyzed. We examine the role of penalty minutes and more specifically, fighting, during the regular season in determining wages for professional hockey players and team-level success indicators. There are substantial returns paid not only to goal scoring skills but also to fighting ability, helping teams move higher in the playoffs and showing up as positive wage premia for otherwise observed low-skill wing players. These estimated per-fight premia, depending on fight success ($10,000 to $18,000), are even higher than those for an additional point made. By introducing a fight fine of twice the maximum potential gain ($36,000) and adding this amount to salaries paid for the team salary cap (fines would be 6.7% of the team salary cap or the average wage of 2 players), then all involved would have either little or no incentives to allow fighting to continue.

In developed countries, obesity tends to be associated with worse labor market outcomes. One possible reason is that obesity leads to less human capital formation early in life. This paper investigates the association between obesity and the developmental functioning of children at younger ages (2-4 years) than ever previously examined. Data from the German Socio-Economic Panel Study are used to estimate models of developmental functioning in four critical areas (verbal skills, activities of daily living, motor skills, and social skills) as a function of various measures of weight (including BMI and obesity status) controlling for various child and family characteristics. The findings indicate that, among boys, obesity is a significant risk factor for lagged development in verbal skills, social skills, and activities of daily living. Among girls, weight generally does not have a statistically significant association with these developmental outcomes. Further investigations show that the correlations exist even for those preschool children who spend no time in day care, which implies that the correlation between obesity and developmental functioning cannot be due to discrimination by teachers, classmates, or even day care providers.

In health care systems today, including those of Switzerland and the United States, participants do not necessarily see the big picture of lifetime health costs and quality of life, and in many systems consumers and providers lack the incentives to manage preventative and chronic care to minimize lifetime private and social health costs. Resource allocation problems induced by asymmetric information and misaligned incentives are exacerbated if consumers fail to have the acuity or perspective needed to make choices consistent with their self-interest when faced with complex health care choices with ambiguous future consequences. This paper examines rationality of consumers’ health perceptions and choices using as a natural experiment the recent introduction in the United States of a highly subsidized market for prescription drug insurance, and draws lessons from this experiment on the practicality of "Consumer Directed Health Care" as an approach to achieving efficient allocation of health care resources by confronting consumers with the full marginal costs of the services they use.

In light of the recent rise in childhood obesity, the School Breakfast Program (SBP) and National School Lunch Program (NSLP) have received renewed attention. Using panel data on over 13,500 primary school students, we assess the relationship between SBP and NSLP participation and (relatively) long-run measures of child weight. After documenting a positive association between SBP participation and child weight, and no association between NSLP participation and child weight, we present evidence indicating positive selection into the SBP. Allowing for even modest positive selection is sufficient to alter the results, indicating that the SBP is a valuable tool in the current battle against childhood obesity, whereas the NSLP exacerbates the current epidemic.

This paper reviews the extent to which policy interventions can affect risky behaviours such as smoking, drinking and diet. The justification for such intervention is typically a market failure, broadly defined. The types of market failure typically encountered are discussed. First and second best interventions are examined and there is a review of the efficacy of such interventions with respect to Ireland.

Obesity is increasing worldwide for both adults and children. Genetic disposition is responsible for some variation in body weight but cannot explain the dramatic increase in the last two decades. The increase must be due to structural and behavioral changes. One such behavioral change is the increase in working females in the last decades. The absence from the mother reduces potential child care time in the family. Reduced child care time may have adverse effects on the prevalence of obesity in children and adults. This paper analyzes the effect of mother�s labor supply in childhood on young adults probability of being obese in Germany. Using a sample drawn from the German Socio-Economic Panel the results show that a higher labor supply of the mother increases the probability for her child to be obese as young adult. This result underlines the importance of childhood environment on children�s later life outcome and the importance of behavioral changes in explaining the increase in obesity.

