Brendan Kennelly

Social capital, life expectancy and mortality: a cross-national examination.

This paper analyses the relationship between social capital and population health. The analysis is carried out within an econometric model of population health in 19 countries in the Organisation for Economic Co-operation and Development countries using panel data covering three different time periods. Social capital is measured by the proportion of people who say that that they generally trust other people and by membership in voluntary associations. The model performs well in explaining health outcomes. We find very little statistically significant evidence that the standard indicators of social capital have a positive effect on population health. By contrast, per capita income and the proportion of health expenditure financed by the government are both significantly and positively associated with better health outcomes. The paper casts doubt upon the widely accepted hypothesis that social capital has a positive effect on health and illustrates the importance of testing this kind of hypothesis in an extended model.

The state of the art in European research on reducing social exclusion and stigma related to mental health: A systematic mapping of the literature

Stigma and social exclusion related to mental health are of substantial public health importance for Europe. As part of ROAMER (ROAdmap for MEntal health Research in Europe), we used systematic mapping techniques to describe the current state of research on stigma and social exclusion across Europe. Findings demonstrate growing interest in this field between 2007 and 2012. Most studies were descriptive (60%), focused on adults of working age (60%) and were performed in Northwest Europe-primarily in the UK (32%), Finland (8%), Sweden (8%) and Germany (7%). In terms of mental health characteristics, the largest proportion of studies investigated general mental health (20%), common mental disorders (16%), schizophrenia (16%) or depression (14%). There is a paucity of research looking at mechanisms to reduce stigma and promote social inclusion, or at factors that might promote resilience or protect against stigma/social exclusion across the life course. Evidence is also limited in relation to evaluations of interventions. Increasing incentives for cross-country research collaborations, especially with new EU Member States and collaboration across European professional organizations and disciplines, could improve understanding of the range of underpinning social and cultural factors which promote inclusion or contribute toward lower levels of stigma, especially during times of hardship.

The Economic Cost of Suicide in Ireland

OBJECTIVE To calculate the costs of suicide in Ireland. METHOD The paper identifies all episodes of suicide in Ireland in 2001 and 2002, and projects the economic costs arising from these episodes over subsequent years. All prices have been converted to 2001 Euros. Both direct and indirect costs were calculated. Indirect costs included both the cost of lost output and human costs. RESULTS The total cost of suicide is estimated at over Euro 906 million in 2001, and over Euro 835 million in 2002 (in 2001 prices). This is equivalent to a little under 1% of the gross national product in Ireland for those years. CONCLUSIONS The results show that investment in health education and health promotion can be justified on the basis of the costs associated with suicide in Ireland. These costs fall on individuals, families, and society. The huge human cost of suffering associated with suicide can also be prevented through appropriate intervention to prevent death occurring. It is important that any suicide prevention strategy should include an evaluative framework to ensure that investment occurs in the areas most likely to generate the highest returns in term of suicides prevented and lives saved.

The economic cost of schizophrenia in Ireland : a cost of illness study

OBJECTIVES Although there are many published reports about the human cost of schizophrenia, there are far fewer estimates of its economic cost, particularly in Ireland. The aim of this study was to provide a prevalence-based estimate of the costs associated with schizophrenia in Ireland during 2006. METHOD Using standard Cost of Illness (COI) procedures we compiled data from many sources including the Health Research Board, the Department of Health and Children and other government publications. Costs relating to health and social care, informal care, lost productivity, premature mortality and other public expenditures were included. Where national data were unavailable, we used bottom-up data from a geographically defined catchment area study and, in some instances, costs from two catchment areas were averaged. We did not measure human or intangible costs. RESULTS The estimated total cost of schizophrenia was €460.6 million in 2006. The direct cost of care was €117.5 million and the burden of indirect costs was €343 million. The cost of lost productivity due to unemployment, absence from work and premature mortality was €277 million. Within indirect costs, the expenditure on informal care borne by families was €43.8 million. CONCLUSIONS Schizophrenia is not a very common condition but is an expensive one. This is attributable to its young age at onset, relatively low mortality rate and high severity particularly in terms of its impact on future employment. Measures to improve outcomes coupled with measures to improve employment such as supported employment strategies may impact significantly on the cost of schizophrenia. The study is limited because the national unit costs of many variables are not directly available and these Irish data are likely to be an underestimate. However, the results are comparable with a 2005 cost of illness study UK study.

Eliciting preferences for resource allocation in mental health care in Ireland

The proportion of total health care expenditure devoted to mental health care in Ireland, at just below 7%, is low relative to other countries. There have been few studies that have examined the relationship between public preferences for different kinds of health care expenditure and priority setting as undertaken by policy-makers and governments. This paper examines citizens rankings and willingness to pay for a community-based mental health care programme in Ireland relative to two other programmes: cancer and elderly care. Respondents rank cancer as the most important programme, followed by elderly care and then mental health care. The contingent valuation survey demonstrated that people are willing to make significant tax contributions to new community-based services for people with mental health problems, counteracting the view sometimes expressed that people do not care at all about mental health care provision. However, the survey also found that people tend to value additional spending on mental health care lower than cancer and elderly care programmes.

Online Assignments in Economics: A Test of Their Effectiveness

This article compares the effectiveness of online and paper-based assignments and tutorials using summative assessment results. All of the students in a large managerial economics course at National University of Ireland, Galway were asked to do six assignments online using Aplia and to do two on paper. The authors examined whether a students performance on a particular section of the exam is affected (1) by how he or she performed on the corresponding assignment and (2) by whether the student completed the corresponding assignment on paper or online. Our results provide little evidence that a students performance on an assignment helps him or her perform better on the corresponding section of the exam. We also found little evidence that the way in which one completes an assignment—on paper or online—has an effect on how one performs on a particular section of the exam.

