Academic journal article Contemporary Economic Policy

Questions and Answers - Inequality in Mortality over the Life Course: Why Things Are Not as Bad as You Think

Academic journal article Contemporary Economic Policy

Questions and Answers - Inequality in Mortality over the Life Course: Why Things Are Not as Bad as You Think

Article excerpt


Janet Currie: I would be happy to take questions.

Bob Eisenbeis (Cumberland Advisors): In your later slides, you indicated and controlled for--or at least provided some information on--assault. We've heard a lot about death rates and murder rates, among African-American men in particular. And I wonder if you had broken that out and looked at that particular issue to see how much that explained what was going on in that cohort?

Janet Currie: I should've mentioned earlier that a lot of this work is done with Hannes Schwandt (Currie and Schwandt 2016a, 2016b, 2016c), at the University of Zurich. The work on Canada includes Michael Baker (Baker, Currie, and Schwandt 2017), at the University of Toronto. The reason I mention that now is because Michael said, when we saw the higher death rates in the United States, at all ages, compared to Canada, that it must be murders that are driving higher U.S. rates. There are a lot of murders in the United States, but there are not enough to be driving the differences in death rates at all ages. Similarly, African-Americans have a higher death rate due to assault, but that is not driving the overall higher death rates. Accidents are still a substantially larger cause of death.

Anna Klis (Northern Illinois University): I have a question regarding the increase in mortality for women from 20 to 49, from 1990 to 2010. It appears that self-harm greatly increased both in Canada and especially in the United States. Does that appear to be the driver? And if so, what kind of health policy implications might that have?

Janet Currie: There has been a big increase in percentage terms, which is very disturbing. But it is a pretty small category in absolute terms, so it is not driving that increase in mortality.

Zadia Feliciano (Queens College, CUNY): What can you tell us about obesity rates? Is there a change in obesity rates for younger children or teenagers, comparing those with higher and lower income? Because it seems like you have an emphasis on policy in terms of spending on insurance programs. What about the large increase in information about staying slimmer, exercising, etc.?

Janet Curie: The latest data from the National Health and Nutrition Examination Survey show declines in obesity for the youngest children. It is not yet clear whether that is a blip in the data or whether the trend has really turned. But there does seem to be at least some leveling off for the youngest children. For teenagers, obesity rates have continued to increase. Though, again, they are increasing at a decreasing rate. Obesity is like smoking, in that there are a lot of different policies that are aimed at trying to do something about obesity, from calorie labeling to trying to get junk food out of schools. Maybe these policies are starting to have an effect.

I think it is very hard as economists to work on these kinds of public health questions, where there are multiple policies, and try to figure out which one(s) are having an impact. But trends in child health indicators are actually pretty positive. Obesity is the one trend that has been going in the wrong direction but it may be starting to reverse.

Morris Altman (University of Newcastle, Australia): First, I am wondering what your thoughts would be, in a society where increasing inequality is a function of falling real income amongst the lower cohorts, all other things remaining the same, what type of changes in mortality and death rates, life expectancy, would you expect or anticipate? Second question, given income inequality and the level of income amongst low income Americans, what would you expect from the anticipated Trump reforms to the medical care system in the United States?

Janet Currie: That is a very long and complicated question. First, ask yourself how one might expect recent changes in inequality to affect health. A lot of the increase in inequality is in the top 1 %, and even the top 0. …

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