SCIENTIFIC PRIZES MCKINSEY & COMPANY 2014

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1 SCIENTIFIC PRIZES MCKINSEY & COMPANY 2014 OCTOBER 9, 2014 Pour tout renseignement: Bruno MORAUX F.R.S.-FNRS Inlichtingen: Bart VAN BEEK FWO 02/ /

2 SCIENTIFIC PRIZES MCKINSEY & COMPANY 2014 Gone are the days when scientists only busied themselves with research and the business world was the exclusive domain of managers and slick city boys. While the interest in companies for scientific research is growing, PhD graduates are increasingly trading in their lab jacket for a pinstripe suit. One of the companies focusing more and more attention on scientists and including these various doctors in its workforce, is McKinsey & Company. Thanks to the patronage of McKinsey & Company, the F.R.S. - FNRS and the FWO are able to award 2 annual scientific Prizes to young researchers in recognition of their PhD thesis in the Exact or Applied Sciences, Social, Economical or Management Sciences, or Biomedical Sciences. The candidates need to demonstrate the social and economical relevance or possible implementation of their PhD thesis. For the F.R.S. FNRS, the Prize is awarded to : Séverine HENRARD Docteur en sciences médicales (UCL), Master en sciences de la santé publique (UCL), Chercheuse à l Université Catholique de Louvain for her PhD thesis : Impact of a rare disease on Public Health today and tomorrow: the case of haemophilia. Rare diseases, such as haemophilia, have become a major Public Health issue the last few years. A rare disease affects a maximum of 5 people out of 10,000 according to European standards. These affections are often serious, chronic and life-threatening diseases, with 80% of them being genetic. It is estimated that between 6,000 and 8,000 distinct rare diseases exist today, affecting between 6% and 8% of the population (approximately 30 million people in the EU). This represents the paradox of rarity: diseases are rare, rare diseases patients are many. The aim of this thesis was to study some implications of a rare disease on Public Health in Belgium, taking the example of haemophilia, a rare haemorrhagic genetic disease. This work included the need for dose individualisation in haemophilia A treatment, assessed factors influencing the motivation of patients to participate in clinical studies aiming to develop new treatments for haemophilia, and estimated the health and economic burden of this disease in Belgium. 2

3 SCIENTIFIC PRIZES MCKINSEY & COMPANY 2014 For the FWO, the Prize is awarded to : Stijn BAERT Dr. economische wetenschappen (UGent), Master economics (UGent), Burg. Ir. computer science (UGent), Postdoctoral medewerker aan het UGent for his PhD thesis : Transitions in youth: on springboards, waterfalls and bottlenecks. In order to develop adequate policy actions to fight youth unemployment, there is need for identifying success factors in first labour market transitions and closely related in school achievement. In this PhD I investigate three factors in this respect: ethnicity, school retention and overeducation at the start of the career. In a first study ethnic gaps in educational attainment and school-to-work transitions are decomposed into differences in observed family endowments and a residual pure ethnic gap. The pure ethnic gap in educational attainment is found to be small if delays are neglected, but substantial if not and for school-to-work transitions. As the latter pure ethnic gap potentially points at discrimination in the labour market, in a second study a field experiment in which pairs of fictitious job applications are sent to real job openings is conducted. It is found that, compared to natives, candidates with a foreign sounding name are equally often invited to a job interview if they apply for bottleneck occupations, but they have to send twice as many applications for occupations for which vacancies are easy to fill. A third study investigates short- and long-term effects of school retention in secondary education. It takes into account the specific waterfall characteristics of the Flemish secondary education system by modelling both yearly schooling attainments and decisions. It is found that grade retention has a positive impact on the next evaluation and can permanently affect subsequent educational achievements. The direction of the permanent effect is essentially heterogeneous: while more able students are permanently penalised by retention, less able students benefit from it. Finally, a fourth study investigates whether for the young unemployed accepting a job below their level of education is a springboard into a job that matches their level of education. The research results indicate that by accepting a job for which one is overeducated rather than only accepting adequate job matches, monthly transition rates into adequate employment fall by 51 98%, depending on the elapsed unemployment duration. 3

