The Benefits of Knowledge: Mortality Risks, Mental health and Life-Cycle Behaviors

项目摘要：撒哈拉以南非洲艾滋病毒高流行率地区成年人预期寿命的近期改善 (SSA)低收入国家在1990年代扭转了以往成人存活率方面的不利趋势， 2000年代初，艾滋病毒/艾滋病的流行大大降低了预期寿命。尽管有这些改进， 有广泛的证据表明，许多人扭曲了生存和疾病的看法（SDPs）， 对自己的生存和疾病环境过于悲观。例如，马拉维农村人口， 他们低估了33- 45%的生存五年的机会，这与相当大的高估是一致的 当地艾滋病的流行率和发病率。这些被扭曲的SDP可能会影响心理健康， 广泛的行为，包括性行为，劳动力供应，人力资本投资和准备 为老年人准备的尽管最近有强有力的证据表明更准确的SDP的贝内，但是， 基于人群的随机对照试验（RCT）直接评估了这一假设。RCT Pro- 作为R21项目的一部分，该项目建立在2016年和2018年为成年人单独资助的收集基础上 在马拉维，目的是（一）探讨通过提供以下信息提高服务点准确性的可能性： 当前的健康和死亡风险，通过健康信息干预，（ii）测试是否更准确 SDPs改善心理健康、生命过程决策和广泛的社会/经济成果， 成年人（= 45岁以上的人）。如果我们的假设得到支持，这项研究将提供强有力的支持。 为具有成本效益的健康信息计划提供端口，这些计划与撒哈拉以南非洲低收入国家高度相关， 近年来，疾病状况/治疗发生了迅速变化，更普遍的是，在老年人中， 鉴于最近在降低老年人死亡率方面取得的进展，老年人可能低估了自己的寿命。 该项目的具体目标包括：（1）在2016年就如何有效地传达 关于成年人近期死亡率水平和趋势的循证信息，以提高 马拉维的生存和疾病感知（SDPs），以及继已经资助的2016年数据收集之后， 对于成年人，进行健康信息干预，随机抽取50%的研究人群（700+） 65个以上村庄的个人），将收到有关最近死亡率的详细信息 健康趋势。(2)在2017年收集关于（a）SDPs（包括对生存的主观期望， 健康，当地艾滋病毒流行率），（B）健康（包括心理健康和认知功能），（c）健康行为 （d）生命周期行为和为老年做准备。(3)使用现有数据、已资助 数据收集和新的数据收集，通过这个项目资助的服务提供点，健康和生命周期的行为， （a）评估卫生信息对下列方面的因果影响：（一）服务提供点，（二）精神卫生和保健， 劳动力供给、储蓄、代际转移和其他生命周期行为，（B）调查 SDPs影响这些行为和结果的途径。

Project Summary: Recent improvements in adult life expectancies in high HIV-prevalence sub-Saharan African (SSA) low-income countries (LICs) have reversed previous adverse trends in adult survival during the 1990s and early 2000s when the HIV/AIDS epidemic considerably reduced life expectancies. Despite these improvements, there is widespread evidence that many individuals have distorted survival and disease perceptions (SDPs) and are overly pessimistic about their own survival and disease environment. For example, rural Malawians un- derestimate their chances to survive five years by 33–45%, which is consistent with considerable overestimation of local HIV prevalence and morbidity. These distorted SDPs are likely to affect mental health and influence a wide range of behaviors, including sexual behaviors, labor supply, human capital investments, and preparations for old-age. Despite the recent strong evidence about the benefits of more accurate SDPs, however, there are no population-based randomized controlled trials (RCTs) that have directly evaluated this hypothesis. The RCT pro- posed as part of this R21 project, which builds on separately-funded collection for mature adults in 2016 and 2018 in Malawi, is designed to (i) explore possibilities to improve the accuracy of SDPs by providing information about current health and mortality risks through a health-information intervention, and (ii) test whether more accurate SDPs improve mental health, life-course decision-making and a broad range of social/economic outcomes among mature adults (= individuals aged 45+). If our hypotheses are supported, this research will provide strong sup- port for cost-effective health-information programs that are highly pertinent in SSA LICs, where mortality levels and disease conditions/treatments have changed rapidly in recent years, and more generally, among older indi- viduals who are likely to underestimate their longevity given recent progress in reductions of old-age mortality. The Specific Aims of this project include: (1) Conduct exploratory research in 2016 on how to effectively convey evidence-based information about recent mortality levels and trends to mature adults to increase the accuracy of survival and disease perceptions (SDPs) in Malawi, and subsequent to the already-funded 2016 data collection for mature adults, conduct a health-information intervention that randomizes 50% of the study population (700+ individuals in 65+ villages) in a treatment group that will receive detailed information about recent mortality and health trends. (2) Collect new data in 2017 on (a) SDPs (including subjective expectations about survival, health, local HIV prevalence), (b) health (including mental health and cognitive function), (c) health behaviors and expenditures, (d) life-cycle behaviors and preparations for old age. (3) Using existing data, already-funded data collection and new data collection funded through this project on SDPs, health and life-cycle behaviors for the period 2006–18, (a) evaluate the causal impacts of health information on (i) SDPs, (ii) mental health and health be- haviors, and (iii) labor supply, savings, intergenerational transfers and other life-cycle behaviors, (b) investigate the pathways through which SDPs affect these behaviors and outcomes.