Within-country Analyses Research Articles

Social security and retirement around the world: lessons from a long-term collaboration

Abstract Declining labor force participation of older men throughout the 20th century and recent increases in participation have generated substantial interest in understanding the effect of public pensions on retirement. The National Bureau of Economic Research's International Social Security (ISS) Project, a long-term collaboration among researchers in a dozen developed countries, has explored this and related questions. The project employs a harmonized approach to conduct within-country analyses that are combined for meaningful cross-country comparisons. The key lesson is that the choices of policy makers affect the incentive to work at older ages and these incentives have important effects on retirement behavior.

‘Free-Market Capitalism’ and Democracy in the Period of Democratic Recession: Investigating the Relationship in 141 Countries, 2006–2017

Since the mid-2000s, democratization has slowed, stopped, and even reversed across the world. At the same time, societies have become more oriented toward free markets as measured by indexes of economic freedom. Relying on a panel sample of 141 developed and developing countries between 2006 and 2017, this paper is the first to investigate whether the two phenomena are related by employing economic freedom data. It finds that there is no net-negative relationship between aggregate economic freedom and democracy in this time-period. Instead, mixed findings of both an overall positive and overall neutral (but not negative) association are uncovered in between-country and within-country analyses, respectively. In between-country analyses, using the disaggregated index shows that the legal system/property rights component drives most of the positive relationship between aggregate economic freedom and democracy in the developed world. The same between-country analyses in the developing world show that freedom of international trade is positively associated with democracy, while modest regulation has a negative relationship. However, additionally controlling for omitted variable bias using country-fixed effects, the paper does not find evidence for either a positive or negative relationship between subsequent changes in levels of economic freedom and democracy.

Achieving good health with a low environmental footprint – A comparison of national indicators

Background Integrated metrics that account for resource use and human health are essential to help identify and support human development pathways that safeguard planetary health. We identify countries that achieved the highest levels of health and development at the lowest cost to Earth’s natural capital and report ecological within-country analyses of associations between indicators of environmental sustainability, human health, and development. Methods We used mixed-effects multiple linear regression models of Healthy Life Expectancy (HALE) and Human Capital (HC) related to Ecological Footprint (EF) and CO2 production emissions, controlling for Gini coefficient and population density applied to data of 216 countries from 1991-2016. We performed stratified analyses by country income level and used likelihood-ratio tests to test for interaction. Results Only Jamaica (1991) and Sri Lanka (2016) achieved high HALE at sustainable EF levels. Each 10% increase in EF was associated with 0·20 (95%CI 0·16,0·24) and 0·21 (95%CI 0·19,0·23) increases in HALE and HC respectively; increases in CO2 production emissions were also associated with increased HALE and HC. There was strong evidence for interaction by income level for each model (p<0·016). Stratified analyses showed that in high income nations HALE and HC decreased with increased levels of EF and CO2. Conclusions Countries with high health metrics at sustainable EF levels may offer valuable lessons for sustainable national development policies. Increased environmental footprint and CO2 emissions appear associated with higher levels of human health and development only up to a certain level of income.

A Critical Assessment of the National Expert Survey Data of the Global Entrepreneurship Monitor

Data collected through the National Expert Survey (NES) of the Global Entrepreneurship Monitor (GEM) are widely used to benchmark and assess the quality and impact of national entrepreneurial ecosystems. Based on a comprehensive analysis of the publicly available NES data, we show that the construct validity of the survey is not sufficient and that the experts differ so greatly in their evaluations of the entrepreneurial framework conditions (EFCs) in a country that meaningful cross-country and within-country (longitudinal) analyses are precluded. We conclude that the currently available NES data are not suited for motivating policy decisions.

The Role of Comparative Law in Political Science

Abstract Comparing laws cross-nationally elucidates how they restrain political and societal actors and how actors may use law instrumentally to reach their goals. The Article analyzes the extant use of comparative law in political science and describes areas where a more in-depth comparative study of law may enhance understandings of how law shapes politics, particularly in the areas of governance, judicial behavior, rights protection, and democratic transitions and breakdowns. For meaningful use of comparative law in the study of politics, scholars must use causal research designs for cross-country analysis and rigorously choose cases for more detailed within-country qualitative analyses. Understanding how laws vary cross-nationally and what differences matter has the potential to shape theories and explanations of the explosive and sometimes subtle political changes witnessed in the twenty-first century.

