ImportanceHealth inequities exist for racial and ethnic minorities and persons with lower educational attainment due to differential exposure to economic, social, structural, and environmental health risks and limited access to health care.ObjectiveTo estimate the economic burden of health inequities for racial and ethnic minority populations (American Indian and Alaska Native, Asian, Black, Latino, and Native Hawaiian and Other Pacific Islander) and adults 25 years and older with less than a 4-year college degree in the US. Outcomes include the sum of excess medical care expenditures, lost labor market productivity, and the value of excess premature death (younger than 78 years) by race and ethnicity and the highest level of educational attainment compared with health equity goals.Evidence ReviewAnalysis of 2016-2019 data from the Medical Expenditure Panel Survey (MEPS) and state-level Behavioral Risk Factor Surveillance System (BRFSS) and 2016-2018 mortality data from the National Vital Statistics System and 2018 IPUMS American Community Survey. There were 87 855 survey respondents to MEPS, 1 792 023 survey respondents to the BRFSS, and 8 416 203 death records from the National Vital Statistics System.FindingsIn 2018, the estimated economic burden of racial and ethnic health inequities was $421 billion (using MEPS) or $451 billion (using BRFSS data) and the estimated burden of education-related health inequities was $940 billion (using MEPS) or $978 billion (using BRFSS). Most of the economic burden was attributable to the poor health of the Black population; however, the burden attributable to American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander populations was disproportionately greater than their share of the population. Most of the education-related economic burden was incurred by adults with a high school diploma or General Educational Development equivalency credential. However, adults with less than a high school diploma accounted for a disproportionate share of the burden. Although they make up only 9% of the population, they bore 26% of the costs.Conclusions and RelevanceThe economic burden of racial and ethnic and educational health inequities is unacceptably high. Federal, state, and local policy makers should continue to invest resources to develop research, policies, and practices to eliminate health inequities in the US.

This study aims to apply approaches, methods, and indicators from the conceptual framework of ecosystem services valuation to a real world, local level case study. It tests a GIS-based mapping and valuation of ecosystem services model in a typical mountain municipality in Bulgaria. Investigation results address opportunities, challenges and limitations in the practical application of the ecosystem services concept. They include an integrated assessment of the ecosystem services in a specific administrative territorial unit and suggest its Total Economic Value. The introduction of the term "ecosystem services dysergy" should contribute to valuation theory and practice. The study upgrades the currently available knowledge base that supports geospatial planning and sustainable development of the Karlovo Municipality and offers recommendations for improvement of the municipal ecosystem services utilization, which include identification, analysis, and visualization of hotspots and dysergy areas.

Does cabinet size have an impact on economic policy in Africa? The average number of ministers has increased steadily for four decades, yet we know little about the economic effects of new portfolios, despite popular complaints about costly cabinets. Comparative studies generate conflicting expectations, either blaming coalition governments for patronage or crediting them with economic restraint. Using data on 45 Sub-Saharan African countries between 1971 and 2006, our empirical analysis links parties and portfolios to budgetary policy performance. We show that cabinets with more ministries are associated with budget surpluses, but they are also slightly more likely to engage in patronage spending. Next, we find that cabinets governing through multiparty coalitions have no consistent impact on budget surpluses. However, they are strongly associated with less extractive government and lower rates of patronage spending compared with single-party cabinets. These results hold after controlling for the type of colonial legacy, economic conditions, population size, constraints on executives, level of democracy, oil income, type of party system and ethnic and religious fractionalization. We conclude that parties and portfolios are both important but they have different effects: adding portfolios to the cabinet may improve economic outcomes by enhancing specialization, but governance through multiparty cabinets generates incentives to both limit extraction and restrain patronage spending.