Cross-National Sources of Health Inequality: Education and Tobacco Use in the World Health Survey

The spread of tobacco use from the West to other parts of the world, especially among disadvantaged socioeconomic groups, raises concerns not only about the indisputable harm to global health but also about worsening health inequality. Arguments relating to economic cost and diffusion posit that rising educational disparities in tobacco use—and associated disparities in health and premature mortality—are associated with higher national income and more advanced stages of cigarette diffusion, particularly among younger persons and males. To test these arguments, we use World Health Survey data for 99,661 men and 123,953 women from 50 low-income to upper-middle–income nations. Multilevel logistic regression models show that increases in national income and cigarette diffusion widen educational disparities in smoking among young persons and men but have weaker influences among older persons and women. The results suggest that the social and economic patterns of cigarette adoption across low- and middle-income nations foretell continuing, and perhaps widening, disparities in mortality.     

Heat and adult health in China

Given projected increases in the frequency of precipitation and temperature extremes in China, we examine the extent adults may be vulnerable to climate anomalies. We link nutrition, health, and economic data from the China Health and Nutrition Survey (1989–2011) to gridded climate data to identify which socioeconomic outcomes are particularly susceptible, including adult underweight incidence, body mass index, dietary intake, physical activity, illness, income, and food prices. We find warm temperatures augment the probability of being underweight among adults, with a particularly large impact for the elderly (ages >?60). Extremely dry and warm conditions produce a 3.3-percentage point increase in underweight status for this group. Consequences on nutrition coincide with changes in illness rather than dietary, income, or purchasing power shifts. Social protection targeting areas prone to excessive heat may consider supplementing bundles of goods with a suite of health care provisions catering to the elderly.     

A Cross-National Analysis of Lifespan Inequality, 1950–2015: Examining the Distribution of Mortality Within Countries

Cross-national health research devotes considerable attention to lifespan and survival rate disparities that are found between countries. However, the distribution of mortality across the world is shaped mostly by what happens within countries. We address this striking gap in the literature by modeling length-of-life inequality for individual nation-states. We use life tables from the United Nation’s (2015) World Population Prospects to estimate inequality levels for 200 countries across 13 waves between 1950 and 2015. We find that lifespan inequality is steadily declining across the world, but that each country’s level of inequality, and the rate at which it declines, vary considerably. Our models account for more than 90% of the longitudinal and cross-sectional variation in country-level lifespan inequality during the 1990–2015 period. Maternal mortality is the strongest predictor in our model, while disease prevalence, access to safe water, and health interventions figure prominently, as well. Gross domestic product per capita shows the expected curvilinear association with lifespan inequality, while primary education (both overall enrollment and gender equity in enrollment), external debt, and migration also play critical roles in shaping health outcomes. By contrast, the distribution of political and economic resources (i.e., democracy and income inequality) is less important.

     

Disease prevalence,disease incidence,and mortality in the United States and in England

We find that both disease incidence and disease prevalence are higher among Americans in age groups 55–64 and 70–80, indicating that Americans suffer from higher past cumulative disease risk and experience higher immediate risk of new disease onset compared with the English. In contrast, age-specific mortality rates are similar in the two countries, with an even higher risk among the English after age 65. We also examine reasons for the large financial gradients in mortality in the two countries. Among 55- to 64-year-olds, we estimate similar health gradients in income and wealth in both countries, but for 70- to 80-year-olds, we find no income gradient in the United Kingdom. Standard behavioral risk factor’s (work, marriage, obesity, exercise, and smoking) almost fully explain income gradients among those aged 55–64 in both countries and a significant part among Americans 70–80 years old. The most likely explanation of the absence of an English income gradient relates to the English income benefit system: below the median, retirement benefits are largely flat and independent of past income, and hence past health, during the working years. Finally, we report evidence using a long panel of American respondents that their subsequent mortality is not related to large changes in wealth experienced during the prior 10-year period.     

