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Purpose: This paper aims to analyze the nature, magnitude and determinants of access to food among rural households in India during the COVID-19 pandemic. Design/methodology/approach: The study is based on the World Bank's Rural Impact Survey, which has documented the shocks of COVID-19 among 2,787 rural households across six states in India. The chi-square test and binary logistics regression have been used to analyze the data. Findings: About 49.7 % of rural households have reported the incidence of food inaccessibility and shortage, and the majority of them reported a reduction in food intake during the COVID-19 outbreak. However, the magnitude of food accessibility varied across the states and the sociodemographic characteristics of the households. Furthermore, regression analysis indicates that family size, social category and occupation as sociodemographic variables and membership in self-help groups, wage employment under Mahatma Gandhi National Rural Employment Guarantee Act and Cash transfer under Pradhan Mantri Kisan Samman Nidhi and Pradhan Mantri Garib Kalyan Yojana as institutional support factors have a significant effect on access to food among rural households. Practical implications: The findings of the study have far-reaching policy implications for developing an effective food distribution system in crisis situations like the COVID-19 outbreak. The study also provides directions for extending the research on determinants of access to food during crisis. Originality/value: The study is based on a large survey data from the rural households in India and provides empirical evidence on access to food faced by rural communities during the COVID-19 lockdown. [ABSTRACT FROM AUTHOR]

Purpose: This work aims to analyse the relationship between public health efficiency and well-being considering a panel of 102 Italian provinces from 2000 to 2016 and evaluates if there are omitted variable biases and endogeneity biases and also evaluates if there are heterogeneous effects among provinces with different income levels. Design/methodology/approach: We use a multi-input and output bootstrap data envelopment analysis to assess public health efficiency. Then, we measure well-being indices using the min-max linear scaling transformation technique. A two-stage least squares model is used to identify the causal effect of improving public health efficiency on well-being to account for time-invariant heterogeneity, omitted variable bias and endogeneity bias. Findings: After controlling for important economic factors, the results show a significant effect of an accountable and efficient public health system on well-being. Those effects are concentrated in the North, the most economically, geographically and environmentally advantageous areas. Research limitations/implications: The use of the sample mean, probably the oldest and most used method for aggregating the indicators, could be affected by variable compensation, with consequent misleading results in the process of constructing the well-being index. Another limitation is the use of lagged values of the main predictor as an instrument in the instrumental variables setting because it could lead to information loss. Finally, the availability of data over a long period of time. Practical implications: The findings could help policymakers adopt measures to strengthen the public health system, encourage private providers and inspire countries worldwide. Social implications: These results draw the attention of local authorities, who play an important role in designing and implementing policies to stimulate local public health efficiency, which puts individuals in the conditions of achieving overall well-being in their communities. Originality/value: For the first time in Italy, a panel of well-being indices was constructed by developing new methodologies based on microeconomic theory. Furthermore, for the first time, the assessment of the relationship between public health efficiency and well-being is carried out using a panel of 102 Italian provinces. [ABSTRACT FROM AUTHOR]

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Background: The Affordable Care Act (ACA), enacted in 2010, aimed to improve healthcare coverage for American citizens. This study investigates the impact of Medicaid expansion (ME) under the ACA on the racial and ethnic composition of nursing home admissions in the U.S., focusing on whether ME has led to increased representation of racial/ethnic minorities in nursing homes. Methods: A difference-in-differences estimation methodology was employed, using U.S. county-level aggregate data from 2000 to 2019. This approach accounted for multiple time periods and variations in treatment timing to analyze changes in the racial and ethnic composition of nursing home admissions post-ME. Additionally, two-way fixed effects (TWFE) regression was utilized to enhance robustness and validate the findings. Results: The analysis revealed that the racial and ethnic composition of nursing home admissions has become more homogeneous following Medicaid expansion. Specifically, there was a decline in Black residents and an increase in White residents in nursing homes. Additionally, significant differences were found when categorizing states by income inequality, and poverty rate levels. These findings remain statistically significant even after controlling for additional variables, indicating that ME influences the racial makeup of nursing home admissions. Conclusions: Medicaid expansion has not diversified nursing home demographics as hypothesized; instead, it has led to a more uniform racial composition, favoring White residents. This trend may be driven by nursing home preferences and financial incentives, which could favor residents with private insurance or higher personal funds. Mechanisms such as payment preferences and local cost variations likely contribute to these shifts, potentially disadvantaging Medicaid-reliant minority residents. These findings highlight the complex interplay between healthcare policy implementation and racial disparities in access to long-term care, suggesting a need for further research on the underlying mechanisms and implications for policy refinement. [ABSTRACT FROM AUTHOR]

