How to invest in human capital pre-natally

Apparently, according to Gordon Brown, it is with cash:

All expectant mothers are to be given a one-off payment of around £120 that they will be encouraged to spend on fresh fruit and vegetables as a way of protecting their children from diseases and incurable conditions later in life.

The plan for a ‘health in pregnancy’ grant will be outlined by Health Secretary Alan Johnson this week in his first major speech outlining how the government plans to tackle the yawning health divide between the richest and poorest in England and Wales.

…the government accepts that some of the 630,000 women who become pregnant each year may choose not to spend the money on healthy food. There is also little published research to show that a financial incentive, combined with nutritional advice, is sufficient to persuade mothers from the most deprived areas to change their lifestyle.

Given the social gradient that exists for cigarette smoking, this faces some real barriers to being properly effective – not to mention the first 7 months of potential malnourishment, and the re-emergence of it after the child is born:

Tam Fry, director of the Child Growth Foundation, said: ‘We know that women who are well educated and with disposable income take their diet seriously during pregnancy and eat well, but for those lower on the social scale, without the education or the money or the help, it’s tough. It’s a sensitive issue to address, but it matters because the weight of a baby at birth can have a profound effect on their health further down the line.

‘By the time a woman falls pregnant, she already needs to be eating well to give her baby the best chance. Tackling it halfway through the pregnancy is really a bit late, though it is very good that the government is waking up to the scale of the problem.’

Having said that, it is not for nothing that an ounce of prevention is held to be worth a pound of cure. To which end a couple of extra pieces of information are relevant, here:

    • We do not actually know that these payments are considered cost-effective assuming every (poor) mother uses the cash for the intended purpose. There is probably some threshold number of properly-responding mothers required for cost-effectiveness to the health care system as a whole (which is, of course, the government’s money as well). That number most likely is less than the total.
    • There is, related to this, the recently-discussed (here) argument of Numbers Needed to Harm (or, in this case, help). Again, for some total number (630,000), there is a different number who we can say adjust entirely their approach to child nutrition as a result of the broader campaign. That number, as predicted, is apparently high enough.
    • While it is easy to make fun of Labour’s Nanny State, handing out what is in fact a small amount of cash (in a country with an average GBP8856 household debt), trying to boss mothers around. In fact it is a part of a more broadly interventionst approach, including nurses visiting homes in deprived areas directly (tones of Brazil’s Programa Saude da Familia and Mexico’s Progresa).
  • Who knows what impact it will have. These are the reason why I’m glad I’m not this fashion of health economist. Amongst other things, I would also insist an OECD government can always afford such interventions (blasphemous in my Eco 1 class – scarcity, scarcity!).

    The other problem, of course, is preparedness:

    …just under one in 12 children in England and Wales is born underweight – less than 5.5lbs. They are not only at greater risk of dying in infancy, but face long-term difficulties such as heart disease, diabetes, lung conditions and impaired cognitive development because their growth has been retarded in the womb by a lack of essential nutrients.

    Another problem driving the high number of underweight babies is the fact that Britain has Europe’s highest rate of teenage births, with an average of 26 children born to every 1,000 women aged between 15 and 19, more than four times the rate in Cyprus, Slovenia, Sweden or Denmark.

    Remember yesterday’s discussion, though: that’s 2.6% – not all that many, relative to this notion that it’s an important factor in underweight babies, bad mothers, etc. The social gradient has more of an impact than an age gradient.

    For those keeping up with Grossman-model-thinking, there is a real problem here, concerning exactly what a government decides to affect, if it is intervening in our bad investment in human capital. Parental health, education and income are important factors. Our education is also a factor in our adult health, but our infant/childhood health has an impact on our education – and both have an impact on our adult health and incomes. From, then, the perspective of social welfare, it is probably unreasonable to judge this according to mere money spent (although government policy should always be judged according to its sales pitch as well as what any intelligent can recognise is actually going on).

    This move by the government is quite possibly one of those things that reveals only over many years the benefits (or lack thereof). Considering the total cost is “only” around GBP80m per year, and that it ought to be, in fact, relatively simple to follow how the money is spent by mothers, it is surely worth the gamble. Rather than thinking of the cost, or our prejudices against poor teenage pregnant girls (socioeconomically “poor”, not with sympathy), why not take the assessment of the economists that it’s worth the gamble and think about what happens if it pays off after all?

    Politics is a different affair, but I’ll have that in a minute.


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