Does Multiracial Matter? A Study of Racial Disparities in Self-Rated Health

How do self-identified multiracial adults fit into documented patterns of racial health disparities? We assess whether the health status of adults who view themselves as multiracial is distinctive from that of adults who maintain a single-race identity, by using a seven-year (2001–2007) pooled sample of the Behavioral Risk Factor Surveillance System (BRFSS). We explore racial differences in self-rated health between whites and several single and multiracial adults with binary logistic regression analyses and investigate whether placing these groups into a self-reported “best race” category alters patterns of health disparities. We propose four hypotheses that predict how the self-rated health status of specific multiracial groups compares with their respective component single-race counterparts, and we find substantial complexity in that no one explanatory model applies to all multiracial combinations. We also find that placing multiracial groups into a single “best race” category likely obscures the pattern of health disparities for selected groups because some multiracial adults (e.g., American Indians) tend to identify with single-race groups whose health experience they do not share.     

Comparing relative effects of education and economic resources on infant mortality in developing countries

Research on the social determinants of health has often considered education and economic resources as separate indicators of socioeconomic status. From a policy perspective, however, it is important to understand the relative strength of the effect of these social factors on health outcomes, particularly in developing countries. It is also important to examine not only the impact of education and economic resources of individuals, but also whether community and country levels of these factors affect health outcomes. This analysis uses multilevel regression models to assess the relative effects of education and economic resources on infant mortality at the family, community, and country level using data from demographic and Health Surveys in 43 low-and lower-middle-income countries. We find strong effects for both per capita gross national income and completed secondary education at the country level, but a greater impact of education within families and communities.     

The effect of natural disaster on fertility,birth spacing,and child sex ratio: evidence from a major earthquake in India

Natural disasters can lead to significant changes in health, economic, and demographic outcomes. However, the demographic effects of earthquakes have been studied only to a limited degree. This paper examines the effect of the 2001 Gujarat earthquake on reproductive outcomes. This earthquake killed more than 20,000 people; injured 167,000; and caused massive losses to property and civic assets. Using data from two large-scale District-Level Household Surveys (2002–2004 and 2007–2008), we employ difference-in-difference and fixed-effect regression models to compare the outcomes across earthquake-affected districts and their neighboring districts during 5 years before and after the earthquake. We find that the earthquake led to significant rises in childbirth rates. It also reduced birth spacing among uneducated, tribal, and Muslim women, and the incidence of male births among rural women. We find considerable variation in the demographic effects of the earthquake across location, household socioeconomic status, and parental age and education.     

Nature’s Experiment? Handedness and Early Childhood Development

In recent years, a large body of research has investigated the various factors affecting child development and the consequent impact of child development on future educational and labor market outcomes. In this article, we contribute to this literature by investigating the effect of handedness on child development. This is an important issue given that around 10% of the world’s population is left-handed and given recent research demonstrating that child development strongly affects adult outcomes. Using a large, nationally representative sample of young children, we find that the probability of a child being left-handed is not significantly related to child health at birth, family composition, parental employment, or household income. We also find robust evidence that left-handed (and mixed-handed) children perform significantly worse in nearly all measures of development than right-handed children, with the relative disadvantage being larger for boys than girls. Importantly, these differentials cannot be explained by different socioeconomic characteristics of the household, parental attitudes, or investments in learning resources.     

Relative Economic Position and Subjective Well-Being in a Poor Society: Does Relative Position Indicator Matter?

Concern for relative income (or status in general) may have important implications for poverty and individual well-being. This paper examines the impact of relative economic position on individual’s level of well-being among poor communities in rural Ethiopia. The analysis uses a self-reported measure of overall life-evaluation as a measure of individual well-being. Despite the fact that well-being is multidimensional, the impact of non-money metric measures of relative economic position on individual well-being has not been given a lot of attention in the literature. In this study, relative economic position is measured using consumption data, asset index, and respondent’s own perception of relative wealth. The asset index captures the non-monetary dimensions of economic welfare, including education, physical assets, and social capital. We use data from the 2004 and 2009 waves of the Ethiopia Rural Household Survey and employ a multilevel modelling technique to account for individual and group level heterogeneity in our empirical analysis. We find no significant relationship between individual well-being and relative economic position measured with in consumption terms. In contrast, we do find a significant negative impact of relative position on individual well-being when we use asset indices and respondent’s own perception of relative wealth to measure relative economic position. Our findings suggest that when individuals compare themselves with others, they evaluate various aspects of their life, including their financial conditions, asset holdings, and social relations, which are hardly captured by consumption or income data in many poor countries.     