We use novel, large-scale data on 17.5 million Americans to study how a policy-driven increase in economic resources affects children's long-term outcomes. Using the 2000 Census and 2001–13 American Community Survey linked to the Social Security Administration's NUMIDENT, we leverage the county-level rollout of the Food Stamps program between 1961 and 1975. We find that children with access to greater economic resources before age five have better outcomes as adults. The treatment-on-the-treated effects show a 6% of a standard deviation improvement in human capital, 3% of a standard deviation increase in economic self-sufficiency, 8% of a standard deviation increase in the quality of neighbourhood of residence, a 1.2-year increase in life expectancy, and a 0.5 percentage-point decrease in likelihood of being incarcerated. These estimates suggest that Food Stamps' transfer of resources to families is a highly cost-effective investment in young children, yielding a marginal value of public funds of approximately sixty-two. [ABSTRACT FROM AUTHOR]

I investigate the effects of California’s paid family leave (CA-PFL) program, the first state-mandated paid leave available to both mothers and fathers in the US. I examine the effects on the overall health of mothers and fathers during two distinct periods: health immediately around childbirth and health following childbirth. To do so, I leverage the variation in the timing of the Survey of Income and Program Participation (SIPP) health care topical module relative to the exact year and month of childbirth. I find that CA-PFL has improved mothers’ health during pregnancy and immediately after childbirth. This improvement in health is accompanied by a reduced likelihood of mothers not working or taking unpaid work absence. Some improvements manifest in fathers’ health too during the same period. However, I observe that fathers report more instances of feeling sick, starting around 5 months after childbirth. Further analysis reveals that the share of fathers not working or taking unpaid work absence rises temporarily when the leave period ends. Understanding the effects on fathers’ health and leave utilization is pivotal to evaluating the program’s overall benefits and potential unintended consequences given the growing focus on enhancing equal access to paid leave for both mothers and fathers. [ABSTRACT FROM AUTHOR]

Nowadays, there is great pressure in cities on the demand and supply of food as well as environmental needs, and where Urban Agriculture emerges in various forms to confront this situation. Indeed, Urban Agriculture is a form of agriculture, highlighting its multiple functions in ensuring food security, maintaining urban ecosystem services, and improve the quality of life. Moreover, the use and transformation of abandoned areas is proving to be an appropriate way of creating new green spaces. This research article focuses on analysing the alignment between governance mechanisms, the distribution of the value created, together with the benefits derived. The comparison is based on four case studies in France, two in Paris ("La Caverne" and "Veni-Verdi") and two in Rouen ("Le Champ des Possibles" and "Le Jardin de l'Astéroïde") with different vocations (social vs economic), and which will serve as a basis for investigations into the theme of Food Governance Structures. This research work consisted of carrying out interviews with the stakeholders involved in Urban Agricultural Projects, as well as on-site visits for analysis and evaluation. An empirical analysis through the NVivo Software is used, which allowed the qualitative analysis of the data. The results show that there are similarities between the different initiatives, such as having a well-structured administrative office headed by a president, treasurer and employees. At the same time, there are a few differences in terms of the type of structure, key priorities and management structure. Indeed, three of the four initiatives evaluated aim to reach out to local residents and to understand the benefits of having agricultural spaces in our cities and to recreate this link with nature, unlike the economic initiative, which focuses more on business and commerce and less on social and educational inclusion. [ABSTRACT FROM AUTHOR]

