Thorhildur Ólafsdóttir

Business cycles, hypertension and cardiovascular disease: Evidence from the Icelandic economic collapse

Abstract Background. Business cycles affect peoples lives. A growing literature examines their effect on health outcomes. The available studies on the relationship between ambient economic conditions and cardiovascular health show mixed results. They are furthermore limited in their outcome measures, focusing mostly on mortality. Methods. We examined the relationship between economic conditions and cardiovascular disease and hypertension, using the Icelandic economic collapse of 2008. Logit regression analyses are used to examine the relationship between economic conditions and the probability of reporting a cardiovascular disease or hypertension. We furthermore investigated potential mediators of this relationship. The data used come from a health and lifestyle survey carried out by the Public Health Institute of Iceland in 2007 and 2009. Results. The crisis was positively related to hypertension in males but no statistically significant relationship was found for females. The mediation analyses indicated partial mediation through changes in working hours and stress level, but negligible mediation through changes in income. The male hypertension was, however, suppressed by concurrent changes in smoking and body weight. Conclusions. Only examining mortality effects of society-wide economic conditions may understate the overall effect on cardiovascular health.

The Icelandic economic collapse, smoking, and the role of labor-market changes

Smoking is related to health deterioration through increased risk of various diseases. Changes in this health behavior could contribute to the documented health improvements during economic downturns. Furthermore, the reasons for changes in behavior are not well understood. We explore smoking behavior in Iceland before and after the sudden and unexpected economic crisis in 2008. Furthermore, to explore the mechanisms through which smoking could be affected we focus on the role of labor-market changes. Both real income and working hours fell significantly and economic theory suggests that such changes can affect health behaviors which in turn affect health. We use individual longitudinal data from 2007 to 2009, incidentally before and after the crisis hit. The data originates from a postal survey, collected by The Public Health Institute in Iceland. Two outcomes are explored: smoking participation and smoking intensity, using pooled ordinary least squares (OLS) and linear probability models. The detected reduction in both outcomes is not explained by the changes in labor-market variables. Other factors in the demand function for tobacco play a more important role. The most notable are real prices which increased in particular for imported goods because of the devaluation of the Icelandic currency as a result of the economic collapse.

The tax-free year in Iceland: A natural experiment to explore the impact of a short-term increase in labor supply on the risk of heart attacks

Evidence is mixed on whether society-wide economic conditions affect cardiovascular health and the reasons for the suggested relationship are largely untested. We explore whether a short-term increase in labor supply affects the probability of acute myocardial infarctions, using a natural experiment in Iceland. In 1987 personal income taxes were temporarily reduced to zero, resulting in an overall increase in labor supply. We merge and analyze individual-level, registry-based data on earnings and AMIs including all Icelandic men and women aged 45-74 during the period 1982-1992. The results support the prominent hypothesis of increased work as a mechanism explaining worsening heart health in upswings, for men aged 45-64 who were self-employed. We furthermore find a larger increase in probability of AMIs during the tax-free year in men aged 45-54 than men aged 55-64.

A compensating income variation approach to valuing 34 health conditions in Iceland

HighlightsValuing health conditions is an important but difficult task.We use compensating income variation (CIV) to value several health conditions.Easily attained health‐related quality of life (HRQoL) proxies are also considered.CIV for some mental‐health conditions may be problematic.HRQoL proxies appear to yield higher values than found using other methods. ABSTRACT Using data from an Icelandic health‐and‐lifestyle survey carried out in 2007, 2009, and 2012, we employ a compensating income variation (CIV) approach to estimate the monetary value sufficient to compensate individuals for the presence of various sub‐optimal health conditions. This method is inexpensive and easy on subjects and has been applied to several desiderata that do not have revealed market prices. The CIV literature is, however, still limited in its application to health and thus information about its suitability is limited. With the aim of shedding light on the methodśs appropriateness we thus provide a broad‐view analysis including a spectrum of diseases and conditions that can be held up against more traditionally used methods. CIV for physical conditions vary greatly, but paralysis, fibromyalgia, chronic back pain, rheumatoid arthritis, urinary incontinence, severe headache and thyroid disease were among those consistently associated with substantial well‐being reductions. Mental‐health results using this method should be read with caution. The societal value of health interventions is multidimensional, including for example increased productivity in the population. However, one of the main positive aspects of increased health is undoubtedly the increased well‐being of the treated subjects. Such quality‐of‐life effects should thus preferably be taken into account. For this reason, information on the value individuals place on recovery from various sub‐optimal health conditions is useful when it comes to prioritizing scarce capital in the health sector. It is therefore vital to estimate the importance individuals place on various health states and hold them up against each other. Furthermore, this paper has scientific value as it sheds light on attributes of a potentially useful method in health evaluations.

Health and Inequality in Health in the Nordic Countries

All five Nordic countries emphasise equal and easy access to healthcare. It is the purpose to explore to which extent the populations of these countries have reached good health and high degree of socio-economic equality of health. Each of the five countries has established extensive public health programmes, although with somewhat different emphasis on the causes of ill-health, such as individual behaviour or social circumstances. Attitudes have changed over time, though. We compare these countries to the UK and Germany by using data from the European Social Survey 2002 and 2012 in addition to OECD Statistics from the same years. Health is measured by self-assessed health in five categories, transformed to a cardinal scale using Swedish time trade-off weights. As socio-economic variable we use household income or length of education. Mean health, based on Swedish TTO weights applied to all countries, is above 0.93 in all the Nordic countries and the UK in 2012, while lower in Germany. Rates in good or very good health in the lower income half of the samples are above 0.6 in most countries and even higher in Iceland and Sweden, but below 0.5 in Germany. However, when displayed in a graph the concentration curves nearly follow the diagonal implying almost no income- or education related inequality in self-assessed health weighted by TTO based preferences. The difference is a natural consequence of using different methods. We compared four key life-style related determinants of ill health and found that while there were differences in relative levels between the countries, Germany had a relatively high level of three of these, followed by the UK. We found no association between level of resources used and health status. In general, the Nordic countries have accomplished good health for their populations and high degree of socioeconomic equality in health. Improvements in life-style related determinants of health would be possible, though.