4 MEMBERS OF THE JURY F.R.S. - FNRS 2014 M. BRUYÈRE Olivier Professeur à l ULg M. CHARIOT Alain Maître de recherches du F.R.S.-FNRS à l ULg M. d ASPREMONT Claude Professeur à l UCL Président du Jury M. FORTEMPS Philippe Professeur à l UMons M. LAPLUME David Professeur à l UMons Mme THOMAS Diane Professeur à l UMons * * * M. GÉRARD Benoît Partner chez McKinsey & Company Observateur 4

5 MEMBERS OF THE JURY FWO 2014 Prof. AERTS Marc UHasselt Prof. CROMBEZ Geert UGent Prof. DECLERCK Paul KU Leuven Prof. HÖFTE Monica UGent Prof. JEGERS Marc VUB Prof. MOLDENAERS Paula KU Leuven Prof. MOSHCHALKOV Victor KU Leuven Prof. SNYDERS Dirk UAntwerpen Prof. STEYAERT Jan VUB Prof. TOLLEBEEK Johan KU Leuven Prof. VAN den BOSSCHE Anne-Marie UAntwerpen Prof. VAN SOOM Ann UGent Prof. WILLEMS Klaas UGent Prof. WINDERICKX Joris KU Leuven 5

6 Séverine HENRARD UCL Impact of a rare disease on Public Health today and tomorrow: the case of haemophilia 6

7 Summary Context Haemophilia is a rare X-linked disease of coagulation which implies a decrease of the circulating coagulation factor VIII (FVIII) in the case of haemophilia A (HA) or factor IX (FIX) in the case of haemophilia B (HB). Approximately 1000 individuals are affected by haemophilia in Belgium. Females are named carriers of haemophilia and males are called haemophiliacs. Due to the deficiency of FVIII or FIX clotting activity in haemophilia and therefore to a deficiency in blood clot formation, spontaneous episodes of bleeding can occur into the joints, muscles, brain, or other internal organs implying serious complications, including premature death, especially in severe or moderate haemophilia cases. Recurrent musculoskeletal bleedings can lead, in the long term, to the destruction of the joint, called haemophilic arthropathy, which is often associated with chronic pain and functional disability. Haemophilia has not only physical consequences but also psycho-social and familial ones affecting both the patient and his family, from prenatal counselling and carrier testing until the end of life of a haemophiliac. In order to compensate the lack in FVIII or FIX activity, treatments have been developed. Nowadays, recombinant or plasmatic products are given to people with haemophilia (PWH) in prophylaxis or on-demand, depending on the severity of the disease. Prophylaxis involves the infusion of clotting factors generally from one to three times per week in order to keep a sufficient level of clotting factor in the blood of the patient to prevent spontaneous bleeding episodes. On-demand treatment involves treating bleeding episodes once they arise or preventing bleeding episodes when the patient knows it can occur (i.e.: before a surgery). These treatments allowed to increase patients quality of life considerably as well as their life expectancy, since complications of episodes of bleeding can be better prevented before they occur, and especially the development of arthropathies. Actually, the life expectancy of haemophiliacs without these treatments does not exceed 30 years, as it was the case until the introduction of the first haemophilia treatments in the 1950 s. Public awareness of rare diseases has increased in the past years, largely as a result of initiatives launched through patients associations. In 2009, the European Union has recommended that each member state establishes and implements national plans to handle rare diseases by the end of Public health interventions that will be implemented for rare diseases in the next years will very likely modify patients life and care; therefore authorities need answers to implement and prioritise these interventions. In the Belgian national plan for rare diseases presented in February 2014 by Laurette Onkelinx, Minister of Social Affairs and Public Health in Belgium, a part was dedicated to haemophilia, showing the great interest of the government for this disease. Belgian health authorities have several questions in relation to haemophilia requiring answers. Some of these questions concern haemophilia treatments (current and under development treatments), patients quality of life and the unknown total cost of 7

