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US cities invested heavily in water and sewer infrastructure throughout the late nineteenth and early twentieth centuries. These investments improved public health and quality of life by helping US cities control typhoid fever and other waterborne diseases. We show that segregated cities invested in water infrastructure earlier but were slower to reach universal access and slower to eliminate typhoid fever. We develop a theoretical model that illustrates how segregation, by facilitating the exclusion of Black households from water and sewer systems, explains these seemingly paradoxical findings.

We examine the health effects of the Lancashire Cotton Famine, a sharp downturn in Britain's cotton textile manufacturing regions that was induced by the US Civil War. Migration was an important response to this downturn, but as we document, migration also introduces a number of empirical challenges, which we overcome by introducing a new methodological approach. Our results indicate that the recession increased mortality among households employed in the cotton textile industry. We also document localized spillover effects on households providing nontradable services in the areas affected by the recession. (JEL E32, I12, J63, N13, N33, N63, N93)

This article reviews the global health and economic consequences of the 1918 influenza pandemic, with a particular focus on topics that have seen a renewed interest because of COVID-19. We begin by providing an overview of key contextual and epidemiological details as well as the data that are available to researchers. We then examine the effects on mortality, fertility, and the economy in the short and medium run. The role of non-pharmaceutical interventions in shaping those outcomes is discussed throughout. We then examine longer-lasting health consequences and their impact on human capital accumulation and socioeconomic status. Throughout the paper we highlight important areas for future work. (JEL E24, E32, I12, I15, J13, J24, N30)

BackgroundSome studies have identified declines in mental health over the course of the COVID-19 pandemic across the world and in different age groups, including older people. As anxiety and depression are common neuropsychiatric symptoms among people with dementia or mild cognitive impairment, the mental health experiences of older people during the pandemic should therefore take cognitive function into consideration. This should also be examined using quantitative measures that were assessed prior to the pandemic. This study addresses such gaps in the evidence base on depression and anxiety among older people with cognitive impairment before and throughout the COVID-19 pandemic.Methods and FindingsUsing data from the English Longitudinal Study of Ageing (ELSA) collected from 2018/19 to Nov/Dec 2020, we estimated changes in depression and anxiety for people aged 50+ in England across three cognitive function groups: no impairment, mild cognitive impairment, and dementia.We found that depression (measured with CES-D score) worsened from 2018/19 to Nov/Dec 2020 for people with mild cognitive impairment (1.39 (95%CI: 1.29-1.49) to 2.16 (2.02-2.30)) or no impairment (1.17 (95%CI: 1.12-1.22) to 2.03 (1.96-2.10)). Anxiety, using a single-item rating of 0-10 also worsened among those with mild cognitive impairment (2.48 (2.30-2.66) to 3.14 (2.95-3.33)) or no impairment (2.20 (2.11-2.28) to 2.85 (2.77-2.95)). No statistically significant increases were found for those with dementia. Using a clinical cutoff for likely depression (CES-D≥4), we found statistically significant increases in the probability of likely clinical depression between 2018/19 and Nov/Dec 2020 for those with no impairment (0.110 (0.099-0.120) to 0.206 (0.191-0.222)) and those with mild impairment (0.139 (0.120-0.159) to 0.234 (0.204-0.263)).We also found that differences according to cognitive function that existed before the pandemic were no longer present by June/July 2020, and there were no statistically significant differences in depression or anxiety among cognitive groups in Nov/Dec 2020.ConclusionsOur findings on measures collected before and during the pandemic suggest a convergence in mental health across cognitive function groups during the pandemic. This suggests mental health services will need to meet an increased demand that will come from older adults, especially those not living with cognitive impairment or dementia. We also found little significant change in mental health outcomes among those with dementia; as their existing need for support will remain, policymakers and care practitioners will need to ensure this group continues to have equitable access to support for their mental health.

Background and Objectives Housing with care is often lauded as a way to combat loneliness and social isolation in later life. This study examined whether housing with care created better outcomes for residents in terms of loneliness and social isolation than they might expect if they were living in the community. Research Design and Methods A survey was distributed to residents of housing with care as part of the Diversity in Care Environments project. It was designed to enable comparison with the English Longitudinal Study of Ageing. Propensity score matching was applied to identify the effect of housing with care residence on loneliness and social isolation. Results People living in housing with care had lower levels of loneliness than would be expected if they lived in the general community, with an average treatment effect on the treated (ATT) of −0.407 (95% CI = −0.601, −0.214). In contrast, social isolation was found to be slightly higher for residents than would be expected if they were in the community (ATT = 0.134 [95% CI = 0.022, 0.247]). Higher social isolation appears driven by less frequent contact with friends and reduced organizational membership rather than any difference in contact with family and children. Discussion and Implications Our research has shown a positive impact on subjective social experiences from housing with care residence, despite a slight increase in objective social isolation. The findings underscore the importance of looking at loneliness and social isolation as distinct concepts as well as the effectiveness of housing with care at improving later-life outcomes.

