Recently I sat down with visiting researcher Andrea Menclova to learn more about her career as an economics professor. The following is our conversation about maternal health in New Zealand and the US, her research, and her career path—edited for space.
Erin: Can you tell me about your journey from undergrad to economics professor to a visiting researcher at Princeton?
Andrea: I’m from the Czech Republic and I studied in Prague. Most Czech students go for an exchange in the EU for a few months but they typically don’t go abroad to get a degree. That’s what I had thought I would do as well but then my dad, who is an academic, went to the University of New Hampshire and he asked: “Who wants to come along?” He was going for a year and I said: “Sure, I’ll do it!” I thought it would be for a year and then I’d return to Prague. I never did, and that was 15 years ago.
In New Hampshire, people who later became influential in my life convinced me to stay and so I stayed and got my Masters first and then a PhD. On the job market, I looked at a lot of places (like most people do these days) and New Zealand seemed very attractive to me. I moved there and have lived in Christchurch on the South Island since.
I met Janet Currie when she was in New Zealand for a conference and she invited me to come to Princeton for my sabbatical.
Erin: Tell me more about your research and how you found your niche in health economics.
Andrea: I’ve always liked applied micro studies and I did empirical research but the specific people I met influenced my career path. I met Karen Conway and Bob Woodward in New Hampshire. They were great mentors and were doing health economics, so I thought I’d try that. I first joined in on one of Karen’s projects and then had spin-offs for my own research. A lot of my work is in the area of infant health. For example, one of the projects I’m working on at the moment is about earthquakes in New Zealand and how such stressful events affect early childhood development in utero.
However, my research interests are broader than that. This is partly because I enjoy some breadth and partly because New Zealand is well suited for it. In New Zealand, there are a lot of good datasets, there are a lot of interesting questions, and there are not as many people who have the expertise and experience to work with data to answer those questions. That’s an opportunity not to be missed. As a result, I’ve done work on asthma in adults, the health and safety legislation, occupational licensing, school achievement, gender differences in promotion paths...
Erin: You talked a little bit about meeting people at the right time in your career. What advice would you have for undergrads for figuring out what they want to do in health or healthcare careers?
Andrea: Having someone who is knowledgeable and who is also supportive is important—especially in the post-graduate years because they are tough. I wouldn’t want to work on a topic that I’m passionate about with a mentor or supervisor who I’m not a great match for.
Erin: What are your current research questions?
Andrea: I’ve got a few. One I’m working on is using US data that I can only get access to while I’m here. In this project, we’re looking at physical activity during pregnancy and its determinants and consequences. We are finding that women who live in more walkable neighborhoods are much more active during pregnancy than women who live in less walkable neighborhoods. This is an intuitive finding but the magnitude of the effect is not as obvious a priori. The finding also translates into lower rates of diabetes and less excessive weight gain during pregnancy.
Erin: How do you use a research finding like this to inform or affect policy—whether in New Zealand or here?
Andrea: That is one thing I like about New Zealand. The downside compared to the US is that NZ is a small country and hence there are fewer people doing research. The upside is that solid research then has a greater policy impact. In a country of 4 million, you need to use all the expertise you can get. For example, I know people in the Treasury and they ask us for advice. So even if a publication doesn’t appear in a top journal, policy-makers read it and they take it seriously—or I guess as seriously as politicians ever do with other objectives in mind!
Erin: You have studied and worked in the US and in New Zealand, if there was one thing that you could take from New Zealand—a health policy or intervention or program—and implement it in the US what would it be? And vice-versa if you were to take something from the US and implement it in New Zealand what would you want shared learning to be?
Andrea: In general, health outcomes in New Zealand are excellent. Part of this is because of the environment and lifestyle, but the health system is also good. It’s a two-tier health system a bit like in Canada: a public system of universal coverage which is very good quality. You can buy private health insurance on top of that which oftentimes gives you access to the same doctors, but faster.
I work in infant health and, in general, I find prenatal and birth services better in the US than in New Zealand. In New Zealand, midwives dominate the field. Midwives have a very important role to play and probably should have a larger role in the US but in New Zealand, it has gone a bit too far. Midwives have the same fixed budget for providing prenatal, delivery and postpartum care as a doctor does. This seems equitable when you first look at it, but the problem is that a lot of the complicated cases go to doctors and it’s more expensive for them to provide care. Additionally, doctors get about 8 years of training whereas midwifery training takes 3 or 4 years. As a result, doctors have left the profession. In Christchurch, a city of a half million people, there are two GP [general practice] obstetricians, and that’s not enough. The idea was nice, it was to give women choice, but a lot of it hasn’t gone as expected and now there is no choice in the other direction. Ideally, you would have midwives and doctors working together but the compensation scheme has created political conflict and has alienated them. As a stereotype, midwives often see doctors as too medical/interventionist and too arrogant while doctors see midwives as incompetent. These characterizations don’t help anyone. It’s an example of a nice idea of making things fair and friendly for pregnant women that hasn’t worked well.
Erin: You teach public finance and health economics back in New Zealand—what are some skills or ideas that you hope your students gain from your classes?
Andrea: Oftentimes, it’s the basics, but students need to hear them repeatedly—and in different contexts—for them to really stick. I want students to look around in the real world and recognize fallacies that other people make such as mixing up causality and correlation. Very often you hear an argument that sounds convincing but you get trained to be immediately suspicious and think: Well, is this causal? Or is there a third factor that is driving both? Or is there reverse causality at play? I feel like I’ve achieved something when students get that suspicion, get behind the rhetorics and think about the underlying truth.
Thank you for your time Andrea. We enjoyed having you at Princeton and wish you the best of luck with your future research.