Economic Inequality and Health Timothy S. Sullivan, Ph.D. Department of Economics and Finance...
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Transcript of Economic Inequality and Health Timothy S. Sullivan, Ph.D. Department of Economics and Finance...
Economic Inequality and Health
Timothy S. Sullivan, Ph.D.Department of Economics and Finance
Southern Illinois University Edwardsville
www.siue.edu/~tsulliv
Economic Inequality and Health
Measuring Economic Inequality Difficulties in Measuring Inequality Myths Surrounding Inequality The Connection Between Economic
Well-being and Health
Economic Inequality and Health
Measuring Economic Inequality Difficulties in Measuring Inequality Myths Surrounding Inequality The Connection Between Economic
Well-being and Health
Measuring Inequality
Quintiles Lorenz Curves & The Gini Coefficient
Quintiles
Second Quintile
$16K-$31K
First Quintile
<$16KThird Quintile
$31K-$48K
Fourth Quintile
$48K-$75K
Fifth Quintile
>$75K
1998 values for Households, from http://www.census.gov/hhes/income/histinc/rdi06.html, accessed 10/21/00
Income Distribution 1970-1998
204.1 4.3 3.9 3.6
20
10.8 10.3 9 9
20
17.4 16.9 15.9 15
20
24.5 24.9 24 23.2
20
43.3 43.7 46.6 49.2
0%
20%
40%
60%
80%
100%
Equality 1970 1980 1990 1998
Source: U.S. Census Bureau, reported in The Wall Street Journal, October 1, 1999, B1.
Building a Lorenz Curve
0
20
40
60
80
100
0 20 40 60 80 100
Equality19701998
Source: U.S. Census Bureau, reported in The Wall Street Journal, October 1, 1999, B1.
Gini Coefficient
Portion of lower triangle not covered by Lorenz Curve
Perfect Equality : Gini=0
One Household Earns all Income: Gini=1
US Gini Coefficient: 1979-1998
0.403 0.446
0
0.2
0.4
0.6
0.8
1
1979 1981 1983 1985 1987 1989 1991 1993 1995 1997
Source: US Bureau of Census, available at http://www.census.gov/hhes/income/histinc/rdi05.html
International Gini Coefficients
South Africa (1993):0.623 Mexico (1992): 0.503 US (1991): 0.379 China (1992): 0.378 Sweden (1992): 0.324 Canada (1992): 0.277
Source: The World Bank, available at http://www.worldbank.org/research/growth/dddeisqu.htm
Economic Inequality and Health
Measuring Economic Inequality Difficulties in Measuring Inequality Myths Surrounding Inequality The Connection Between Economic
well-being and Health
Difficulties Measuring Inequality
What to measure?– Net Income– Total Compensation– Wealth– Consumption
“Feast or Famine” workers Household Structure
What to Measure?
Net Income?– Welfare benefits?– EITC?– After taxes? Which taxes?
Total Compensation?– Medical Plans?– 401K Contributions by Employer?
What to Measure?
Wealth?– House?– Pension Plan?– Family Farm?
Consumption?– Reduces Gini (1994) from 0.432 to 0.317
Source: US Bureau of the Census, reported by Litvan, Laura M., “Do Income Data Give Americans Wrong Ideas About Inequality,” Investor’s Business Daily, July 23, 1996.
Feast or Famine Workers
0
10
20
30
40
50
60
70
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6
Worker #1 Worker #2
Country A
Gini=.225
Feast or Famine Workers
0
10
20
30
40
50
60
70
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6
Worker #1 Worker #2
Country BGini=0.225 & 0.420
Feast or Famine Workers
Adding annual variability to workers’ salaries will typically increase annual measures of inequality, even when there is no change in long-run inequality.
Variability may be due to more bonus & commission-based pay or more workers in cyclical industries.
Changing Household Structure
If inequality is measured at the household level, composition of household is important:– 1996: 53.1% married couple– 1969: 70.4% married couple
Source: Author’s calculations based upon McNeil, Jack, Changes in Median Household Income: 1969-1996, US Bureau of the Census, P23-196, Table 3, available at
http://www.census.gov/hhes/income/mednhhld/p23text.html
Economic Inequality and Health
Measuring Economic Inequality Difficulties in Measuring Inequality Myths Surrounding Inequality The Connection Between Economic
Well-being and Health
Myths Surrounding Inequality
The Rich are Getting Richer ……. The rich are:
– Born into money– Extravagant– Lucky
More inequality means more poor people doing without basics
Myth #1: “The Rich are Getting Richer, and the Poor are getting Poorer”
0
20
40
60
80
100
High Score Low Score
ECON 327 Quiz Scores
Quiz1 Quiz2 Quiz3
The statement implies that people remain in their category
1993-94:– 24% of poor became
non-poor– 3% of non-poor
became poorSource: Author’s calculations based upon Dynamics of Economic Well-Being: Poverty 1993-1994, US Bureau of the Census, available at http://www.census.gov/hhes/poverty/povdynam/pov93t5.html
Myth #2: “The rich are …..”
