Posts Tagged ‘health’

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According to a new report on inequality in the Brazilian city of São Paulo, compiled by Rede Nossa São Paulo (pdf, in Portuguese), the gap in the average age of death between the poorest and richest districts of the city is almost 24 years. Thus, for example, the average age of death in Jardim Paulista is 79.4 years while that of residents of Jardim Ângela is only 55.7 years.

This should come as no surprise since Brazil is one of the most unequal countries on the planet.

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However, lest we forget, the United States is also characterized by levels of inequality that are comparable to those in Brazil: in 2014, the top 1 percent of Americans captured 20.2 percent of pre-tax income, while their Brazilian counterparts managed to take home 27.6 percent. Perhaps even more damning, the share of income of the bottom 50 percent of both countries—while rising in Brazil and continuing to fall in the United States—was only 12.5 percent in 2014.

As it turns out, the obscene levels of inequality in the United States have resulted in a life expectancy at birth that is lower than most other high-income countries—and the gains in future years are expected to lower than in most other countries.

According to a an article published earlier this year in the British health journal Lancet,

Notable among poor-performing countries is the USA, whose life expectancy at birth is already lower than most other high-income countries, and is projected to fall further behind such that its 2030 life expectancy at birth might be similar to the Czech Republic for men, and Croatia and Mexico for women. The USA has the highest child and maternal mortality, homicide rate, and body-mass index of any high-income country, and was the first of high-income countries to experience a halt or possibly reversal of increase in height in adulthood, which is associated with higher longevity. The USA is also the only country in the OECD without universal health coverage, and has the largest share of unmet health-care needs due to financial costs. Not only does the USA have high and rising health inequalities, but also life expectancy has stagnated or even declined in some population subgroups. Therefore, the poor recent and projected US performance is at least partly due to high and inequitable mortality from chronic diseases and violence, and insufficient and inequitable health care.

In the case of both Brazil and the United States, the poor will continue to die younger unless and until the fundamental causes of economic inequality are eliminated.

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Social Security may have decreased the rate of poverty among retirees in the United States.* But it certainly hasn’t solved the problem of inequality.

As is clear from the chart above, from a recent report from the Organisation for Economic Co-operation and Development, old-age inequality among current retirees in the United States is higher than in all other OECD countries, except Chile and Mexico.

But wait, it’s probably going to get worse. That’s because, within each generation of workers, inequality has been rising. For example, researchers tracked U.S. income inequality for four different generations—people born in 1920, 1940, 1960, and 1980. For each group, inequality has been more extreme than the previous generation.

The inequalities among people of working age are a primary reason for inequalities among older Americans. That’s because, with highly unequal current incomes, only households at the top are able to accumulate adequate retirement savings. Everyone else is forced to have the freedom to rely on Social Security payments.

But that’s not the only reason for rising retirement inequality. Ill health is another critical source of difference. It can cause problems at work and trigger the loss of earnings, and of course work can also damage people’s health. As the authors of the report note,

Americans are far more unhealthy than their peers in a number of other countries and people from low socio-economic backgrounds are particularly affected by bad health.

And if ill health follows workers into old age or strikes them after retirement, they will need some kind of long-term care—but the social support for such care is much lower in the United States than in other countries.

Someone with median income receiving home care for moderate needs in the some US states may have as little as 6% of the cost of their care paid by the social protection system. This compares to about 45% in the Czech Republic and Israel and almost 100% in Sweden, Iceland and the Netherlands.

As the authors of the report observe, “ageing unequally starts early and builds up from childhood to old age.” This is no more so than in the United States where severe and growing inequalities in different dimensions—such as education, health, employment, earnings, and wealth—reinforce each and grow over the course of people’s lives.

What we’re seeing, then, is high levels of inequality among older Americans. And, given current trends, it’s only going to get worse for future generations.

 

*But the poverty rate among Americans older than 65 years is still high, at almost 20 percent, and the depth of poverty—the amount by which the average income of poor older people falls below the poverty line—is greater than 30 percent. And, just as worrisome, the poverty risk appears to be shifting from the old to the young. For example, while poverty rates for the elderly have fallen since the mid-1980s (by 2.5 percentage points for Americans 66 to 75 years), they’ve increased for younger workers (by 4 percentage points for those 18 to 25 years).

Inequality

The latest IMF Fiscal Monitor, “Tackling Inequality,” is out and it represents a direct challenge to the United States.

It’s not just a rebuke to Donald Trump, who with his allies is pursuing under the guise of “tax reform” a set of policies that will lead to even greater inequality—or, for that matter, Republicans in state governments across the country that have sought to cut back on programs targeted at poor Americans. It also takes to task decades of growing inequality in the United States, under both Democratic and Republican administrations.

As is clear from the chart above, the distribution of both income and wealth in the United States has become increasingly unequal since the mid-1970s. The share of income captured by the top 1 percent has more than doubled (from 10 to 20 percent), while it’s share of total wealth has increased dramatically (from 23 percent to 39 percent). Meanwhile, the share of income of the bottom 50 percent has declined precipitously (from 20 percent to 12.5 percent) and it’s share of wealth, which was never very high (at 0.9 percent), is now nonexistent (at negative 0.1 percent).

And what is the United States doing about it? Absolutely nothing. Over the course of the past four decades it’s done very little to tackle the problem of growing inequality—and what it has done has been spectacularly ineffective. Thus, inequality has grown to obscene levels.