The historical transition to a low fertility regime was central for long-run growth, but what caused it? Existing economic explanations largely focus on the economic incentives to limit fertility. This article presents new evidence highlighting the importance of cultural forces as a complementary driver of the fertility transition. We leverage a sharp change in fertility in Britain in 1877 and document large synchronized declines in fertility among culturally British households residing outside of Britain, in Canada, the US, and South Africa, relative to their non-British neighbours. We propose a plausible catalyst for the change: the famous Bradlaugh–Besant trial of 1877.

BackgroundInequalities between different areas in the UK according to health and employment outcomes are well-documented. Yet it is unclear which health indicator is most closely linked to labour market outcomes, and whether associations are restricted to the older population.MethodsWe used the ONS Longitudinal Study (LS) to analyse which measures of health-in-a-place were cross-sectionally associated with three employment outcomes in 2011: not being in paid work, working hours (part-time, full-time), and economic inactivity (unemployed, retired, sick/disabled, other). Nine health indicators from local-authority census and vital records data were chosen to represent the older working age population (50-74y) and linked with LS data. Interactions by gender and age category (16-49y vs 50-74y) were tested.FindingsFor all health-in-a-place measures, LS members aged 16-74 who resided in the tertile of local authorities with the ‘unhealthiest’ older population, had higher odds of not being in paid work, including all four types of economic inactivity. The strongest associations were seen for the health-in-a-place measures that were self-reported, long-term illness and self-rated health (SRH) (OR 1·60 [95% CI 1·52–1·67/8]). Within each measure, associations were slightly stronger for men than women and for the 16-49y versus 50-74y LS sample. In models adjusted for individual SRH and gender and age category interactions, health-in-a-place gradients were apparent across all economic inactivity’s. However, these same gradients were only apparent for women in part-time work and men in full-time work.InterpretationImproving health of older populations may lead to wider economic benefits for all.FundingHealth Foundation

What governs labour force participation in later life and why is it so different across countries? Health and labour force participation in older ages are not strongly linked, but we observe a large variation across countries in old-age labour force participation. This points to the important role of country-specific regulations governing pension receipt and old-age labour force participation. In addition to the statutory eligibility age for a pension, such country-specific regulations include: earnings tests that limit the amount of earnings when pension benefits are received; the amount of benefit deductions for early retirement; the availability of part-time pensions before normal retirement; special regulations that permit early retirement for certain population groups; and either subsidies or extra costs for employers if they keep older employees in their labour force. This paper asks two questions: Can we link a relatively low labour force participation at ages 60–64 to country-specific regulations that make early retirement attractive? and Can we link a relatively high labour force participation at ages 65–74 to country-specific regulations that make late retirement attractive? To answer these questions, we compared the experiences in a set of developed countries around the world in order to understand better the impact of country-specific rules and laws on work and retirement behaviour at older ages and, by consequence, on the financial sustainability of pension systems.

BackgroundUK state pension eligibility ages are linked to average life expectancy, which ignores wide socioeconomic disparities in both healthy and overall life expectancy.ObjectivesInvestigate whether there are occupational social class differences in the amount of time older adults live after they stop work, and how much of these differences are due to health.MethodsParticipants were 76 485 members of the Office for National Statistics Longitudinal Study (LS), who were 50–75 years at the 2001 census and had stopped work by the 2011 census. Over 10 years of follow-up, we used censored linear regression to estimate mean differences in years between stopping work and death by occupational social class.ResultsAfter adjustment for age, both social class and health were independent predictors of postwork duration (mean difference (95% CI): unskilled class vs professional: 2.7 years (2.4 to 3.1); not good vs good health: 2.4 years (1.9 to 2.9)), with LS members in the three manual classes experiencing ~1 additional year of postwork duration than professional workers (interaction p values all ConclusionsLower social class groups are negatively affected by uniform state pension ages, because they are more likely to stop work at younger ages due to health reasons.

