These roots [of health inequalities] lie primarily in what Dr. Marmot identifies as the social determinants of health (SDH). These are not simply economic, although of course poverty is associated with bad health—a link established in the 19th century by Edwin Chadwick in Britain and Lemuel Shattuck in the U.S. But “poverty is not destiny,” Dr. Marmot insists. Rather, he seeks to develop a model of SDH that is intrinsically linked with human autonomy and control. Prosperity brings all sorts of empowerments, just as poverty denies them. It is the empowerment rather than the absolute poverty that he believes is most crucial.
For the poorest 50 percent of countries in 1960, the growth in full income was 4.1 percent, of which only 2.4 percentage points were attributed to GDP growth. This was in contrast to the richest 50 percent of countries that had a growth in full income of 2.6 percent, of which most of it was due to GDP growth, i.e., 2.2 percentage points. Thus, the poorest and richest countries grew at about the same rate in GDP, 2.4 percent vs 2.2 percent, but the poorer countries grew much faster when incorporating health into the full income, 4.1 percent vs 2.6 percent
In sum, valuing gains in national levels of health between 1960 and 2000 is an important component of reducing overall world inequality. Once health is accounted for, there was a significant reduction in inequality throughout the world between 1960 and 2000 that cannot be perceived from measuring income alone.
Our use of fossil fuels, Mr. Epstein says, correlates with dramatic increases in life expectancy and income, especially in the developing world. No other technology available to us today can meet the energy needs of everyone on the planet. The average American uses machine energy of 186,000 calories per day, equal to that produced by 93 physical laborers, and the vast majority of this is produced by fossil fuels. These fuels, Mr. Epstein writes, have turned us into “supermen” compared to our ancestors. “Mankind’s use of fossil fuels is supremely virtuous—because human life is the standard of value, and because using fossil fuels transforms our environment to make it wonderful for human life.”
Public health insurance programs comprise a large share of federal and state government expenditure, and these programs are due to be expanded as part of the 2010 Affordable Care Act. Despite a large literature on the effects of these programs on health care utilization and health outcomes, little prior work has examined the long-term effects of these programs and resultant health improvements on important outcomes, such as educational attainment. We contribute to filling this gap in the literature by examining the effects of the public insurance expansions among children in the 1980s and 1990s on their future educational attainment. Our findings indicate that expanding health insurance coverage for low-income children has large effects on high school completion, college attendance and college completion. These estimates are robust to only using federal Medicaid expansions, and they are mostly due to expansions that occur when the children are older i.e., not newborns. We present suggestive evidence that better health is one of the mechanisms driving our results by showing that Medicaid eligibility when young translated into better teen health. Overall, our results indicate that the long-run benefits of public health insurance are substantial.
Now, the World Bank’s David Evans and Anna Popova are out with a new paper reviewing what evidence is out there about aid to the global poor and alcohol/tobacco consumption. They found 19 studies which attempted to measure the effect of cash transfers — both no strings attached ones and ones families receive if they fulfill certain conditions, like school attendance — on the purchase and consumption of “temptation goods”; the studies contained a total of 44 estimates of cash’s effect in various contexts. 82 percent of those estimates showed that the transfers reduced consumption of or spending on alcohol and tobacco. The vast majority of those weren’t statistically significant, so the best conclusion is that there’s no evidence transfers affect drinking or smoking behavior.
We know health insurance influences health — but can it change educational outcomes, too? A new study says yes.The paper, recently published by the National Bureau of Economic Research, examined expansions of Medicaid in the 1980s and 1990s. The authors found that the expansions resulted in consistent improvements in high school and college attainment.A 10 percentage point increase in childhood Medicaid eligibility reduced the rate of high school dropouts by 5 percent and increased completion of a bachelor’s degree by 3.3 to 3.7 percent.
A paper written in 2003 by David Kindig and Greg Stoddard in the American Journal of Public Health took a stab at it. They write –Although the term “population health” has been much more commonly used in Canada than in the United States, a precise definition has not been agreed upon even in Canada, where the concept it denotes has gained some prominence.They proceeded to define it as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” They go on to explain –We support the idea that a hallmark of the field of population health is significant attention to the multiple determinants of such health outcomes, however measured. These determinants include medical care, public health interventions, aspects of the social environment income, education, employment, social support, culture and of the physical environment urban design, clean air and water, genetics, and individual behavior.In other words: Everything under the sun.Such an all-inclusive definition is not very helpful, so people keep trying. Ten years later Michael Stoto gave it a shot in a paper published by Academy Health, “Population Health in the Affordable Care Act Era.” This paper spends half its space explaining some of the different definitions currently in use. The balance of the paper is suggesting to researchers how they can tailor their projects to take advantage of funding opportunities presented by ObamaCare.