Addressing cross-national generalizability in educational impact evaluation

Evaluation of educational programs has accelerated dramatically in the past quarter century. With this expansion has come clear methodological improvement involving randomized control studies and other approaches for establishing causation that considerably strengthen their internal validity. Such studies are, however, conducted within individual countries with the institutional structure of the schools and the national labor markets, and they are seldom replicated either within or across countries. A natural question is whether the results of an individual high-quality educational evaluation in one country can be reasonably applied in other countries. This paper focuses on existing research into differences across countries that, while generally impossible to incorporate into program evaluations, potentially have direct effects on key elements of policy and on the outcomes that can be expected. In particular, available cross-national studies on a variety of topics suggest using caution when generalizing evaluation results across countries, because student results are likely to vary systematically with a number of fundamental country-level institutional characteristics that are not explicitly considered in within-country evaluation analyses. Unfortunately, there is currently too little replication of basic research studies to provide explicit guidance on when and where cross-national generalizations are possible.

Infant Formula Consumption Is Positively Correlated with Wealth, Within and Between Countries: A Multi-Country Study

ABSTRACTBackgroundIn contrast with the ample literature on within- and between-country inequalities in breastfeeding practices, there are no multi-country analyses of socioeconomic disparities in breastmilk substitute (BMS) consumption in low- and middle-income countries (LMICs).ObjectiveThis study aimed to investigate between- and within-country socioeconomic inequalities in breastfeeding and BMS consumption in LMICs.MethodsWe examined data from the Demographic Health Surveys and Multiple Indicator Cluster Surveys conducted in 90 LMICs since 2010 to calculate Pearson correlation coefficients between infant feeding indicators and per capita gross domestic product (GDP). Within-country inequalities in exclusive breastfeeding, intake of formula or other types of nonhuman milk (cow/goat) were studied for infants aged 0–5 mo, and for continued breastfeeding at ages 12–15 mo through graphical presentation of coverage wealth quintiles.ResultsBetween-country analyses showed that log GDP was inversely correlated with exclusive (r = −0.37, P < 0.001) and continued breastfeeding (r = −0.74, P < 0.0001), and was positively correlated with formula intake (r = 0.70, P < 0.0001). Continued breastfeeding was inversely correlated with formula (r = −0.79, P < 0.0001), and was less strongly correlated with the intake of other types of nonhuman milk (r = −0.40, P < 0.001). Within-country analyses showed that 69 out of 89 did not have significant disparities in exclusive breastfeeding. Continued breastfeeding was significantly higher in children belonging to the poorest 20% of households compared with the wealthiest 20% in 40 countries (by ∼30 percentage points on average), whereas formula feeding was more common in the wealthiest group in 59 countries.ConclusionsBMS intake is positively associated with GDP and negatively associated with continued breastfeeding in LMICs. In most countries, BMS intake is positively associated with family wealth, and will likely become more widespread as countries develop. Urgent action is needed to protect, promote, and support breastfeeding in all income groups and to reduce the intake of BMS, in light of the hazards associated with their use.

Ancient Origins of the Global Variation in Economic Preferences

This paper shows that contemporary population-level heterogeneity in risk aversion, time preference, altruism, positive reciprocity, negative reciprocity, and trust partly traces back to the structure of the migration patterns of our very early ancestors. To document this pattern, we link differences in preferences between populations to the length of time elapsed since the ancestors of the respective groups broke apart from each other, as proxied by genetic and linguistic distance measures. Preference differences are significantly increasing in ancestral distance in both cross-country regressions and within-country analyses across groups of migrants.

