Sunday, August 13, 2017

mortality inequality and increases in mortality

Democrats spend a lot of political energy on "inequality" these days. But it seems like mostly a convenient tool to grasp for power. How and why? That's a separate blog post. Here, I'm going to focus on inequality in mortality and recent increases in mortality-- and why these will get limited attention and a focus on symptoms over primary causes.  

First, consider Sam Peltzman's 2009 journal article on mortality inequality. Peltzman notes that a consideration of income or wealth inequality is incomplete if not accompanied by a measure of lifespan inequality-- whether underestimating inequality (if lifespans are an extension of other inequalities) or overestimating inequality (if lifespans counter other inequalities or are if lifespans are roughly equivalent). Generally, income and lifespan are positively related, but the correlation sharply decreases both within and between countries, at higher income levels. Longevity was a larger source of inequality in days past, so inequality in this sense has dropped dramatically. Peltzman calculates a "mortality Gini coefficient" for countries-- and shows the results at a point in time and across time periods. Then he analyzes state and county level data-- with state-level convergence by 1960, but continued correlation at the county level. Very cool!

Second, consider recent work by Case and Deaton on shorter lifespans and increased mortality and morbidity rates in the US for Caucasians in midlife since the turn of the 21st century. (This is despite big improvements with cancer and heart attacks-- the biggies.) These trends "continued unabated to 2015, with additional increases in drug overdoses, suicides, and alcoholic-related liver mortality, particularly among those with a high-school degree or less." This problem has presumably gotten worse since the close of their data in 2010. The problems here are connected to lifestyle choices and a lack of hope-- what Case and Deaton call "death by despair".

Compared to other developed countries: "Mortality rates in comparable rich countries have continued their pre-millennial fall at the rates that used to characterize the US." And in Europe, this includes those with more or less education. So, this is a problem special to the US

Falling incomes may be part of the story, but we don't see the same results with the same income profiles of other races or Europeans. Looking at education: "Mortality is rising for those without, and falling for those with, a college degree. This is true for non-Hispanic white men and women in all age groups from 25-29 through 60-64. Mortality rates among blacks and Hispanics continue to fall..." So, it's connected to less-educated folks.

Their theory: "We propose a preliminary but plausible story in which cumulative disadvantage over life, in the labor market, in marriage and child outcomes, and in health, is triggered by progressively worsening labor market opportunities at the time of entry for whites with low levels of education." If so, it will take years to change if at all-- and the public policy options are limited (at least what is feasible politically). The point to the "over-prescription of opioids" and they allude to the importance of marriage/family and education (esp. K-12) but they avoid policy RX's there. 

Of course, for those familiar with Murray's Coming Apart, all of this is familiar and a big chunk of the cause/effect is quite clear. The inability to see how life is for the non-elite-- and the inability to understand why we might be "coming apart"-- is part of the Dems/Left's lack of empathy, their tin ear politically, and ultimately (and ironically) their profound lack of compassion.

One funny little thing in closing, since the authors are apparently unaware of the non-existent ROI on Social Security: "Those in midlife now can expect to do better in old age as they receive Social Security and Medicare." How nice, we've taken your money for all these years and now, if you survive, you'll be better off financially.

Third, on the spiritual angles of cause and effect, Aaron Kheriarty's article in First Things is helpful. He focuses on suicide and connects the dots between all of the above.

Finally, consider Charles Murray's comments before a Senate committee on the topic (along with Robert Putnam). These relate to his work in Coming Apart-- essential reading if you find this important. But here, he focuses on self-destructive behavior-- particularly by choosing instant gratification. This is made more likely when we have trouble with family structure and stability; in a culture with less social capital; with mores that promote sexual liberty and confusion; and so on. 

As Murray notes, the solutions are much more likely to be cultural than political. Hopefully, the politics will improve or stay out of the way. Hopefully, the Church, our country's handful of liberals, and our country's handful of conservatives will lead the way.


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