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Governments in many low- and middle-income countries are developing health insurance products as a complement to tax-funded, subsidized provision of healthcare through publicly-operated facilities. We discuss two rationales for this transition. First, health insurance would boost fiscal revenues for healthcare, as post-treatment out-of-pocket payments to providers would be replaced by pre-treatment insurance premia to health ministries. Second, increased patient choice and carefully designed physician reimbursements would increase quality in the healthcare sector. Our essay shows that, at best, these objectives have only been partially met. Despite evidence that health insurance has provided financial protection, consumers are not willing to pay for unsubsidized premia. Health outcomes have not improved despite an increase in utilization. We argue that this is not because there was no room to improve the quality of care but because behavioral responses among healthcare providers have systematically undermined the objectives of these insurance schemes.

In lower-income countries, the economic contractions that accompany lockdowns to contain COVID-19 transmission can increase child mortality, counteracting the mortality reductions achieved by the lockdown. To formalize and quantify this effect, we build a macrosusceptible-infected-recovered model that features heterogeneous agents and a country-group-specific relationship between economic downturns and child mortality and calibrate it to data for 85 countries across all income levels. We find that in some low-income countries, a lockdown can produce net increases in mortality. The optimal lockdown that maximizes the present value of aggregate social welfare is shorter and milder in poorer countries than in rich ones.

Global terrorist organizations attract radicalized individuals across borders and constitute a threat for both sending and receiving countries. We use unique personnel records from the Islamic State in Iraq and the Levant (Daesh) to show that unemployment in sending countries is associated with the number of transnational terrorist recruits from these countries. The relationship is spatially heterogeneous, which is most plausibly attributable to travel costs. We argue that poor labor market opportunities generally push more individuals to join terrorist organizations, but at the same time limit their ability to do so when longer travel distances imply higher migration costs.

The objective of this paper is to provide an estimate of the elasticity of elephant poaching with respect to prices. Ivory being a storable commodity subjects its price to Hotelling’s no-arbitrage condition, hence allowing identification of the supply curve. The price of gold, one of many commodities used as stores of value, is thus used as an instrument for ivory prices. The supply of illegal ivory is found to be price inelastic with an elasticity of 0.4, with changes in consumer prices passing-through to prices faced by producers at a rate close to unity. Estimations based on a number of alternative estimation approaches all confirm the conclusion that supply is inelastic. The paper ends with a brief discussion on what such a finding implies for elephant conservation policies.

Utilities the world over grapple with how to set prices to recover fixed costs. This paper considers optimal utility provision and pricing when consumers form habits without being aware of it. Data from a multi-year pricing experiment among nearly 1500 rural piped water customers in Vietnam reveal evidence of habit formation. A novel test based on the Euler equation rejects the hypothesis that consumers are aware of or sophisticated about such intertemporal dependence in favor of them being unaware or naive. As a result, the paper finds that, first, the long-run price elasticity is nearly three times larger than the short-run elasticity; second, an ex-ante willingness-to-pay elicitation would understate by nearly two-thirds consumers' ex-post valuations; and, third, when the policy maker has distributional concerns, an optimal two-part tariff that ignores habit formation is too progressive and sets the marginal price too high, with an attendant welfare loss of up to 8 percent.

In many developing countries, environmental quality remains low and policies to improve it have been inconsistently effective. This paper conducts a case study of environmental policy, focusing on an unprecedented ruling by the Supreme Court of India, which targeted industrial pollution in the Ganga River. Difference-in-difference estimations indicate that the ruling led to reductions in river pollution and one-month infant mortality. To look at the mechanisms of impact, the paper tests whether the identified health impact is fully explained by changes in pollution induced by the policy, and fails to reject that it indeed is. In so doing, the analysis also quantifies the adverse impact of water pollution on infant health and documents the persistence of such impacts in downstream communities.

This paper analyzes the spatial distribution of refugees over 1987-2017 and establishes several stylized facts about refugees today compared with past decades. (i) Refugees today travel longer distances. (ii) Refugees today are less likely to seek protection in a neighboring country. (iii) Refugees today are less geographically concentrated. And (iv) refugees today are more likely to reside in a high-income OECD country. The findings bring new evidence to the debate on refugee burden-sharing.

