Joan Hamory Hicks

Worms at Work: Long-Run Impacts of a Child Health Investment

This study estimates long-run impacts of a child health investment, exploiting community-wide experimental variation in school-based deworming. The program increased labor supply among men and education among women, with accompanying shifts in labor market specialization. Ten years after deworming treatment, men who were eligible as boys stay enrolled for more years of primary school, work 17% more hours each week, spend more time in nonagricultural self-employment, are more likely to hold manufacturing jobs, and miss one fewer meal per week. Women who were in treatment schools as girls are approximately one quarter more likely to have attended secondary school, halving the gender gap. They reallocate time from traditional agriculture into cash crops and nonagricultural self-employment. We estimate a conservative annualized financial internal rate of return to deworming of 32%, and show that mass deworming may generate more in future government revenue than it costs in subsidies.

The Case for Mass Treatment of Intestinal Helminths in Endemic Areas

Two articles published earlier this year in the International Journal of Epidemiology [1,2] have re-ignited the debate over the World Health Organization’s long-held recommendation of mass-treatment of intestinal helminths in endemic areas. In this note, we discuss the content and relevance of these articles to the policy debate, and review the broader research literature on the educational and economic impacts of deworming. We conclude that existing evidence still indicates that mass deworming is a cost-effective health investment for governments in low-income countries where worm infections are widespread.

Does Mass Deworming Affect Child Nutrition? Meta-analysis, Cost-Effectiveness, and Statistical Power

The WHO has recently debated whether to reaffirm its long-standing recommendation of mass drug administration (MDA) in areas with more than 20 percent prevalence of soil-transmitted helminths (hookworm, whipworm, and roundworm). There is consensus that the relevant deworming drugs are safe and effective, so the key question facing policymakers is whether the expected benefits of MDA exceed the roughly

Commentary: Deworming externalities and schooling impacts in Kenya: a comment on Aiken et al. (2015) and Davey et al. (2015)

0.30 per treatment cost. The literature on long run educational and economic impacts of deworming suggests that this is the case. However, a recent meta-analysis by Taylor-Robinson et al. (2015), (hereafter TMSDG), disputes these findings. The authors conclude that while treatment of children known to be infected increases weight by 0.75 kg (95 percent CI: 0.24, 1.26; p=0.0038), there is substantial evidence that MDA has no impact on weight or other child outcomes. This paper updates the TMSDG analysis by including studies omitted from that analysis and extracting additional data from included studies, and finds that the TMSDG analysis is underpowered: Power is inadequate to rule out weight gain effects that would make MDA cost effective relative to comparable interventions in similar populations, and underpowered to reject the hypothesis that the effect of MDA is different from the effect that might expected, given dewormings effects on those known to be infected. The hypothesis of a common zero effect of multiple-dose MDA deworming on child weight at longest follow-up is rejected at the 10 percent level using the TMSDG dataset, and with a p value < 0.001 using the updated sample. In the full sample, including studies in settings where prevalence is low enough that the WHO does not recommend deworming, the average effect on child weight is 0.134 kg (95 percent CI: 0.031, 0.236, random effects). In environments with greater than 20 percent prevalence, where the WHO recommends mass treatment, the average effect on child weight is 0.148 kg (95 percent CI: 0.039, 0.258). The implied average effect of MDA on infected children in the full sample is 0.301 kg. At 0.22 kg per U.S. dollar, the estimated average weight gain per dollar is more than 35 times that from school feeding programs as estimated in RCTs. Under-powered meta-analyses are common in health research, and this methodological issue will be increasingly important as growing numbers of economists and other social scientists conduct meta-analysis.

Jealous of the Joneses: conspicuous consumption, inequality, and crime

Commentary: Deworming externalities and schooling impacts in Kenya: a comment on Aiken et al. (2015) and Davey et al. (2015) Joan Hamory Hicks, Michael Kremer and Edward Miguel* University of California, Center for Effective Global Action, Berkeley, California, USA, Department of Economics, Harvard University and NBER, Cambridge, Massachusetts, USA and Department of Economics, University of California, Berkeley and NBER

Economics of Mass Deworming Programs

Empirical research on the relationship between economic inequality and crime has focussed on income inequality, despite the fact that income is not easily observed by potential criminals. We extend this literature by shifting the focus from income to its visible manifestation—conspicuous consumption. Using variation within US states over time, we document a robust association between the distribution of conspicuous consumption and violent crime. Our results link violent crime to inequality in visible expenditure, but not to inequality in total expenditure, suggesting that information plays a key role in the determination of crime. Furthermore, focussing on conspicuous expenditure allows for new tests of competing theories of crime. Our findings are consistent with social theories that link crime with relative deprivation, but provide little support for traditional economic theory.