Overeducation,Skills and Wage Penalty: Evidence for Spain Using PIAAC Data

Despite well documented high levels of socioeconomic inequalities, health gradients by socioeconomic status (SES) in contemporary China have been reported to be limited. Using data from the 2010–2012 China Family Panel Studies, we reexamine associations between three sets of SES—human capital, material conditions, and political capital—and self-rated health among Chinese adults 18–70 years old, capitalizing on anchoring vignette data to adjust for reporting heterogeneity. We find strong evidence of substantial variations in reporting behaviors by education, cognition, and family wealth but not by family income or political capital. Failing to correct for reporting heterogeneity can bias the estimates of SES gradients in self-rated health as much as nearly 40 %. After vignette adjustment, we find significantly positive associations of education, family income, wealth, and political capital with self-rated health. Individuals’ cognitive capacity, however, does not predict self-rated health.     

Altruism Within the Family: A Comparison of Father and Mother Using Life Happiness and Life Satisfaction

Studies on intra-household allocation of resources show that exogenous increase in mothers’ income has larger effect on children’s outcomes than the same increase in fathers’ income, suggesting gender differences may exist in parents’ altruism towards their children. Using self-reported life happiness and life satisfaction, we investigate the differences by gender in mutual altruism between father and child as well as mother and child dyads in Singapore. We found that mutual altruism exists between mother and child, but not between father and child. These findings are robust to the measure of self-reported well-being. Further, we find that gender difference in altruism of fathers and mothers is not driven by the difference in the extent of future old age support desired by fathers and mothers from their children.     

Child mortality and fertility: public vs private education

How does the effect of child mortality reductions on fertility and education vary across educational systems? To answer this question, we develop an overlapping-generations model where altruistic parents care about both the number and human capital of their surviving children. We find that, under a private education system, if income is low initially, the economy converges to a Malthusian stagnation steady state. For a high level of initial income, the economy reaches a growth path in which children’s education rises and fertility decreases with income. In the growth regime under private education, exogenous shocks that lower child mortality are detrimental for growth: fertility increases and education declines. In contrast, under a public education system, the stagnation steady state does not exist, and health improvement shocks are no longer detrimental for growth. We therefore offer a new rationale for the introduction of public education.     

Unraveling Health Disparities Among Sexual and Gender Minorities: A Commentary on the Persistent Impact of Stigma

ABSTRACT

LGBT (lesbian, gay, bisexual, and transgender) populations experience disparities in health outcomes, both physical and mental, compared to their heterosexual and cisgender peers. This commentary confronts the view held by some researchers that the disparate rates of mental health problems reported among LGBT populations are the consequences of pursuing a particular life trajectory, rather than resulting from the corrosive and persistent impact of stigma. Suggesting that mental health disparities among LGBT populations arise internally, de novo, when individuals express non-heterosexual and non-conforming gender identities ignores the vast body of evidence documenting the destructive impact of socially mediated stigma and systemic discrimination on health outcomes for a number of minorities, including sexual and gender minorities. Furthermore, such thinking is antithetical to widely accepted standards of health and wellbeing because it implies that LGBT persons should adopt and live out identities that contradict or deny their innermost feelings of self.     

Inequality, Wealth and Health: Is Decreasing Income Inequality the Key to Create Healthier Societies?

