25 Mar 23 | News

Meet a researcher

Matteo Pinna Pintor

Health and Health Systems

Matteo, you joined LISER in October 2019. How do you look back on your arrival here?

I joined as a freshly graduated PhD in development economics. I was at SOAS, the School of Oriental and African Studies in London. Arriving at LISER was a mixed experience. One the one hand, as a political science graduate who decided due course to turn to applied economics, it was a big personal achievement. On the other hand, opening a new chapter is always challenging. Luckily, I landed in the best possible research team, LISER’s health and health system unit. I owe a special tribute to the unit’s leader, Marc Suhrcke, and to my closest collaborator, Till Seuring – who recently left for other adventures. I learned a lot from them, and it’s a real pleasure to work together.

What have you been working in these years?

I have been working mainly on three projects, two related to the epidemiology of conflict and one on the economic cost of heatwaves.

I think I first need to ask you a clarification: what is conflict epidemiology?

Epidemiology applies statistical tools to study health and disease at the level of populations – as a complement to the clinical and biomedical focus on the individual and its physiological systems. The causal factors investigated in epidemiology are manifold, and include those “social determinants” that act remotely to influence more proximate factors like pathogens or medical risk factors. Think of material deprivation, financial insecurity, lack of civil rights, social connections, or voice at the workplace. In large parts of the developing world, progress in population health has also been held back by large-scale shocks like civil wars, waves of political repression, and other less visible forms of organized violence and coercion. Evidence on these phenomena using the tools of epidemiology and health economics can, if done sensibly, inform the design of health interventions in conflict-affected populations, and support social actors advocating for nonviolent solutions to social divisions and disputes.

What did these projects focus on?

In one of my projects, together with Marc Suhrcke, I looked at a type of coercive measure that is currently much in vogue, but rarely considered as a threat to health: economic sanctions. As a form of warfare, they are probably as old as states, but their use has increased substantially after the Cold War. Comprehensive trade embargoes imposed in the early nineties against countries like Haiti and Iraq sparked intense debate, as limited but consistent evidence emerged documenting increases in child mortality and malnutrition, shortages of medical equipment and ordinary goods needed for healthcare delivery such as electricity and fuel. These reports raised the issue whether the burden of economic isolation imposed by sanctions could largely fall not on the presumptive political targets, but rather on the civilian population at large.

Even if food and medicines are exempted from restrictions, more specialized but equally crucial items may not – think of chemicals to make water drinkable, laboratory reagents, pesticides, or spare parts for x-ray machines. Establishing a list of exempted items is complicated by the fact that some items can have both medical and military applications, and this complexity can make the process vulnerable to arbitrary political interference. Exempted trade is often made more costly by the licensing system which has to be put in place, and by the risk of violating its often vague terms of operation. If these transaction costs are large, exemptions will fail to protect ‘humanitarian’ trade. Moreover, even with perfect exemptions in place, sanctions that substantially worsen macroeconomic performance in target countries can also impact population health. Domestic firms engaged in international trade will have to find new suppliers and customers, which likely increases production costs and unemployment –shrinking household budgets in way that can easily affect health.

The last decade saw a new surge of measures against countries such as Venezuela, Syria, Iran, and Russia. The WHO was interested in getting an updated picture of the issue, and commissioned a review of the global evidence. It was a difficult task: we had to make sense of a highly fragmented literature based on data that is often very incomplete. It is also a politically charged topic, as sanctioning and sanctioned states regularly push the blame on the opposite side. However, if sanctions prevent ordinary citizens to access life-saving treatment or force them to resort to counterfeit drugs on the black market, this must be known, and all involved parties asked to do what they can in order to prevent and minimize civilian harm. After reviewing more than 180 studies from countries like Iran, Iraq, Haiti, Cuba, Burundi, and former Yugoslavia – among others – we concluded that the risks are real, and lend support to ongoing policy efforts to make independent monitoring procedures an integral element of sanction policy.

Another non-conventional form of conflict I am interested on is military curfews. These are mandated restrictions to freedom of movement, imposed during military operations taking place in civilian areas, usually in regions affected by long-standing armed insurgencies. These measures may also fail to discriminate between military targets and civilians, by disrupting basic aspects of daily life and preventing the delivery of health services. Astonishingly, next to nothing is known on the topic. Yet these measures have been routinely employed by central governments in a number of countries. The same right and duty every country has to protect its population from terrorism and other security threats also commits them to a proportionate and adequate use of force while doing so. Data on military curfews exists for a few countries, and I am part of a team of economists and epidemiologists which is beginning to look at the issue. By shining a spotlight on the health conditions of populations under curfews, analyses such as these can help building momentum for reforms aimed at strengthening civilian control of the military.

Very interesting. Let me ask you about the other research area you mentioned, which I guess must be related to the climate change-related Horizon 2020 project of which LISER is part.

Yes, EXHAUSTION – a Horizon 2020 project which brought together a large consortium of research institutions scattered across Europe to cast light on the implications of extreme climate events – mainly heatwaves and air pollution – on health and the economy. I’ve been working on this project with Till Seuring and Marc Suhrcke. Our main task is to provide estimates of economic costs of these increasingly frequent events, in terms of lower labor productivity and higher healthcare costs. It is well known that heatwaves pose a threat to health, but the implications for the working population are only sparsely documented. We focused on the effect of high temperature on individual workers’ productivity, linking various socio-economic surveys from the UK to high-resolution climate variables. Perhaps the main reason behind the current incomplete picture is that there is no universally valid, direct measure of labor productivity, as the output of individual workers is either unobservable or very specific to the occupation and task in which the individual is engaged. Indirect indicators exist, but come with substantial caveats. For example, wages might in some contexts be a good marker of labor productivity, but for most sectors in advanced economies wages are relatively fixed – especially in the very short period in which heat stress can interfere with work. Moreover, in those settings, most of the damage can take the form of reduced effort at work, which would not affect nominal counts of hours worked or sick leave days. Hence, the productivity loss of each individual episode of heat stress may be too small to be detected by these standard indicators. Yet, once spread over large populations and projected into a warmer and more variable future climate, these effects may be substantial. We thus decided to look for any such ‘hidden’ cost by using self-reported assessments of health-related under-performance at work, and explore associations with high temperatures.

Early results have been submitted to the European Commission and are being presented to a range of audiences. They show that even in a country that is not exactly famous for warm weather, the United Kingdom, heat can substantially affect workers’ health and economic performance.

Link to his profile