This study presents evidence of recruitment discrimination against obese individuals in Sweden by sending fictitious applications to real job openings. Otherwise identical applications were randomly assigned a portrait photograph of an obese or a normalweight job applicant. Applications with an obese applicant receive twenty percent fewer callbacks for an interview. It is also found that discrimination is the same against men and women and that it varies across occupations in a systematic way in that firms hiring employees in occupations with more customer contact discriminate more. The tentative conclusion is that customer discrimination and/or statistical discrimination based on the correlation between job performance and being obese is the explanation. Also, opposite to what is expected, register data show that the share of obese employees is higher in occupations were discrimination is found to be higher.

Economic evaluation of projects involving changes in mortality risk conventionally assumes that lives are statistical, i.e., that risks and policy-induced changes in risk are small and similar among a population. In reality, baseline mortality risks and policy-induced changes in risk often differ among individuals although these differences are imperfectly known. We examine the effects of information about heterogeneity of risk on economic evaluation. Although social welfare (defined as aggregate expected utility) is unaffected by information about risk heterogeneity, the economic valuation of changes in risk (the sum of individual compensating or equivalent variations) is sensitive to this information. The effect of information on economic valuation and hence the outcome of a benefit-cost analysis (BCA) depends on: i) whether information is about heterogeneity of the baseline and/or change in risk, ii) whether risk is valued using willingness to pay (WTP) or willingness to accept (WTA) measures, iii) the status quo policy, and iv) whether individuals are risk-averse or risk-neutral in wealth. We show that BCA does not systematically favor identified over statistical lives and suggest some political factors that may explain the apparent publicdecision bias toward protecting identified lives.

Obesity has become a major health issue. Research in economics has provided NEWLINE important insights as to how technological progress reduced the relative price of food and NEWLINE contributed to the increase in obesity. However, the increased availability of food might well NEWLINE have overstrained will power and led to suboptimal consumption decisions relative to NEWLINE people’s own standards. We propose the economics of happiness as an approach to study the NEWLINE phenomenon. Based on proxy measures for experienced utility, it is possible to directly NEWLINE address whether certain observed behavior is suboptimal and therefore reduces a person’s NEWLINE well-being. It is found that obesity decreases the well-being of individuals who report limited NEWLINE self-control, but not otherwise.

Using the Implicit Association Test, we investigate whether employers and students possess implicit and explicit negative attitudes and implicit performance stereotypes toward Arab-Muslim men relative to native Swedish men. We also examine if employers and students have implicit and explicit performance stereotypes toward obese individuals relative to people of normal weight. The results demonstrate that employers and students both implicitly and explicitly associate Arab-Muslim men with less work performance. Also, they have more implicit negative attitudes toward this ethnic group. Obese individuals are both implicitly and explicitly associated with less work performance compared with normal-weight individuals.

We study the effect of permanent income innovations on health for a prime-aged population. Using information on more than half a million individuals sampled over a twenty-five year period in three different cross-sectional surveys we aggregate data by date-of-birth cohort to construct a 'synthetic cohort' dataset with details of income, expenditure, socio-demographic factors, health outcomes and selected risk factors. We then exploit structural and arguably exogenous changes in cohort incomes over the eighties and nineties to uncover causal effects of permanent income shocks on health. We find that such income innovations have little effects on a wide range of health measures, but do lead to increases in mortality and risky health behaviour.

Using an overlapping generation model à la Blanchard (1985) with human capital accumulation, this article demonstrates that the influence of environment on optimal growth in the long-run may be explained by the detrimental effect of pollution on life expectancy. It also shows that, in such a case, greener preferences are growth- and welfare-improving even if the ability of the agents to learn is independent to pollution and utility is additively separable. Finally, it establishes that it is possible to implement a win-win environmental policy.

We use conjoint choice questions to investigate people s preferences for income and reductions in mortality risks delivered by contaminated site remediation policies. Our survey is self-administered using the computer by residents of four cities in Italy with severely contaminated sites. We estimate the Value of a Statistical Life to be about €5.6 million for an immediate risk reduction. If the risk reduction takes place 20 years from now, however, the implied VSL is about €1.26 million. The discount rate implicit in the responses to the conjoint choice questions is about 7%. People are willing to pay for permanent risk reductions, but not just any amount. Risk reductions in the nearer future are valued more highly than risk reductions in the more distant future. We also find that the VSL is individuated, in the sense that it depends on observable individual characteristics of the respondents, familiarity with contaminated sites, concern about the health effects of exposure to toxicants, having a family member with cancer, perceived usefulness of possible government actions, and the respondent s beliefs about the goals of government remediation programs. Additional questions suggest that respondents discount lives, and do so at a discount rate in the ballpark of that implicit in their risk v. money tradeoffs.

