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Health Economics

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Why, at the peak of the Jim Crow era early in the twentieth century, did life expectancy for African Americans rise dramatically? And why, when public officials were denying African Americans access to many other public services, did public water and sewer service for African Americans improve and expand? Using the qualitative and quantitative tools of demography, economics, geography, history, law, and medicine, Werner Troesken shows that the answers to these questions are closely connected. Arguing that in this case, racism led public officials not to deny services but to improve them—the only way to "protect" white neighborhoods against waste from black neighborhoods was to install water and sewer systems in both—Troesken shows that when cities and towns had working water and sewer systems, typhoid and other waterborne diseases were virtually eradicated. This contributed to the great improvements in life expectancy (both in absolute terms and relative to whites) among urban blacks between 1900 and 1940. Citing recent demographic and medical research findings that early exposure to typhoid increases the probability of heart problems later in life, Troesken argues that building water and sewer systems not only reduced waterborne disease rates, it also improved overall health and reduced mortality from other diseases.

Troesken draws on many independent sources of evidence, including data from the Negro Mortality Project, econometric analysis of waterborne disease rates in blacks and whites, analysis of case law on discrimination in the provision of municipal services, and maps showing the location of black and white households. He argues that all evidence points to one conclusion: that there was much less discrimination in the provision of public water and sewer systems than would seem likely in the era of Jim Crow.

Medicine and Morality in a Time of Crisis

The war on terrorism and the threat of chemical and biological weapons have brought a new urgency to already complex moral and bioethical questions. In the Wake of Terror presents thought-provoking essays on many of the troubling issues facing American society, written by experts from the fields of medicine, health care policy, law, political science, history, philosophy, and theology.

One of the first potential casualties of catastrophic circumstances is civil liberties. In the past, medical experiments conducted for national security purposes have violated ethical standards, and this book questions whether current policy provides sufficient safeguards against further abuses. It also focuses on public health issues, offering contrasting views on the extent to which civil authorities should be allowed to restrict freedom of movement in the name of national security and debating whether aggressive public health interventions improve public confidence and cooperation or detract from them.

A major area of concern is preparedness for future terrorist attacks. Chapters are devoted to ethical issues involved in the development, distribution, and rationing of vaccines and antidotes; resource allocation and medical triage; the moral duties of emergency health workers and other first responders; and the obligations of private entities such as managed care organizations and pharmaceutical companies. Contributors also address the implications of terrorism for our health insurance system and the role of genetic advances in bioterrorism. Underlying all of these issues, the authors argue, is the need to maintain a spirit of social solidarity, which can in turn only be achieved if preparations are publicly acknowledged and generally regarded as both prudent and fair.

Contributors: George Annas, Ronald Bayer, James Childress, James Colgrove, Evan DeRenzo, Lisa Eckenwiler, Alan R. Fleischman, Lawrence O. Gostin, James G. Hodge, Jr., Kenneth Kipnis, Paul Lombardo, Eric Meslin, Ann Mills, Jonathan D. Moreno, Griffin Trotter, Patricia Werhane, Emily Wood.

Economic Models of Global Warming

Humanity is risking the health of the natural environment through a myriad of interventions, including the atmospheric emission of trace gases such as carbon dioxide, the use of ozone-depleting chemicals, the engineering of massive land-use changes, and the destruction of the habitats of many species. It is imperative that we learn to protect our common geophysical and biological resources. Although scientists have studied greenhouse warming for decades, it is only recently that society has begun to consider the economic, political, and institutional aspects of environmental intervention. To do so raises formidable challenges of data modeling, uncertainty, international coordination, and institutional design.Attempts to deal with complex scientific and economic issues have increasingly involved the use of models to help analysts and decision makers understand likely future outcomes as well as the implications of alternative policies. This book presents in detail a pair of models of the economics of climate change. The models, called RICE-99 (for the Regional Dynamic Integrated model of Climate and the Economy) and DICE-99 (for the Dynamic Integrated Model of Climate and the Economy) build on the authors' earlier work, particularly their RICE and DICE models of the early 1990s. They can help policy makers design better economic and environmental policies.

This important series presents timely economic research on health care and health policy issues. Each volume contains papers from an annual conference of researchers, government officials, and policy experts held in Washington, D.C. Topics include the effects of health policy reforms, changes in health care organization and management, measurement of health outcomes, health care output and productivity, the role of health-related behavior, health and aging, health and children, and health care financing.

Price and Quality in Optometry

The healthcare industry in America consists of a multitude of specialty professions. While most of these require licensing through state agencies, the legislation involved largely rubber stamps the desires of the professional associations, self-perpetuating and self-regulating bodies that effectively impose restrictions on entry to the profession, type and location of practice, and advertising.

