We examine the intergenerational persistence of health in a low- and middle-income country, using longitudinal datasets from Indonesia. Our study evaluates both objective and self-reported health outcomes including self-reported health (SRH), hemoglobin levels, anemia, pulse, hypertension, and adiposity measures (BMI, overweight and waist-hip ratio) to assess the persistence of these conditions across generations.

Linking the health of adult children to their parents, we find significant differences in persistence between objective and subjective health measures. SRH and adiposity show stronger persistence, especially through maternal health, with daughters more susceptible. In contrast, objective measures like waist-hip ratio show minimal intergenerational persistence, suggesting individual lifestyle factors play a larger role. Daughters are more affected by maternal health in hemoglobin, anemia, pulse rate and BMI, while paternal health has a weaker but notable influence.

Our results remain robust across regions and ethnic groups. We conclude that the persistence of intergenerational health significantly hinders socioeconomic mobility, underscoring the need for maternal health-oriented health policies, including prenatal care, nutrition, and family-based interventions to reduce the transmission of chronic diseases such as anemia and obesity.

Currently, Dr. Huixia Wang is an associate professor at Hunan University. Her research interests encompass health economics, environmental economics, and development economics, with a particular focus on assessing the health impacts of pollution, climate change, and economic fluctuations in developing countries. She earned both her PhD and MA in economics from the University of Hawaii at Manoa.

Co-sponsored by Peking University's Institute for Global Health and Development and the Asia Health Policy Program

This event delves into the complex landscape of technological advancements in healthcare, focusing on the critical balance between embracing innovative tools and managing their implications for provider skills and patient outcomes. It presents two pivotal papers that collectively shed light on the nuanced trade-offs inherent in the adoption of new technologies like robotic surgery. The first paper utilizes a Roy model to articulate the coexistence of new and incumbent technologies, emphasizing the trade-offs between different quality dimensions and productivity. The second paper examines the adoption of surgical robots in England's healthcare system. It offers an insightful analysis of how such technologies can bridge the skill gap among healthcare providers, potentially leading to more equitable patient outcomes. The study underscores a significant variance in the benefits of robotic surgery based on the surgeon's expertise, highlighting an uneven landscape of technology utilization. Through these discussions, the event aims to navigate the intricate interplay between technological innovation, healthcare provider skill enhancement, and the ultimate goal of improved patient care.

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Nathaniel Breg earned his PhD at Carnegie Mellon University and his BA at Tufts University. His interest in health care providers intersects with questions from labor economics and industrial organization. Nate's current research investigates how providers respond to incentives, how they decide to adopt new technology, and how health care services affect local economies and local health. He is a 2020-2021 recipient of the Fellowship in Digital Health from CMU's Center for Machine Learning and Health. He previously worked at RTI International on evaluations of government health care initiatives, prospective payment systems, and health care delivery quality measures.

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Elena Ashtari Tafti is an applied microeconomist working on topics at the intersection of innovation, health, and personnel economics. In September 2023, she joined the Ludwig Maximilian University of Munich as an Assistant Professor in Economics. Elena holds a PhD in Economics from University College London and is a Scholar at the Institute of Fiscal Studies (IFS) and the Centre for Microdata Methods and Practice (CeMMAP).

Please note that this event is now webinar only

In this seminar, three presenters from Google Health will share their perspectives on what it takes to bring a medical AI product from “code to clinic” in Southeast Asia. Google Health’s mission is to help everyone, everywhere be healthier, applying cutting-edge artificial intelligence (AI) technologies to improve patient outcomes and care delivery and incubate new AI-based products from initial research to clinical deployment. Representing different facets of a multidisciplinary team of experts (Product, Partnerships, and Program Management), the presenters will discuss the journey of developing and deploying a diagnostic AI solution that addresses an unmet need for the detection of diabetic blindness in Southeast Asia, real-world challenges and opportunities (particularly in the context of low- and middle-income countries), and the importance of building strategic partnerships and trust.

