Key Sources Flashcards
(102 cards)
Jensen and Miller, 2007
Socioeconomic determinants of health inequalities within countries:
o Food culture
Giffen behavior = a situation in which consumers respond to an increase in the price of a good by demanding more of it
Subsidizing the prices of dietary staples for extremely poor households in two provinces of China, found strong evidence of Giffen behavior for rice in Hunan, and weaker evidence for wheat in Gansu
The data provide new insight into the consumption behavior of the poor, who act as though maximizing utility subject to subsistence concerns, with both demand and calorie elasticities depending significantly, and non-linearly, on the severity of their poverty
Understanding this heterogeneity is important for the effective design of welfare programs for the poor
Inequalities in Health: Report of a Research Working Group (1980) (‘Black report’)
The working group on inequalities in health, chaired by Sir Douglas Black, had been commissioned in 1977 by the Labour government to investigate the variation in health outcomes across social classes and consider the causes and policy implications
- Artefact – argument that way in which data was being measured over time had changed (REJECTED as an explanation for health inequalities)
- Genetics – people in poorer sociological conditions more likely to marry others in poorer sociological conditions (REJECTED)
- Social selection – those with health conditions may end up in lower paying jobs (not found to be a main driver of socioeconomic health inequalities)
- Healthcare – access (plausible?)
- Behavior – diet, etc. (plausible?)
- Material deprivation – experience of being poor (found to be primary driver of health inequalities)
The report found inequalities in access to health services, particularly preventative services, with low rates of uptake by the working classes
The group’s recommendations focused on increased government intervention and spending in community health and primary care, but also on broader social policy such as increasing child benefit, improving housing and agreeing minimum working conditions with unions
Michael Marmot, 2004
‘Health and longevity are intimately related to [relative] position in the social hierarchy’
Relative position in the social hierarchy, rather than absolute wealth, is what matters in determining health inequalities
Captain John Graunt
Started publishing causes of death in London in the 15th century
Used socio-epidemiological tools to demonstrate that people die of different things, and at differing rates
‘Lives on the Line’
Shows life expectancies in London by tube station—health inequalities evident even within a city
Grossman, 1972
Suggests that education may result in increased productivity in activities associated with the ‘production of health,’ raising the benefits of health inputs such as doctor visits and therefore making an individual more efficient in producing health
Cutler and Lleras-Muney, 2010; Rosenzweig and Schulz, 1981
Propose that education serves to affect health-relevant behaviors such as drinking, smoking, dietary choices, and adherence to safety precautions, perhaps by directly teaching what is healthy, or by producing educated people who are better able to both obtain and critically evaluate health information, as is suggested by Kenkel, 1991, Nayga, 2000, and de Walque, 2007
Kenkel, 1991; Nayga, 2000; de Walque, 2007
Suggest that education affects health-relevant behaviors by producing educated people who are better able to both obtain and critically evaluate health information
Lochner, 2012; Oreopoulos and Salvanes, 2011
Postulate other channels through which education can affect health outcomes, such as by raising income and therefore facilitating the purchase of healthier foods, as well as residence in healthier environments and acquisition of better health insurance
o Oreopoulos and Salvanes also argue that schooling improves trust and social interaction
Becker and Mulligan, 1997; Fuchs, 1982
Hypothesize that education might improve health and health behaviors by positively affecting certain psychological predispositions, such as sense of control and time preferences
Gathmann, Jürges, and Reinhold, 2015: overview
In an effort to establish the existence of a causal relationship between education and health, as well as to reconcile the divergent results found in much of the previous literature, Gathmann, Jürges, and Reinhold (2015) conduct a multi-country analysis, examining 18 compulsory schooling reforms implemented in European countries over the course of the twentieth century to estimate the average effect of compulsory schooling on mortality
In doing so, they compare various time periods and countries using harmonized data, rather than relying upon the different data sources and mortality measures frequently utilized by preceding studies
This analysis illuminates whether compulsory schooling reforms have a comparable effect on mortality rates across a range of diverse settings and countries, ultimately granting a better understanding of whether the treatment effects of these reforms are systematically associated with the characteristics of a given country
Gathmann, Jürges, and Reinhold: conclusions (1)
