This paper estimates a neoclassical growth model that includes female and male education as separate explanatory variables. The model can be reparameterised so that the gender gap in education enters the model. The interpretation of its coefficient depends crucially on what other education variables appear in the equation. The average longrun effects of female and male education on output per worker are estimated for a cross section of countries using long time averages of the data. The results support the World Bank's emphasis on the importance of female education in raising labour productivity and are robust to various sensitivity analyses.
Public health interventions have received increased attention from policy makers, and there has been a corresponding increase in the number of economic evaluations within the domain of public health. However, methods to evaluate public health interventions are less well established than those for medical interventions. Focusing on health as an outcome measure is likely to underestimate the impact of many public health interventions. This paper provides a review of outcome measures in public health; and describes the benefits of using the capability approach as a means to developing an all encompassing outcome measure.
BackgroundIndia currently has more than 60 million people with Type 2 Diabetes Mellitus (T2DM) and this is predicted to increase by nearly two-thirds by 2030. While management of those with T2DM is important, preventing or delaying the onset of the disease, especially in those individuals at ‘high risk’ of developing T2DM, is urgently needed, particularly in resource-constrained settings. This paper describes the protocol for a cluster randomised controlled trial of a peer-led lifestyle intervention program to prevent diabetes in Kerala, India.Methods/designA total of 60 polling booths are randomised to the intervention arm or control arm in rural Kerala, India. Data collection is conducted in two steps. Step 1 (Home screening): Participants aged 30–60 years are administered a screening questionnaire. Those having no history of T2DM and other chronic illnesses with an Indian Diabetes Risk Score value of ≥60 are invited to attend a mobile clinic (Step 2). At the mobile clinic, participants complete questionnaires, undergo physical measurements, and provide blood samples for biochemical analysis. Participants identified with T2DM at Step 2 are excluded from further study participation. Participants in the control arm are provided with a health education booklet containing information on symptoms, complications, and risk factors of T2DM with the recommended levels for primary prevention. Participants in the intervention arm receive: (1) eleven peer-led small group sessions to motivate, guide and support in planning, initiation and maintenance of lifestyle changes; (2) two diabetes prevention education sessions led by experts to raise awareness on T2DM risk factors, prevention and management; (3) a participant handbook containing information primarily on peer support and its role in assisting with lifestyle modification; (4) a participant workbook to guide self-monitoring of lifestyle behaviours, goal setting and goal review; (5) the health education booklet that is given to the control arm. Follow-up assessments are conducted at 12 and 24 months. The primary outcome is incidence of T2DM. Secondary outcomes include behavioural, psychosocial, clinical, and biochemical measures. An economic evaluation is planned.DiscussionResults from this trial will contribute to improved policy and practice regarding lifestyle intervention programs to prevent diabetes in India and other resource-constrained settings.Trial registrationAustralia and New Zealand Clinical Trials Registry: ACTRN12611000262909.
SUMMARYThis editorial questions the implications of the capability approach for health economics. Two specific issues are considered: the evaluative space of capablities (as opposed to health or utility) and the decision-making principle of maximisation. The paper argues that the capability approach can provide a richer evaluative space enabling improved evaluation of many interventions. It also argues that more thought is needed about the decision-making principles both within the capability approach and within health economics more generally. Specifically, researchers should analyse equity-oriented principles such as equalisation and a 'decent minimum' of capability, rather than presuming that the goal must be the maximisation of capability.