This paper analyzes theoretically and empirically the impact of comparative advantage in international trade on fertility. It builds a model in which industries differ in the extent to which they use female relative to male labor and countries are characterized by Ricardian comparative advantage in either female labor or male labor intensive goods. The main prediction of the model is that countries with comparative advantage in female labor intensive goods are characterized by lower fertility. This is because female wages and therefore the opportunity cost of children are higher in those countries. The paper demonstrates empirically that countries with comparative advantage in industries employing primarily women exhibit lower fertility. The analysis uses a geography-based instrument for trade patterns to isolate the causal effect of comparative advantage on fertility.

As the world's most traded commodity, oil production is typically well monitored and analyzed. It also has established links to geopolitics, international relations, and security. Despite this attention, the illicit production, refining, and trade of oil and derivative products occur all over the world and provide significant revenues outside of the oversight and regulation of governments. A prominent manifestation of this phenomenon is how terrorist and insurgent organizations-including the Islamic State group, also known as ISIL/ISIS or Daesh-use oil as a revenue source. Understanding the spatial and temporal variation in production can help determine the scale of operations, technical capacity, and revenue streams. This information, in turn, can inform both security and reconstruction strategies. To this end, we use satellite multi-spectral imaging and ground-truth pre-war output data to effectively construct a real-time census of oil production in areas controlled by the ISIL terrorist group. More broadly, remotely measuring the activity of extractive industries in conflict-affected areas without reliable administrative data can support a broad range of public policy and decisions and military operations.

The objective of this paper is to provide an estimate of the elasticity of elephant poaching with respect to prices. Ivory being a storable commodity subjects its price to Hotelling's no-arbitrage condition, hence allowing identification of the supply curve. The price of gold, one of many commodities used as stores of value, is thus used as an instrument for ivory prices. The supply of illegal ivory is found to be price-inelastic with an elasticity of 0.4, with changes in consumer prices passing-through to prices faced by producers at a rate close to unity. Estimations based on a number of alternative estimation approaches all confirm the conclusion that supply is inelastic. The paper ends with a brief discussion on what such finding implies for elephant conservation policies.

Accurately measuring oil production in low-governance contexts is an important task. Many terrorist organizations and insurgencies -- including the Islamic State group, also known as ISIL/ISIS or Daesh -- tap oil as a revenue source. Understanding spatial and temporal variation in production in their territory can help address such threats by providing near real-time monitoring of their revenue streams, helping to assess long-term economic potential, and informing reconstruction strategies. More broadly, remotely measuring extractive industry activity in conflict-affected areas and other regions without reliable administrative data can support a broad range of public policy decisions and academic research. This paper uses satellite multi-spectral imaging and ground-truth pre-war output data to effectively construct a real-time day-to-day census of oil production in areas controlled by the terrorist group. The estimates of production levels were approximately 56,000 barrels per day (bpd) from July-December 2014, drop to an average of 35,000 bpd throughout 2015, before dropping further to approximately 16,000 bpd in 2016.

Using a database of 76,046 empirical economics papers published between 1985 and 2004 in the top 202 economics journals, the authors report two associations. First, per-capita research output on a given country increases with the country's per capita gross domestic product (GDP). Regressions controlling for data availability and quality in the country, indicators of governance and the use of English yield an estimated research-GDP elasticity of 0.37; surprisingly, the United States (US) is not an outlier in the production of empirical research. Second, papers written about the US are far more likely to be published in the top five economics journals, even after the quality of research has been partially controlled for through fixed-effects for the authors' institutional affiliations; the estimates suggest that papers on the US are 2.6 percentage points more likely to be published in the top-five journals. This is a large effect because only 1.5 percent of all papers written about countries other than the US are published in the top-five journals. The authors speculate about the interpretations of these facts, and invite further analysis and additions to the public release of the database that accompanies this paper.

The estimated duration of forced displacement situations is a key parameter in defining an adequate response to the crisis. Where the crisis is short, humanitarian aid may suffice; when it lasts, development interventions are required. Using data from the United Nations High Commissioner for Refugees, this paper proposes propose a new approach to estimate the mean and median durations of exile, and their variations over time. The analysis finds that people who were refugees at the end of 2015 have been in exile for an average duration of 10.3 years and a median duration of 4 years; the average duration of exile has varied between 10 and 15 years since the late 1990s. The number of people who are in protracted situations (over five years) has been steady at 5 million to 7 million since the mid-1990s, and currently stands at 6.6 million. For those people, the average duration of exile is as long as 21.2 years. All these estimates are very sensitive to two situations: Afghanistan, where the crisis has been ongoing since 1979 and increases all averages, and the Syrian Arab Republic, which is relatively recent and lowers the averages.