The first key takeaway from the multi-country analysis described in the paper is that, throughout the 20th century, compulsory education reforms carried a stronger effect on health among men than women, with the authors finding that, on average, a lengthening of compulsory schooling resulted in small reductions in mortality among men, but finding no significant reductions in mortality for women
Though the risk of dying between the ages of 18 and 38—the 20-year mortality rate—is reduced by 2.9% for men, with similar effects found for 30- to 50-year mortality, women’s mortality is not affected by the schooling reforms at any age
Various explanatory mechanisms for these asymmetrical effects are explored:
o The authors ultimately find that the disparities CANNOT be attributed to gendered differences in compliance with the new schooling laws, since, on average, the reforms have increased years in school by roughly the same amount for both genders: 0.501 for men and 0.541 for women
o Moreover, they find NO SUBSTANTIATION for the plausible explanation that the health benefits of compulsory schooling are realized through labor market participation, such as via higher earnings or higher occupational status, the idea being that lower rates of female participation in the labor market may account for the negligible effects of (especially earlier) reforms on female mortality
o Though the authors do not possess the data necessary to test this theorized relationship empirically, they suggest that the differential effect could potentially be the consequence of gender-specific occupational choices, with men traditionally overrepresented in blue-collar jobs, and therefore exposed in greater numbers to occupational health hazards (through greater educational attainment, a proportion of these men may have been able to acquire less dangerous white-collar jobs)
Gathmann, Jürges, and Reinhold: conclusions (2)
The second key finding of the study is that early twentieth century reforms are altogether more effective in reducing mortality than later reforms
The authors write, “Across alternative specifications, the effects on male mortality are larger if the education reform is implemented prior to 1930. On average, these reforms reduce male mortality between the ages 18 and 38 by 6.4%. In contrast, reforms implemented after 1970 reduce male mortality between the ages 18 and 38 by just 1.2%”
One proposed explanation for this pattern is that the earlier reforms increase the average school leaving age by more years than the later reforms:
o The authors do find that mortality reductions (indicated by an odds ratio smaller than one) are positively correlated with the effect of a given compulsory schooling reform on educational attainment, although THIS CORRELATION EXISTS TO A MUCH LESSER EXTENT FOR WOMEN
The authors recognize the possibility that reductions in mortality could be greater for the early reforms because compulsory schooling proves particularly effective when baseline educational attainment is low:
o However, they ultimately DISMISS THIS HYPOTHESIS, finding that the relationship between the minimum schooling requirements in place immediately before a reform and the estimate of the reform effects on mortality is very weak for men, and essentially nonexistent for women
The paper further postulates that if average income levels are low and/or poverty rates are high, additional compulsory education might beget higher income, and therefore potentially facilitate more health-improving investments:
o Using data on GDP per capita in the years around the reform as a proxy for average income, the authors find that reductions in mortality among men are slightly larger in countries with lower GDP per capita, but THERE IS NO EQUIVALENT RELATIONSHIP FOR WOMEN
o These results are in keeping with evidence from a Swedish compulsory schooling reform study that demonstrated stronger mortality reductions for men who came from more disadvantaged socioeconomic backgrounds (Meghir et al., 2012)
Gathmann, Jürges, and Reinhold, 2015: in sum
The evidence collected by the authors “strongly suggests that conflicting results reported in the previous literature [on the causal effects of formal education on health outcomes] are not a coincidence but rather a systematic feature of different reform settings”
Sen
Theories about the origins of health inequalities:
Capabilities
o Not necessarily interested in the set of outcomes people experience, but rather in their possibilities or capabilities
- Retaining the sense of individuality/preferences
o Things like status matter—an individual’s capacities/capabilities are shaped by how society views them
o What it means to have a ‘good life’ is contingent upon the country/society in which an individual is embedded
Piketty
Income inequality and health: mechanisms
o Share of growth: In countries with larger income inequality, the wealthier receive a greater share of economic growth than the poor
Kimberlé Williams Crenshaw
Intersectionality:
o Multiplicity
o E.g., position of black women within an institutional setting diminished on two accounts – black, women
o Institutional context important here
Thomas Shapiro, “Toxic Inequality”
Discrimination and health: Poverty