The paper presents estimation of the health losses from urban air pollution in Ukraine. The methodology developed by US EPA and adjusted in Russia for Eastern European transition countries was applied for health risk assessment. PM2.5 was identified as the major source of human health risk, based on experience from the Russian studies. In the absence of reliable computed concentrations of PM2.5, the study was based on monitoring data of total suspended particle (TSP) emissions in Ukraine. Additional cases of mortality and morbidity were calculated based on reporting data on TSP concentration that was recalculated into PM2.5. Then the concentration–response function was applied to estimate individual risk. Next, individual risk was applied to the population exposed to the concentration reported for each city included in the analysis (we selected most polluted cities). For each city we considered individual data on baseline mortality and morbidity and population structure. In total, air pollution related mortality represents about 6 percent of total mortality in Ukraine. In Russia the corresponding indicator totals about 4 percent. The relative mortality risk attributed to air pollution calculated per 100 000 population in both countries is about 55-59 cases. Since applied method is sensitive to the primary data uncertainties we conducted sensitivity analysis applying Monte-Carlo method. Economic damage related to mortality risk was estimated at about 4 percent of GDP. There was no relevant WTP study in Ukraine therefore we applied the benefit-transfer method in order to estimate VSL, since mortality attributed to air pollution is major component of health losses (about 94 percent). In order to compare and aggregate mortality and morbidity risks we recalculated them in DALY. Then morbidity represents about 30 percent of total air pollution health load. Data on baseline morbidity is less reliable than data on baseline mortality; therefore the morbidity risk estimates are more uncertain than mortality estimates. It is likely that morbidity risk is underestimated. Regardless of uncertainties mentioned above and some problems with reported data we can conclude that the mortality risk attributed to air pollution is significant. Therefore, costs of air pollution in Ukraine are sizable and in the nearest future may offset the economic growth. Recovery of the Ukrainian economy based on restoration of polluting industries may lead to stagnation since mortality and morbidity risks not only puts burden on the economy, but also reduce labor force.

We present a proof-of-concept analysis of the measurement of the health damage of ozone (O3) produced from nitrogen oxides (NOx = NO + NO2) emitted by individual large point sources in the eastern United States. We use a regional atmospheric model of the eastern United States, the Comprehensive Air Quality Model with eXtensions (CAMx), to quantify the variable impact that a fixed quantity of NOx emitted from individual sources can have on the downwind concentration of surface O3, depending on temperature and local biogenic hydrocarbon emissions. We also examine the dependence of resulting ozone-related health damages on the size of the exposed population. The investigation is relevant to the increasingly widely used ?cap and trade? approach to NOx regulation, which presumes that shifts of emissions over time and space, holding the total fixed over the course of the summer O3 season, will have minimal effect on the environmental outcome. By contrast, we show that a shift of a unit of NOx emissions from one place or time to another could result in large changes in resulting health effects due to ozone formation and exposure. We indicate how the type of modeling carried out here might be used to attach externality-correcting prices to emissions. Charging emitters fees that are commensurate with the damage caused by their NOx emissions would create an incentive for emitters to reduce emissions at times and in locations where they cause the largest damage.

Male life expectancy at birth fell by over six years in Russia between 1989 and 1994. Many other countries of the former Soviet Union saw similar declines, and female life expectancy fell as well. Using cross-country and Russian household survey data, we assess six possible explanations for this upsurge in mortality. Most find little support in the data: the deterioration of the health care system, changes in diet and obesity, and material deprivation fail to explain the increase in mortality rates. The two factors that do appear to be important are alcohol consumption, especially as it relates to external causes of death (homicide, suicide, and accidents) and stress associated with a poor outlook for the future. However, a large residual remains to be explained.

