We estimate the causal impacts of GLP-1 treatment on labor market outcomes using linked Danish administrative data and a matched stacked difference-in-differences design. We compare patients who initiate GLP-1 treatment during the first two years of Semaglutide availability to observably similar patients who initiate four years later. We find that GLP-1 treatment reduces long-term sickness leave by 17.3%. We estimate total fiscal benefits of GLP-1 initiation of approximately 1.3–1.5% of annual labor income per employed individual. We do not detect statistically significant or economically meaningful impacts on income, labor force participation, or employment over four years.

Using administrative data on the universe of firms in Denmark, we find that even temporary and small health shocks to employee health like seasonal influenza can significantly reduce firm profitability. The effects are driven by labor-intensive firms and decrease in firm size and financial flexibility, suggesting that firms that are better able to shift resources can insulate themselves better. Our results indicate that employees are shielded from these negative effects, while owners (especially of small firms) see reduced dividends. Back-of-the-envelope calculations propose that all but the largest firms may benefit from subsidizing vaccination programs for their employees.

Using Danish administrative data linked to two independent, validated postpartum depression screenings, we study how postpartum mental health shocks shape women's labor market trajectories. Event-study estimates show no pre-birth differences in trends between depressed and non-depressed mothers, but persistent employment gaps that widen immediately after birth. Health-care utilization patterns indicate that these differences reflect acute mental health shocks rather than pre-existing trends. The penalties are concentrated among less educated mothers and those in less family-friendly jobs. Our results highlight postpartum depression as a meaningful and unequal contributor to the motherhood penalty.

Mental health disorders tend to emerge in childhood, with half starting by age 14. This makes early intervention important, but treatment rates are low, and antidepressant treatment for children remains controversial since an FDA warning in 2004 that highlighted adverse effects. Linking individuals across Danish administrative registers, we provide some of the first evidence of impacts of antidepressant treatment in childhood on objectively measured mental health indicators and economic outcomes over time, and the first attempt to investigate under- vs over-treatment. Leveraging conditional random assignment of patients to psychiatrists with different prescribing tendencies, we find that treatment during ages 8-15 improves test scores at age 16, particularly in Math, increases enrollment in post-compulsory education at age 18, and that it leads to higher employment and earnings and lower welfare dependence at ages 25-30. We demonstrate, on average, a reduction in suicide attempts, self-harm, and hospital visits following AD initiation. The gains to treatment are, in general, larger for low SES children, but they are less likely to be treated. Using a marginal treatment effects framework and Math scores as the focal outcome, we show positive returns to treatment among the untreated. Policy simulations confirm that expanding treatment among low SES children (and boys) generates substantial net benefits, consistent with under-treatment in these groups. Our findings underscore the potential of early mental health treatment to improve longer term economic outcomes and reducing inequality.

We consider the health effects of "precision" screening policies for cancer guided by algorithms. We show that machine learning models that predict breast cancer from health claims data outperform models based on just age and established risk factors. We estimate that screening women with high predicted risk of invasive tumors would reduce the long-run incidence of later-stage tumors by 40%. Screening high-risk women would also lead to half the rate of cancer overdiagnosis that screening low-risk women would. We show that these results depend crucially on the machine learning model's prediction target. A model trained to predict positive mammography results leads to policies with weaker health effects and higher rates of overdiagnosis than a model trained to predict invasive tumors.

While better health has been shown to lead to more education, both in the developed and in the developing world, the causal link from education to health is less clear. In this paper, we examine the role of an education policy that presumably reduced educational attainment on the health of young adults affected by the policy and on children born after the intervention. Using aggregate data and a synthetic control method, we find limited evidence of an effect on the health of adults and some evidence of effects on the health of children. Our analyses help better understand the determinants of the intergenerational transmission of poverty and inequality in the context of a developing country.

We investigate the effects on educational outcomes of a sudden change in the language of instruction in Rwanda from one non-native language (French) to another (English). This change, enacted in 2008, affected all levels of education without any language training for students or teachers. Using a synthetic control approach, we find that the change in the language of instruction led to an immediate and persistent decline in primary school enrollment and to a decline in secondary school enrollment at the time when the first cohort fully affected by the policy would have started secondary school. As a direct consequence of lower school enrollment, we also find a reduction in the expected number of years of schooling. We provide suggestive evidence that the decline in enrollment is due to higher drop-out rates, mostly among students who are old-for-grade.

More education is generally associated with delayed marriage and fertility. We investigate the causal link between a policy that plausibly reduced educational attainment in Rwanda and teen fertility. In 2008, Rwanda suddenly changed the language of instruction at all levels of schooling from French to English, despite the fact that a very small fraction of the population was able to speak English. This led to a significant reduction in primary and secondary school enrollment. Using both a synthetic control approach with aggregate data and a difference-in-differences approach with individual-level data, we document an increase in teen fertility as a result of this policy. Although more imprecise, our results also suggest that the effects are larger in urban areas.

We investigate the effects of radiation therapy on the mortality and economic outcomes of breast cancer patients. We implement a 2SLS strategy within a difference-in-differences framework exploiting variation in treatment stemming from a medical guidelines change in Denmark. We reproduce the results from an RCT showing the lifesaving benefits of radiotherapy. We then show radiation therapy also has economic returns: ten years after diagnosis, treatment increases employment by 37% and earnings by 45%. Previous work has documented a substantial employment drop after a breast cancer diagnosis. Our results imply that radiation therapy can reduce this effect by 70%.