The short term economic outlook for the Middle East and North Africa (MENA) region remains “cautiously pessimistic”. A combination of civil wars and refugee inflows, terrorist attacks, cheap oil, and subdued global economic recovery is expected to keep average growth in the MENA region around 3 percent in 2016, for the fourth year in a row. Furthermore, the humanitarian and economic situation in the war torn countries keep deteriorating. In this report we will explore ways in which a strategy of reconstruction of Syria—the most war-ravaged country in the region—could help foster a sustainable peace. This report argues that the impact of the civil war on the Syrian society will be persistent, and the challenges facing the country need to be addressed now. The report calls for the international community to be the guarantor of an inclusive reconstruction strategy that not only makes peace sustainable tomorrow, but makes it happen today: peace and reconstruction are two sides of the same coin.

Distances involved in accessing basic services can constitute a major barrier to development. This paper analyzes the relationship between the distance separating households from microfinance institutions’ offices in Niger, and the low levels of development and performance of the microfinance sector in the country. To cope with the effects of geographical distance, microfinance institutions adapt their policies through more restrictive loan conditions, higher interest rates and more intensive screening. This then leads us to discuss the tension between access and sustainability in the context of financial services for the poor.

We identify birth wantedness as a source of better child outcomes. In Vietnam, the year of birth is widely believed to determine success. As a result, cohorts born in auspicious years are 12 percent larger. Comparing siblings with one another, those of auspicious cohorts are found to have two extra months of schooling. The Vietnamese horoscope being gender-specific, this difference will be shown to be driven by birth planning. Children born in auspicious years are more likely to have been planned, thus benefitting from a more favorable growth environment. (JEL J12, J13, O15, P23, Z13)

The authors analyze the relationship between international trade and the quality of economic institutions such as contract enforcement, rule of law, or property rights. The literature on institutions has argued, both empirically and theoretically, that larger firms care less about good institutions and that higher inequality leads to worse institutions. Recent literature on international trade enables the authors to analyze economies with heterogeneous firms, and argue that trade opening leads to a reallocation of production in which large firms grow larger, while small firms become smaller or disappear. Combining these two strands of literature, the authors build a model that has two key features. First, preferences over institutional quality differ across firms and depend on firm size. Second, institutional quality is endogenously determined in a political economy framework. They show that trade opening can worsen institutions when it increases the political power of a small elite of large exporters that prefer to maintain bad institutions. The detrimental effect of trade on institutions is most likely to occur when a small country captures a sufficiently large share of world exports in sectors characterized by economic profits.

The relationship between poverty and mental health has received considerable attention in the recent literature. However, the associations presented in existing studies typically rely on limited samples of individuals and on proxy indicators for poverty such as education, the lack of tap water, or being unemployed. We revisit the relationship between poverty and mental health using data from nationally representative household surveys in Bosnia and Herzegovina, Indonesia and Mexico, along with special surveys from India and Tonga. As in previous studies, we find that individuals who are older, female, widowed, and in poor health are more likely to report worse mental health outcomes. Individuals living with others with poor mental health are significantly more likely to report worse mental health themselves. The size of the coefficients and their significance are comparable across the five countries. In contrast to previous studies, the relationship between higher education and better mental health is weak or non-existent. Furthermore, there is no consistent association between consumption poverty and mental health - in two countries mental health measures are marginally worse for the poor; in two countries there is no association; and in one country mental health measures are better for the poor compared to the non-poor. Moreover, the sizes of the coefficients for both education and consumption poverty are small compared to other factors considered here. While the lack of an association between consumption poverty and mental health implies that poor mental health is not a "disease of affluence", neither is it a disease of poverty. Changes in life circumstances brought on, for instance, by illness may have a greater impact on mental health than levels of poverty. Effective public health policy for mental health should focus on protecting individuals and households from adverse events and on targeted interventions following such adverse changes.

During the past decade, the use of conditional cash transfer programs to increase investment in human capital has generated considerable excitement in both research and policy forums. This article surveys the existing literature, which suggests that most conditional cash transfer programs are used for essentially one of two purposes: restoring efficiency when externalities exist or improving equity by targeting resources to poor households. The programs often meet their stated objectives, but in some instances there is tension between the efficiency and equity objectives. The overall impact of a program depends on the gains and losses associated with each objective.

