Health Decision-Making in the Aftermath of Disaster

摘要 灾害如何影响卫生决策？灾害的影响是否至少部分地通过变化来发挥作用 在经济偏好和心理因素上的差异公共卫生项目能否帮助社区免受 灾害的影响？我们通过研究一场发生在一场灾难中的重大灾难来探讨这些问题。 我们正在对莫桑比克的一个社区级公共卫生项目进行随机评估。之前 在2017 - 2018年的灾难中，该研究小组对大约4，500人进行了基线调查 家庭，并促进随机分配方案，Força à Comunidade e Crianças（FCC， "加强社区和儿童"）。在76个社区中， 组，接收FCC程序;其余作为对照组。2019年3月，飓风伊达， 非洲有史以来最具破坏性的飓风袭击了我们的研究区域。FCC计划实现了 一套相互关联的健康、教育和经济干预措施。家庭与社区相连 支持网络，鼓励访问和使用当地公共卫生诊所，提供信息，以改善 健康决策，并参与小额信贷计划。我们首先估计人类和经济 损失，以及对危险性行为（包括性交易）、性传播感染 (STI)检测、STI发病率和COVID-19相关结果。我们在调查样本中估计影响 在灾难发生之前确定，因此能够处理选择偏差（例如，差分采样 包括基于灾害暴露），否则会影响治疗效果估计。影响估计 将利用研究社区飓风暴露的异质性。然后，我们将研究对 个人偏好和心理因素可能介导灾害对健康决策的影响， 制作。检查动机信念偏见（在这种情况下，过度乐观的健康风险否认）是 特别新颖;它是一个新的行为经济学前沿，但尚未在健康方面进行经验评估- 相关背景。我们的测量工具已经过试用、完善，并已准备好大规模实施。最后， 我们将评估联邦通信委员会的计划是否有助于保护社区免受灾害的负面影响 风险性行为的暴露; STI检测、患病率和治疗;以及COVID-19相关 结果。因果推理将依赖于FCC程序的灾前随机分配。我们还将 检查该计划实现其保护效果的机制。该项目的研究结果可以 帮助指导未来公共卫生项目的设计。对经济学和心理学的见解 灾后决策可以提出新的干预措施，以减轻灾害引起的环境恶化， 健康决定。关于公共卫生项目是否以及如何保护人们免受灾害的证据可以 指导其优化设计。

Abstract How do disasters affect health decision-making? Do disaster impacts operate, at least in part, through changes in economic preferences and psychological factors? Can public health programs help shield communities from the impacts of disasters? We pursue these questions by studying a major disaster that struck in the midst of a randomized evaluation we are conducting of a community-level public health program in Mozambique. Prior to the disaster, in 2017-2018, this study team had administered a baseline survey of approximately 4,500 households, and had facilitated random assignment of the program, Força à Comunidade e Crianças (FCC, “Strengthening Communities and Children”). Out of 76 communities, half were assigned to the treatment group, receiving the FCC program; the remainder serve as the control group. In March 2019, Cyclone Idai, the most destructive cyclone ever recorded in Africa, struck our study areas. The FCC program implements an interrelated set of health, educational, and economic interventions. Households are connected to community support networks, encouraged to visit and use local public health clinics, provided with information to improve health decision-making, and participate in microfinance programs. We first estimate human and economic losses, as well as impacts on risky sexual behaviors (including transactional sex), sexually transmitted infection (STI) testing, STI incidence, and COVID-19-related outcomes. We estimate impacts in a survey sample determined prior to the disaster, and are thus able to deal with selection biases (e.g., differential sample inclusion based on disaster exposure) that otherwise compromise treatment effect estimates. Impact estimates will exploit heterogeneity in hurricane exposure across study communities. Then, we will study impacts on individual preferences and psychological factors that may mediate the effects of disasters on health decision- making. Examining motivated belief biases (in this context, over-optimism maintained by health risk denial) is particularly novel; it is a new behavioral economics frontier but has not been empirically evaluated in health- related contexts. Our measurement tools are piloted, refined, and ready for large-scale implementation. Finally, we will assess whether the FCC program helps shield communities from the negative impacts of disaster exposure on risky sexual behaviors; STI testing, prevalence, and treatment; and on COVID-19-related outcomes. Causal inference will rely on the pre-disaster random assignment of the FCC program. We will also examine mechanisms through which the program achieves its protective effects. This project's findings can help guide the design of public health programs in the future. Insights into the economics and psychology of post-disaster decision-making can suggest novel interventions to mitigate disaster-induced deterioration of health decisions. Evidence on whether and how public health programs shield people from disasters can provide guidance on their optimal design.