8 haemophilia including the treatment cost. Indeed the Belgian Social Security has required a better control on antihaemophilic factors utilisation for all medical prescribers in early The aim of this thesis was to address some issues related to haemophilia which could have implications on public health including replacement therapy, the motivation of patients to participate in the development of new treatments and the impact of the current treatment on quality of life and economic costs. This multifaceted work tried to assess all of these aspects that could be seen at first as independent into a common Public Health perspective. Importance of treatment individualisation and evaluation of the impact of morphometric variables First, the substitutive treatment of haemophilia consisting of regular intravenous infusions of coagulation Factor VIII (FVIII) or Factor IX (FIX) is efficient and allows preventing haemorrhagic complications. In this context, a correct dosing of exogenous coagulation factor VIII is crucial as under-dosing puts patients at risk of haemorrhage, and over-dosing results in a waste of expensive concentrates. We demonstrated that the actual FVIII dose calculation is no longer applicable in overweight or underweight patients with haemophilia. With the common used formula, underweight patients are subject to underdosing and are therefore at risk of haemorrhage, and overweight patients are subject to over-dosing resulting in a waste of expensive concentrates. Given these considerations, FVIII dosing for prophylaxis or for treating or preventing bleeding episodes should be individualised rather than using fixed and arbitrary dosing. In conclusion, based on our findings, the clinical practice to use the ideal BW rather than the actual BW should be considered in dose calculations. In addition, we hypothesize that new coagulation factors under development would be subject to the same morphometric influences due to their larger size and we encourage pharmaceuticals that are developing these new treatments to take into consideration the patient s body build in their clinical trials. It is important for the new treatments not to make the same mistake as with the actual FVIII concentrates regarding dose calculations. Our recommendations for the new dose calculation are applicable to all haemophiliacs A around the world and could have therefore a huge impact for better treating these patients. In addition, individually adapting the FVIII dose is increasingly relevant as a result of the growing number of obese haemophiliacs and will save a substantial amount of money in this period of economic constraints, without decreasing the efficacy of the treatment. Implementation of strategies to increase motivation for clinical studies The World Federation of Haemophilia indicates that approximately 400,000 people worldwide have haemophilia; however only about one quarter of them received at least minimally adequate treatment, essentially because the majority of countries around the world cannot pay for these costly treatments. The challenge now is to provide current treatments to all haemophiliacs. This could be achieved by the development of new treatments, like gene therapy. In addition, the current replacement therapies have limitations, like the pain and difficulty associated with intravenous injections, the frequency of the infusions, the time it takes to the patient to prepare and inject the product as well 8

9 as the development of inhibitors. Therefore, there is a need for new treatments development. In order to develop and validate new treatments, the patients participation in clinical trials is essential. Without patients engagement, new drugs development is no longer possible. The recruitment of a sufficient number of participants affected by haemophilia in clinical studies is a major problem. We tried to evaluate the patients motivation for clinical study and the factors influencing their willingness to participate. The major predictors are the knowledge of clinical studies that patients had and the patients age. These findings support the view that physicians should provide patients with unbiased information on clinical research. Providing patients information explaining the different phases of clinical studies could be one way to improve their knowledge and therefore decrease their fear regarding clinical studies and enhance patients participation in these trials and at the end, the development of new treatments for all haemophiliacs. We stated that these conclusions could also be applicable for other diseases. A website was developed at the Haemophilia Comprehensive Centre of the Cliniques universitaires Saint-Luc in Brussels, Belgium, in order to increase patient awareness of the need to participate in clinical haemophilia research (http://participatetoinnovate.com), explaining the different clinical research steps, why patient participation is required, what challenges remain in the field of haemophilia therapy, or expected benefits of participating in a clinical study. A leaflet was also made available for patients, inviting them to consult the website. In addition, the development of new drugs like long-lasting factors could increase the haemophiliacs quality of life, especially for patients using prophylaxis for which this could provide a potential reduction of the number of intravenous injections. The spacing of injections and therefore the reduction of the total annual dose given to a patient per year could influence positively the cost of haemophilia treatment, depending on the price of new drugs. Importance of evaluation of the health and economic burden of rare diseases Finally, even if the life expectancy and the quality of life of haemophiliacs has improved since the last decades and especially in developed countries like Belgium where they have access to replacement therapy treatment, a lot remains to be done. Indeed, haemophiliacs life expectancy has significantly increased since the 1980 s, reaching now almost the life expectancy of the normal population. However, the quality of life is still lower in haemophiliacs than in the general population. We tried to estimate, for the first time, the health burden due to haemophilia in Belgium by means of Disability Adjusted Life Years (DALY) calculation. Our analysis indicates that haemophilia results in a small global health burden but in contrast in a high individual health burden, especially for patients with severe haemophilia. In addition, the number of years of life lost due to premature mortality is 16.6%, showing that the haemophiliacs life expectancy has increased considerably thanks to the development of new treatments in the 1980 s and is now close to life expectancy of the general population, but efforts still have to be done to better improve quality of life of these patients. Finally, we estimated for the first time ever the total cost of haemophilia in Belgium, including direct and indirect (societal) costs. This analysis highlights the high cost of haemophilia, with a mean lifetime costs of 7.8 million per people with haemophilia during his life, and especially of haemophilia replacement therapy which accounts for three-quarter of the total cost. This may largely be explained 9