Born into money– 80% are first-generation– Most attended public school
Lazy– average 45-55 hours per week– Self-employed in a practical business
Extravagant– 40% drive cars over 3 years old– 81% clip coupons
Source: Stanley, Thomas J., and William D. Danko, The Millionaire Next Door, reported by Anita Sharpe in The Wall Street Journal, November 12, 1996, pg B1.
Myth #3: “More inequality means more poor people doing without the basics”
Poor Households Own:– Color Television (93%)– VCR (75%)– Automobile (70%)
• 27% own two, or more, cars
– Air Conditioning (67%)– Microwave (64%)– Home (41%)
Source: Rector, Robert, “America Has the World’s Richest Poor People,” The Wall Street Journal, September 24, 1998.
Economic Inequality and Health
Measuring Economic Inequality Difficulties in Measuring Inequality Myths Surrounding Inequality The Connection Between Economic
Well-being and Health
Components of Health
Inputs Health Insurance Risk Factors Outcomes
Inputs: Food
In 1994, poor children were eight times more likely than non-poor children to report that there was sometimes “not enough to eat.”
In general, the nutrient intake of poor children is similar to non-poor children.
Sources: America’s Children: Key National Indicators of Well-Being, Federal Interagency Forum on Child and Family Statistics, 1997, pg. 16.
US Department of Agriculture, Agricultural Research Service, February 1999, Data Tables: Food and Nutrient Intakes by Income, 1994-96, http://www.barc.usda.gov/bhnrc/foodsurvey/pdf/Income.pdf.
Input: No Physician Contact (children under 6)
0
2
4
6
8
10
12
Per
cent
White Black Hispanic
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 151.
Input: No Physician Contact (children under 18: 1999-2000)
0
5
10
15
20
25
30
35
Per
cent
White Black Hispanic
Poor Near Poor Nonpoor
Source: Health, United States, 2002; with Chartbook on Trends in the Health of Americans, National Center for Health Statistics, Hyattsville, MD, 2002, pg. 224.
Input: No Physician Contact (children under 18: 1999-2000)
0
5
10
15
20
25
30
35
40
Per
cent
Poor Near poor Nonpoor
Insured Uninsured
Source: Health, United States, 2002; with Chartbook on Trends in the Health of Americans, National Center for Health Statistics, Hyattsville, MD, 2002, pg. 224.
Input: No Physician Contact (men 18-64)
0
5
10
15
20
25
Per
cent
White Black Hispanic
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 158.
Input: No Physician Contact (women 18-64)
0
2
4
6
8
10
12
14
16
Per
cent
White Black Hispanic
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 158.
Input: Mammogram w/in 2 yrs(women 50+)
0
10
20
30
40
50
60
70
80
Per
cent
White Black Hispanic
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 159.
Input: Dental Visit w/in 1 year(children 2-17: 2000)
010
20304050
607080
90
Per
cent
White Black Hispanic
Poor Near Poor Nonpoor
Source: Health, United States, 2002; with Chartbook on Trends in the Health of Americans, National Center for Health Statistics, Hyattsville, MD, 2002, pg. 235.
Input: Dental Visit w/in 1 year(adults 18-64: 2000)
0
10
20
30
40
50
60
70
80
Per
cent
White Black Hispanic
Poor Near Poor Nonpoor
Source: Health, United States, 2002; with Chartbook on Trends in the Health of Americans, National Center for Health Statistics, Hyattsville, MD, 2002, pg. 235.
Input: No Physical Leisure Activity (adults 18+)
0
10
20
30
40
50
60
Per
cent
Men Women
Below Poverty 1-2 x Poverty 2-4 x Poverty 4 x Povert
Source: Schoenbron, Charlotte A., Patricia Barnes, Leisure-Time Physical Activity Among Adults: United States, 1997-98, Advance data from vital and health statistics; no. 325, NCHS, April, 2002 .
Inputs: ImmunizationsBelow
PovertyAbove
Poverty
Combined
(4:3:1:3)
71% 78%
DTP 76% 84%
Polio 87% 90%
Hib 90% 95%
Source: Health, United States, 2002; with Chartbook on Trends in the Health of Americans, National Center for Health Statistics, Hyattsville, MD, 2002, pg. 220.
Inputs: Uncontrolled Hypertension
(males 20+)
0
5
10
15
20
25
30
35
Per
cent
White Black Hispanic
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 157.
Inputs: Uncontrolled Hypertension
(females 20+)
0
5
10
15
20
25
30
Per
cent
White Black Hispanic
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 157.
No Health Insurance(children under 18)
0
5
10
15
20
25
30
35
Per
cent
White Black Hispanic
Poor Near Poor Middle High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 150.
No Health Insurance(men 18-64)
0
10
20
30
40
50
60
Per
cent
White Black Hispanic
Poor Near Poor Middle High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 158.
No Health Insurance(women 18-64)
05
101520
25303540
45
Per
cent
White Black Hispanic
Poor Near Poor Middle High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 158.
Risk Factor: Cigarette Smoking (Adolescents 12-17)
0
5
10
15
20
25
Per
cent
Boys Girls
Poor Near Poor Middle High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 148.
