Deaton - What Does the Empirical Evidence Tell us About the Injustice of Health Inequalities?

What does the empirical evidence tell us about the injustice of health inequalities?

Angus Deaton
Center for Health and Wellbeing
Princeton University
January 2011

ABSTRACT
Whether or not health inequalities are unjust, as well as how to address them, depends on how they are caused. I review a range of health inequalities, between men and women, between aristocrats and commoners, between blacks and whites, and between rich and poor within and between countries. I tentatively identify pathways of causality in each case, and make judgments about whether or not each inequality is unjust. Health inequalities that come from medical innovation are among the most benign. I emphasize the importance of early life inequalities, and of trying to moderate the link between parental and child circumstances. I argue that racial inequalities in health in the US are unjust and add to injustices in other domains. The vast inequalities in health between rich and poor countries are arguably neither just nor unjust, nor are they easily addressable. I argue that there are grounds to be concerned about the rapid expansion in inequality at the very top of the income distribution in the US; this is not only an injustice in itself, but it poses a risk of spawning other injustices, in education, in health, and in governance.

Graph of the year? Mother's education and breastfeeding

Its that time when people reflect on the year gone by, lists of pivotal events, dead celebs etc. There are also lots of suggestions for "graph of the year" going round. It's pretty arbitrary of course since it depends on what people find interesting. Graphs are great but they have the potential to mislead since, by their nature, they are simple but evocative.
Anyway, here is one I find very striking. It graphs the rate of breastfeeding initiation (i.e. whether the child is breastfed at all) by their mother's education level using the Growing Up in Ireland data. It is one of the most pronounced socio-economic gradients I have come across. A child whose mother is a graduate has about a 77% chance of being breastfed. At the other end of the scale it is a staggering 17%. If, instead of looking at "ever" you look at a duration of "6 weeks+" the story is much the same.
Note that the average (i.e. the % ever breastfed, using sampling weights) is about 45% which is way lower than pretty much anywhere else I have looked at. The US and UK data are in the low 70's. Many countries are higher. Why there is such a low average and such a steep socio-economic gradient in Ireland I don't know. But given the benefits to mother and child it should be a matter for concern - and action.

Life expectancy and socio-economic status

A useful Irish Times article documents CSO data on how life expectancy varies with socio-economic status and other variables: "Life expectancy is longest among those with the highest social class and the highest level of education. Male professional workers have a life expectancy of 81.4 years, for example, 6.1 years higher than their unskilled counterparts...For women, professional workers have the highest life expectancy, at 86 years, while unskilled workers have the lowest, 81 years."

Education and health behaviours

A priori it seems reasonable that one of the benefits of more education is better health. For a start there is a positive socioeconomic gradient: more educated people have better health on average. That does not imply one causes the other: both are forms of human capital so it could be some common factor like discount rates that drives the association. But one might think more educated people make better health investment decisions if they are more aware of health risks and there may also be direct cash effects. This paper however finds no evidence of effects.

The causal relationship between education, health and health related behaviour: Evidence from a natural experiment in England
Nils Braakmann (Newcastle University Business School)
I exploit exogenous variation in the likelihood to obtain any sort of academic degree between January- and February-born individuals for 13 academic cohorts in England. For these cohorts compulsory schooling laws interacted with the timing of the CGE and O-level exams to change the probability of obtaining an academic degree by around 2 to 3 percentage points. I then use data on individuals born in these two months from the British Labour Force Survey and the Health Survey for England to investigate the effects of education on health using being February-born as an instrument for education. The results indicate neither an effect of education on various health related measures nor an effect on health related behaviour, e.g., smoking, drinking or eating various types of food.

All Ireland Travellor Health Study Results

The All-Ireland Travellor Health study results were launched recently. Details of this are available on the website link here

One of the key findings is that Travellers of all ages continue to have much higher mortality rates than people in the general population, with Traveller men now living on average 15 years less than men in the general population and Traveller women living on average 11.5 years less than women in the general population. Deaths from respiratory diseases, cardiovascular diseases and suicides were more markedly increased in Travellers compared to the general population. The suicide rates among Traveller men were identified as 7 times higher than suicide rates among men in the general population.