10 by the introduction of safe recombinant treatment and a wide introduction of prophylaxis during the last 20 years, which prevents earlier death and allows now the patient to have almost the same life expectancy as the general population and minimises and prevents long-term haemophilia complications, such as arthropathies, as well as increased disability. 10

11 Curriculum Vitae SÉVERINE HENRARD Place and date of birth: Messancy (Belgium), 16/08/1985 Address: Rue Schetzel, 138A, L-2518 Luxembourg Mobile phone: +32 (0)498/ Nationality: Belgian Education and Training June 2010 Dec PhD in Medical Sciences Université Catholique de Louvain (UCL), Belgium Institute of Health and Society (IRSS) Cliniques universitaires Saint-Luc, Belgium Division of Haematology, Haemostasis and Thrombosis Unit Thesis: Impact of a rare disease on Public Health today and tomorrow: the case of haemophilia. Supervisors: Prof. N. Speybroeck and Prof. C. Hermans Sept Jan (expected) Master in Statistics, option Biostatistics in progress UCL, Belgium Faculty of Science, Louvain School of Statistics, Biostatistics and Actuarial Sciences Sept June 2009 Master in Public Health, option Epidemiology and Clinical Research and Health Services Research UCL, Belgium Faculty of Medicine (Academic grade: Grande distinction (equivalent to magna cum laude)) Sept June 2007 Master in Biomedical Sciences, option Clinical Biomedical Sciences UCL, Belgium Faculty of Medicine, School of Biomedical Sciences (Academic grade: Grande distinction (equivalent to magna cum laude)) Sept June 2005 Bachelor in Biomedical Sciences Facultés Universitaires Notre-Dame de la Paix Namur, Belgium Faculty of Medicine (Academic grade: Distinction (equivalent to cum laude)) 11

12 Sept June 2003 High School degree in Science, Mathematics and Latin Institut Sainte-Marie Arlon, Belgium (Mention très bien (equivalent to magna cum laude)) Work experience Dec Present Post-Doctoral Researcher UCL, Belgium Institute of Health and Society (IRSS) June 2010 Dec PhD Student UCL, Belgium Institute of Health and Society (IRSS) Cliniques universitaires Saint-Luc, Belgium Division of Haematology, Haemostasis and Thrombosis Unit Sept Sept Teaching Assistant UCL, Belgium Faculty of Public Health Awards McKinsey & Company Scientific Award, 2014 F.R.S.-FNRS This scientific prize is awarded to a young researcher that has demonstrated the social and economic relevance or practical implementation of his/her PhD. Scientific publications IN JOURNALS WITH IMPACT FACTOR 2014 Henrard S, Speybroeck N, Hermans C. Participation of people in haemophilia in clinical studies on new treatments: an investigation of patients motivations and existing barriers. [submitted] Maes F, Dalleur O, Henrard S, Wouters D, Scavée C, Spinewine A, Boland B. Risk scores and geriatric profile: can they really help us in anticoagulation decision making among older patients suffering from atrial fibrillation? Clin Interv Aging 2014;9: Henrard S, Devleesschauwer B, Beutels P, Callens M, De Smet F, Hermans C, Speybroeck N. The health and economic burden of haemophilia in Belgium: a rare, expensive and challenging disease. Orphanet J Rare Dis 2014;9:39. 12

