Fabrice Etilé

Do health changes affect smoking? Evidence from British panel data

This paper uses seven waves of British Household Panel Survey (BHPS) data to examine the link between health developments while smoking (both ones own and those of other smokers in the same household) and future cigarette consumption. We find those whose health worsens when smoking smoke less in the future, and are more likely to quit. This correlation is consistent with both a Grossman model of health demand (where all parameters are known) and with learning about the health consequences of smoking (where there is uncertainty). There is little effect on smoking from health developments amongst other smokers in the same household. As such, impersonal information provision may have less of an effect on smoking than the delivery of personalised health information, for example through the medical profession.

Happy house: Spousal weight and individual well-being

We use life satisfaction and Body Mass Index (BMI) information from three waves of the GSOEP to test for social interactions in BMI between spouses. Social interactions require that the cross-partial effect of partners weight and own weight in the utility function be positive. Using life satisfaction as a utility proxy, semi-parametric regressions show that the correlation between satisfaction and own BMI is initially positive, but turns negative after some threshold. Critically, this latter threshold increases with partners BMI when the individual is overweight. The negative well-being impact of own BMI is thus lower when the individuals partner is heavier, which is consistent with social contagion effects in weight. However, this relationship may also reflect selection on the marriage market or omitted variables, and it is difficult to think of convincing instruments that would allow causality to be clearly established.

Schooling and smoking among the baby-boomers: an evaluation of the impact of educational expansion in France

Post-war expansion of education in France transformed the distribution of schooling for the cohorts born between the 1940s and the 1970s. However, throughout this expansion the proportion with the highest levels of qualifications remained stable, providing a natural control group. We evaluate the impact of schooling on smoking, for the beneficiaries of the post-war expansion, by comparing changes in their outcomes across birth cohorts with changes within the control group. We uncover robust evidence that educational expansion contributed to a decline in smoking prevalence of 2.9 points of percentage for men and 3.2 points for women at the turn of the 21st century. Our results also suggest that the persistence of the schooling-smoking gradient is better explained by differences in the education-related opportunity costs of smoking than by differences in information about smoking dangers.

Do High Consumers of Sugar-Sweetened Beverages Respond Differently to Price Changes? A Finite Mixture IV-Tobit Approach

This study compares the impact of sugar-sweetened beverages (SSBs) tax between moderate and high consumers in Australia. The key methodological contribution is that price response heterogeneity is identified while controlling for censoring of consumption at zero and endogeneity of expenditure by using a finite mixture instrumental variable Tobit model. The SSB price elasticity estimates show a decreasing trend across increasing consumption quantiles, from -2.3 at the median to -0.2 at the 95th quantile. Although high consumers of SSBs have a less elastic demand for SSBs, their very high consumption levels imply that a tax would achieve higher reduction in consumption and higher health gains. Our results also suggest that an SSB tax would represent a small fiscal burden for consumers whatever their pre-policy level of consumption, and that an excise tax should be preferred to an ad valorem tax.

Education policies and health inequalities: evidence from changes in the distribution of Body Mass Index in France, 1981-2003.

This paper contributes to the debate over the effectiveness of education policies in reducing overall health inequalities as compared to public health actions directed at the less-educated. Recentered Influence Function (RIF) regressions are used to decompose the contribution of education to the changing distribution of Body Mass Index (BMI) in France, between 1981 and 2003, into a composition effect (the shift in population education due to a massive educational expansion), and a structure effect (a changing educational gradient in BMI). Educational expansion has reduced overall BMI inequality by 3.4% for women and 2.3% for men. However, the structure effect on its own has produced a 10.9% increase in overall inequality for women, due to a steeper education gradient starting from the second quartile of the distribution. This structure effect on overall inequality is also large (7.6%) for men, albeit insignificant as it remains concentrated in the last decile. Educational expansion policies can thus reduce overall BMI inequalities; but attention must still be paid to the BMI gradient in education even for policies addressing overall rather than socioeconomic health inequalities.

Food Price Policies and the Distribution of Body Mass Index: Theory and Empirical Evidence from France

This paper uses French food-expenditure data to examine the effect of the local prices of 23 food product categories on the distribution of Body Mass Index (BMI) in a sample of French adults. A dynamic choice model using standard assumptions in Physiology is developed. It is shown that the slope of the price-BMI relationship is affected by the individuals Physical Activity Level (PAL). When the latter is unobserved, identi cation of price effects at conditional quantiles of the BMI distribution requires quantile independence between PAL and the covariates, especially income. Using quantile regressions, unconditional BMI distributions can then be simulated for various price policies. In the preferred scenario, increasing the price of soft drinks, breaded proteins, deserts and pastries, snacks and ready-meals by 10%, and reducing the price of fruit and vegetables in brine by 10% would decrease the prevalence of overweight and obesity by 24% and 33% respectively. The fall in health care expenditures would represente up to 1.39% of total health care spendings in 2004.

Mandatory labels, taxes and market forces: An empirical evaluation of fat policies.

The public-health community views mandatory Front-of-Pack (FOP) nutrition labels and nutritional taxes as promising tools to control the growth of food-related chronic diseases. This paper uses household scanner data to propose an ex-ante evaluation and comparison of these two policy options for the fromage blanc and dessert yogurt market. In most markets, labelling is voluntary and firms display fat labels only on the FOP of low-fat products to target consumers who do not want to eat fat. We here separately identify consumer preferences for fat and for FOP fat labels by exploiting an exogenous difference in legal labelling requirements between these two product categories. Estimates of demand curves are combined with a supply model of oligopolistic price competition to simulate policies. We find that a feasible ad valorem fat tax dominates a mandatory FOP-label policy from an economic perspective, but both are equally effective in reducing average fat purchases.

Globalisation and national trends in nutrition and health - a grouped fixed effects approach to inter-country heterogeneity

Using a panel dataset of 70 countries spanning 42 years (1970-2011), we investigate the distinct effects of social globalisation and trade openness on national trends in markers of diet quality (supplies of animal proteins, free fats and sugar, average body mass index, and diabetes prevalence). Our key methodological contribution is the application of a grouped fixed-effects estimator, which extends linear fixed-effects models. The grouped fixed-effects estimator partitions our sample into distinct groups of countries in order to control for time-varying unobserved heterogeneity that follows a group-specific pattern. We find that increasing social globalisation has a significant impact on the supplies of animal protein and sugar available for human consumption, as well as on mean body mass index. Specific components of social globalisation such as information flows (via television and the Internet) drive these results. Trade openness has no effect on dietary outcomes or health. These findings suggest that the social and cultural aspects of globalisation should receive greater attention in research on the nutrition transition.

The Effect of Introducing a Minimum Price on the Distribution of Alcohol Purchase: A Counterfactual Analysis

We use counterfactual analysis techniques to evaluate the impact of a

Front-of-pack Nutri-Score labelling in France: an evidence-based policy

2 minimum unit price (MUP) on the distribution of Australian (Victorian) household off-trade alcohol purchases. Our estimates suggest that a