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Infectious disease outbreaks can exact a high human and economic cost through illness and death. But, as with severe acute respiratory syndrome (SARS) in East Asia in 2003, or the plague outbreak in Surat, India, in 1994, they can also create severe economic disruptions even when there is, ultimately, relatively little illness or death. Such disruptions are commonly the result of uncoordinated and panicky efforts by individuals to avoid becoming infected, of preventive activity. This paper places these "SARS type" effects in the context of research on economic epidemiology, in which behavioral responses to disease risk have both economic and epidemiological consequences. The paper looks in particular at how people form subjective probability judgments about disease risk. Public opinion surveys during the SARS outbreak provide suggestive evidence that people did indeed at times hold excessively high perceptions of the risk of becoming infected, or, if infected, of dying from the disease. The paper discusses research in behavioral economics and the theory of information cascades that may shed light on the origin of such biases. The authors consider whether public information strategies can help reduce unwarranted panic. A preliminary question is why governments often seem to have strong incentives to conceal information about infectious disease outbreaks. The paper reviews recent game-theoretic analysis that clarifies government incentives. An important finding is that government incentives to conceal decline the more numerous are non-official sources of information about a possible disease outbreak. The findings suggest that honesty may indeed be the best public policy under modern conditions of easy mass global communications.

Disease Control and Prevention --- Health Monitoring and Evaluation --- Health, Nutrition and Population

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This report describes the findings of a study on the continua of care for tuberculosis, hypertension and diabetes in South Africa forming part of an evaluation of the National Adherence Guidelines for Chronic Diseases. Conducted by the National Department of Health in collaboration with the National Health Laboratory Service, the World Bank, and Boston University/Health Economics and Epidemiology Research Office, the study used routine data from 24 health facilities in Gauteng, KwaZulu-Natal, Limpopo, North West provinces. Observational cohorts of patients were created using clinic records and applying eligibility criteria. In the screening cohort of 3600 patients, 46 percent of eligible patients had a TB screen (83 percent of HIV patients) with 8 percent having positive screens. For hypertension, 72 of eligible patients were screened and 19 percent positive. For diabetes, 56 percent of eligible patients had evidence of screening in the past three years and 4 percent were positive. In the diagnosed cohort of 1,096 patients, treatment initiation was 98 percent for TB, 92 percent for hypertension and 82 percent for diabetes. Treatment success was 71 percent for TB, 22 percent for hypertension 18 percent for diabetes. The results demonstrated that considerable efforts are made to find cases and retain them in care, but that there is room for further improvement to maximize patient outcomes in chronic care.

Diabetes --- Disease Control and Prevention --- Health Monitoring and Evaluation --- Health Policy and Management --- Health, Nutrition and Population --- Tuberculosis

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The COVID-19 pandemic has ravaged the global economy, either reversing or slowing ongoing efforts to eliminate extreme poverty in many countries. Despite recent progress, including increased recoveries and lower death rates, India is ranked third globally in absolute numbers of COVID-19 reported cases. India's chronic underinvestment in health, coupled with a hard-hit economic sector, has further entrenched segments of India's population in vulnerability and poverty. The exodus of millions of migrants from the cities has contributed to the spread of infection from urban to rural areas, where health systems are weaker. As economic activities are revived following a period of lockdowns, policy makers must make smart choices that prevent and rein in the spread of COVID-19. In the absence of effective treatment and a vaccine, preventive measures combined with testing and tracing, followed by quarantine and isolation and supportive treatment, are critical to minimize the spread of COVID-19 and rejuvenate livelihoods to restore India's economy. In this paper, authors bring together promising testing and tracing lessons and approaches from India and globally, based on a desk review of various initiatives and analyses of secondary data. Key lessons and findings are that: (i) testing and tracing is central to an effective COVID-19 response; (ii) a robust response to an unprecedented pandemic requires creative approaches, such as active case finding, pooled testing, testing environmental samples, triangulation of microdata, effective contact tracing, and partnering with the private sector; (iii) optimizing COVID-19 testing capacity should not negatively impact ongoing disease control programs; (iv) containment of COVID-19 should go hand-in-hand with preparation for future pandemics. We also summarize innovations and bottlenecks to rapidly scale up testing capacities at the state level, including strategies for optimizing the role of the private sector and introducing new technologies to enhance access to testing in rural populations. This paper offers options especially relevant to Indian policy makers, with a focus on sustained health systems strengthening.

Coronavirus --- COVID-19 --- Disease Control and Prevention --- Health Monitoring and Evaluation --- Health, Nutrition and Population --- Public Health Promotion

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Costa Rica stands out for being among the most politically stable, progressive, prosperous, and environmentally conscious nations in the Latin America and the Caribbean region. Its development model has brought important economic, social, and environmental dividends, with sustained growth, upward mobility for a large share of the population, important gains in social indicators, and significant achievements in reforestation and conservation. However, there are a number of development challenges that need to be addressed to maintain the country's successful development path. This Systematic Country Diagnostic takes stock of the poverty, inequality, and growth trends, addressing the following questions: To what extent has the Costa Rican development model been inclusive? What has driven growth in Costa Rica in recent years, and what are the bottlenecks that need to be addressed? How sustainable is the development model of Costa Rica economically, socially, and environmentally?.

Economic Theory and Research --- Environment --- Environmental Economics and Policies --- Finance and Financial Sector Development --- Health Monitoring and Evaluation --- Health, Nutrition and Population --- Macroeconomics and Economic Growth --- Rural Development

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The authors examine how a government-run cash transfer program targeted to poor mothers in rural Ecuador influenced the health and development of their children. This program is of particular interest because, unlike other transfer programs that have been implemented recently in Latin America, receipt of the cash transfers was not conditioned on specific parental actions, such as taking children to health clinics or sending them to school. This feature of the program makes it possible to assess whether conditionality is necessary for programs to have beneficial effects on children. The authors use random assignment at the parish level to identify the program's effects. They find that the cash transfer program had positive effects on the physical, cognitive, and socioemotional development of children, and the treatment effects were substantially larger for the poorer children than for less poor children. Among the poorest children in the sample, those whose mothers were eligible for transfers had outcomes that were on average more than 20 percent of a standard deviation higher than those for comparable children in the control group. Treatment effects are somewhat larger for girls and for children with more highly-educated mothers. The authors examine three mechanisms-better nutrition, greater use of health care, and better parenting-through which the transfers might influence child development. The program appeared to improve children's nutrition and increased the chance they were treated for helminth infections. But children in the treatment group were not more likely to visit health clinics for growth monitoring, and the mental health and parenting of their mothers did not improve.

Child development --- Clinics --- Families --- Health care --- Health Monitoring and Evaluation --- Health, Nutrition and Population --- Mental --- Mental health --- Mortality --- Nutrition --- Nutritional status --- Parenting