Medicare?s prospective payment system (PPS), introduced in 1983, pays hospitals a fixed price for each stay rather than reimbursing costs. Previous studies evaluated its first few years using endogenous measures to control for heterogeneity in patients? health. We examine PPS over a full decade using competing risks Cox survival models and a national longitudinal survey with independent information on patients? health. New findings include: risk of death in hospital increased; risk of discharge to a nursing home continued to increase as PPS matured; and risk of nursing home admission from the community following hospital discharge rose. HMOs may have contributed to these outcomes.

We use conjoint choice questions to ask public health and climate change experts, contacted at professional meetings in 2003 and 2004, which of two hypothetical countries, A or B, they deem to have the higher adaptive capacity to certain effects of climate change on human health. These hypothetical countries are described by a vector of seven attributes, including per capita income, inequality in the distribution of income, measures of the health status of the population, the health care system, and access to information. Probit models indicate that our respondents regard per capita income, inequality in the distribution of income, universal health care coverage, and high access to information as important determinants of adaptive capacity. A universal-coverage health care system and a high level of access to information are judged to be equivalent to $12,000-$14,000 in per capita income. We use the estimated coefficients and country sociodemographics to construct an index of adaptive capacity for several countries. In panel-data regressions, this index is a good predictor of mortality in climatic disasters, even after controlling for other determinants of sensitivity and exposure, and for per capita income. We conclude that our conjoint choice questions provide a novel and promising approach to eliciting expert judgments in the climate change arena.

A contingent valuation study is conducted to estimate willingness to pay (WTP) for reducing the risks of skin cancer arising from exposure to solar UV light in New Zealand, where skin cancer incidence rates are among the highest in the world. A split sample design contrasts dichotomous choice (DC) with open ended (OE) methods for eliciting WTP responses. We attempt to distinguish theoretically consistent preferences from those which are procedurally variant and constructed. This is achieved both through explicit testing of the influence of available heuristics upon responses and a novel scope sensitivity test. The latter test addresses concerns that survey respondents sometimes fail to understand a specified change in provision. This is achieved by holding the good constant but making its remit vary from just the individual respondent to their entire household. A key feature of this latter test is whether the observed degree of scope sensitivity is not only statistically significant but also conforms to prior expectations. While our OE responses show clear evidence of preference construction, the DC responses pass both forms of testing. We conclude by arguing that the degree of scope sensitivity and its conformity with prior expectations should form a focal criterion for future validity testing.

Der prozentuale Anteil Übergewichtiger und adipöser Menschen in der Bevölkerung der westlichen Industrieländer nimmt seit einigen Jahrzehnten stetig zu. Dies gilt sowohl für Erwachsene als auch für Kinder und Jugendliche.In Deutschland sind ca. zwei Drittel der männlichen Bevölkerung und ca. die Hälfte der weiblichen Bevölkerung übergewichtig oder adipös. Der Anteil adipöser Kinder und Jugendlicher liegt bei ca. sieben Prozent.

This paper deals with the question how to model health effects after the cessation of a randomised controlled trial (RCT). Using clinical trial data on severe congestive heart failure patients we illustrate how survival beyond the cessation of a RCT can be predicted based on parametric survival models. In the analysis we compare the predicted survival and the resulting incremental cost-effectiveness ratio (ICER) of different survival models with the actual survival/ICER. Our main finding is that the results are highly sensitive to the choice of survival model and that extensive sensitivity analysis in the CE analysis is required. We also show that adding the true survival after the end of the clinical study will underestimate the true variability.

We study international trade of innovative goods subject to scientific uncertainty on consumers' health effects. Trade of these goods is often at the centre of international disputes. We show that a new trade protectionism may arise because of the scientific uncertainty. A free riding effect is individuated implying a more conservative behaviour by countries. We also study the informative role played by producers (lobbies) in revealing valuable information. We find that producers reveal more information when the effects of harmful consumption on health are long lasting. Our results are robust to several extensions (e.g. product labelling, firm liability).