Countries make differing policy choices. They can serve as a scientific laboratory for drawing lessons on the policy paths to follow or to avoid and the consequences of those institutional choices on individuals at older ages. In this special issue we bring together six articles that evaluate the influence of institutions on retirement decisions, health and well-being of older adults using common data that have emerged with the international network of health and retirement studies to study key life outcomes such as health, work, and lifecycle transitions at older ages. [ABSTRACT FROM AUTHOR]

The government often contracts with private firms to deliver in-kind safety net benefits. These public–private partnerships generate agency problems that could increase costs, but cost containment reforms may discourage firm participation. We study a 2012 reform of California's Special Supplemental Nutrition Program for Women, Infants, and Children that reduced the number of small vendors. We show that within-zip-code access to small vendors increases take-up among first-time and foreign-born mothers, suggesting that small vendors are distinctly effective at lowering take-up barriers among women with high program learning costs. Thus, cost containment reforms may have unintended consequences of inequitably reducing program access. [ABSTRACT FROM AUTHOR]

The school meals program is the largest nutritional assistance program for school-aged children. Whereas program eligibility historically was determined by family income, recent reforms allow schools to offer free meals to all students. This work evaluates the effect of the Community Eligibility Provision (CEP), the largest school-wide free meals program, on academic performance. I leverage within- and across-state variation in the timing of CEP participation and find universal free meals increases breakfast and lunch participation by 38 and 12 percent, respectively. Math performance improves in districts with baseline low free meal eligibility, particularly among racial/ethnic groups with low income-based participation rates. [ABSTRACT FROM AUTHOR]

Beginning in the 1990s, states have received unprecedented flexibility to determine Supplemental Nutrition Assistance Program (SNAP) eligibility and program administration. We find state SNAP policies accounted for nearly half of the 2000–2016 caseload increase. State economic conditions also play an important role in caseload changes, accounting for almost half of the 2007 through 2013 increase. Within distinct periods of our 1990–2016 data, policy and the economy make different contributions to caseload changes. Policy simulations indicate that mandating states to maintain their 2000 SNAP policies, prior to the greatest expansion in latitude, would have lowered 2000–2016 caseload growth by 38%. [ABSTRACT FROM AUTHOR]

Upwards of 70% of the Covid19 death toll in Sweden has been people in elderly care services (as of mid-May 2020). We summarize the Covid19 tragedy in elderly care in Sweden, particularly in the City of Stockholm. We explain the institutional structure of elderly care administration and service provision. Those who died of Covid19 in Stockholm's nursing homes had a life-remaining median somewhere in the range of 5 to 9 months. Having contextualized the Covid19 problem in City of Stockholm, we present an interview of Barbro Karlsson, who works at the administrative heart of the Stockholm elderly care system. Her institutional knowledge and sentiment offer great insight into the concrete problems and challenges. There are really two sides to the elderly care Covid19 challenge: The vulnerability and frailty of those in nursing homes and the problem of nosocomial infection—that is, infection caused by contact with others involved in the elderly care experience. The problem calls for targeted solutions by those close to the vulnerable individuals. [ABSTRACT FROM AUTHOR]

Have we reached the point where more spending on health care and other forms of social protection is not producing better health as measured by reductions in population mortality? Drawing on two decades of research and mortality statistics (1995–2015) for 17 OECD countries, our analysis confirms and builds on the observed relationship between the returns and investments in health and social welfare spending. First, the results suggest that there is a differential effect of socioeconomic, lifestyle and demography variables on total and cause-specific mortality rates. Second, the basic premise of an association between health care expenditure and mortality rates is reinforced in models that take into account public-only health expenditure and its impact on older age groups. Third, a strong protective effect of government-sponsored welfare expenditure on infant mortality was observed. This effect is weaker on other causes of death and suggests that older individuals, in this sample of developed countries, may have reached a stage of the epidemiological transition in which health improvement is indifferent to government assistance and depends largely on behavioural change. [ABSTRACT FROM AUTHOR]