How do world and European standard populations impact burden of disease studies? A case study of disability-adjusted life years\xa0(DALYs) in Scotland

BackgroundDisability-Adjusted Life Years (DALYs) are an established method for quantifying population health needs and guiding prioritisation decisions. Global Burden of Disease (GBD) estimates aim to ensure comparability between countries and over time by using age-standardised rates (ASR) to account for differences in the age structure of different populations. Different standard populations are used for this purpose but it is not widely appreciated that the choice of standard may affect not only the resulting rates but also the rankings of causes of DALYs. We aimed to evaluate the impact of the choice of standard, using the example of Scotland.MethodsDALY estimates were derived from the 2016 Scottish Burden of Disease (SBoD) study for an abridged list of 68 causes of disease/injury, representing a three-year annual average across 2014–16. Crude DALY rates were calculated using Scottish national population estimates. DALY ASRs standardised using the GBD World Standard Population (GBD WSP) were compared to those using the 2013 European Standard Population (ESP2013). Differences in ASR and in rank order within the cause list were summarised for all-cause and for each individual cause.ResultsThe ranking of causes by DALYs were similar using crude rates or ASR (ESP2013). All-cause DALY rates using ASR (GBD WSP) were around 26% lower. Overall 58 out of 68 causes had a lower ASR using GBD WSP compared with ESP2013, with the largest falls occurring for leading causes of mortality observed in older ages. Gains in ASR were much smaller in absolute scale and largely affected causes that operated early in life. These differences were associated with a substantial change to the ranking of causes when GBD WSP was used compared with ESP2013.ConclusionDisease rankings based on DALY ASRs are strongly influenced by the choice of standard population. While GBD WSP offers international comparability, within-country analyses based on DALY ASRs should reflect local age structures. For European countries, including Scotland, ESP2013 may better guide local priority setting by avoiding large disparities occurring between crude and age-standardised results sets, which could potentially confuse non-technical audiences.

Impact of caesarean section on breastfeeding indicators: within-country and meta-analyses of nationally representative data from 33 countries in sub-Saharan Africa

ObjectiveTo examine the impact of caesarean section on breastfeeding indicators—early initiation of breastfeeding, exclusive breastfeeding under 6 months and children ever breastfed (at least once)—in sub-Saharan Africa.DesignSecondary analysis of Demographic...

Improving quality and equity in schools in socially disadvantaged areas

ABSTRACTBackground: Recent effectiveness studies have investigated the relationship between two dimensions of effectiveness – namely, quality and equity. Specifically, the question of whether effective schools can also reduce the initial differences in student outcomes attributed to student background factors has been examined. In this context, the Dynamic Approach to School Improvement (DASI) makes use of theory and the research findings of effectiveness studies to try to improve school effectiveness in terms of quality and equity.Purpose: This study aimed to examine whether the implementation of DASI in primary schools in socially disadvantaged areas in four European countries (Cyprus, England, Greece and Ireland) was able to promote student learning outcomes in mathematics and to reduce the impact of student background factors on student achievement in mathematics.Design and methods: A sample of 72 primary schools across the four countries was randomly split into experimental and control groups. At the beginning and at the end of the school year, mathematics tests were administered to all students of Grades 4–6 (n = 5560; student ages 9–12 years). The experimental group made use of DASI. Within-country multilevel regression analyses were conducted to evaluate the impact of the intervention and search for interaction effects between the use of DASI and student background factors on final achievement.Results: In each country, the experimental group achieved better results in mathematics than the control group. At the beginning of the intervention, the achievement gap based on socio-economic status (SES) was equally large in the experimental and the control groups. Only in the experimental group did the achievement gap based on SES become smaller. However, DASI was not found to have an effect on equity when the equity dimension was examined by focusing on the achievement gap based on either gender or ethnicity.Conclusions: Implications of findings are drawn and the importance of measuring equity in terms of student achievement gaps based on different background factors, rather than only on SES, is emphasised. We propose the evaluation of the impact of interventions on promoting equity by the use of various criteria.

Spatial Patterns of Development: A Meso Approach

Over the past two decades, the literature on comparative development has moved from country-level to within-country analyses. The questions asked have expanded in scope as economists have used satellite images of light density at night and other big spatial data to proxy for development at the desired level. The focus has also shifted from uncovering correlations to identifying causal relations, using elaborate econometric techniques including spatial regression discontinuity designs. In this review, we show how the combination of geographic information systems with insights from disciplines ranging from the earth sciences to linguistics and history has transformed the research landscape on the roots of the spatial patterns of development. We discuss the limitations of the luminosity data and associated econometric techniques and conclude by offering some thoughts on future research.

Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys.

The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data. Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI). Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes). The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.