Risk Factor: Cigarette Smoking (adults 18+)
0
5
10
15
20
25
30
35
40
Per
cent
Men Women
Poor Near Poor Middle High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 155.
Risk Factor: Sedentary Lifestyle (adolescents 12-17)
0
5
10
15
20
25
30
Per
cent
Boys Girls
Poor Near Poor Middle High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 149.
Risk Factor: Overweight(adolescents 12-17)
02468
101214161820
Per
cent
White Black Hispanic
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 148.
Risk Factor: Overweight(men 20+)
05
10152025
303540
45
Per
cent
White Black Hispanic
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 156.
Risk Factor: Overweight(female 20+)
0
10
20
30
40
50
60
Per
cent
White Black Hispanic
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 156.
Outcome: Elevated Blood Lead(children 1-5)
0
5
10
15
20
25
Per
cent
White Black Hispanic
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 148.
Outcome: Elevated Blood Lead(adults 18+)
02468
101214161820
Per
cent
White Black Hispanic
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 157.
Outcome: Asthma Hospitalization (children 1-14)
0
1
2
3
4
5
6
7
8
Per
cent
White Black
<$20K $20K-$30K $30K-$40K >$40K
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 151.
Outcome: Life Expectancy (45-year-old male)
0
5
10
15
20
25
30
35
Yea
rs
White Black
<$10K $10K-15K $15K-$25K >$25K
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 152.
Outcome: Life Expectancy (65-year-old male)
0
246
81012
141618
Yea
rs
White Black
<$10K $10K-15K $15K-$25K >$25K
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 152.
Outcome: Life Expectancy (45-year-old female)
0
5
10
15
20
25
30
35
40
Yea
rs
White Black
<$10K $10K-15K $15K-$25K >$25K
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 152.
Outcome: Life Expectancy (65-year-old female)
0
5
10
15
20
25
Yea
rs
White Black
<$10K $10K-15K $15K-$25K >$25K
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 152.
Outcome: Heart Disease Death Rate (25-64-year-old male)
0
50
100
150
200
250
300
350
400
White Black
<$10K $10K-15K >$15
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 152.
Outcome: Heart Disease Death Rate (65+-year-old male)
0
50
100
150
200
250
300
350
400
White Black
<$10K $10K-15K >$15
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 152.
Outcome: Heart Disease Death Rate (25-64-year-old female)
0
50
100
150
200
White Black
<$10K $10K-15K >$15
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 152.
Outcome: Heart Disease Death Rate (65+-year-old female)
0
200
400
600
800
1000
1200
1400
1600
White Black
<$10K $10K-15K >$15
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 152.
Outcome: Lung Cancer Death Rate (25-64-year-old)
0
20
40
60
80
100
Men Women
<$10K $10K-15K $15K-$25K >$25K
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 153.
Outcome: Lung Cancer Death Rate (65+-year-old)
0
100
200
300
400
500
600
Men Women
<$10K $10K-15K $15K-$25K >$25K
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 153.
Outcome: Diabetes Death Rate (45+-year-old)
0
10
20
30
40
50
60
Men Women
<$10K $10K-15K $15K-$25K >$25K
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 153.
Outcome: Fair or Poor Health(all persons 2000)
0
5
10
15
20
25
30
Per
cent
White Black Hispanic
Poor Near Poor Nonpoor
Source: Health, United States, 2002; with Chartbook on Trends in the Health of Americans, National Center for Health Statistics, Hyattsville, MD, 2002, pg. 192.
Outcome: Fair or Poor Health(males 18 or older)
0
5
10
15
20
25
30
35
40
Per
cent
White Black Hispanic
Poor Near Poor Middle High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 154.
Outcome: Fair or Poor Health(females 18 or older)
0
5
10
15
20
25
30
35
40
Per
cent
White Black Hispanic
Poor Near Poor Middle High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 154.
Outcomes: Activity Limitation: All Persons (2000)
0
5
10
15
20
25
30
Per
cent
White Black Hispanic
Poor Near Poor Nonpoor
Source: Health, United States, 2002; with Chartbook on Trends in the Health of Americans, National Center for Health Statistics, Hyattsville, MD, 2002, pg. 189.
Outcome: Activity Limitation (adults 18-64 years old)
0
5
10
15
20
25
30
35
40
Per
cent
White Black Hispanic
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 154.
Outcomes: Activity Limitation: Children under 18
01
2345
678
9
Per
cent
White Black Hispanic
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 147.
Outcome: Difficulty with Daily tasks
(70+-year-old)
05
1015202530354045
Per
cen
t
Men Women
Poor Near Poor Middle/High
Source: Pamuk E., Makue D, Heck K, Reuben C, Lochner K. Socioeconomic Status and Health Chartbook, National Center for Health Statisics, Hyattsville, MD, 1998, pg. 154.
Summary
There are strong correlations between income and health inputs & outcomes
Correlation isn’t causation!– Reverse Causation?– Intervening variables (risk factors)– Common response
Thank You Very Much!