In England, state support for older people with disabilities consists of a national system of non‐means‐tested cash disability benefits and a locally administered means‐tested system of social care. Evidence on how the combination of the two systems targets those in most need is lacking. We estimate a latent factor structural equation model of disability and receipt of one or both forms of support. The model integrates the measurement of disability and its influence on receipt of state support, allowing for the socio‐economic gradient in disability, and adopts income and wealth constructs appropriate to each part of the model. We find that receipt of each form of support rises as disability increases, with a strong concentration on the most disabled, especially for local‐authority‐funded care. The overlap between the two programmes is confined to the most disabled. Less than half of recipients of local‐authority‐funded care also receive a disability benefit; a third of those in the top 10 per cent of the disability distribution receive neither form of support. Despite being non‐means‐tested, disability benefits display a degree of income and wealth targeting, as a consequence of the socio‐economic gradient in disability and likely disability benefit claims behaviour. The scope for improving income/wealth targeting of disability benefits by means testing them, as some have suggested, is thus less than might be expected. [ABSTRACT FROM AUTHOR]

In low income settings, food assistance is increasingly becoming part of AIDS treatment and care programs with the aim of improving adherence to AIDS treatment, enhancing household food security and strengthening economic wellbeing. Yet, evidence of its economic impact is sparse. This paper uses primary data to examine the short term impact of a food assistance program on labor supply as measured by the hours worked, labor market participation rates and transitions to employment within HIV/AIDS affected households in Zambia. We find that food assistance is generally a labor supply disincentive to HIV-infected patients receiving treatment as it reduced their hours worked by up to 54%, transitions to employment by up to 70% and also reduced the labor market participation rates of male patients by 72%. Among non-infected adult family members, there were no significant effects on labor market participation. However, propensity score estimates show that food assistance generally increased the intensity of work by males regardless of the length of AIDS treatment, but for females there was a disincentive effect that disappeared when the patient had spent a longer time on AIDS treatment and was therefore healthier and less likely to be cared for. These findings suggest that food assistance can inadvertently reduce the labor supply of HIV-infected individuals, but this is compensated for by the increased labor supply among other family members. [ABSTRACT FROM AUTHOR]

We evaluate the effect of postnatal participation in the Women, Infants, and Children (WIC) programme on breastfeeding decisions using the data from the IFPS II. We find that the infant’s WIC participation positively affects the hazard of discontinuing breastfeeding, both partial and exclusive (and is thus associated with abbreviated breastfeeding duration). No significant association is found between the mother’s participation and the hazards of stopping exclusive or partial breastfeeding. Such differential effects might be a result of the programme’s policy, according to which the infant, but not the mother needs to be enrolled to receive free formula. [ABSTRACT FROM PUBLISHER]

By providing affordable healthcare to many Americans for the first time, the Affordable Care Act increases demand for public mental health services. It is, however, unclear if states' provision standards for supply of mental health services will be able to accommodate this demand increase. Both the demand and supply of public mental health services vary within states; it is necessary to measure both locally. In this paper, we estimate the prevalence of mental illness within 30 geographical regions in the state of Virginia, a representative example of how many states organize their public mental health systems and how mental illness prevalence can be measured locally. Our methodology extends the analysis in Stern (Health Serv. Outcomes Res. Methods 14:109-155, 2014) by covering an entire state and accounting for peoples' insurance status. The latter allows us to compare estimates of demand for public mental health services among those 30 geographical regions. We find that over 66,000 uninsured and Medicaid-insured individuals in Virginia are not provided with public mental health services. The deficit varies locally, with several regions having no deficit and others having 5000 or more untreated people. We also estimate that a large portion of the unserved people with mental illness are uninsured but would be insured for mental health services through Medicaid if Virginia were to accept the Medicaid expansion associated with the Affordable Care Act. These results provide evidence that there is significant variation in the demand for and public health systems' ability to supply mental health services within states. This implies states can better serve populations relying on mental health care by allocating scarce public mental health dollars to localities reflecting their need. [ABSTRACT FROM AUTHOR]