The weight of work: the association between maternal employment and overweight in low- and middle-income countries

BackgroundMaternal employment has increased in low-and middle-income countries (LMIC) and is a hypothesized risk factor for maternal overweight due to increased income and behavioral changes related to time allocation. However, few studies have investigated this relationship in LMIC.MethodsUsing cross-sectional samples from Demographic and Health Surveys, we investigated the association between maternal employment and overweight (body mass index [BMI] ≥ 25 kg/m2) among women in 38 LMIC (N = 162,768). We categorized mothers as formally employed, informally employed, or non-employed based on 4 indicators: employment status in the last 12 months; aggregate occupation category (skilled, unskilled); type of earnings (cash only, cash and in-kind, in-kind only, unpaid); and seasonality of employment (all year, seasonal/occasional employment). Formally employed women were largely employed year-round in skilled occupations and earned a wage (e.g. professional), whereas informally employed women were often irregularly employed in unskilled occupations and in some cases, were paid in-kind (e.g. domestic work). For within-country analyses, we used adjusted logistic regression models and included an interaction term to assess heterogeneity in the association by maternal education level. We then used meta-analysis and meta-regression to explore differences in the associations pooled across countries.ResultsCompared to non-employed mothers, formally employed mothers had higher odds of overweight (pooled odds ratio [POR] = 1.3; 95% Confidence Interval [CI] 1.2, 1.4) whereas informally employed mothers, compared to non-employed mothers, had lower odds of overweight (POR = 0.72; 95% CI: 0.64, 0.81). In 14 LMIC, the association varied by education. In these countries, the magnitude of the formal employment-overweight association was larger for women with low education (POR = 1.5; 95% CI: 1.1, 1.9) compared to those with high education (POR = 1.2; 95% CI: 1.0, 1.3).ConclusionsFormally employed mothers in LMIC have higher odds of overweight and the association varies by educational attainment in 14 countries. This knowledge highlights the importance of workplace initiatives to reduce the risk of overweight among working women in LMIC.

A General Theory of Power Concentration: Demographic Influences on Political Organization

Why is the exercise of political power highly concentrated in some polities and widely dispersed in others? We argue that one persistent causal factor is demographic. Populous polities are characterized by more concentrated structures of authority. To explain this relationship we invoke two mechanisms: efficiency and trust. The theory is demonstrated with a wide variety of empirical measures and in two settings: (1) cross-country analyses including most sovereign states and extending back to the 19th century and (2) within-country analyses focused on states, counties, and localities in the United States.

Kinship, Fractionalization and Corruption

Norms of nepotism and favoritism create corruption, subverting and disrupting impartial institutions and hampering economic development. However, the presence and strength of such norms varies widely within and between countries, and the literature has suggested that this variation is driven, in part, by ethnic fractionalization, with mixed results. We provide evidence for an overlooked -- but deep-rooted -- source of variation in corruption: sub-ethnic fractionalization, driven by mating patterns. The theory of kin selection provides a straightforward justification for norms of nepotism and favoritism among relatives; more subtly, it also implies that the returns to such norms may be influenced by mating practices. Specifically, in societies with high levels of sub-ethnic fractionalization, where endogamous (and consanguineous) mating within kin-group, clan and tribe increases the local relatedness of individuals, the relative returns to norms of nepotism and favoritism are high. In societies with exogamous marriage practices, the relative returns to norms of impartial cooperation with non-relatives and strangers are increased. Using cross-country and within-country regression analyses and a cross-country lab experiment, we provide evidence for this account. Our cross-country analyses show that corruption levels are robustly associated with consanguineous marriage rates, even when controlling for previously studied deep determinants of comparative development. Our within-country analysis exploits variation in consanguinity across Italian provinces and identifies the same pattern. Lab experiments in two countries with different mating patterns provide evidence for our proposed mechanism from subjects who interacted with kin, co-ethnics and strangers in a stylized corruption game.

Comparison of long-term mortality after ruptured abdominal aortic aneurysm in England and Sweden.