In a world with volatile food prices, countries have an incentive to shelter their populations from induced real income shocks. When some agents are net food producers while others are net consumers, there is scope for insurance between the two groups. A domestic social protection scheme would therefore transfer resources away from the former group to the latter in times of high food prices, and do the reverse otherwise. This paper shows that in the presence of consumer preference heterogeneity, implementing the optimal social protection policy can potentially induce higher food price volatility. Such policy indeed generates a counter-cyclical demand shock that amplifies the effects of the underlying food shortage. The results call for a reassessment of food stabilization policies. In particular, the authors urge caution against the systematic condemnation of trade insulation practices.

This brief summarizes the results of a gender impact evaluation study, entitled Hand washing behavior change at scale : evidence from a randomized evaluation in Vietnam, conducted in 2010 in Vietnam. The study evaluates a large-scale hand washing campaign in three provinces of Vietnam on the household level. The program did not have an impact on hand washing with soap behavior. Knowledge about the correct way to wash was high at baseline, and some areas of knowledge improved, but it did not have an impact on the already high access to soap within households and modest effects on the self-reported hand washing behavior of mothers. Observed hand washing behaviors remained very low; mostly caregivers wash their hands with water only. Funding for the study derived from the Bill and Melinda Gates Foundation.

The authors survey the recent literature on the mental health effects of conflict. They highlight the methodological challenges faced in this literature, which include the lack of validated mental health scales in a survey context, the difficulties in measuring individual exposure to conflict, and the issues related to making causal inferences from observed correlations. They illustrate how some of these issues can be overcome in a study of mental health in post-conflict Bosnia and Herzegovina. Mental health is measured using a clinically validated scale; conflict exposure is proxied by administrative data on war casualties instead of being self-reported. The analysis suggests that there are no significant differences in overall mental health across areas which are affected by ethnic conflict to a greater or lesser degree.

As natural disasters hit with increasing frequency, especially in coastal areas, it is imperative to better understand how much natural disasters affect economies and their people. This requires disaggregated measures of natural disasters that can be reliably linked to households, the first challenge this paper tackles. In particular, a methodology is illustrated to create natural disaster and hazard maps from first hand, geo-referenced meteorological data. In a second step, the repeated cross-sectional national living standard measurement surveys (2002, 2004, and 2006) from Vietnam are augmented with the natural disaster measures derived in the first phase, to estimate the welfare effects associated with natural disasters. The results indicate that short-run losses from natural disasters can be substantial, with riverine floods causing welfare losses of up to 23 percent and hurricanes reducing welfare by up to 52 percent inside cities with a population over 500,000. Households are better able to cope with the short-run effects of droughts, largely due to irrigation. There are also important long-run negative effects, in Vietnam mostly so for droughts, flash floods, and hurricanes. Geographical differentiation in the welfare effects across space and disaster appears partly linked to the functioning of the disaster relief system, which has so far largely eluded households in areas regularly affected by hurricane force winds.

We conduct an empirical analysis of the geographic, economic, and social factors that contributed to the spread of civil war in Nepal over the period 1996—2006. This within-country analysis complements existing cross-country studies on the same subject. Using a detailed dataset to track civil war casualties across space and over time, several patterns are documented. Conflict-related deaths are significantly higher in poorer districts and in geographical locations that favor insurgents, such as mountains and forests; a 10 percentage point increase in poverty is associated with 25—27 additional conflict-related deaths. This result is similar to that documented in cross-country studies. In addition, the relationship with poverty and geography is similar for deaths caused by the insurgents and deaths caused by the state. Furthermore, poorer districts are likely to be drawn into the insurgency earlier, consistent with the theory that a lower cost of recruiting rebels is an important factor in starting conflict. On the other hand, geographic factors are not significantly associated with such onset, suggesting that they instead contribute to the intensity of violence only after conflict has started. Finally, in contrast to some cross-country analyses, ethnic and caste polarization, land inequality, and political participation are not significantly associated with violence.

The authors survey the recent literature on the mental health effects of conflict. They highlight the methodological challenges faced in this literature, which include the lack of validated mental health scales in a survey context, the difficulties in measuring individual exposure to conflict, and the issues related to making causal inferences from observed correlations. They illustrate how some of these issues can be overcome in a study of mental health in post-conflict Bosnia and Herzegovina. Mental health is measured using a clinically validated scale; conflict exposure is proxied by administrative data on war casualties instead of being self-reported. The analysis suggests that there are no significant differences in overall mental health across areas which are affected by ethnic conflict to a greater or lesser degree.