People

Jere R. Behrman

Professor | Economics

Dr. Behrman’s research is in empirical microeconomics, economic development, early childhood development, labor economics, human resources, economic demography, household behaviors, life-cycle and intergenerational relations, and policy evaluation. He has published over 460 professional articles and 35 books.

He has worked with numerous international organizations and governments, been involved in professional research or lecturing in over 40 countries, principal investigator or investigator on over 160 research projects and received various honors for his research, including Econometric Society Fellow, 40th Anniversary Fulbright Fellow, 2008 biennial Carlos Diaz-Alejandro Prize for outstanding research contributions to Latin America, 2011 Doctor Honoris Causa from the University of Chile, member of the US National Institutes of Child Health and Development (NICHD) Advisory Council, 2017 Population Association of America Irene B. Taeuber Award, member of the National Academy of Science, Engineering and Medicine (NASEM) Committee on Population.

Selected Publications

Arindam NandiJere R. BehrmanMaureen M BlackSanjay KinraRamanan Laxminarayan

(2020). “Relationship between Early-Life Nutrition and Ages at Menarche and First Pregnancy, and Childbirth Rates of Young Adults: Evidence from Apcaps in India.” Maternal & Child Nutrition. 16(1) e12854.

India’s Integrated Child Development Services (ICDS) provides daily supplementary nutrition and other public health services to women and children. We estimated associations between exposure to early-childhood ICDS nutrition and adult reproductive outcomes.

During 1987-1990, a balanced protein-calorie supplement called “upma”-made from locally available corn-soya ingredients-was rolled out by subdistricts near Hyderabad and offered to pregnant women and children under age 6 years. In a controlled trial, 15 villages received the supplement and 14 did not. We used data from a 2010-2012 resurvey of adults born during the trial (n = 715 in intervention and n = 645 in control arms). We used propensity score matching methods to estimate the associations between birth in an intervention village and menarcheal age, age at first pregnancy, and fertility of adults.

We found that women born in the intervention group during the trial, as compared with the control group, had menarche 0.45 (95% confidence interval [CI: 0.22, 0.68]; p < .001) years later and first pregnancy 0.53 (95% CI [0.04, 1.02]; p < .05) years later. Married women from the intervention group had menarche 0.36 (95% CI [0.09, 0.64]; p < .01) years later, first cohabitation with partner 0.8 (95% CI [0.27, 1.33]; p < .01) years later, and first pregnancy 0.53 (95% CI [0.04, 1.02]; p < .05) years later than married women in the control group.

There was no significant difference between intervention and control group women regarding whether they had at least one childbirth or the total number of children born. The findings were similar when we employed inverse propensity score weighted regression models.

Linda H. AikenMarta SimonettiDouglas M SloaneConsuelo CerónDavid BravoAlejandra GalianoPaz SotoJere R. BehrmanHerbert L SmithMatthew D McHughEileen T Lake

(2021). “Hospital nurse staffing and patient outcomes in Chile: a multilevel cross-sectional study”, The Lancet Global Health, In Press.

 

Background

Unrest in Chile over inequalities has underscored the need to improve public hospitals. Nursing has been overlooked as a solution to quality and access concerns, and nurse staffing is poor by international standards. Using Chile’s new diagnosis-related groups system and surveys of nurses and patients, we provide information to policy makers on feasibility, net costs, and estimated improved outcomes associated with increasing nursing resources in public hospitals.

Methods

For this multilevel cross-sectional study, we used data from surveys of hospital nurses to measure staffing and work environments in public and private Chilean adult high-complexity hospitals, which were linked with patient satisfaction survey and discharge data from the national diagnosis-related groups database for inpatients. All adult patients on medical and surgical units whose conditions permitted and who had been hospitalised for more than 48 h were invited to participate in the patient experience survey until 50 responses were obtained in each hospital. We estimated associations between nurse staffing and work environment quality with inpatient 30-day mortality, 30-day readmission, length of stay (LOS), patient experience, and care quality using multilevel random-effects logistic regression models and zero-truncated negative binomial regression models, with clustering of patients within hospitals.

Findings

We collected and analysed surveys of 1652 hospital nurses from 40 hospitals (34 public and six private), satisfaction surveys of 2013 patients, and discharge data for 761 948 inpatients. Nurse staffing was significantly related to all outcomes, including mortality, after adjusting for patient characteristics, and the work environment was related to patient experience and nurses’ quality assessments. Each patient added to nurses’ workloads increased mortality (odds ratio 1·04, 95% CI 1·01–1·07, p<0·01), readmissions (1·02, 1·01–1·03, p<0·01), and LOS (incident rate ratio 1·04, 95% CI 1·01–1·06, p<0·05). Nurse workloads across hospitals varied from six to 24 patients per nurse. Patients in hospitals with 18 patients per nurse, compared with those in hospitals with eight patients per nurse, had 41% higher odds of dying, 20% higher odds of being readmitted, 41% higher odds of staying longer, and 68% lower odds of rating their hospital highly. We estimated that savings from reduced readmissions and shorter stays would exceed the costs of adding nurses by US$1·2 million and $5·4 million if the additional nurses resulted in average workloads of 12 or ten patients per nurse, respectively.

Interpretation

Improved hospital nurse staffing in Chile was associated with lower inpatient mortality, higher patient satisfaction, fewer readmissions, and shorter hospital stays, suggesting that greater investments in nurses could return higher quality of care and greater value.

Funding

Sigma Theta Tau International, University of Pennsylvania Global Engagement Fund, University of Pennsylvania School of Nursing’s Center for Health Outcomes, and Policy Research and Population Research Center.
Maureen M BlackJere R. BehrmanBernadette Daelmans
et al (2021). “The principles of Nurturing Care promote human capital and mitigate adversities from preconception through adolescence.”

A comprehensive evidence-based framework is needed to guide policies and programmes that enable children and adolescents to accrue the human capital required to meet the Sustainable Development Goals (SDGs).

This paper proposes a comprehensive, multisectoral, multilevel life-course conceptualization of human capital development by building on the Nurturing Care Framework (NCF), originally developed for the foundational period of growth and development through the age 3 years. Nurturing care (NC) comprises stable environments that promote children’s health and nutrition, protect from threats, and provide opportunities for learning and responsive, emotionally supportive, and developmentally enriching relationships. NC is fostered by families, communities, services, national policies, and beyond.

The principles apply across the life course, endorse equity and human rights, and promote long-term human capital. This paper presents an evidence-based argument for the extension of the NCF from preconception through adolescence (0–20 years), organised into six developmental periods: preconception/prenatal, newborn/birth, infancy/toddlerhood, preschool, middle childhood, and adolescence.

The proposed framework advances human capital within each developmental period by promoting resilience and adaptive developmental trajectories while mitigating the negative consequences of adversities.

Attaining the SDGs depends on strengthening human capital formation, extending throughout childhood and adolescence and supported by NC. Embedded in enabling laws, policies, and services, the dynamic NCF components can mitigate adversities, enhance resilience and promote the well-being of marginalised groups. The life-course extension of the NCF is strategically positioned to enhance human capital, attain the SDGs, and to ensure that children or adolescents are not left behind in reaching their developmental potential.

Close