Abstract

Internal migration can increase regional disparities in healthcare costs between economically disadvantaged and more prosperous regions in the same country. Persons who move to more prosperous regions tend to be young and healthy while persons who move to or remain in economically disadvantaged regions are on average older and sicker. In this study, we propose a novel framework that allows estimating the effect of internal migration and resulting changes in population composition on average healthcare costs in different regions. Our framework refines a “move people back” approach by adjusting for place effects. Based on data for the entire population of the Netherlands we show that internal migration during the 1998-2018 period  increased average healthcare costs in economically disadvantaged provinces by up to 3.4%, and it explains 29.3% of regional variation in healthcare costs.

Abstract

India consistently ranks among the countries with the highest levels of ambient air pollution worldwide. At the same time, it faces significant challenges in neonatal health, with newborns having low birth weights which have been shown to have long-term impacts on health and labor market outcomes. Using data from the Indian Demographic and Health Survey (DHS), we examine the impact of in-utero exposure to particulate matter (PM2.5) on birth outcomes. We exploit quasi-random variation in wind direction as an instrument for in-utero particulate matter exposure for each child. We find that reducing in-utero PM2.5 exposure by one standard deviation would lead to a 1.1% increase in average birth weight and reduce the incidence of low birth weight (LBW) and very low birth weight (VLBW) births by 2.9 and 0.7 percentage points, respectively. We extend our analysis to examine potential nonlinear effects of pollution exposure on birth outcomes. While we find no evidence of heterogeneous effects across different pollution thresholds, our results indicate that pollution disproportionately affects individuals in the lower tail of the birth weight distribution, with no impact at the upper tail.

Abstract

Characteristics of a place, such as healthcare access and the local environment, influence healthcare utilization. Refugees resettled in developed countries are often assigned locations based on the host country’s assignment policies, yet the impact of initial placement on their healthcare usage remains understudied. I use Dutch administrative data to examine the effect of conditions in the initial municipality on healthcare utilization of refugees, leveraging the random assignment of refugees. Being assigned to a municipality with a higher healthcare utilization as measured by depression medication usage, hospital visits, and general practitioner costs among non-refugees increases healthcare utilization of refugees. I provide suggestive evidence on possible mechanisms and find that local healthcare access and socio-economic status of the municipality play an important role in healthcare utilization of refugees. This study contributes to the ongoing policy debates on providing separate and more targeted healthcare services for the refugee population.

Abstract

In this study, I delve into the factors shaping the adoption of new farming practices among Indian farmers, with a particular focus on the role of information access and its diverse sources. Leveraging nationally representative data on rural households from the National Sample Survey Office, Government of India for the year 2019, I employ logistic regression to gauge the likelihood of farmers adopting new agricultural techniques based on the information they receive from various channels. Additionally, I undertake spatial linear regression analysis to unravel the dynamics of information spillovers pertaining to new farming practices across districts. The results highlight the significance of the information source in driving adoption decisions, with progressive farmers and input dealers emerging as influential sources. Moreover, the spatial analysis provides compelling evidence of information diffusion across district boundaries, highlighting the varying efficacy of different information channels. These findings offer valuable insights for policymakers aiming to craft targeted interventions aimed at shaping farmers' decision-making processes regarding the adoption of innovative farming practices.

Abstract

Previous research, focusing primarily on high income countries, has linked later sunsets to sleep deficits and worse health outcomes. These results might not generalize to low- and middle- income countries, which have different socioeconomic, cultural, and environmental conditions. Using data from the 2015-16 and 2019-21 waves of India’s Demographic and Health Surveys (DHS) and exploiting within-district variation in annual average sunset times, we estimate the causal impact of later sunsets on the long-term health outcomes of individuals. We find that later sunsets leads to a lower prevalence of anemia, diabetes, and thyroid disorders and an improvement in the overall health index. To explore mechanisms, we analyze variation in time allocation due to a later sunset time using the 2019 Time Use Survey. We find that individuals experiencing later sunsets sleep better and exercise more, but do not change their sedentary leisure activities. Additionally, they consume healthier food and increase labor supply. These lifestyle changes may explain the health improvements associated with delayed sunsets in India.