Richa Tiwari's work focuses on driving research on Google’s health innovations and working with partners on real-world deployment of digital and AI solutions in APAC and Africa. Richa holds a PhD in Molecular Biology and has over a decade of experience in Pharma, bringing cancer treatments to market and running clinical trials. An accidental technologist and a scientist at heart, Richa is passionate about bringing forward cutting-edge health tech innovations to address healthcare challenges

Sunny Virmani, during his time at Google and Verily Life Sciences, has focused on translating machine learning research into real-world clinical applications working with key opinion leaders and partners globally. His team’s pioneering research in the field of diabetic retinopathy screening using machine learning has helped advance the technology in this field significantly. Previously, he has held Product Management positions at Carl Zeiss Meditec and Philips Healthcare building products in the field of medical imaging. By education, he is an engineer with a Masters degree in Biomedical Engineering.

Rajroshan Sawhney leads Partnerships for Google Research (Health AI & Sustainability). During his time at Google, Raj has focused on catalyzing the adoption of human-centered AI in healthcare by driving strategic partnerships across both public and private sector in APAC, working closely with regulators, policy makers and academic partners to improve health outcomes in low-resource environments, and to develop go-to-market strategies to graduate research into real-world deployments.  Prior to Google, Raj was the Head of Strategic Partnerships and Corporate Development at a leading Computer Vision startup based out of San Francisco and Singapore. Raj holds a Computer Science BE (Hons) degree from BITS-Pilani, is a member of Mensa International and the India Young Leaders Forum.

The Human and Planetary Health initiative at the Stanford Woods Institute for the Environment is hosting a dialogue with Chris Field, Director of the Stanford Woods Institute for the Environment and Reginaldo Haslett-Marroquin, an expert in regenerative poultry production and practicing regenerative farmer. Learn more and register on the event page.

Co-sponsored by Peking University Institute for Global Health and Development, and the Asia Health Policy Program

Plastic pollution and antibiotic resistance are significant threats to human health. The overuse of plastic products and antibiotics, often driven by individual behaviors, plays a major role in these challenges. The presence of externalities leads to further overuse, intensifying the problem. In this webinar, we will present two research studies that employ the nudge strategy to explore its effectiveness as a low-cost method in promoting socially desirable behaviors. We will focus on the contexts of disposable cutlery consumption and antibiotic utilization, providing insights into how subtle behavioral interventions can have a meaningful impact.

Title 1: Reducing single-use cutlery with green nudges: Evidence from China’s food-delivery industry

Rising consumer demand for online food delivery has increased the consumption of disposable cutlery, leading to plastic pollution worldwide. In this work, we investigate the impact of green nudges on single-use cutlery consumption in China. In collaboration with Alibaba’s food-delivery platform, Eleme (which is similar to Uber Eats and DoorDash), we analyzed detailed customer-level data and found that the green nudges—changing the default to “no cutlery” and rewarding consumers with “green points”— increased the share of no-cutlery orders by 648%. The environmental benefits are sizable: If green nudges were applied to all of China, more than 21.75 billion sets of single-use cutlery could be saved annually, equivalent to preventing the generation of 3.26 million metric tons of plastic waste and saving 5.44 million trees. 

Title 2: The Impact of Self- or Social-regarding Messages: Experimental Evidence on Antibiotics Purchases in China

We study two interventions in Beijing, China, that provide patients with information on antibiotic resistance via text message to discourage the overuse of antibiotics. The messages were sent once a month for five months. One intervention emphasizes the threat to the recipient's own health and is found to have negligible effects. The other intervention, which highlights the overall threat to society, reduces antibiotics purchases by 17% in dosage without discouraging healthcare visits and other medicine purchases. The results demonstrate that prosocial messaging can have the potential to address public health issues that require collective action.

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Yuhang Pan's research fields include environmental economics, health economics, and development economics, with a particular focus on using causal inference approach to study the impact of environmental pollution, public policy, and climate change on health and social welfare. His works have been published in both economics and scientific journals, such as Science, Nature Sustainability, and the Journal of Environmental Economics and Management. Dr. Pan obtained his undergraduate degree from Beijing Normal University in 2015 and his doctoral degree from the Hong Kong University of Science and Technology in 2021. Prior to joining Peking University, he worked as a postdoctoral researcher at the Faculty of Business and Economics at the University of Hong Kong.

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Jianan Yang's primary research fields are health economics and development economics, with specific interests in health policy reform, medical behavior, and pharmaceutical innovation. She employs both experimental and quasi-experimental methods to explore policy-related questions, particularly examining their impact on patient welfare. She has published in top journals like the Journal of Development Economics. She earned her bachelor’s degrees in Economics and Mathematics from Renmin University of China in 2016, and her Ph.D. in Economics from the University of California, San Diego in 2022. Before joining Peking University, she was the 2022-2023 Developing Asia Health Policy Postdoctoral Fellow at Stanford University. 