o Structural racism –> dispossession, economic exclusion –> poverty
o Inherited/accumulated wealth
- Intergenerational inequality
Matthew, Rodrigue, and Reeves, 2016; Reeves and Matthew, 2016
Black babies remain more than twice as likely as their white counterparts to die within the first year of life, even when adjusting for maternal education and income level; in fact, as reported by the Centers for Disease Control and Prevention, a black woman in the United States with an advanced/professional degree faces a higher probability of losing her infant than does a white woman who possesses an eighth-grade education or less
Creanga et al., 2017
Maternal mortality also disproportionately affects black women, perhaps to an even greater extent than infant mortality—between the years 2011 and 2013, pregnancy-related mortality ratios for non-Hispanic black women in the U.S. exceeded those of non-Hispanic white women by a factor of 3.4, with similar trends evident in the period 2006-2010
David and Collins, 2007
Representative of the consensus forged by the field at large in recent years, David and Collins conclude that “[o]verall patterns of racial disparities in mortality and secular changes in rates of prematurity as well as birth-weight patterns in infants of African immigrant populations contradict the genetic theory of race and point toward social mechanisms”
Perhaps the rival explanation most commonly offered for the disproportionately high rates of infant and maternal mortality witnessed among African Americans invokes alleged differences in genetic predispositions to various health-related conditions, with one’s race effectively treated as “a proxy for geographic ancestry and genetics”
Should we proceed under the assumption that genes and ancestry are primarily responsible for disparities in birth outcomes, then would we expect birthweight patterns of African immigrants to the United States to be comparable to those of native-born black Americans—this is not the case:
o Comparing the birth-weights of US-born white women, US-born black women, and African-born black women over a period of 15 years, David and Collins (2007) find that “[t]he overall birth-weight distributions for infants of US-born White women and African-born women were almost identical, with US-born Black women’s infants comprising a distinctly different population, weighing hundreds of grams less”
o Thus, David determined “there was something about growing up black in the United States and then bearing a child that was associated with lower birth weight” (as cited in Chatterjee and Davis, 2017, para. 24)
Levy and Sidel, 2006
Social injustice = “the denial or violation of economic, sociocultural, political, civil, or human rights of specific populations or groups in the society based on the perception of their inferiority by those with more power or influence”
o Insofar as public health is concerned, Levy and Sidel define inequity—injustice—as occurring in the presence of “systematic disparities in health (or in the major social determinants of health) between social groups that have different levels of underlying social advantage or disadvantage—that is, different positions in a social hierarchy”
If genetic composition did in fact prove to be the driving force behind racial variations in infant and maternal outcomes, then any claim of social injustice would become much more tenuous, since no “denial or violation of economic, sociocultural, political, civil, or human rights” would be occurring, and there would arguably exist no “systematic disparities in health…between social groups”, at least insofar as we understand ‘systematic’ to refer to the operations of social institutions
Collins and David, 1990
The last decade of the twentieth century saw the publication of studies that challenged or directly contradicted the risk factors traditionally thought responsible for the worsened neonatal outcomes of black babies relative to their white counterparts; namely, poverty and lack of education
o Researchers found that even middle-class, educated black women carried a higher relative risk of giving birth to smaller, premature babies who were less likely to survive, a finding which served to cast significant doubt upon the commonly accepted theory that greater risk of poverty, combined with reduced likelihood of having completed education before bearing children, can account for much of the considerably higher rates of mortality among infants born to black women
Collins et al., 2004; Mustillo et al., 2004
The last decade of the twentieth century saw the publication of studies that challenged or directly contradicted the risk factors traditionally thought responsible for the worsened neonatal outcomes of black babies relative to their white counterparts; namely, poverty and lack of education
o Continued research into the potential causes of the relatively poor pregnancy outcomes experienced by this group eventually gave rise to a new dominant narrative—that cumulative exposure to racism and racial discrimination throughout the course of a black woman’s lifetime represents an independent risk factor for preterm delivery and low birthweight, which in turn increases the probability of infant mortality by a large margin