Concern has been raised regarding international discrepancies in perioperative mortality after repair of ruptured abdominal aortic aneurysm (rAAA). The variation in in-hospital mortality is difficult to interpret, owing to international differences in discharge strategies. This study compared 90-day and 5-year mortality in patients who had a rAAA in England and Sweden. Patients undergoing rAAA repair were identified from English Hospital Episode Statistics and the Swedish Vascular Registry (Swedvasc) between 2003 and 2012. Ninety-day and 5-year mortality were compared after matching for age and sex. Within-country analyses examined the impact of co-morbidity, teaching hospital status or hospital annual caseload, adjusted with causal inference techniques. Some 12 467 patients underwent rAAA repair in England, of whom 83.2 per cent were men; the median (i.q.r.) age was 75 (70-80) years. A total of 2829 Swedish patients underwent rAAA repair, of whom 81.3 per cent were men; their median (i.q.r.) age was 75 (69-80) years. The 90-day mortality rate was worse in England (44.0 per cent versus 33.4 per cent in Sweden; P < 0.001), as was 5-year mortality (freedom from mortality 38.6 versus 46.3 per cent respectively; P < 0.001). In England, lower mortality was seen in teaching hospitals with larger bed capacity, higher annual caseloads and greater use of endovascular aneurysm repair (EVAR). In Sweden, lower mortality was associated with EVAR, high annual caseload, or surgery on weekdays compared with weekends. Short- and long-term mortality after rAAA repair was higher in England. In both countries, mortality was lowest in centres performing greater numbers of AAA repairs per annum, and more EVAR procedures.

Ethnic Diversity and Social Trust

We argue that residential exposure to ethnic diversity reduces social trust. Previous within-country analyses of the relationship between contextual ethnic diversity and trust have been conducted at higher levels of aggregation, thus ignoring substantial variation in actual exposure to ethnic diversity. In contrast, we analyze how ethnic diversity of the immediate micro-context—where interethnic exposure is inevitable—affects trust. We do this using Danish survey data linked with register-based data, which enables us to obtain precise measures of the ethnic diversity of each individual’s residential surroundings. We focus on contextual diversity within a radius of 80 meters of a given individual, but we also compare the effect in the micro-context to the impact of diversity in more aggregate contexts. Our results show that ethnic diversity in the micro-context affects trust negatively, whereas the effect vanishes in larger contextual units. This supports the conjecture that interethnic exposure underlies the negative relationship between ethnic diversity in residential contexts and social trust.

Economic and humanistic burden of illness in generalized anxiety disorder: an analysis of patient survey data in Europe.

BackgroundWhilst studies suggest that generalized anxiety disorder (GAD) represents a considerable health care burden in Europe, there is a paucity of published evidence. This study investigated the burden of illness associated with GAD across five European countries (France, Germany, Italy, Spain, and the UK).MethodsInformation from the 2008 European National Health and Wellness Survey database was analyzed. Bivariate, multivariate, and cost analyses were used to compare patients with GAD and propensity-matched controls.ResultsCompared with non-GAD controls, patients with GAD had more comorbidities and were more likely to smoke but less likely to be employed, use alcohol, or take exercise. They also had significantly worse health-related quality of life, and significantly greater work impairment and resource use, which increased as GAD severity increased. Within-country analyses demonstrated results similar to those for the five European countries overall, with the largest differences in resource use between patients with GAD and non-GAD controls documented in France and Germany. The average mean differences in direct costs were relatively small between the GAD groups and controls; however, indirect costs differed substantially. Costs were particularly high in Germany, mainly due to higher salaries leading to higher costs associated with absence from work. The limitation of this study was that the data were from a self-reported Internet survey, making them subject to reporting bias and possibly sample bias.ConclusionAcross all five European countries, GAD had a significant impact on work impairment, resource use, and economic costs, representing a considerable individual and financial burden that increased with severity of disease. These data may help us to understand better the burden and costs associated with GAD.

Using student ratings to measure quality of teaching in six European countries

This paper argues for the value of using student ratings to measure quality of teaching. An international study to test the validity of the dynamic model of educational effectiveness was conducted. At classroom level, the model consists of eight factors relating to teacher behaviour: orientation, structuring, questioning, teaching modelling, application, management of time, teacher role in making classroom a learning environment and assessment. In each participating country (i.e. Belgium/Flanders, Cyprus, Germany, Greece, Ireland and Slovenia), a sample of at least 50 primary schools was used and all grade 4 students (n = 9967) were asked to complete a questionnaire concerning the eight factors of the dynamic model. Structural equation modelling techniques were used to test the construct validity of the questionnaire. Both across- and within-country analyses revealed that student ratings are reliable and valid for measuring the functioning of the teacher factors of the dynamic model. Implications for teacher education are drawn.