The COVID-19 pandemic presented challenges that may have impacted people with cognitive impairment in disproportionate ways. Using the ELSA COVID-19 sub-study collected in 2020, we examined the experiences of people across three cognitive function groups (no impairment, mild impairment, and dementia) with respect to a range of social and health outcomes, including: shielding and self-isolation; access to health and care services; changes in lifestyle behaviours during the pandemic, and the impacts on mental health, wellbeing, and other psychosocial measures. Differences among cognitive function groups varied according to both outcomes and time. For example, people with dementia were around 2.4 times more likely to be shielding in June/July than those with no impairment, but no difference was found for November/December. On many measures, people with dementia fared similarly to those with no impairment once controlling for other factors.

This article reviews the global health and economic consequences of the 1918 influenza pandemic, with a particular focus on topics that have seen a renewed interest because of COVID-19. We begin by providing an overview of key contextual and epidemiological details as well as the data that are available to researchers. We then examine the effects on mortality, fertility, and the economy in the short and medium run. The role of nonpharmaceutical interventions in shaping those outcomes is discussed throughout. We then examine longer-lasting health consequences and their impact on human capital accumulation and socioeconomic status. Throughout the paper we highlight important areas for future work.

Lesbian, gay, bisexual and trans+ (LGBT+) people report poorer health than the general population and worse experiences of healthcare particularly cancer, palliative/end-of-life, dementia and mental health provision. This is attributable to: (a) social inequalities, including ‘minority stress’; (b) associated health-risk behaviours (eg, smoking, excessive drug/alcohol use, obesity); (c) loneliness and isolation, affecting physical/mental health and mortality; (d) anticipated/experienced discrimination and (e) inadequate understandings of needs among healthcare providers. Older LGBT+ people are particularly affected, due to the effects of both cumulative disadvantage and ageing. There is a need for greater and more robust research data to support growing international and national government initiatives aimed at addressing these health inequalities. We identify seven key research strategies: (1) Production of large data sets; (2) Comparative data collection; (3) Addressing diversity and intersectionality among LGBT+ older people; (4) Investigation of healthcare services’ capacity to deliver LGBT+ affirmative healthcare and associated education and training needs; (5) Identification of effective health promotion and/or treatment interventions for older LGBT+ people, and subgroups within this umbrella category; (6) Development of an (older) LGBT+ health equity model; (7) Utilisation of social justice concepts to ensure meaningful, change-orientated data production which will inform and support government policy, health promotion and healthcare interventions.

We explore the extent to which increased import competition affected crime in US labor markets between 1991 and 2006, and whether access to unemployment insurance attenuated this relationship. In the average labor market, property crime rates rose by 3.4 percent following an interquartile increase in import competition. Increasing unemployment insurance generosity by one standard deviation, however, mitigated over half of the increase. A simple cost-benefit analysis indicates that 4.5-13 percent of the costs of increasing unemployment insurance generosity were recovered in the form of lower crime rates. This highlights a new and important positive externality of unemployment insurance.

Air pollution was severe in the 19th century, yet its health consequences are often overlooked due to a lack of pollution data. We offer a new approach for inferring local coal use levels based on local industrial structure and industry specific coal use intensity. This allows us to provide the first estimates of the mortality effects of British industrial coal use in 1851-1860. Exploiting wind patterns for identification, we find that a one standard deviation increase in coal use raised infant mortality by 6-8% and that industrial coal use explains roughly one-third of the urban mortality penalty observed during this period. This article is protected by copyright. All rights reserved.

The historical fertility transition is one of the most important events in economic history. This study provides new evidence on the role that ideas about family planning played in this transition. We begin by documenting a link between the famous Bradlaugh-Besant trial that took place in England in 1877, which revolved around the morality of family planning, and the sharp decline in fertility that took place in Britain beginning in that year. We then show that similar declines are observed among populations living outside of Britain but with strong cultural and linguistic links to Britain. Our findings highlight the importance of changing social norms in the historical fertility transition and provide novel evidence showing that cultural and linguistic ties can play an important role in rapidly transmitting social change around the world.

How does ethnic diversity in government impact public good provision? We construct a novel dataset linking the ethnicity of California city council candidates to election outcomes and expenditure decisions. Using a regression discontinuity approach, we find that increased diversity on the council leads to less spending on public goods. This is especially true in cities with high segregation and economic inequality. Those serving on councils that experience an increase in diversity also receive fewer votes when they run for reelection. These results point towards disagreement within the council generating lower spending. (JEL D72, H41, H70, J15, R23, R51)

Are government finances and policy outcomes different under politicians with business experience? We study California city councils and implement a regression discontinuity strategy to provide causal evidence on this issue. Ultimately, we find no evidence that the election of a candidate with business experience impacts city expenditures, revenues, unemployment rates, and other outcomes. Future vote shares for candidates with business experience are also unaffected, which suggests that these politicians are not having an impact that is observed to voters but unobserved in our data.

