Welcome, Carla Guerriero! Carla, who is an Assistant Professor in the Department of Economics and Statistics at the University of Naples Federico II and an Honorary Research Fellow in Health Economics at the London School of Hygiene and Tropical Medicine, is visiting Princeton’s Center for Health and Wellbeing this semester. I recently sat down with Carla to learn more about how she incorporates children’s perspectives in her research on family decision making about health and wellbeing. Below is our conversation, condensed and edited for clarity and space.
Erin: Can you tell me how you became interested in health economics?
Carla: I did my bachelors at the University of Naples, Federico II. I was struck by how the HIV/AIDS epidemic in Sub Saharan Africa was dramatically affecting economies—even richer countries like Botswana and South Africa; I became interested in the link between health and economics. I applied for a masters at the London School of Economics, and I moved to London where I’ve been living for the last nine years. After my masters, I worked as a research assistant on a big randomized control trial. We were administering drugs to patients that were bleeding from trauma and we found that a cheap generic drug administered immediately after trauma can significantly affect their probability of survival. Because of the low price, the drug would be easily available in low-income settings and make a large impact on morbidity and mortality. I was fascinated by this research, so I decided to do Ph.D. at the London School of Hygiene and Tropical Medicine.
Erin: What did your Ph.D. research focus on?
Carla: I come from a region in Italy—Campania—that has, unfortunately, became known worldwide for problems associated with environmental hazards after the book and subsequent movie, Gomorrah, by Roberto Saviano was released. I wanted to contribute, and my Ph.D. focused on the cost-benefit analysis of environmental interventions targeting children. A lot of children in Naples, where I did my analysis, are asthmatic and therefore suffer from environmental-related health problems. The first part of my Ph.D. research was a willingness-to-pay study. I asked children whether they would be willing to contribute to an environmental policy that targeted health and wellbeing. Even very young children were interested in the link between environment and health. I also found that the older the children are, the more they can influence the decisions of their own families, so it's important to understand and take their views into consideration.
Erin: How does your current research build on your Ph.D. research?
Carla: My current research builds on my Ph.D. research by focusing on the role of children as a decision maker in the family. I'm conducting a research project called CHILDROLE, funded by Fondazione Banco di Napoli in Italy. I start with very young children—from five-year-olds up to 19-year-olds. How do they assess risk and decide what type of motorbike helmet to buy or whether or not to buy a helmet, for example. I want to understand the individual preferences for goods, and which preferences will prevail in the process of decision-making. This research has important implications for policies targeting the family. From past studies, we know that, in aggregate, if we give a subsidy to the mother instead of the father it dramatically changes the likelihood that it will be spent on goods for the child. However, what we don't know is whether the mother makes the decision on how to spend the money or depending on the item—particularly food—whether it’s the child who decides how to spend the money.
Erin: What has your experience been like collecting data from children? Do you use the same methods as you do with adults or have you had to adapt your process?
Carla: With very young children, like four-, five-, and six-year-olds, you cannot use the same questionnaire because they have a different ability to grasp the quantitative measures—they have little to no idea about money. They also do not have well-defined preferences. So in order to get at how they preference goods, I do very simple little experiments with them. But from seven-years-old, you can ask the same questions to the parents and the children.
Erin: I saw that one of your papers is on indoor Nitrous Oxide exposure in London schools and its effects on the rates and severity of childhood asthma. There is a link between pollution, health, and climate change here; what is it like to work across different institutions and sectors to address environmental determinants of health?
Carla: It's easier to implement things that are addressing health problems than climate change from a policy perspective because they’re more immediate. We did the same study in two different types of schools, one new school with insulated windows and the other one was an old Victorian-era school with a lot of drafts and where a lot of air pollution was coming from outside. Both schools were located very near a high traffic road. However, we observed a statistically significant difference in asthma rates. This study further confirmed that you need to locate any new schools you build far away from traffic and roads. Also, something as simple as retrofitting the windows in already existing schools that are located close to traffic or polluted areas can be a way to address both indoor pollution and the problem of asthma for children. This can also address the problem of climate change because you need less heating and will have lower CO2 emissions. In this way, interventions that are addressing health can also address climate change.
Another element that is very important is understanding the policy-making process. One of the harder parts in implementing an intervention that addresses the environment is that, for example, in this case, the Ministry of Education, the Transport Department, and the National Health Service (NHS) are all interested stakeholders. The education minister is in charge of maintaining the school, but the cost of increased asthma rates shifts to the NHS [National Health Service]. The challenge with passing environmental policies is that you need to link all these different departments and think about diagonal funding streams so that institutions don’t just shift costs to other institutions. It's very fascinating because you need to have a broad perspective.
Erin: What are some of the questions about the link between the environment and health that are really important but that we are not necessarily thinking about enough right now?
Carla: The environment is going to play a bigger role in the future. There is further epidemiological evidence that even during the gestational period, it is very important whether or not you're exposed to pollutants. It's easiest to see it with low birth weight, and it's also associated with several outcomes later in life—even educational achievements. So during these nine months, we need to protect the mother from environmental pollution. Climate change will make this even harder to do.
Erin: Who are some of the people that have inspired your thinking and who do you look up within your field?
Carla: Janet Currie for sure. I was really inspired by the work of Angus Deaton in health economics, he is a pioneer in many ways. I am also inspired by the work of Mark Fleurbaey because of his work on the environment and cost-benefit analyses. It's important for me to be at Princeton because there are all these people that work on things that are related to my work. What has really impressed me here is that I've had a very warm welcome. It's a very little town with a strong sense of community, so you never feel alone. Everybody's really nice.
Erin: I’ve heard that you like sea turtles. Can you tell me about them?
Carla: Every summer I go to Greece where there is a sea turtle protection society called Archelon. The Caretta Caretta sea turtles are there and we protect the mothers when they go to nest because these beaches are highly touristic and people blindly put their umbrella in turtle nests otherwise.
Thanks for your time, Carla. We’ve enjoyed getting to know you this semester.