Essays in Wellbeing, Health and Human Capital Development

My thesis focuses broadly on two instruments that may significantly influence human capital development and population health (i) sleep and (ii) policy instruments in particular austerity measures and behavioral interventions targeting health systems and public health. In policy discussions aimed at improving human capital outcomes, a neglected area of research is sleep. Although a much researched topic in medicine, the economic and social penalty of sleep disorders is poorly understood. With the aim of contributing to the scarce literature on sleep and its role in human capital accumulation, chapter 1 investigates how sleep, a basic physiological need and an important part of daily routine affect human capital development. Chapter 1 presents the findings from four research papers that study the correlates, prevalence estimates and consequences of sleep problems at different points across the lifecycle. We provide evidence suggesting that sleep matters for a range of outcomes over the lifespan. Our findings call for minimizing disparities in sleep health by developing and implementing effective interventions to reduce overall inequalities in health and wellbeing. In chapter 2, I discuss the effects of hospital closures in Italy on patient health outcomes. Austerity policies are a frequent response to economic crises and fiscal deficits in both developed and developing countries. While the policies may vary in regard to their context, intensity and implementation, such models recommend reducing public expenses and social investments. In Europe, the austerity policies have not spared the health system and budgetary restrictions may very often include closure of hospital facilities. Hospital closures are said to be advantageous if the closed hospitals are inefficient or underutilized. Such closures may actually improve patient outcomes. On the other hand, closures could potentially harm population health through congestion in nearby hospitals and increased travel time in accessing care. In our study, using patient discharge data of AMI patients in Italy, we find that individuals belonging to municipalities exposed to a home hospital closure (closure of a hospital receiving most admission from a municipality in a year) compared to those who were not, had an increased likelihood of experiencing an in-hospital death, increase in cardiac and circulatory disease related 30, 90 and 365-day readmissions and length of stay following an initial AMI admission. We also find that hospital closures are associated with an increase in travel time and bed utilization rates, which in the second stage worsens patient outcomes. Most importantly, the effects of closure are persistent indicating the adaption to this negative shock to be very slow. The negative effects of hospital closures are most significant during emergency crises leaving the hospital system to be overburdened with less capacity and huge demand. One such crisis is pandemics. In chapter 3, I focus on the COVID-19 pandemic which put a huge stress on the public health system in Europe and all over the world. The chapter focuses on the commitment and acceptability to COVID-19 preventive measures, and in general a snapshot of the public perception of the European population during the pandemic. When health care capacity is limited and saving lives depends solely on non-pharmaceutical interventions, understanding public behavior during the crises is of utmost importance in targeting policies aimed at the flattening the curve. To summarize, this thesis is comprised of three main chapters that investigates how physiological processes and government policies independently influence human capital, health and behavioral outcomes across life-cycle.