5There is growing interest in operationalising the capability approach to measure quality of 6 life. This paper reports the results of a research project undertaken in 2007 that sought to 7 reduce and refine a longer survey in order to provide a summary measure of wellbeing and 8 capability in the realm of public health. The reduction and refinement of the questionnaire 9 took place across a number of stages, using both qualitative (five focus group discussions and 10 17 in-depth interviews) and quantitative (secondary data analysis, N=1,048 and primary data 11 collection using postal surveys and interviews, N=45) approaches. The questionnaire was 12 reduced from its original 60+ questions to 24 questions (including demographic questions). 13Each of Nussbaum's ten Central Human Capabilities are measured using one (or more) of the 14 18 specific capability items which are included in the questionnaire (referred to as the OCAP-15 18). Analysis of the questionnaire responses (N=198) found that respondents differed with 16 respect to the levels of capabilities they reported, and that these capabilities appear to be 17 sensitive to one's gender, age, income and deprivation decile. An index of capability, 18 estimated by assuming equal weight for each capability question, found that the average level 19 of capability amongst respondents was 12.44 (range 3-17.75). This index was found to be 20 highly correlated with a measure of health (EQ-5D) and wellbeing (global QoL), although 21 some differences were apparent. This project operationalised the capability approach to 22 produce an instrument to measure the effectiveness (and cost effectiveness) of public health 23 interventions; the resulting OCAP-18 appears to be responsive and measure something 24 supplementary to health and wellbeing, thus offers a promising addition to the current suite of 25 outcome measures that are available. Sen's Capability Approach (Sen 1985;1993) would appear to provide a possible solution to 77 the limitations of QALYs, as it expands the evaluative space (so it can include non-health 78 outcomes like empowerment, participation, housing, and crime) to consider whether a 79 programme/policy/intervention enhances an individual's capability (Lorgelly et al. 2010). 80Previous evaluative approaches focus on subjective-wellbeing (utilitarism) or the availability 81 5 of means for a good life (resourcism). The alternative paradigm of the capability approach 82 instead suggests that the focus of wellbeing should be a set of valuable 'beings and doings' 83 (for example being in good health or having loving relationships), which can be measured by 84 opportunities (capabilities) or outcomes (functionings) (Sen 1992). Sen desires that policies 85 ought to promote the "capabilities of persons to lead the kind of lives they value -and have 86 reason to value ' (Sen 1999, p.18). Of interest in its application to public health is the 87 evaluative space; it diverges from narrow utility space, which is concerned with the pleasure 88 obtained from...
Objectives Interventions to prevent postpartum common mental disorders (PCMD) among unselected populations of women have had limited success. The aim was to determine whether What Were We Thinking (WWWT) a gender-informed, psychoeducational programme for couples and babies can prevent PCMD among primiparous women 6 months postpartum. Design Cluster-randomised controlled trial. Setting 48 Maternal and Child Health Centres (MCHCs) from 6 Local Government Areas in Melbourne, Australia were allocated randomly to usual care (24) or usual care plus WWWT (24). Participants English-speaking primiparous women receiving primary care at trial MCHCs were recruited to the intervention (204) and control (196) conditions. Of these, 187 (91.7%) and 177 (90.3%) provided complete data. Intervention WWWT is a manualised programme comprising primary care from a trained nurse, print materials and a face-to-face seminar. Main outcome measures Data sources were standardised and study-specific measures collected in blinded computer-assisted telephone interviews at 6 and 26 weeks postpartum. The primary outcome was PCMD assessed by Composite International Diagnostic Interviews and Patient Health Questionnaire (PHQ) Depression and Generalised Anxiety Disorder modules. Results In intention-to-treat analyses the adjusted OR (AOR) of PCMD in the intervention compared to the usual care group was 0.78 (95% CI 0.38 to 1.63, ns), but mild to moderate anxiety symptoms (AOR 0.58, 95% CI 0.35 to 0.97) and poor self-rated health (AOR 0.46, 95% CI 0.22 to 0.97) were significantly lower. In a per protocol analysis, comparing the full (three component) intervention and usual care groups, the AOR of PCMD was 0.36, (95% CI 0.14 to 0.95). The WWWT seminar was appraised as salient, comprehensible and useful by >85% participants. No harms were detected. Conclusions WWWT is readily integrated into primary care, enables inclusion of fathers and addresses modifiable risks for PCMD directly. The full intervention appears a promising programme for preventing PCMD, optimising family functioning, and as the first component of a stepped approach to mental healthcare. Trial registration number ACTRN12613000506796; Results.
PurposeThe ICECAP-A and EQ-5D-5L are two index measures appropriate for use in health research. Assessment of content validity allows understanding of whether a measure captures the most relevant and important aspects of a concept. This paper reports a qualitative assessment of the content validity and appropriateness for use of the eq-5D-5L and ICECAP-A measures, using novel methodology.MethodsIn-depth semi-structured interviews were conducted with research professionals in the UK and Australia. Informants were purposively sampled based on their professional role. Data were analysed in an iterative, thematic and constant comparative manner. A two stage investigation - the comparative direct approach - was developed to address the methodological challenges of the content validity research and allow rigorous assessment.ResultsInformants viewed the ICECAP-A as an assessment of the broader determinants of quality of life, but lacking in assessment of health-related determinants. The eq-5D-5L was viewed as offering good coverage of health determinants, but as lacking in assessment of these broader determinants. Informants held some concerns about the content or wording of the Self-care, Pain/Discomfort and Anxiety/Depression items (EQ-5D-5L) and the Enjoyment, Achievement and attachment items (ICECAP-A). ConclusionUsing rigorous qualitative methodology the results suggest that the ICECAP-A and EQ-5D-5L hold acceptable levels of content validity and are appropriate for use in health research. This work adds expert opinion to the emerging body of research using patients and public to validate these measures.
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