Industry Characteristics and Interest Group Formation: An Empirical Study

The role of interest groups in the political process has been the subject of much analysis in both political science and economics. However, few studies have examined directly the factors which influence the variation in interest group formation across industrial sectors and between countries. Using data on 75 industrial sectors in 10 countries, we examine the way in which variations in interest group formation are explained by variations in industrial and political characteristics. In cross-sectional empirical relationships we test for the significance of a variety of industry and political variables. Our results indicate that industry characteristics such as the proportion of total demand purchased by households and the concentration ratio are related to variations in interest group formation. We discuss the implications that our results have for recent theoretical work on the effect of interest groups on economic policy.

The Economics of Independent Living: Efficiency, Equity and Ethics.

People with disabilities are routinely denied the exercise of choice in their daily lives. There are strong efficiency arguments for the promotion of greater choice and autonomy for disabled people. There are equally strong moral arguments for an investment in the capabilities of disabled people to allow them to participate in both the educational system and the labour market. This investment will not come cheaply nor will the pay-off always be of such magnitude to justify the expenditure on narrow cost-benefit criteria. Those who value efficiency above everything else must, however, set out the system of justice implied by such a choice. The conclusions of a narrow efficiency argument may turn out to be unacceptable to the majority of citizens. Likewise, however, those who value equity at all costs must consider the implications of their approach for individual freedom, economic growth and technical efficiency. This paper is an attempt to explore the meaning of efficiency and equity in the context of independent-living programmes for people with disabilities.

Welfarism, IIA and arrovian constitutional rules

Two contradictory views on the relationship between independence of irrelevant alternatives and welfarism have appeared in the social choice literature. I show that the contradictory views result from the use of two different forms of independence of irrelevant alternatives. It is shown that one form implies welfarism while the other does not.

How should cost-of-illness studies be interpreted?

The effects of suicide and self-harm are enormous whether the perspective is personal, national, or worldwide. WHO estimates that more than 800 000 people die by suicide in the world each year. In The Lancet Psychiatry, Apostolos Tsiachristas and colleagues estimate that more than 200 000 episodes of self-harm are treated in hospitals in England every year. The personal cost is well known to anybody who has lost a family member, friend, or patient to suicide. Tsiachristas and colleagues calculate the hospital resource use and care costs for all presentations for self-harm to the John Radcliffe Hospital in Oxford between April, 2013, and March, 2014. Altogether, the authors analyse detailed costs of 1623 presentations by 1140 patients. The individual-level information in the paper is outstanding and is broader and deeper than has been available in England and most other countries hitherto. The authors estimated that the average hospital cost of each episode of self-harm was £809. When this figure is extrapolated to all of England, the total hospital costs of self-harm is almost £162 million a year. More than 30% of the average cost of the presentations were attributed to the cost of a psychological assessment even though only 75% of the episodes included such an assessment. Tsiachristas and colleagues estimate that it would cost the NHS £51 million if every episode of self-harm included a psychological assessment as NICE have recommended for a number of years. The reasons researchers on suicide and service providers focus so much attention on people who present with self-harm are well known. Not only is self-harm itself something to be avoided, but good evidence also suggests that people who self-harm are one of the groups with the highest risk of suicide. Figuring out ways of treating people who present in hospital after self-harming has been a top priority for health agencies for some time. In a systematic review and meta-analysis of psychosocial interventions after self-harm, Hawton and colleagues found sufficient evidence to conclude that cognitive behavioural therapy was effective in adult patients after self-harm. O’Connor and colleagues designed and analysed a randomised control trial for a brief psychological intervention for people admitted to hospital following an episode of self-harm and found that the intervention did not affect the number of people who re-presented with self-harm or the number of re-presentations per patient. Although the Article from Tsiachristas and colleagues does not include an evaluation of any particular intervention, it does prepare the way for detailed economic modelling of the costs and benefits of a range of interventions for self-harm. The broad area of calculating some or all of the total costs of particular illnesses is an exercise that distinguishes health economics from other specialities in economics and I sometimes wonder whether it has been a good idea to put so much effort into calculating the costs of illnesses. At some stage, most cost-of-illness studies include a suggestion that the large amount spent on the specific illness could be reduced if more attention were paid to preventing or ameliorating the underlying factors that result in the illness. Tsiachristas and colleagues make a similar point in their paper. Several problems exist with that approach. One is that it is essentially what economists call a partial equilibrium approach. It focuses attention on one illness or problem without acknowledging that resources saved if one illness is prevented will likely be balanced by increased spending on treating another illness. Suppose for a moment that an appropriate cost of illness study had been done for every possible disease and that the total cost of illness was aggregated. The implied counterfactual from such an exercise is a world in which nobody gets sick and everybody dies suddenly at some predetermined age. Additionally, cost of illness studies often identify that more, not less, should be spent on a particular problem. Tsiachristas and colleagues found that only 75% of patients who presented with self-harm received a psychological assessment, even though NICE recommend that everyone should have one. The best available evidence is that these assessments are an appropriate element of the care programme for a person who has presented with self-harm. Highlighting the cost of these assessments as something that could potentially be saved obscures the more important issue, namely, why doesn’t every person who presents with self-harm receive a psychological assessment. Vi ct or d e Sc hw an be rg /S cie nc e Ph ot o Li br ar y