A wide range of interventions, from subsidized grains all the way to conditions on nutrition in conditional cash transfers, have either been tried or put in place in different countries in order to fight under-nutrition. A number of important policy experiments in recent years, directly or indirectly, offer important insights into how best to design these interventions. This essay is an attempt to pull together some of those insights, with the aim of saying something about what the optimal design should look like. [ABSTRACT FROM AUTHOR]

This article estimates the impact of the introduction of Medicaid managed care (MMC) on the formal Medicaid participation of children. We employ a quasi-experimental approach exploiting the location-specific timing of MMC implementation in Kentucky. Using data from the March Current Population Survey from 1995 to 2003, our findings suggest that the introduction of MMC increases the likelihood of being uninsured and decreases formal Medicaid participation. This finding is consistent with an increase in 'conditional coverage,' waiting until medical care is needed to sign up or re-enroll in Medicaid. These effects are concentrated among low-income children and absent for high-income children. We find no evidence of 'crowd-in,' substituting private coverage for Medicaid. These results are robust to multiple placebo tests and imply the potential for less formal participation (i.e., more conditional coverage) among the Affordable Care Act-Medicaid expansion population (which is likely to be primarily covered under MMC) than is typically predicted. [ABSTRACT FROM AUTHOR]

The spread of HIV and AIDS and risky sexual behavior continues to be a problem in Sub-Saharan African countries despite government measures to educate people on the risk and severity of the disease and measures to promote safe sex practices such as making condoms readily available at reduced or no cost. We examine whether people decide to engage in risky sexual behavior due to low income and low life expectancy. Sub-Saharan Africa is characterized by conditions that significantly reduce life expectancy such as unsanitary conditions prevalent in poverty stricken areas, inaccessibility to health care, and dangerous working conditions such as those in very poor mining regions. Moreover, since income per capita in these countries is very low, the opportunity cost associated with dying from AIDS and foregoing future consumption is very low. We examine how a government provided life insurance benefit may be an effective means of deterring risky sexual behavior. To evaluate this policy prescription we develop a life-cycle model with personal and family consumption and endogenous probability of survival. In the model, agents can receive life insurance benefits if their death is not the result of AIDS. We demonstrate that excessive risky behavior does result from low life expectancy and low levels of income and illustrate the conditions for which the life insurance benefit can replicate the effects of higher income and life expectancy, deterring risky sexual behavior and reducing the spread of HIV/AIDS. [ABSTRACT FROM AUTHOR]

Background: User fee removal policies have been extensively evaluated in relation to their impact on access to care, but rarely, and mostly poorly, in relation to their impact on household out-of-pocket (OOP) spending. This paucity of evidence is surprising given that reduction in household economic burden is an explicit aim for such policies. Our study assessed the equity impact on household OOP spending for facility-based delivery of the user fee reduction policy implemented in Burkina Faso since 2007 (i.e. subsidised price set at 900 Communauté Financière Africaine francs (CFA) for all, but free for the poorest). Taking into account the challenges linked to implementing exemption policies, we aimed to test the hypothesis that the user fee reduction policy had favoured the least poor more than the poor. Methods: We used data from six consecutive rounds (2006-2011) of a household survey conducted in the Nouna Health District. Primary outcomes are the proportion of households being fully exempted (the poorest 20 % according to the policy) and the actual level of household OOP spending on facility-based delivery. The estimation of the effects relied on a Heckman selection model. This allowed us to estimate changes in OOP spending across socio-economic strata given changes in service utilisation produced by the policy. Findings: A total of 2,316 women reported a delivery between 2006 and 2011. Average household OOP spending decreased from 3,827 CFA in 2006 to 1,523 in 2011, without significant differences across socio-economic strata, neither in terms of households being fully exempted from payment nor in terms of the amount paid. Payment remained regressive and substantially higher than the stipulated 900 CFA. Conclusions: The Burkinabè policy led to a significant and sustained reduction in household OOP health spending across all socio-economic groups, but failed to properly target the poorest by ensuring a progressive payment system. [ABSTRACT FROM AUTHOR]