In its sixth round of funding, the Center for Health Research is pleased to award two new small research grants.
Pharmaceutical supply and pricing in developing countries have received increasing attention in recent years, but demand behavior is still poorly understood. This is particularly true for chronic disease drugs which are of increasing importance in low- and middle-income countries. The public health community has faced great challenges in raising coverage of child vaccines that require only a few low-cost doses. How effective will supply-side subsidies be for raising the demand for chronic disease drugs that must be taken for years?
Anti-hypertensive medications are of particular interest because they receive relatively little publicity in most developing countries, in contrast to the intense campaigns surrounding child vaccines, and because they provide no immediate discernible relief of symptoms. Will Dow will use his 2006 Small Grant to concentrate on data from eight middle-income countries in Latin America (Argentina, Barbados, Brazil, Chile, Costa Rica, Cuba, Mexico, and Uruguay) where hypertension has become an important health issue.
He will begin his study with descriptive cross-country comparisons of hypertension drug use in these eight countries to determine how aggregate hypertension drug use levels compare internationally, both between these varying countries and with the United States. He hopes to learn whether people in Latin America demand these little publicized drugs that provide no immediate symptom relief and whether usage rates are higher in countries with well developed primary care systems and good health outcomes such as Costa Rica and Cuba.
He will then use data from the Mexican “Health and Aging Survey” to analyze within-country socioeconomic differentials such as the rates of hypertension drug use by the (presumably educated) wealthy and the uneducated poor. He will also examine whether the presence of health insurance has lead to increased awareness and utilization of hypertension drugs, and whether expanding health insurance to the poor, as Mexico is doing, helps to narrow any socioeconomic differentials in the use of this type of chronic disease drug.
The United States—through the Superfund program—has spent more than $30 billion to clean up hazardous waste sites. Enrico Moretti hopes to better understand the consequences to infant health of exposure to toxic wastes from hazardous waste sites.
Most of the earlier epidemiological research aimed to assess whether living near a hazardous waste site increases the risk of adverse health effects. Nearly all of these studies are cross-sectional in nature, comparing health outcomes among individuals that live near these sites to individuals that live elsewhere. The evidence on whether such proximity leads to worse health outcomes for adults and children has been mixed, primarily because populations living near toxic waste sites are typically different from the general population, and so are likely to have different health outcomes regardless of exposure status.
Dr. Moretti will use his 2006 Small Research Grant to circumvent many of these problems by measuring the health impact of Superfund site clean-ups, rather than the effect of proximity to sites that haven’t been cleaned-up. By comparing the change in birth outcomes in the years immediately preceding and following a clean-up, he hopes to remove any bias that may be due to fixed unobserved characteristics of the site.
Dr. Moretti’s project will also make use of the Superfund’s selection rule— a nonlinear function of a continuous and noisy measure of risk—that determined the first 400 hazardous waste sites (out of 690) to be slated for Superfund clean ups. He will use the rule to implement a quasi-experimental regression discontinuity design, which will allow him to compare health outcomes at similar hazardous sites, only some of which are cleaned-up.
By quantifying the benefits of the Superfund program in terms of its effects on infant health, Dr. Moretti’s study will provide important insights into how to shape future Superfund activities and inform policymakers on the exact magnitude and nature of risk of exposure to toxic waste.
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