We investigate the effects of early-life medical treatments on the treated children and their families. We use a regression discontinuity design that exploits changes in medical treatments across the very low birth weight (VLBW) cutoff. Using administrative data from Denmark, we establish that VLBW children have better health and higher test scores. We find that these benefits spill over to other family members: mothers enjoy better mental health, and siblings have higher test scores. Maternal mental health improvements seem to be driven by better focal child health and sibling spillovers by improved interactions within the family and parental compensating behavior.

We investigate the effects of perinatal medical treatments on low-income newborns who are classified as low-risk. A policy rule in The Netherlands states that low-risk deliveries before week 37 should be supervised by physicians and later deliveries only by midwives with no physician present. This creates large discontinuities in the probability of receiving medical interventions only physicians are allowed to perform. Using a regression discontinuity design, we find that babies born slightly before the week-37 cutoff are significantly less likely to die than babies born slightly later. Our data suggest that physician supervision of birth reduces the likelihood of adverse events such as fetal distress or emergency C-section. Our results indicate that low-income women benefit from receiving a higher level of medical care even if no explicit risk factors have been recognized, pointing to challenges in identifying all high-risk pregnancies. "Back-of-the-envelope" calculations suggest this additional care is highly cost-effective.

While many studies examine the effect of primary education quality on labor market outcomes in developing countries, little is known about the effects at higher levels. We exploit the quasi-experiment provided by a large-scale education reform launched in Senegal in 2000 to investigate how quality improvements at the university level affect employment. Our difference-in-difference estimates suggest that young high-skilled workers experienced a nine percentage-point employment gain relative to older workers. They are also more likely to have "better" jobs (in the service industry or government), suggesting a reduction in the mismatch between the quality of high-skill labor demanded and supplied.

Many developed countries have recently experienced sharp increases in home birth rates. This paper investigates the impact of home births on the health of low-risk newborns using data from the Netherlands, the only developed country where home births are widespread. To account for endogeneity in location of birth, we exploit the exogenous variation in distance from a mother's residence to the closest hospital. We find that giving birth in a hospital leads to substantial reductions in newborn mortality. We provide suggestive evidence that proximity to medical technologies may be an important channel contributing to these health gains.

It has long been debated how legalizing same-sex marriage would impact (different-sex) family formation. In this paper, I use data on OECD member countries for the period 1980-2009 to examine the effects of the legal recognition of same-sex couples (through marriage or an alternative institution) on different-sex marriage, divorce, and extramarital births. Estimates from difference-in-difference models indicate that the introduction of same-sex marriage or of alternative institutions has no negative effects on family formation. These findings are robust to a multitude of specification checks, including the construction of counterfactuals using the synthetic control method. In addition, the country-by-country case studies provide evidence of homogeneity of the estimated effects.

It has long been argued that the legalization of same-sex marriage would have a negative impact on marriage. In this article, I examine how different-sex marriage in the Netherlands was affected by the enactment of two laws: a 1998 law that provided all couples with an institution almost identical to marriage (a "registered partnership") and a 2001 law that legalized same-sex marriage for the first time in the world. I first construct a synthetic control for the Netherlands using OECD data for the period 1988-2005 and find that neither law had significant effects on either the overall or different-sex marriage rate. I next construct a unique individual-level data set covering the period 1995-2005 by combining the Dutch Labor Force Survey and official municipal records. The estimates from a discrete-time hazard model with unobserved heterogeneity for the first-marriage decision confirm the findings in the aggregate analysis. The effects of the two laws are heterogeneous, with presumably more-liberal individuals (as defined by their residence or ethnicity) marrying less after passage of both laws and potentially more-conservative individuals marrying more after passage of each law.

Economists have long been interested in understanding the relationship between health and socio-economic outcomes. Existing research consistently links poor health during early childhood to worse well-being in the long-run, including health, educational attainment, and labor market outcomes (Almond and Currie, 2011; Almond, Currie, and Duque, 2018; Currie et al., 2010). Growing evidence also indicates that child health shocks affect the socio-economic outcomes of other family members, such as parental labor supply (Gunnsteinsson and Steingrimsdottir, 2019; Breivik and Costa-Ramón, 2022; Eriksen et al., 2021; Adhvaryu et al., 2022), parental health (Burton, Lethbridge, and Phipps, 2008; Adhvaryu et al., 2022), and sibling academic achievement (Black et al., 2021). A natural question then is whether medical care aimed at improving childhood health may alleviate or eliminate these negative long-run consequences

Our reply to the letter by de Jonge et al (2016) on how to interpret our findings related to the effect of a hospital birth on low-risk newborn mortality in the context of the home birth debate.

A summary of our findings on the effects of a hospital birth on low-risk newborn mortality. (In Dutch)

My reply to Dinno (2014), who argues that finding no evidence of change in the marriage rate is not proof of absence of change and suggests using equivalence tests to verify that the same-sex marriage law had no effect on the different-sex marriage rate.

Although Kenya's financial system is by far the largest and most developed in East Africa and its stability has improved significantly over the past years, many challenges remain. This paper assesses the stability, efficiency, and outreach of Kenya's banking system, using aggregate, bank-level, and survey data. Banks' asset quality and liquidity positions have improved, making the system more resistant to shocks, and interest rate spreads have declined, in part due to reduction in the overhead costs of foreign banks. Outreach remains limited, but has improved in recent years, driven by mobile payments services in the domestic remittance market. Fostering a level regulatory playing field for all deposit-taking institutions is a key remaining challenge. Specifically, an effective but not overly burdensome framework for regulation and supervision of microfinance institutions and cooperatives is a priority. Maintaining an openness to new, and non-bank, providers of financial services, which has enabled the success of mobile payments, could also further outreach.