TY - THES A1 - Fritz, Manuela T1 - Health challenges of the 21st century - Empirical essays on the health and economic burden of non-communicable diseases and climate change in Southeast Asia N2 - In the ongoing 21st century, low- and middle-income countries will face two health challenges that are thoroughly different from what these countries have been dealing with in preceding centuries. First, they are confronted with surging rates of non-communicable diseases (NCDs), and second, climate change will take its toll and is predicted to cause catastrophic health impairments and exacerbate chronic health conditions further. Both will pose a disproportionate health and economic burden on low- and middle-income countries, which are also the countries least able to cope with them. By threatening individual health and socioeconomic improvements, and by putting an immense burden on already constrained health care systems, they impede the progress in poverty reduction and widen health inequities between the rich and the poor. Against this background, this thesis investigates the potential of NCD prevention and treatment measures in the context of Southeast Asia, with case studies in Indonesia. Specifically, it seeks to understand what kind of health interventions have the potential to be (cost-)effective considering the cultural background, lifestyle, health literacy and health system capacities in the region. Further, this thesis analyzes the interplay between NCDs and climate change and assesses the financial burden that both might pose in the decades to come. Hence, this thesis contributes to a better understanding of how the two health challenges of the 21st century, NCDs and climate change, can be addressed in the context of Southeast Asia and offers insights into what type of health policies and interventions can play a supportive role. KW - Health KW - Climate change KW - Non-communicable diseases KW - Southeast Asia Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:739-opus4-12649 ER - TY - JOUR A1 - Fritz, Manuela T1 - Temperature and non‐communicable diseases: Evidence from Indonesia's primary health care system JF - Health Economics N2 - Climate change induced rising temperatures will pose a detrimental threat to decent health in the coming decades. Especially at risk are individuals with chronic diseases, since heat can exacerbate a variety of health conditions. In this article, I examine the heat‐morbidity relationship in the context of Indonesia, focusing on chronic, non‐communicable diseases, namely diabetes, cardiovascular and respiratory diseases. Using a novel dataset from the Indonesian national health insurance scheme Jaminan Kesehatan Nasional/Badan Penyelenggara Jaminan Sosial (BPJS) and linking it with meteorological data on the daily‐district level, I estimate the causal effect of high temperatures on the daily number of primary health care visits. The results show that on a hot day all‐cause visits and visits with a diagnosis of diabetes and cardiovascular diseases increase by 8%, 25% and 14%, respectively. These increases are permanent and not offset by visit displacement or ‘harvesting’. Visits related to respiratory diseases seem not to be affected by high temperatures. I use several climate change scenarios to predict the increase in visits and costs by the end of the century, which all forecast a substantial financial burden for the health care system. These results might have relevance for other middle‐income countries with similar climatic conditions. KW - climate change KW - health KW - Indonesia KW - JKN/BPJS kesehatan KW - non‐communicable diseases KW - temperature Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:739-opus4-11429 VL - 31 IS - 11 SP - 2445 EP - 2464 PB - Wiley CY - Hoboken ER - TY - JOUR A1 - Fritz, Manuela A1 - Grimm, Michael A1 - Weber, Ingmar A1 - Yom-Tov, Elad A1 - Praditya, Benedictus T1 - Can social media encourage diabetes self-screenings? A randomized controlled trial with Indonesian Facebook users JF - npj | Digital medicine N2 - Nudging individuals without obvious symptoms of non-communicable diseases (NCDs) to undergo a health screening remains a challenge, especially in middle-income countries, where NCD awareness is low but the incidence is high. We assess whether an awareness campaign implemented on Facebook can encourage individuals in Indonesia to undergo an online diabetes self-screening. We use Facebook’s advertisement function to randomly distribute graphical ads related to the risk and consequences of diabetes. Depending on their risk score, participants receive a recommendation to undergo a professional screening. We were able to reach almost 300,000 individuals in only three weeks. More than 1400 individuals completed the screening, inducing costs of about US$0.75 per person. The two ads labeled “diabetes consequences” and “shock” outperform all other ads. A follow-up survey shows that many high-risk respondents have scheduled a professional screening. A cost-effectiveness analysis suggests that our campaign can diagnose an additional person with diabetes for about US$9. KW - Health care economics KW - Population screening KW - Risk factors Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:739-opus4-15157 VL - 2024 IS - 7 PB - Macmillan Publishers Limited CY - Basingstoke ER - TY - JOUR A1 - Fritz, Manuela T1 - Wave after wave: determining the temporal lag in Covid-19 infections and deaths using spatial panel data from Germany JF - Journal of Spatial Econometrics N2 - The Covid-19 pandemic requires a continuous evaluation of whether current policies and measures taken are sufficient to protect vulnerable populations. One quantitative indicator of policy effectiveness and pandemic severity is the case fatality ratio, which relies on the lagged number of infections relative to current deaths. The appropriate length of the time lag to be used, however, is heavily debated. In this article, I contribute to this debate by determining the temporal lag between the number of infections and deaths using daily panel data from Germany’s 16 federal states. To account for the dynamic spatial spread of the virus, I rely on different spatial econometric models that allow not only to consider the infections in a given state but also spill over effects through infections in neighboring federal states. My results suggest that a wave of infections within a given state is followed by increasing death rates 12 days later. Yet, if the number of infections in other states rises, the number of death cases within that given state subsequently decreases. The results of this article contribute to the better understanding of the dynamic spatio-temporal spread of the virus in Germany, which is indispensable for the design of effective policy responses. KW - Covid-19 KW - Spatio-temporal models KW - Time lag effects KW - Spatial spillovers KW - Spatial Durbin model KW - Germany Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:101:1-2022112821095396799160 VL - 2022 IS - 3 PB - Springer Nature CY - Berlin ER -