In May 2020, a 45-year-old African-American man, B, with a history of insulin-dependent type 2 diabetes, was hospitalized for SARS-CoV-2 pneumonia. He was a home health care worker who traveled to the client’s home by public transport. Mr. B lived with his wife and two children. His children attended school remotely for a Covid-19 pandemic. Prior to admission, he had difficulty breathing and had a mild fever, but continued to work because he was the only source of support for his family and needed money to pay for insulin. Eventually, his symptoms worsened and he was forced to be admitted to the hospital.
Mr. B’s case reflects the difficulties faced by many during the pandemic and underscores the importance of public health intervention. Despite the development of an effective SARS-CoV-2 vaccine, many experts argue that preventative actions such as masking, frequent examinations, and physical distance continue to be important in reducing the spread of the disease. doing. However, the adoption of these behaviors is far from universal, and the burden of illness on people left out of society, such as races, ethnic minorities, low-income adults and people with disabilities, is disproportionately reduced. ..
We believe that economics can critically inform public health efforts to tackle such challenges. Alfred Marshall, written in 1890, defined economics as “the study of mankind in the business of normal life …”.[that] Examine that part of personal and social behavior that is most closely associated with the use of material requirements for achievement and well-being. Simply put, economics is a study of the trade-offs that individuals, institutions, or countries face when making decisions under the constraints of resources and time. Public health experts and researchers, of course, are primarily focused on improving health, but economists are just one of the key factors that people may value. thinking about.1 This insight is an important aspect of the usefulness of economics in informing public health policy.
An important element of the economic model in public health.
Economic modeling can be complex, but the key concepts that can guide decision making are intuitive and accessible to non-economists. Mr. B’s case provides a useful starting point for understanding how to use economic insights to increase adoption of preventive behavior at the population level and reduce inequality in health outcomes (see). ). table).
The first step in building an economic model is to identify the relevant actors (that is, those who want to maximize the adoption of health and health behaviors). In this case, Mr. B is the protagonist. Next, we need to identify the benefits that these actors can benefit from adopting health-related behaviors. Is adopting this behavior a priority? If so, how is it ranked compared to competing priorities? People may overlook the benefits of certain behaviors, including how it improves their health. Conversely, they fully explain the true cost of their actions towards others and society (especially if that action increases the risk of illness for others) and the cost to the public health sector (ie, negative externalities). You may not have. Mr. B believed that physical distance was important to avoid infection of himself and his family, neighbors, and clients.
In addition, you need to understand the personal and structural costs and constraints that make it more difficult to adopt health-related behaviors than others. For Mr. B, practicing physical distance involved a considerable opportunity cost. His work could not be done from home. Therefore, physical distance means losing the coveted wages. Structural constraints also played a major role in Mr. B’s decision. Colored races are unbalancedly employed in low-wage industries with increased occupational exposure to SARS-CoV-2 but relatively less worker protection such as health insurance and illness.2 For example, the home health industry should exempt workers from the 2020 Coronavirus Assistance Economic Security (CARES) Act so that paid family and sick leave provisions do not lead to a shortage of workers. I successfully insisted that there was. In addition, we weigh the competitive risk that black men like Mr. B are more likely to be subject to racial profiling by being infected with SARS-CoV-2 without a mask or wearing a mask. Often you are forced to do. Economic analysis also needs to consider cognitive or psychological costs.3 Preventive action recommendations and politicalized messaging changes (for example, the benefits of masking, the types of masks that provide adequate protection, and when masks can be removed) are a burden to individuals analyzing competing messaging. increase. Such an analysis may be difficult for those facing many cognitive burdens imposed by challenges such as precarious employment.
Applying economic analysis to Mr. B’s case reveals the benefits and costs of adopting prophylactic health behaviors in populations facing high morbidity and mortality from Covid-19. It provides some useful insights that public health policy makers can apply to many different illnesses.
First, information campaigns, by themselves, may have minimal effect, as they rarely mitigate the basic trade-offs people face when adopting physical distance or masking. there is. In addition, a universal message or an individual’s implicit or explicit condemnation of not being involved in preventative health behavior can undermine credibility. This type of message can question whether policy makers sympathize with them when they work on complex decisions. During the current pandemic. This disconnection can further undermine other disease prevention efforts such as contact tracing and vaccination campaigns.
Second, the existence of externalities can motivate the use of policies such as physical distance obligations (and incentives and penalties), but economic analysis shows that the burden of such policies is unequal to the group. It suggests that it may affect. For example, forced business closures can bring benefits of infection control, but the resulting loss of income is for some groups (eg, low-income workers such as Mr. B) to others. May be more harmful than.
Third, the economic analysis of Mr. B’s case reveals the importance of social and economic policies that can alleviate financial difficulties. Policies such as paid sickness, eviction of peasants, cash benefits, and increased unemployment benefits can help enhance overall well-being during times of crisis while reducing the cost of increasing physical distance. These policies are a method with cognitive and opportunity costs in mind, as the cumbersome process of applying for public benefits can make it difficult for people with difficult living environments to access them. Must be done at.
Fourth, economic analysis highlights the importance of intervening to reduce structural constraints. Policies aimed at improving access to personal protective equipment for home health workers, providing their own health care, and including them in federal relief packages would not be possible otherwise. Helps reduce the spread of illness among such essential workers. Take time out of work.
Fifth, looking at Mr. B’s case through an economic lens reveals the variability of personal and community conditions that shape the trade-offs associated with engaging in preventive action. While national studies and data are useful guides, public health approaches informed by economic models that explain the situation in a region are essential for developing effective policies for a particular region or group.
The insights gained from applying economics to Mr. B’s case can also be applied to a broader macro-level trade-off in public health investment. At the national level, public health spending was $ 93 billion in 2018, while health care was $ 3.6 trillion ($ 2018), or 2.5 cents per dollar. Public health spending remained flat or declined between 2008 and 2018, with the most dramatic declines in state spending occurring in the areas of maternal, child and family health and environmental health. During that period, the average state spending per capita decreased from $ 80.40 to $ 75.83.Four
Meanwhile, the community health system is increasingly intervening to influence social determinants of health, such as housing. Increasing the centrality of the healthcare system in the provision of health care and social services can be accompanied by trade-offs. For example, health care organizations have more financial resources than public health and social services institutions, but are more healthy than institutions that may have knowledge and practical expertise in upstream health drivers. It may be less effective or less efficient at dealing with social determinants. ..Five Understanding how these trade-offs affect the optimal allocation of scarce social resources is especially important for improving the health of those who are left out of society. Trade-off discussions must be aware of the fact that policy makers can assign significantly different weights to specific benefits and harms in decision making (for example, ongoing school closures during a pandemic). Discussion). Many economists will argue that those who are most affected by a given policy or health condition should decide how to weigh the various benefits and harms.
Public health professionals come from a wide range of disciplines that reflect the multifaceted range of issues they must address. Economics adds meaningfully to these perspectives by clarifying key trade-offs and revealing new policy options, including those that go beyond the provision of public health services. An important contribution of economics to public health is the elucidation of complex trade-offs that can affect health-related behaviors. This includes non-monetary costs and benefits that are often ignored by policy makers. Economic models help public health policy makers create more equitable policies that more fully describe the living experiences and realities of different populations.