Two exciting AWS Systems Manager features that help manage your fleet at scale are Systems Manager Inventory and Systems Manager Patch Manager. With Systems Manager Inventory, you can specify the type of metadata you want to collect from your instances, which instances to collect it from, and when to collect it. AWS Systems Manager Patch Manager gives you the tools you need to automate the process of scanning or installing patches on your instances.

With AWS Lambda you can deploy and execute code that can be triggered from a multitude of event sources without provisioning or the need to maintain any host servers. Lambda functions can run a number of different languages to include PowerShell Core. In this chapter, I’ll explain how to set up AWS Lambda using PowerShell and to execute PowerShell code as a Lambda function.

Now that you’ve been creating resources in the cloud with PowerShell, you’ll need a simple and secure way to manage all those resources. AWS Systems Manager is a convenient set of management tools that lets you configure and manage your AWS resources at scale.

AWS Systems Manager includes several powerful features which can help you manage fleets of Amazon EC2 instances. In this chapter, we'll take a look at AWS Systems Manager Run Command, Automation, and State Manager which all use a shared object known as Systems Manager (SSM) Documents. Since SSM Documents are a common thread between all these features, it makes sense to dive into them first. So we’ll look at what documents are and how to work with them, and then we’ll see how they are used with Run Command, Automation, and State Manager.

An important area in which cloud can add value to your organization is in End-User Computing; this is because you are able to quickly and easily provision virtual desktops, streaming applications, without the need of purchasing expensive hardware and making a long-term financial commitment. There are two specific End-User Computing AWS services which we will focus on, Amazon WorkSpaces and Amazon AppStream 2.0. These services provide users access to their documents, applications, and other resources, from anywhere and anytime, as long as they, users, are on a supported device. These services both provide a pay-as-you-go model and also give you the flexibility to always have the resources running or run them when you need them.

In this chapter, we will cover the AWS Directory Service, which is a highly scalable and managed multi-directory store; it can be used for authentication and Single Sign-On services. As mentioned, there are multiple directories supported by AWS Directory Service, each one helping solve a unique business problem, including authentication services for traditional applications, support for SaaS application developers, and cloud applications with complex authentication relationships. The directories available include Amazon Cloud Directory, AD Connector, Amazon Cognito, Simple AD, and Microsoft AD. As one can imagine, each of these directories has enough depth, nuance, and complexity to warrant a dedicated chapter in this book. However, in this section we will focus on the services that are most frequently used with Microsoft Workloads and managed with PowerShell; these are Microsoft AD, AD Connector, and Simple AD.

Does minority representation in a legislative body differentially impact outcomes for minorities? To examine this question, we study close elections for California city council seats between white and nonwhite candidates. We find that nonwhite candidates generate differential gains in housing prices in majority nonwhite neighborhoods. This result, which is not explained by correlations between candidate race and political affiliation or neighborhood racial composition and income, suggests that increased representation can reduce racial disparities. Our results strengthen with increased city-level segregation and councilmember pivotality. Regarding mechanisms, we observe changes in business patterns and policing behavior, which may help explain our results.

Almond (2006) argues that in utero exposure to the 1918 influenza pandemic lowered socioeconomic status in adulthood, whereas Brown & Thomas (2018) find that the effect disappears after controlling for parental characteristics of the 1919 birth cohort. We link microdata from the 1920 and 1930 censuses to WWII enlistment records and city-level in uenza data. This allows us to adopt an empirical approach that overcomes the selection concerns raised by Brown & Thomas (2018). Results indicate that in the absence of the pandemic, the 1919 birth cohort would have been more likely to graduate from high school, an effect that is largely unaffected by including parental controls and city-specific time trends. Adding household fixed effects (and thus exploiting variation among brothers) yields similar but somewhat larger results.

Infants who are underweight at birth earn less, score lower on tests, and become less educated as adults. Previous studies have found mixed evidence that socioeconomic status mitigates these effects. In this paper, we reconcile these findings using a unique data set in which adoptees were quasi-randomly assigned to families. We find that median income within a zip code mitigates the effects of low birth weight, as in Currie and Moretti (2007). Interactions between low birth weight and other family characteristics are not statistically significant, which is consistent with Currie and Hyson (1999). These results cannot be explained by differences in genetics, prenatal health care, or neonatal health care.