Background. There is scant research examining income-based inequalities in risk factors of non-communicable diseases (NCDs) and inequities of preventive care services across the South Asian population.
Methods. We conducted a cross-sectional study of 202,682 adults aged 18 or above in four South Asian countries: Bangladesh, India, Pakistan, and Sri Lanka. We combined South Asia Biobank (SAB) surveillance data with environmental mapping exposure and 24-h dietary recall to estimate income-based inequalities using concentration curves and concentration indices (CI) that measure the magnitude and directional inequality effects. We also computed the horizontal inequity index (HII) for need-standardised healthcare utilisation and advice by measuring the extent to which the distribution of health promotion advice matches the distribution of diet-related risk factor variables across the income distribution. We reported concentration index coefficients and standard errors.
Results. Inequalities in exposure and diet-related risk factors of NCDs were observed. Underweight was concentrated amongst the poor (CI = − 0.16, SE = 0.005, p < 0.001), while overweight and obesity were concentrated amongst the rich (CI = 0.11, SE = 0.003, p < 0.001). Non-recommended intake of fats (CI = 0.04, SE = 0.003, p < 0.001) and carbohydrates were concentrated amongst the rich (CI = 0.05, SE = 0.003, p < 0.001), while non-recommended intake of free sugars (CI = − 0.05, SE = 0.004, p < 0.001) and fruits and vegetables amongst the poor (CI = − 0.07, SE = 0.005, p < 0.001). Exposure to unhealthy outlets was concentrated amongst the rich (CI = 0.02, SE = 0.002, p < 0.001). There were persistent and pro-rich inequities in healthcare utilisation (HII = 0.02, SE = 0.002, p < 0.001) and advice for salt reduction (HII = 0.02, SE = 0.004, p < 0.001), fat reduction (HII = 0.02, SE = 0.004, p < 0.001), healthy weight (HII = 0.03, SE = 0.006, p < 0.001), and fruits and vegetables consumption (HII = 0.04, SE = 0.004, p < 0.001).
Conclusions. These findings indicate the need to address and mitigate income-based inequalities in diet-related risk factors of NCDs and underscore the need of policies directed at mitigating NCDs risk exposure and achieving improved and equitable access to healthcare.
Background. The built environment around schools that are regularly accessed by young people is determined by governments, national and regional policies in each country or region. Zoning regulations for tobacco and alcohol sales are expected to restrict availability and access by young people. This study aimed to examine (non) compliance with tobacco and alcohol zoning regulations around schools in Bangladesh, India, Pakistan and Sri Lanka.
Methods. In a representative sample of geographic locations in Bangladesh, India North (Delhi) and India South (Chennai), Pakistan and Sri Lanka, the built environment was mapped by systematically walking all streets within the site boundary to collect data on different types of tobacco and alcohol retailers and schools. Data was collected on KoboToolBox, and the maps indicating zoning compliance were created using ArcGIS. Descriptive analysis of outlet compliance to the zoning laws was conducted at the national and school levels, with heterogeneity analyses done by school type, income level and outlet type for tobacco and alcohol.
Results. The zoning regulations for tobacco and alcohol differed among the settings ranging from 50 to 100 m for tobacco and absolute bans to 500 m for on-premise alcohol. Among the five different settings within the four countries, 441 areas were studied, including 3615 schools. Non-compliance with the zoning laws is evident in all jurisdictions for both tobacco and alcohol. Within restricted zones around schools (location non-compliant with zoning laws), 12–38% of outlets selling tobacco and 16% to 100% of outlets selling alcohol were identified. For supply non-compliance, 3–70% of shops within the school buffer zones were selling tobacco, while only 0.2–1% of shops were selling alcohol.
Conclusions. Non-compliance with tobacco and alcohol zoning regulations has been observed around schools in Bangladesh, India (North and South), Pakistan and Sri Lanka. Within each country, there was a higher percentage of alcohol outlets that were location non-compliant than for tobacco, except for South India. In India and Sri Lanka, there was a higher percentage of supply non-compliance for tobacco than alcohol. This study calls for governments to strictly enforce existing zoning regulations that are expected to restrict access to tobacco and alcohol for young people.
The obesity epidemic constitutes a large and growing share of public health spending. This paper investigates parental views on providing healthy food choices in school lunches in an attempt to contribute to a better understanding of the parents’ role in addressing childhood overweight. I created a survey that was circulated at an elementary school in Victoria, B.C. The results are discussed using a standard microeconomic framework in which parental choices of their children’s lunches depend on their views (“utility”) as well as the restrictions they face. My results suggest that parents perceive price not to be a major factor in the decision to include fruits or vegetables in their child(ren)’s school lunch. The reason provided most frequently by parents for not including fruits or vegetables every day is the expectation that their child(ren) would refuse to eat them, or have too little time at school to eat them. Some parents also mention preparation time as a reason for not including fruits and vegetables.
Using individual-level panel data from Understanding Society I estimate the response to a disease diagnosis — heart attack or diabetes diagnosis — on a healthy lifestyle index. To overcome the endogeneity of a diagnosis, I match on initial health risks. I find individuals improve their overall lifestyle healthiness when faced with a large negative health event such as a diagnosis (heart attack or diabetes) whereas they do not respond to solely receiving information about certain disease risk factors, via a diagnosis of high blood pressure or chest pain. The drivers of the overall e ect are a decrease in the number of cigarettes smoked and an increase in the probability to quit drinking alcohol; there is no signifcant effect found for either diet or exercise. I find some heterogeneity by sex, but only when looking at individual lifestyle behaviours. Overall, the findings suggest that the realization of a disease diagnosis leads individuals to improve their lifestyle behaviours, while only a signal about their health risks leads to no such change.
Exists as: EUI Working Paper ECO 2020/02 (no longer current version, previous title: "Impact of a Health Shock on Lifestyle Behaviours")
Most recent version (Aug 2022) available on this website (click on title above)
This paper explores the associations between household determinants of dietary change — characteristics, circumstances, and particularly also the changes thereof — with particular focus on changing towards a more plant-based diet. Three analyses are under-taken to address three questions: what are the characteristics of 1) households making a change to a more plant-based diet, temporary or more permanent? 2) households not sustaining their more plant-based diet? 3) households being most likely of a certain changer-type (not, short or long)? These questions are answered using the Nielsen HomeScan Consumer Panel data. I find certain characteristics are positively associated with diet change: being vegetarian, being a one-person household, working less than 30 hours per week, changes in education, changes in income, and moving home; negatively associated characteristics include: having children at home, being of white ethnicity or stop working. These associations can be used to better understand the costs and benefits associated with diet changes.
Adopting a healthier lifestyle can improve quality of living. Personality characteristics (Big 5) have been shown to predict certain lifestyle behaviours. Using a UK household panel data, Understanding Society, a propensity score matching approach estimates the impact of a health shock on lifestyle improvements, with particular emphasis on the interactive effect of personality characteristics. This paper finds that individuals with changer-type personality characteristics, high or low scores of the Big 5 personality characteristics as suggested by the literature, further improve their lifestyle following a shock. No significant effect is found for the individuals with the non-changer-type personality characteristics. Furthermore, this significant effect is only found when individuals experience a strong shock, diagnosis of disease, while not when they experience a weak shock, diagnosis of disease risks. Heterogeneity across personality characteristics suggests some behavioural change costs are likely partially inuenced by personality.
For additional work in progress, please see my CV.