13 Dalleur O, Boland B, Losseau C, Henrard S, Wouters D, Speybroeck N, Degryse JM, Spinewine A. Reduction of Potentially Inappropriate Medications Using the STOPP Criteria in Frail Older Inpatients: A Randomised Controlled Study. Drugs Aging 2014;31(4): Carvalhosa AM, Henrard S, Lambert C, Hermans C. Physical and mental quality of life in adult patients with haemophilia in Belgium: the impact of financial issues. Haemophilia 2013; 20(4): Henrard S, Speybroeck N, Hermans C. Impact of being underweight or overweight on factor VIII dosing in hemophilia A patients. Haematologica 2013; 98(9): Vaes B, Boland B, Scavée C, Henrard S, Wallemacq P, Van Pottelbergh G, Mathei C, Pasquet A, Vanoverschelde JL, Rezzoug N, Speybroeck N, Degryse J. Value of adding natriuretic peptides and electrocardiographic findings to assess the presence of cardiac dysfunction in patients 80 years of age. Am J Cardiol 2013; 111(8): Dalleur O, Spinewine A, Henrard S, Losseau C, Speybroeck N, Boland B. Inappropriate prescribing and related hospital admissions in frail older persons according to STOPP and START criteria. Drugs Aging 2012; 29(10): Sävendahl L, Maes M, Albertsson-Wikland K, Borgström B, Carel JC, Henrard S, Speybroeck N, Thomas M, Zandwijken G, Hokken-Koelega A. Long-term mortality and causes of death in isolated GHD, ISS, and SGA patients treated with recombinant growth hormone during childhood in Belgium, The Netherlands, and Sweden: Preliminary report of 3 countries participating in the EU SAGhE study. J Clin Endocrinol Metab 2012; 97(2):E Henrard S, Speybroeck N, Hermans C. Body weight and fat mass index as strong predictors of factor VIII in vivo recovery in adults with hemophilia A. J Thromb Haemost 2011; 9(9): Jadoul M, Nguyen PT, Henrard S, Coche E, Goffin E, Devuyst O. Coronary artery calcification: is it a strong predictor of cardiovascular events? Nephrol Dial Transplant 2011; 26(7): Nguyen PT*, Henrard S*, Coche E, Goffin E, Devuyst O, Jadoul M. Coronary artery calcification: a strong predictor of cardiovascular events in renal transplant recipients. Nephrol Dial Transplant 2010; 25(11): * Both authors contributed equally to this work 2009 Francart J, Vaes E, Henrard S, Legrand C, Baas P, Gaafar R, van Meerbeeck JP, Sylvester R, Robert A. A prognostic index for progression-free survival in malignant mesothelioma with application to the design of phase II trials: A combined analysis of 10 EORTC trials. Eur J cancer 2009; 45(13):

14 Invited lectures Henrard S. Cost of haemophilia in Belgium. Global Health Economic Summit organized by the Global Health Economics and Outcomes Research Team of Bayer HealthCare (Beijing, China, September 5 th, 2014). Henrard S. Motivation des patients à participer à des études cliniques : le cas de l hémophilie. National Conference EUROPLAN on rare diseases (Brussels, Belgium, February 28 th, 2014) Henrard S. Impact of being underweight or overweight on factor VIII dosing in hemophilia A patients. Pfizer NV/SA (Brussels, Belgium, January 27 th, 2014) Scientific communications SELECTED INTERNATIONAL ORAL PRESENTATIONS Henrard S, Speybroeck N, Hermans C. Major impact of underweight and overweight on Factor VIII dosing in 201 patients with severe haemophilia A treated with Advate, Kogenate FS or ReFacto AF/Xyntha. 45 th annual meeting of the American Society of Hematology (Atlanta, GA, USA, from 08/12/2012 to 11/12/2012). Henrard S, Hermans C, Devleesschauwer B, Speybroeck N. Assessment of the health and the economic burden of haemophilia in Belgium: A rare, very expensive and largely unknown disease with multiple public health challenges. 5 th Annual European Public Health Conference 2012 (Malta, from 07/11/2012 to 10/11/2012). Henrard S, Speybroeck N. Health indicators and socio-economic and health systems determinants in Europe: a discussion based on the exploration of the ATLAS website. A joint WHO-European Commission Action (2006WHO03) (Copenhagen, Denmark, from 18/08/2010 to 19/08/2010). Henrard S, Nguyen PT, Coche E, Goffin E, Robert A, Devuyst O, Jadoul M. Coronary calcifications predict cardiovascular events in renal transplant recipients. 41st Annual Meeting of the American Society of Nephrology. (Philadelphia, Pennsylvania, USA, from 05/11/2008 to 09/11/2008). SELECTED INTERNATIONAL POSTER COMMUNICATIONS Henrard S, Devleesschauwer B, Beutels P, Callens M, De Smet F, Hermans C, Speybroeck N. The disability adjusted life years (DALYs) and economic burden due to haemophilia in Belgium. World Federation of Hemophilia 2014 World Congress (Melbourne, Australia, from 11/05/2014 to 15/05/2014). Henrard S, Speybroeck N, Hermans C. Participation for innovation: survey of motivation for clinical studies evaluating new treatments for haemophilia. XXIV Congress of the International Society on Thrombosis and Haemostasis (Amsterdam, The Netherlands, from 29/06/2013 to 04/07/2013). 14