Lucky Late Bloomers? The Consequences of Early Marriage for Women in Western Kenya

Soil-transmitted helminth (STH) and schistosomiasis infections affect more than 1 billion people, mainly in lowand middle-income countries, particularly school-age children. Although light infections can be fairly asymptomatic, severe infections can have significant health effects, such as malnutrition, listlessness, organ damage, and internal bleeding (Bundy, Appleby, and others 2017).1 Low-cost drugs are available and are the standard of medical care for diagnosed infections. Because diagnosis is relatively expensive, and treatment is inexpensive and safe, the World Health Organization (WHO) recommends periodic mass treatments in areas where worm infections are greater than certain thresholds (WHO 2015). A number of organizations, including the Copenhagen Consensus, GiveWell, and the Abdul Latif Jameel Poverty Action Lab, which have reviewed the evidence for, and comparative cost-effectiveness of, a wide range of development interventions, have consistently ranked deworming as a priority for investment.2 However, Taylor-Robinson and others (2015) challenge this policy, accepting that those known to be infected should be treated but arguing that there is substantial evidence that mass drug administration (MDA) has no impact on a range of outcomes.3 This chapter discusses the economics of policy choices surrounding public investments in deworming and considers policy choices under two frameworks: • Welfare economics or public finance approach. Individuals are presumed to make decisions that maximize their own welfare, but government intervention may be justified in cases in which individual actions create externalities for others. These externalities could include health externalities from reductions in the transmission of infectious disease, as well as fiscal externalities if treatment increases long-term earnings and tax payments. Evidence on epidemiological and fiscal externalities from deworming will be important for informing decisions under this perspective. • Expected cost-effectiveness approach. Policy makers should pursue a policy if the statistical expectation of the value of benefits exceeds the cost. Future monetary benefits should be discounted back to the present. Policy makers may also value nonfinancial goals, such as weight gain or school participation; they should pursue a policy if the statistical expectation of the benefit achieved per unit of expenditure exceeds that of other policies that policy makers are considering.

Should the WHO withdraw support for mass deworming

We examine the impact of early marriage across a wide range of outcomes for women in rural western Kenya. The timing of physical maturation in girls has been shown to influence marriage timing in a quasi-random manner, and we find that each additional year that menarche is delayed is associated with an increase of 0.25 years in age at first marriage. Using age of menarche as an instrument for marital age, we show that delayed marriage increases female educational attainment, some academic test scores, and self-reported measures of health. At the same time, age of marriage appears to have little direct effect on many other important life outcomes including labor market participation, earnings, attitudes and beliefs, marriage market outcomes, and child health.

Commentary: Assessing long-run deworming impacts on education and economic outcomes: a comment on Jullien, Sinclair and Garner (2016)

1 World Bank, Washington DC, United States of America, 2 Harvard T. H Chan School of Public Health, Boston, Massachusetts, United States of America, 3 Center for Effective Global Action, University of California, Berkeley, Berkeley, California, United States of America, 4 Department of Economics, University of California, Berkeley, Berkeley, California, United States of America, 5 Department of Economics, Harvard University, Cambridge, Massachusetts, United States of America

Are female politicians more responsive to international crises

Commentary: Assessing long-run deworming impacts on education and economic outcomes: a comment on Jullien, Sinclair and Garner (2016) Sarah Baird, Joan Hamory Hicks, Michael Kremer and Edward Miguel* Milken Institute School of Public Health, George Washington University, Washington, DC, USA, University of California, Center for Effective Global Action, Berkeley, CA, USA, Department of Economics, Harvard University and NBER, Cambridge, MA, USA and Department of Economics, University of California, Berkeley, and NBER, Berkeley, CA, USA