The idea that the level of stratification of societies contributes to the well-being of their members is gaining popularity. We contribute to this debate by investigating whether reducing inequalities in the income distribution of societies is a strategy for improving population health, especially appropriate for those countries that have reached the limits of economic growth. We test this idea on a dataset covering 140 countries and 2360 country-year observation between 1987 and 2008 and formulate hypotheses separately for countries with different level of economic development. We indeed found that countries with higher levels of income inequality also have lower levels of life expectancy (our measure of population health), and this result was consistent both in cross-sectional and longitudinal analyses. However, the relationship was found only among low- and middle-developed countries. In the group of high-developed countries, the relationship between income inequality and life expectancy was non-significant, which contradicts the literature. Expectations on the relationship between a country’s wealth and health were confirmed: economic growth does contribute to improving population health, but this effect is weaker in more economically developed countries. These results imply that a decrease in a country’s income inequality parallel with an increase in its wealth can help to improve health in economically lesser-developed countries, but not in high-developed countries.     

The Impact of Macro-Economic Circumstances and Social Protection Expenditure on Economic Deprivation in 25 European Countries, 2007–2011

In this study, we investigate to what extent macro-economic circumstances and social protection expenditure affect economic deprivation. We use three items from round five of the European Social Survey (2010–2011) to construct our latent outcome variable, which we label economic deprivation in the 3 years before 2010–2011. The results of our linear multilevel regression analyses indicate that in countries that perform worse economically, individual experiences of economic deprivation are more prevalent: the stronger the rise in the unemployment rate and the lower a country’s wealth, the more economic deprivation individuals experience. We also find that in countries with high levels of social protection, people experience less economic deprivation as compared to countries with low levels of social protection. In turn, adverse economic conditions in a country temper these positive outcomes of social welfare arrangements. Finally, our study reveals that the strength of the relationship between a low income and economic deprivation strongly varies according to the economic circumstances in a country and the generosity of the welfare state.     

Are Migrants Going Up a Blind Alley? Economic Migration and Life Satisfaction around the World: Cross-National Evidence from Europe, North America and Australia

Are migrants satisfied with their decision to move to another country? Research shows that the income-wellbeing relationship is weak in wealthy countries, usually countries of destination. Are then economic migrants mistaken? Employing data from the Gallup World Poll, a representative sample of the world population, we investigate whether a general pattern of association exists between income and the cognitive component of subjective wellbeing, and whether this pattern differs by immigration status in 16 high-income countries. In only a handful of countries do we find a distinctive immigrant advantage in translating income into higher life evaluation or life satisfaction: Australia, Belgium, the Netherlands, Portugal and Sweden. For immigrants in most of these countries, income increases cognitive wellbeing even in the fifth income quintile. Depending on the measure used, immigrants in Canada, Denmark, Finland, Italy and the US only have positive income-wellbeing associations at or below the third quintile. We take this as evidence that, among recent arrivals, income is positively associated with wellbeing up to the point in which non-pecuniary factors associated with long-term residence become dominant. We also find a number of “frustrated achievers” among the foreign born in the US, France and Finland. These immigrants report a negative association, in absolute value, between income and life satisfaction or life evaluation.     

Gender differences in the link between childhood socioeconomic conditions and heart attack risk in adulthood

A growing body of evidence shows that childhood socioeconomic status (SES) is predictive of disease risk in later life, with those from the most disadvantaged backgrounds more likely to experience poor adult-health outcomes. Most of these studies, however are based on middle-aged male populations and pay insufficient attention to the pathways between childhood risks and specific adult disorders. This article examines gender differences in the link between childhood SES and heart attack risk trajectories and the mechanisms by which early environments affect future disease risk. By using methods that model both latent and path-specific influences, we identify heterogeneity in early life conditions and human, social, and health capital in adulthood that contribute to diverse heart attack risk trajectories between and among men and women as they age into their 60s and 70s. We find that key risk factors for heart attack operate differently for men and women. For men, childhood SES does not differentiate those at low, increasing, and high risk for heart attack. In contrast, women who grew up without a father and/or under adverse economic conditions are the most likely to experience elevated risk for heart attack, even after we adjust for the unequal distribution of working and living conditions, social relationships, access to health care, and adult lifestyle behaviors that influence health outcomes.