In this hybrid seminar, Professor Lee will reflect on her pioneering and collaborative research on late-life cognition and dementia across multiple settings. Drawing on empirical evidence and carefully harmonized surveys of health and aging (e.g., for Korea, Japan, China, India, the US and Europe), Professor Lee will assess the state of knowledge and evidence regarding risk and resilience factors and the potential for preventing cognitive decline. Her talk will conclude with discussion of current initiatives and global dialogues (political, academic, and industry) about healthy brain aging.

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Dr. Jinkook Lee is a Research Professor of Economics and the Program Director of Global Aging, Health, and Policy at the University of Southern California. Her research focuses on the economics of aging, with interdisciplinary training and expertise in large-scale population surveys. As the Principal Investigator on several NIH-funded grants, she laid the groundwork for studying Alzheimer’s Disease and Related Dementia and their risk factors and impacts in low and middle-income countries. She has developed the country’s first and only population representative dementia study in India and helped developing sister studies in China, Kenya, Nepal, Pakistan, and Malawi. She provides scientific advice for WHO, OECD, World Bank, and Asia Development Bank and serves on the editorial boards for several scientific journals. She previously held a professorship at Ohio State University and the Pardee RAND Graduate School. She received her Ph.D. from Ohio State University and B.S. from Seoul National University.

AHPP 2023-24 Colloquium series, “Technology, Trust, and Healthy Aging”

Patient trust is an important driver of the demand for healthcare. But it may also impact supply: doctors who realize that patients may not trust them may adjust their behavior in response. We assemble a large dataset that assesses clinical performance using standardized-patients (akin to audit studies in economics) in low-income countries to investigate this possibility; most of these data are on healthcare providers who practice in the private sector on a fee-for-service basis. 

We establish that patients receive low quality of care, with a generous definition suggesting that fewer than 50% of cases are correctly managed, and between 70% and 90% of expenditures are medically unnecessary. Strikingly, and in contrast to the literature suggesting that the main problem with fee-for-service provision is over-treatment, the majority of these unnecessary expenditures are incurred because patients are incorrectly rather than over-treated. 

We then rule out two plausible explanations for low quality of care: low levels of medical knowledge and low market incentives to invest effort. In our data, there are many healthcare providers who know how to correctly treat the patient and could substantially increase their revenue by doing so given the price-quality gradients we estimate, but still treat the patient incorrectly. 

A model of the patient-provider relationship in which patients have incomplete information about the quality of providers generates predictions consistent with our findings. The theory additionally suggests that issuing a credible signal of quality should raise the average quality of care among providers, even if their underlying ability remains unchanged. 

We assess this prediction through an evaluation of a highly publicized training program with informal healthcare providers in West Bengal, India. The program has no impact on knowledge, yet substantially raises the quality of care, leading to an increase in the likelihood of correct treatment, a 19% decline in unnecessary expenditures for patients and a 9% increase in revenues for providers. We conclude that low trust undermines clinical performance in an economically and medically significant manner.

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Reshmaan Hussam is an assistant professor of business administration in the Business, Government and International Economy Unit at Harvard University's Business School, a Faculty Research Fellow at the National Bureau of Economic Research (NBER), and a faculty affiliate at the Abdul Latif Jameel Poverty Action Lab (J-PAL) and the Bureau for Research and Economic Analysis of Development (BREAD).

Her research explores questions at the intersection of development and behavioral economics, with research in three areas: migration, health, and finance.  Her most recent work engages refugee populations including the Rohingya in Bangladesh, examining the psychosocial value of employment in contexts of mass unemployment, the role of home in migration decision-making, and refugee preferences for repatriation, integration, and resettlement. In her work in health, which involves field experiments across South Asia, she considers the puzzle of the ubiquitously low adoption of low-cost, high-return goods, behaviors, and technologies in the developing world, exploring the role of learning and habit formation in behavior change. Her work in finance explores how to identify high-return microentrepreneurs using local community knowledge in India and how to increase credit access and returns to capital among refugee communities in Uganda.

Prior to joining HBS, Professor Hussam was a postdoctoral fellow at the Economic Growth Center at Yale University. She received her SB and PhD in economics from MIT.