Abstract

Rising temperatures due to climate change pose significant challenges to how much and how effectively individuals can work, particularly in low- and middle-income countries such as India, where exposure to extreme heat is becoming more common. While existing research documents adverse effects of heat on labor outcomes, little is known about how individuals adjust their work patterns within a day. This study examines the impact of ambient temperature on time allocation, with a focus on intraday substitution of time spent on paid work. The study uses nationally representative data from the 2019 Indian Time Use Survey combined with high-frequency temperature data measured at 30-minute intervals. We estimate the effect of temperature on total daily time spent on paid work and on the likelihood of working during specific periods of the day. Our results show that extreme heat has limited effects on overall daily work hours but leads to substantial intraday reallocation of labor. Individuals shift work from the hottest periods midday toward early morning or late evening. This pattern is primarily driven by younger men and workers in self-employed or agricultural jobs, who have greater flexibility in their schedules and are more exposed to ambient heat. In contrast, salaried workers reduce work during peak heat without compensatory increases at other times. These findings highlight the importance of flexible work arrangements and targeted heat-mitigation policies to sustain productivity and worker well-being in a warming climate.

Abstract

This paper examines the impact of the Covid-19 pandemic on short-term health behaviors in India, focusing on dietary choices, smoking, and alcohol consumption. Using Demographic and Health Survey (DHS) data from 2019–2021, we exploit exogenous variation in survey timing induced by the nationwide lockdown to identify causal effects. Comparing individuals surveyed before and after the onset of the pandemic within the same districts, we find significant reductions in unhealthy food consumption and smoking. Individuals surveyed post-pandemic were 36 percent less likely to consume unhealthy food daily and 13 percent less likely to smoke, relative to pre-pandemic means. These effects are driven primarily by reduced fried food consumption and fewer cigarettes smoked. We also find suggestive evidence of a reduction in alcohol consumption post-pandemic. Our findings provide new evidence that a large public health shock can induce improvements in health behaviors in a developing country context, but only in the short term.

Abstract

Air pollution is a major concern in India which is driven by long-term structural factors such as rapid urbanization, rising energy demand, motorization, and sustained economic growth. Among various pollutants, particulate matter, specifically PM2.5, has been widely documented to have significant adverse health effects. This paper documents a structural shift in the factors that contribute to PM2.5 concentrations in India around 2011, using satellite-based data spanning 2001 to 2019 across all Indian districts. Combining information on land use, economic activity, environmental conditions and emissions, we classify these factors into four categories: agricultural burning, environmental buffers, urbanization, and vehicular emissions. Our analysis shows that green cover declined substantially between 2001 and 2005, while nighttime light intensity increased markedly after 2011. We also find that agricultural burning is strongly associated with air pollution across seasons in the southern and north-eastern regions of India. Furthermore, we employ a Shapley–Owen decomposition to quantify the relative contribution of each category to the variation in (PM2.5) concentrations across districts. The results indicate a notable shift in the drivers of air pollution over time. Before 2011, environmental buffers represented most of the variation in pollution levels between districts. Post 2011, vehicular emissions and urbanization emerged as major contributors. These findings highlight the need for targeted and region-specific policy interventions to address air pollution in India.

Abstract

Regional variation in mortality and health is prevalent across various countries. However, the mechanisms which can explain these differences remain an open question. This paper investigates whether chronic disease burden can explain regional variation in mortality and to what extent such variation is driven by place effects versus internal migration. We use Swedish administrative data covering the entire population in the period 2005–2021. We use information on prescribed medications allows us to measure incidence and intensity of chronic diseases at the individual level. We document substantial geographic variation in both chronic conditions and mortality across Swedish municipalities, with clear rural–urban gradients. To isolate the role of place, we employ a mover-based design that compares individuals who move across regions while accounting for time-invariant individual characteristics. We find that only 9% of the regional variation in chronic conditions can be attributed to place effects. We further show that internal migration accounts for approximately 31% of the remaining variation. Our findings suggest that much of the observed spatial variation reflects differences in underlying health needs rather than inefficiencies in healthcare provision, with important implications for the interpretation of geographic disparities in health.