Nancy Folbre, economist at UMass-Amherst, has a thought-provoking piece on yesterday's NY Times Economix Blog, "Born to Lose: Health Inequality at Birth."In the post, she summarizes some of the work by Princeton's Janet Currie and others, on the relationship between health disadvantages at birth, and future economic well-being and educational achievement.
One of the most fascinating and important interdisciplinary research agendas of the last decade has been the effort by economists, sociologists and epidemiologists to understand how inequality is reproduced in the developed world, and how/why inequality matters. To the extent that I have any optimism left about the possibility of a more just America, it is based on my reading of this literature. Of course, as a theoretical and empirical matter this question (inequality) is hardly new; the reproduction of capitalist class relations has generated some of the most insightful intellectual work of the past 150 years, starting with Marx.
But this work -- typified for me by the vital work of Richard Wilkinson and Kate Pickett in Great Britain, and James Heckman, Thomas Shapiro/Melvin Oliver, and Annette Lareau in the US -- is different. It isn't theoretical, at least not primarily. Rather, it seeks to understand how inequality is partly rooted in such things as pre-natal and and infant health, the environmental factors shaping cognitive development, social capital, nutrition, exposure to violence, the correlation of all of these things with place, and the overall income and wealth inequality in the society in which children are raised. It acknowledges the vital importance of resources, of course (family income and wealth), and the power that shapes their distribution. But it also attempts to show us why and how a lack of wealth and income matters -- how it shapes places, families, bodies, minds, and ways of seeing the world. In the context of the US, as I have argued elsewhere (and will argue further here in the future), the ubiquity of racial and economic segregation also appears to profoundly shape all of these things, and thus the distribution of primary social goods. It is (and will be) my contention that untying the knot of metropolitan segregation is likely to unravel many more things. But more on that later.
I see 3 absolutely vital (and interrelated) insights coming from this stuff:
1. International comparisons (see Wilkinson's work with Kate Pickett) reveal that income inequality within developed societies tends to have enormous impacts on health, culture and quality of life for all citizens, not just the least privileged. In other words, citizens living in societies with great inequalities of income tend to have worse outcomes in terms of mental health, obesity, social trust, exposure to violence, life expectancy, and social mobility. The statistical correlations are simply too strong and consistent not to be at least in part causative. The graph below comes from Wilkinson and Pickett, and can be found on their website. Note the strong relationship between income inequality and infant mortality, which appears to be recursive -- in other words, inequality leads to high infant mortality rates, which tends to reproduce inequality, etc.
2. Policy matters, because those developed nations with less inequality (and the improved quality of life that seems to stem from it) are more equal because they have chosen it -- its not culture that matters here, or economic growth. And just as the circle of inequality is vicious, the circle of equality is virtuous: in so far as a society chooses to be more equal, it tends to be more willing to make decisions (even sacrifices) that will benefit the collective good.
Here is a brief 3 minute summary of Wilkinson and Pickett's work (and its implications), by the authors themselves:
3. Policy also matters, because this research indicates that targeted early interventions (in terms of health, cognitive development, and even parenting) are both more effective and more economically efficient than the American social safety net tends to be, particularly if they are undertaken as part of a larger effort to reshape labor markets, regulations, and safety net policies toward greater equality and less insecurity.
Folbre, in her article, reminds us that scholars have long argued that low birth weight is an important predictor of future health problems, as well as future earnings problems. Indeed, they demonstrate statistical effects almost as strong as children’s test scores, in terms of predicting future outcomes. And of course, test scores and educational achievement are themselves powerfully subject to early childhood health issues. Among other things, for example, low birth weight increases the probability of suffering from attention deficit hyperactivity disorder and lowers the probability of graduating from high school. Dropping out, in turn, increases the likelihood of giving birth to infants with low birth weight. Summarizing recent findings, Janet Currie finds that children of black mothers who dropped out of high school are three times as likely as children of white college-educated mothers to suffer low birth weight.
