Posts Tagged ‘health’

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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.”

redistribution

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.

UBI

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.

lowndes

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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Tom Toles Editorial Cartoon - tt_c_c170206.tif

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While I was finishing up the latest right-wing libertarian dystopian finance novel, I was also trying to figure out the dystopia that the U.S. healthcare system has become.

Clearly, for most Americans, the combination of private healthcare and private health insurance (and, now with Obamacare, public subsidies) is a nightmare. There is a glaring contradiction between healthy profits and the health of the U.S. population. Over the course of the next couple of weeks, I plan to explore various dimensions of that system.

To start with, consider how much of an outlier the United States is in terms of expenditures and outcomes compared to other countries. As Max Roser explains,

the US spends far more on health than any other country, yet the life expectancy of the American population is not longer but actually shorter than in other countries that spend far less.

If we look at the time trend for each country we first notice that all countries have followed an upward trajectory – the population lives increasingly longer as health expenditure increased. But again the US stands out as the the country is following a much flatter trajectory; gains in life expectancy from additional health spending in the U.S. were much smaller than in the other high-income countries, particularly since the mid-1980s.

This development led to a large inequality between the US and other rich countries: In the US health spending per capita is often more than three-times higher than in other rich countries, yet the populations of countries with much lower health spending than the US enjoy considerably longer lives. In the most extreme case we see that Americans spend 5-times more than Chileans, but the population of Chile actually lives longer than Americans.

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An anti-austerity protest has brought 150,000 people—students, workers, and others—to the streets of London to demand David Cameron’s resignation.

The March for Health, Homes, Jobs and Education was organised by activist group the People’s Assembly. The demonstrators called for an end to austerity, and demanded that David Cameron quit over the revelation that he profited from his father’s offshore investment fund. . .

The People’s Assembly used the protest to make “Four Demands”. With regards to health, they called for an end to Government spending cuts and the alleged privatisation of the NHS. The protestors’ demand over housing included rent controls and the protection of social housing.

On jobs, they called for a universal living wage and the scrapping of the Trade Union Bill, and they also demanded an end to student tuition fees and “the marketisation of education”.

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No, that’s not the democratic socialist candidate for the Democratic nomination. It was actually Al Capone who once said that “Capitalism is the legitimate racket of the ruling class.”*

That racket—and, with it, challenges to the legitimacy of capitalism—was evident in a wide variety of news stories yesterday.

life span

First, there was the issue of health. Once again, we’re learning that the capitalist racket is affecting health. In particular, the gap in life span between rich and poor is widening. The top 1 percent among American men live 15 years longer than the poorest 1 percent; for women, the gap is 10 years. These rich men and women have gained three years of longevity just in this century.

And for some groups—especially white working-class men and women—death rates are actually rising.**

Public health experts say the rising white death rate reflects a broader health crisis, one that has made the United States the least healthy affluent nation in the world over the past 20 years. The reason these early deaths are so conspicuous among white women, these experts say, is because in the past the members of this comparatively privileged group have been unlikely to die prematurely. . .

[Anne] Case said that the whites who are dying are not America’s elites.

“They may be privileged by the color of their skin,” she said, “but that is the only way in their lives they’ve ever been privileged.”

Second, consider the problem of international trade. Michael Riordan challenged Carrier Corporation’s recent decision to transfer its Indianapolis plant’s manufacturing operations and about 1,400 jobs to Monterrey, Mexico.

The transfers of domestic manufacturing jobs to Mexico and Asia have benefited Americans by bringing cheaper consumer goods to our shores and stores. But when the victims of these moves can find only lower-wage jobs at Target or Walmart, and residents of these blighted cities have much less money to spend, is that a fair distribution of the savings and costs?

Recognizing this complex phenomenon, I can begin to understand the great upwelling of working-class support for Bernie Sanders and Donald J. Trump — especially for the latter in regions of postindustrial America left behind by these jarring economic dislocations.

And as a United Technologies shareholder, I have to admit to a gnawing sense of guilt in unwittingly helping to foster this job exodus. In pursuing returns, are shareholders putting pressure on executives to slash costs by exporting good-paying jobs to developing nations?

Even Lawrence Summers, desperate (like most mainstream economists) to maintain free international trade and global integration, had to admit that the globalization agenda has been a racket by and for those at the very top:

The core of the revolt against global integration, though, is not ignorance. It is a sense — unfortunately not wholly unwarranted — that it is a project being carried out by elites for elites, with little consideration for the interests of ordinary people. They see the globalization agenda as being set by large companies that successfully play one country against another. They read the revelations in the Panama Papers and conclude that globalization offers a fortunate few opportunities to avoid taxes and regulations that are not available to everyone else. And they see the kind of disintegration that accompanies global integration as local communities suffer when major employers lose out to foreign competitors.

Finally, when coupled with the revelations in the Panama Papers, there’s the growing suspicion that the 1 percent are both abandoning the rest of society (by hiding their money and avoiding taxes) and remaking the rules of the game (by using their money to influence elections and legislation). As Aditya Chakrabortty explains,

the Panama Papers confirm that the super-rich have effectively exited the economic system the rest of us have to live in. Thirty years of runaway incomes for those at the top, and the full armoury of expensive financial sophistication, mean they no longer play by the same rules the rest of us have to follow. Tax havens are simply one reflection of that reality. Discussion of offshore centres can get bogged down in technicalities, but the best definition I’ve found comes from expert Nicholas Shaxson who sums them up as: “You take your money elsewhere, to another country, in order to escape the rules and laws of the society in which you operate.” In so doing, you rob your own society of cash for hospitals, schools, roads…

But those who exited our societies are now also exercising their voice to set the rules by which the rest of us live. The 1% are buying political influence as never before. Think of the billionaire Koch brothers, whose fortunes will shape this year’s US presidential elections. In Britain, remember the hedge fund and private equity barons, who in 2010 contributed half of all the Conservative party’s election funds – and so effectively bought the Tories their first taste of government in 18 years.

Capitalism, of course, has always been a racket of the ruling class. Now, it seems—with revelations about unequal health and life spans, the costs of globalization, the ability of a tiny group at the top to exercise both exit and voice, and much more—its legitimacy is being called into question.

 

*Chicago’s most famous gangster was no anticapitalist radical. On the contrary:

“Listen,” he said, “don’t get the idea I’m one of those goddam radicals. Don’t get the idea I’m knocking the American system. The American system…” As though an invisible chairman had called upon him for a few words, he broke into an oration upon the theme. He praised freedom, enterprise and the pioneers. He spoke of “our heritage”. He referred with contempuous [sic] disgust to Socialism and Anarchism. “My rackets,” he repeated several times, “are run on strictly American lines and they’re going to stay that way”…his vision of the American system began to excite him profoundly and now he was on his feet again, leaning across the desk like the chairman of a board meeting, his fingers plunged in the rose bowls.

“This American system of ours,” he shouted, “call it Americanism, call it Capitalism, call it what you like, gives to each and every one of us a great opportunity if we only seize it with both hands and make the most of it.” He held out his hand towards me, the fingers dripping a little, and stared at me sternly for a few seconds before reseating himself.

**Consider this extraordinary statistic:

Compared with a scenario in which mortality rates for whites continued to fall steadily after 1998, roughly 650,000 people have died prematurely since 1999 — around 450,000 men and nearly 200,000 women.

That number nearly equals the death toll of the American Civil War.