15 Henrard S, Speybroeck N, Hermans C. Body weight and fat mass index as strong predictors of in vivo factor VIII recovery in adults with hemophilia A. Bayer HealthCare Hematology Conference (Budapest, Hungary, from 13/10/2011 to 15/10/2011). Henrard S, Speybroeck N, Hermans C. Body weight and fat mass index as strong predictors of in vivo factor VIII recovery in adults with hemophilia A. XXIII Congress of the International Society on Thrombosis and Haemostasis (Kyoto, Japan, from 23/07/2011 to 28/07/2011). Henrard S, Maréchal C, Lambert C, Deneys V, Hermans C. Evaluation of thrombophilia screening in women with obstetrical complications: A "Real World" experience. XXI Congress of the International Society on Thrombosis and Haemostasis (Geneva, Switzerland, from 06/07/2007 to 12/07/2007). Projects EUROPEAN PROJECTS Project «SAGhE Safety and Appropriateness of Growth hormone treatments in Europe», in collaboration with the Pediatric endocrinology Department of the Cliniques universitaires Saint-Luc, Brussels, Belgium and 7 European countries ( ) Project Health indicators and socio-economic and health systems determinants in Europe: a discussion based on the exploration of the ATLAS website. A joint WHO- European Commission Action (2006WHO03) in collaboration with the World Health Organization Regional Office for Europe and the European Commission (2010) NATIONAL PROJECTS Consultant in statistical analyses of data and Quality of Life assessments for Promethera Biosciences (Since April 2014) Project Beginning of life/end of life and extreme prematurity funded by the Houtman Fund ( ) Project Adolescence, chronic illness and health behaviour : an action research for innovative solutions for prevention and health promotion involving hospital and school health services, funded by Innoviris ( ) Project Adaptation to climate change in Wallonia Health aspects, in collaboration with the Université libre de Bruxelles, Université de Liège, TEC (Tourisme, Territoire, Transport, Environnement Conseil), EcoRes and the Walloon Air and Climate agency ( ) Academic teaching activities Teaching assistant at the Faculty of Public Health Université Catholique de Louvain (Belgium) Tutor (Practical teacher) in statistics, biostatistics, epidemiology, statistical and epidemiological software 15

16 Lecturer in biostatistics and epidemiology to Master students (since January 2012) (Co-)Supervisor of Master theses in Public Health and Physiotherapy Member of the jury of master theses in Public Health, Medicine, Physiotherapy and Law Services to the scientific community Scientific representative at the Université catholique de Louvain (UCL) President of Scientific Members of the UCL (May 2014-Sept 2014) Scientific representative at the academic Council of UCL ( ), at the Faculty of Public Health of the UCL ( ) and at the Institute of Health and Society ( ) Member of the Steering Committee of the PhD day of the Doctoral Graduate School of Public Health, Heath and Society organized by the Université catholique de Louvain, the Université libre de Liège, the Université libre de Bruxelles, the Institute of Public Health and the Université de Namur ( ) 16