Many of the mechanisms that underlie this inequality are linked to characteristics of the physical environment, such as exposure to environmental toxins. These are of course deeply tied to place, to geography; in the U.S., this means that economic and racial segregation tend to magnify these inequalities. Currie’s work, for example, shows that black and Latino children are "significantly more likely than white children to be born to mothers living in proximity to such hazards, supporting arguments long made by environmental justice advocates."
Here is clearly a case where policy matters, as I indicated above. Stricter environmental regulation, along with efforts to reduce racial and class segregation, are likely to affect infant health...which will, in turn, affect schooling and earnings later in life for low-income kids. Research on environmental regulation backs this up, indicating that laws like the 1970 Clean Air Act have helped to reduce infant mortality in the U.S.
Folbre makes the point well:
Greater publicity for economic research on the impact of regulation might quiet critics of the Environmental Protection Agency, who often focus on its short-term costs rather than its long-term benefits. Would changing its name — perhaps to the Environmental Child-Protection Agency — help win over the family-values crowd?
I will have much more to say about all of this research and implications in the coming weeks, when my students begin to read Wilkinson and Pickett's book. Clearly, policy interventions that affect the very young have two great virtues: they can appeal to a broad swath of the American public, and they are much more likely to work than what we have thus far tried.
I remember you discussing this with me a few weeks ago. It is an interesting topic. I had to look up causes of preterm labor on good ole Wikipedia I admit, and now recall that most premature deliveries are of unknown cause. Interestingly race may play a large role; however in going over many of the other possible causes, poor prenatal care is probably significant as is maternal stress.
Here are a couple of other areas that are of interest and may go against the grain of common thinking a bit:
(1) "Hard times or good times? Inequalities in the health effects of economic change" in Int J Public Health (2011) 56:3–5 - very interestingly points that - "A ‘pro-cyclical’ relationship
has been reported in several studies; i.e. mortality rates get
worse when the economy is growing and improve during
periods of economic recession (Gerdtham and Ruhm 2006;
Ruhm 2000; Tapia Granados 2005; Tapia Granados and Ionides
2008; Laporte 2004; Neumayer 2004). In other words,
economic recession is associated with relatively good population
health. Many mechanisms have been put forward to
explain this, including an increase in work demands and
working hours during periods of growth, heavier traffic
generating more accidents, increase in consumption of
alcohol (Ruhmand Black 2002) and tobacco (Ruhm2000), as
well as reductions in physical activity levels (Ruhm 2000),
leisure time and social interactions. However, in this commentary,
we argue that not only do the health effects of the
macroeconomic cycle vary in respect to how key factors are
measured (i.e. competing measures of the economic cycle,
lag effect, variation by health outcome), but they also depend
on individuals’ characteristics and place of residence."
(2) "Cross-National Comparisons of Time Trends in Overweight Inequality by
Socioeconomic Status Among Women Using Repeated Cross-Sectional Surveys
From 37 Developing Countries, 1989–2007" in American Journal of Epidemiology 2011 - points out among other findings that in countries with high GDP AND high income inequality that it is the wealthier group who is more overweight, wherease in the high GDP AND low inequality, it is the lower classes that are overweight.
Thanks for this Mason. Really interesting stuff! I wonder if the "Hard Times or Good Times" study might find different results if they correlated their findings with cross-national measures of income inequality? In other words, I wonder if recessions have the same effects on health regardless of the inequality of a given society?
Part of Wilkinson and Pickett's argument, as I understand it, is that unequal societies tend to generate higher levels of stress across the class structure. Certainly there is evidence to indicate that stress levels in periods of high unemployment go up (particularly for the jobless themselves, of course). I imagine that is more true in the US, however, where we lack the safety net that other wealthy nations have.
Hard to unpack all of this, and figure out which variables are causative -- but its all really important too!
2 download s128
4 cbet hondablack
6 daftar osg777
8 daftar game slot joker
Post a Comment