Might American deaths of despair spread to other developed countries? On the one hand, perhaps not. Parsing the data shows just how uniquely bleak the situation is in the United States. When it comes to deaths of despair, the United States is hopefully less a bellwether than a warning, an example for the rest of the world of what to avoid. On the other hand, there are genuine reasons for concern. Already, deaths from drug overdose, alcohol, and suicide are on the rise in Australia, Canada, Ireland, and the United Kingdom. Although those countries have better health-care systems, stronger safety nets, and better control of opioids than the United States, their less educated citizens also face the relentless threats of globalization, outsourcing, and automation that erode working-class ways of life throughout the West and have helped fuel the crisis of deaths of despair in the United States.
In the past, gains in longevity went hand in hand with broader improvements in health-care systems, governance, and infrastructure. That meant the byproducts of better health—a growing young work force, less deadly cities, and a shift in countries’ health-care needs to the problems of older people—were sources of wider prosperity and inclusion. Today, improvements in health are driven more by targeted medical interventions and international aid than by general development. Without that development, the changes that now accompany declines in infectious diseases are potential sources of instability: rising youth unemployment, overcrowded and underbuilt cities, surging rates of premature chronic diseases, and more migration.
Although the decline in marriage has been cited as a possible contributor to the “despair” afflicting marginalized White communities, these studies have not directly considered mortality by marital status. This paper uses complete death certificate data from the Mortality Multiple Cause Files with American Community Survey data to examine age-specific mortality rates for married and non-married people from 2007 to 2017. The overall rise in White mortality is limited almost exclusively to those who are not married, for men and women. By comparison, mortality for Blacks and Hispanics has fallen or remained flat regardless of marital status (except for young, single Hispanic men). Analysis by education level shows death rates have risen most for Whites with the lowest education, but have also increased for those with high school or some college. Because mortality has risen faster for unmarried Whites at all but the lowest education levels, there has been an increase in the marriage mortality ratio. Mortality differentials are an increasingly important component of the social hierarchy associated with marital status.
SeaTE: Subjective ex ante Treatment Effect of Health on Retirement by Pamela Giustinelli, Matthew D. Shapiro :: SSRNJanuary 2, 2019
This paper develops an innovative approach to measuring the effect of health on retirement. The approach elicits subjective probabilities of working at specified time horizons fixing health level. Using a treatment-effect framework, within-individual differences in elicited probabilities of working given health yield individual-level estimates of the causal effect of health (the treatment) on working (the outcome). We call this effect the Subjective ex ante Treatment Effect (SeaTE). The paper then develops a dynamic programming framework for the SeaTE. This framework allows measurement of individual-level value functions that map directly into the dynamic programming model commonly used in structural microeconometric analysis of retirement. The paper analyzes conditional probabilities elicited in the Vanguard Research Initiative (VRI)—a survey of older Americans with positive assets. Among workers 58 and older, a shift from high to low health would on average reduce the odds of working by 28.5 percentage points at a two-year horizon and 25.7 percentage points at a four-year horizon. There is substantial variability across individuals around these average SeaTEs, so there is substantial heterogeneity in taste for work or returns to work. This heterogeneity would be normally unobservable and hard to disentangle from other determinants of retirement in data on realized labor supply decisions and health states. The paper’s approach can overcome the problem that estimates of the effect of health on labor supply based on behavioral (realizations) data can easily overstate the effect of health on retirement whenever less healthy workers tend to retire earlier for reasons other than health.
The Unintended Consequences of Flexicurity: The Health Consequences of Flexible Employment by Keith A. Bender, Ioannis Theodossiou :: SSRNJanuary 2, 2019
While atypical employment contracts offer flexibility in the labor market, these kinds of contracts are inherently insecure and may generate stress among affected workers. This study examines the impact of atypical forms of employment (specifically seasonal or temporary jobs or a fixed time contracts) on workers’ health. Survival analysis shows that, other things equal, the longer percent of time spent in flexible employment contracts increases the odds of falling into ill health for a variety of health conditions. The results are robust to controlling for the endogeneity in the relationship.
Informal Bankruptcy: Health Expenditure Shocks and Financial Distress Avoidance by G. Nathan Dong :: SSRNOctober 19, 2018
This article studies the financial decision-making behavior of U.S. families that have difficulties paying for their medical bills and investigate what alternatives they have to avoid filing for formal bankruptcy and what influence their motivation to do so. Using household financial and demographic information from the Health Tracking Household Survey in 2007 and 2010, this article finds that families with younger age members, minority ethnic background, more doctor visits, and without insurance made more diverse and severe choices to finance the payments before resorting to personal bankruptcy. Interestingly, households with better education seek more diverse but easier financing methods, suggesting that financial literacy may play a dual role in undertaking financial planning—strategic default and bankruptcy avoiding.
The Relationship between Reverse Mortgage Borrowing, Domain and Life Satisfaction by Cäzilia Loibl, Donald R. Haurin, Julia Brown, Stephanie Moulton :: SSRNOctober 19, 2018
Objectives: Reverse mortgages allow adults aged 62 and older to borrow against the equity in their homes without incurring monthly loan repayments.
This study examines the relationship of reverse mortgage borrowing with older adults’ satisfaction with their financial situation, housing, health, and daily life/leisure as well as with life as a whole.
Method: A new national data set of 1,088 older adults, comprised of loan data, credit histories, and responses to a phone survey, was created. Our estimation strategy compares reverse mortgage borrowers to older adults who obtained mandatory counseling but not a reverse mortgage.
Results: Reverse mortgage borrowers have significantly higher financial and housing satisfaction compared to non-borrowers; no differences were found for health, daily life/leisure, and general satisfaction. These satisfaction domains contribute differently to general satisfaction for reverse mortgage borrowers relative to non-borrowers: housing satisfaction has a greater influence for borrowers and health a greater influence for non-borrowers.
Discussion: Our study provides new knowledge about the longer-term outcomes of reverse mortgage borrowers. The positive association of reverse mortgage borrowing for housing and financial satisfaction and, in turn, general satisfaction, provides insights regarding borrower experiences with this controversial financial tool.