Professionalism and the Public Interest provides a case study of one such profession—optometry and vision care—as a means of arriving at some valid general conclusions about professional practices, especially (but not exclusively) those in the medical field. To what extent does the practice of self-regulation promote self-interest over the public interest? And are the high, fixed-fee, noncompetitive, unadvertised prices set for services justified by the "noncommercial," "professional" quality of those services? One of the major conclusions of the book is that the high prices that prevail in optometry—and medicine generally—restrict full access to the affluent, which actually lowers the quality of health care available to the average citizen, whereas a competitive price structure would tend to raise the quality of such available to the public at large.

Begun skillfully handles the instrumental resources in sociology, political science, and economics in his analysis, much of which is based on a data set that he assembled from a national survey of optometrists. State-by-state comparison of legislation relating to the optometric profession is provided, including information on which states require continuing education of optometrists, which states prohibit advertising by optometrists and opticians, and which states restrict mercantile location.

From Malthus to Becker, the economic approach to population growth and its interactions with the surrounding economic environment has undergone a major transformation. Population Economics elucidates the theory behind this shift and the consequences for economic policy.Razin and Sadka systematically examine the microeconomic implications of people's decisions about how many children to have and how to provide for them on population trends and social issues of population policy. The authors analyze how these decisions affect labor supply, consumption, savings and bequests, investments in human capital, and economic growth, along with related new issues such as migration and income redistribution across generations, in an integrated microeconomic framework.Population Economics is a thoroughly modern treatment of population economics as a field in public economics. It integrates and extends Marc Nerlove's Household and Economy: Welfare Economics of Endogenous Fertility, as well as work written jointly with colleagues that has appeared in various journals and other publications.

This important series presents timely economic research on health care and health policy issues. Each volume contains papers from an annual conference held in Washington, D.C. Topics include the effects of health policy reforms, changes in health care organization and management, measurement of health outcomes, health care output and productivity, the role of health-related behavior, health and aging, health and children, and health care financing.

Infectious Disease, Environmental Change, and Their Effects on National Security and Development

In recent decades, new pathogens such as HIV, the Ebola virus, and the BSE prion have emerged, while old scourges such as tuberculosis, cholera, and malaria have grown increasingly resistant to treatment. The global spread of disease does not threaten the human species, but it threatens the prosperity and stability of human societies.

In this pathbreaking book, Andrew Price-Smith investigates the influence of infectious disease on nations' stability and prosperity. He also provides a theoretical and empirical foundation for the emerging field of health security. Price-Smith shows that the global proliferation of infectious disease will limit the ability of states to govern themselves effectively and to maximize their economic power. Because infectious disease can cause poverty, intra-state violence and political instability may increase. This in turn may have negative long-term effects on regional economic and political stability, damaging international relations and development.

Price-Smith takes an interdisciplinary approach to topics ranging from the effects of global environmental change on the spread of disease to the feedback loop between public health and the strength of a nation's economy and its political stability over time. As the proliferation of infectious disease threatens international stability and the policy interests of the United States in years to come, its study will become an increasingly important subfield of political science.

Environmentalism and Democracy in the Twenty-First Century

In this book, environmentalist and lawyer William Shutkin describes a new kind of environmental and social activism spreading across the nation, one that joins the pursuit of environmental quality with that of civic health and sustainable local economies. In the face of challenges posed by often corrosive market forces and widespread social disaffection, this civic environmentalism is creating nothing less than a new public discourse and dynamic social vision grounded in environmental action.

Shutkin points the way to vibrant, sustainable communities through four inspiring examples of civic environmentalism in action: the redevelopment of contaminated urban land for agriculture in inner-city Boston, mass-transit-based development and waterfront restoration in Oakland, protection of open space and conservation-based development in rural Colorado, and smart-growth and sustainability strategies in suburban New Jersey. The book's underlying message is that the nation's environmental health is a critical factor in its success as a vital democracy. Social health, democratic community, and environmentalism, Shutkin shows, are one.

From the author's preface:

"This book asserts that environmentalism is as much about protecting ordinary places as it is about preserving wilderness areas; as much about promoting civic engagement as it is about pursuing environmental litigation; and as much about implementing sound economic development strategies as it is about negotiating global climate change treaties. Ultimately, I believe, environmentalism is nothing less than about our conception of ourselves as a social and political community—what the bald eagle, our national symbol, really means."

Why It's Time for Health Care Rationing

Although managed health care is a hot topic, too few discussions focus on health care rationing—who lives and who dies, death versus dollars. In this book, physician and bioethicist Peter A. Ubel argues that physicians, health insurance companies, managed care organizations, and governments need to consider the cost-effectiveness of many new health care technologies. In particular, they need to think about how best to ration health care. Ubel believes that standard medical training should provide physicians with the expertise to decide when to withhold health care from patients. He discusses the moral questions raised by this position, and by health care rationing in general. He incorporates ethical arguments about the appropriate role of cost-effectiveness analysis in health care rationing, empirical research about how the general public wants to ration care, and clinical insights based on his practice of general internal medicine. Straddling the fields of ethics, economics, research psychology, and clinical medicine, he moves the debate forward from whether to ration to how to ration. The discussion is enlivened by actual case studies.

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