17 Stijn BAERT UGent Transitions in youth: on springboards, waterfalls and bottlenecks 17

18 Summary During the years of my PhD the youth unemployment rate grew from 16% in 2008 to 24% in This high incidence of unemployment at the start of the career is particularly worrisome, since it can induce long-lasting scars on the subsequent career development. The risks posed by a scarred generation have motivated many governments to take action, notably by scaling up funds for youth labour market programs. However, in order to develop adequate policy actions to fight youth unemployment in Europe and elsewhere, there is need for identifying success factors in first labour market transitions and closely related in school achievement. In the four chapters of my PhD I present studies on three factors in this respect: ethnicity, school retention and overeducation at the start of the career. A first study is motivated by the fact that in Belgium, as in many other countries, school and labour market transitions are much more successful for native youth than for ethnic minority youth. The question is whether policy action targeted at the latter youth is the right response. It is if the observed gaps are induced by pure ethnic differences in preferences and expectations or by discrimination. However, if these gaps just mirror different family endowments that result in different levels of educational attainment and therefore in different labour market performances, then no specific measures for minority youth are required to eliminate these gaps. Therefore, in the first study of my PhD, the observed gaps in educational attainment and first labour market outcomes between native and immigrant youth in Flanders are decomposed into (i) differences in observed family endowments and (ii) a residual pure ethnic gap. In line with the literature, the pure ethnic gap in educational attainment is found to be small if educational delays are neglected, as former studies did. However, this pure ethnic gap is substantial if these delays are taken into account and for school-to-work transitions. In order to test whether the pure ethnic gap in the transition from school to work is due to hiring discrimination, in a second study the results of a field experiment on unequal treatment based on ethnic origin are reported. This chapter contributes to the international economic literature in being the first to test the theoretical relationship between hiring discrimination and labour market tightness in an empirical way. To this end, we sent out fictitious job applications of school-leavers, randomly assigned to individuals with a native and a Turkish sounding name, to vacancies for jobs requiring no work experience in Flanders. In line with theoretical expectations, we find that, compared to natives, candidates with a Turkish sounding name are equally often invited to a job interview if they apply for occupations for which vacancies are difficult to fill, but they have to send twice as many applications for occupations for which labour market tightness is low. Grade retention is used in many countries as a tool to improve poor academic performances. The hypothesis is that, by resitting the same grade, low-achieving students have extra time to catch up to the grade-level requirements, in terms both of knowledge and emotional maturity. However, retention might generate personal and academic costs. In a third study, we investigate both the short- and long-term educational effects of grade retention controlling for school track mobility. By doing so we find that grade retention has a positive impact on the next evaluation and can permanently affect 18

19 subsequent educational achievements. The direction of the permanent effect is heterogeneous: while more able students are permanently penalised by retention, less able students benefit from it. Numerous studies have shown that many young workers start their career in a job with a functional level under their educational level. Given that overeducated workers have lower earnings and job satisfaction, one might wonder why young job seekers accept such jobs. One potential answer is given by the career mobility theory stating that overeducation is an investment in work experience which enhances promotion opportunities to higher level positions inside or outside the firm. In a fourth study we test this hypothesis. More concretely, we are the first to investigate whether graduates who accept a job below their level of education accelerate or delay the transition into a first job that matches their level of education. The research results show that overeducation is a trap. By accepting a job for which one is overeducated rather than only accepting adequate job matches, monthly transition rates into adequate employment fall by 51 98%, depending on the elapsed unemployment duration. 19

20 Curriculum Vitae STIJN BAERT Kraanlei 2 / GENT BELGIUM Date and place of birth: 14/10/1983, Lokeren, Belgium Nationality: Belgian Marital status: Unmarried Academic Awards 2014 Best Teaching Assistant Award. Election among all Master students of the faculty of Economics and Business Administration (3nd edition) Best Teaching Assistant Award. Election among all Master students of the faculty of Economics and Business Administration (2nd edition) P&V Foundation Price Awarded for my book chapter Ethnic discrimination in the Flemish labour market for school-leavers. Jonas in preference to Okan? by the P&V Foundation (1500 euro) Best Teaching Assistant Award. Election among all Master students of the faculty of Economics and Business Administration (1st edition) VDK-award Award for the student with the best results in the Master of Science in Economics (823/1000) (375 euro). Skills EDUCATION Doctor of Economic Sciences (Ghent University). Title: Transitions in Youth: on Springboards, Waterfalls and Bottlenecks. 20

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