What’s interesting about the IMF report is that it raises—and then challenges—every important argument made by mainstream economists and members of the economic and political elite.

Should we worry just about income inequality? Well, no, since “changes in income inequality are reflected in other inequality dimensions, such as wealth inequality.”

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Doesn’t the United States take care of the problem by redistribution? Absolutely not, since only Israel does less than the United States in terms of lowering inequality (as measured by the Gini coefficient) through taxes and transfers.

But doesn’t tackling inequality through progressive income taxes lower economic growth? Again, no: “There is not strong empirical evidence showing that progressivity has been harmful for growth.”

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Nor is there any justification for low tax rates on those at the top in terms of social preferences. Most Americans, according to a recent Gallup survey, most believe that the rich and corporations don’t pay their fair share of taxes. In fact, the IMF notes, perhaps thinking about the United States, “societal preferences may not be reflected in actual policy implementation because of the concentration of political power in certain affluent groups.”

Clearly, much more can be done to lower the degree of inequality in the United States.

As a sign of the times, the IMF even chooses to discuss the role a Universal Basic Income might play in decreasing inequality.

Proponents argue that a UBI can be used as a redistributive tool to help address poverty and inequality better than means-­tested programs, which su er from information constraints, high administrative costs, and other obsta­cles that limit benefit take-­up. A UBI could also help address increased income uncertainty resulting from the impact of technology (particularly automation) on jobs.

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According to its calculations, a Universal Basic Income in the United States (calibrated at 25 percent of median per capita income, in addition to existing programs) would cost only 6.5 percent of national income and achieve a remarkable reduction in both inequality (by more than 5 Gini points) and poverty (by more than 10 percentage points).

What puts the United States in stark relief is the contrast between the whole panoply of inequality-reducing policies that are available—from more progressive income taxes and the adoption of wealth taxes to reducing gaps in education and health programs—and the fact that the United States is moving in the opposite direction.

The United States is simply not tackling the problem, with the inevitable result: current levels of economic inequality are—by any measure, and especially in comparison to what could be but isn’t being done—grotesque.

Bloody hell!

Posted: 13 October 2017 in Uncategorized
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Over the years, I’ve written about many different dimensions of the relationship between health and economic inequality on this blog—from children’s brain development to car crashes.

But, as Kat Arney [ht: ja] explains, “Unpicking the biological connections between external socioeconomic forces and an individual’s health is no easy task.”

Now apparently, researchers in England are beginning to unpick those connections, by measuring biological markers in the bloodstream. And what they’ve discovered is fascinating—and disturbing.

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Apparently, measuring the levels of two molecules—an individual’s C-reactive protein and fibrinogen (as in the charts above)—and matching them against their socioeconomic position starts to reveal the hidden mechanisms connecting social inequality and health. And the missing link turns out to be stress.

“You have stressful life events such as bereavement or divorce, but we’re talking about understanding chronic long-term stresses,” Kumari says. “One of the things we think about is why is disadvantage stressful? For something like low income, it could be because you don’t have the same levels of control over your life. Maybe you can manage it for a little while, but over the long term it becomes a chronic stress. These things are hard to measure and capture.”

Bartley agrees more needs to be done to understand the financial causes of stress across society. “Debt is deadly for people – it’s the ultimate lack of control,” she says. “Housing is also a huge issue and it doesn’t get researched enough – living in poor situations is depressing, especially if you’re bringing up children. People in poverty can end up in social isolation, and that’s known to be associated with all kinds of unhealthy outcomes.”

From a policy perspective, if you know when health inequalities begin and when they peak, it becomes possible to target these age groups and allocate resources more effectively. A far more effective response, of course, would be to eradicate the grotesque inequalities that characterize contemporary society.

Toward this end, public health experts might suggest eliminating capitalism, which would decrease stress and improve people’s health.

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By the 1960s, it was known as “Bloody Lowndes”—because of the long history of lynchings and other forms of racial terrorism against the poor, majority-black population. Then, they began to fight back, with the assistance of the Student Non-Violent Coordinating Committee, forming the the Lowndes County Freedom Organization, which was the first independent black political party in the county since Reconstruction.

But the county remained poor, with a median household income of only $25,876 and a poverty rate of 28.5 percent, with a still-declining population that has been mostly consigned to oblivion.

Lowndes has been largely forgotten—until yesterday, when a new study was published concerning the health of the county’s residents.

What is remarkable is that the study was published in The American Journal of Tropical Medicine and Hygiene and it documents a high incidence of hookworm, an infection that affects 430 million people worldwide, causing iron deficiency, impaired cognitive development, and stunting in children.

This was supposed to be a parasite found only in poor, Third World countries, with poor sanitation and a natural environment suitable for the hookworm life-cycle. It’s a public health problem that I vividly remember from all my years working in and teaching development economics, especially in Latin America.

But here we are in the United States—where hookworm had been rampant, especially in the deep south, in the earlier twentieth century. But by the 1980s public health experts assumed the parasite and the attendant public-health problems had disappeared altogether. However, the authors of the study found that more than one third (34.5 percent) of the participants tested positive for Necator americanus, the American species of hookworm.

Clearly, the authors understand the significance and implications of their study:

The discovery of these parasitic diseases within the United States begins to shift the idea behind global health. One concept is blue marble health, which reveals that many of the world’s neglected tropical diseases are paradoxically found in some of the wealthiest countries, especially in these small regions of extreme poverty.

 

Cartoon of the day

Posted: 28 April 2017 in Uncategorized
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