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Social Policy Can Save Lives

Mortality study shows how policy can break the link between poverty and poor health

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In the United States, the mortality gap between rich and poor is much more pronounced than in France, and it has been increasing for older Americans. Not even the rich seem to benefit from this inequality.
mortality inequality
A new study by IPR economist Hannes Schwandt reveals income inequality and inequality in mortality are not necessarily linked.

Income inequality and health inequality are not necessarily connected, according to a new study of U.S. and French death rates examining the often-studied link between poverty and poor health.

Social policies could break that link and might explain why health and mortality trends differ between the two countries and across age groups within each country, says study co-author and IPR economist Hannes Schwandt. He explains that this research becomes increasingly important as skilled-based technological change and globalization bring on large structural changes and challenges, like rapidly growing income inequality.

“Investing in social systems has huge returns for society overall and might be worthwhile not only for the individual, but from a broader societal perspective,” Schwandt said.

Comparing death rates across different countries, socioeconomic groups, and over time is difficult, so Schwandt and his co-authors, economists Janet Currie of Princeton and Josselin Thuilliez of France’s National Research Center, use a new method. They divided all U.S. counties and the French equivalent, départements, into 20 groups that contained 5 percent of each nation’s population. After ranking each group by their overall poverty rate in 1990 and 2010, they were able to compare how death rates varied in the richest and poorest areas and view how the rates changed over time. 

Hannes Schwandt
Hannes Schwandt

Despite increasing income inequality in both the United States and France, they find patterns of mortality vary, sometimes quite dramatically, between the countries and across all age groups.

For infants and children in France, mortality is “remarkably similar” in rich and poor areas. This means there is little to no mortality inequality for those age groups, despite increased income inequality. And while for older ages, mortality in France is higher among the poor than among the rich, this gap did not increase over the past decades.

In the United States, the mortality gap between rich and poor is much more pronounced than in France, and it has been increasing for older Americans. Not even the rich seem to benefit from this inequality. Even in the wealthiest areas, mortality improvements for many age groups have been more moderate in the United States than in France. 

But it is not all bad news for Americans. For infants, children, and adolescents, mortality improvements were strongest in poorest areas. In other words, mortality inequality among younger Americans actually decreased at the same time that economic inequality increased. Social policy likely had something to do with this, offers Schwandt, who pointed to the expansion of public health insurance for children in the late 1980s, food and nutrition programs, and other policies aimed to help children.

“For these new generations that benefitted from those policies, you see strong improvements in mortality, in particular in the most disadvantaged areas,” Schwandt said. “These policies are successful, and they’ve been shown to be very cost effective.”

In fact, France and the United States could learn a lot from each other’s health and social policies, Schwandt says.

France’s healthcare system could explain its low mortality inequality.  Schwandt said France’s universal approach offers high-quality care with low out-of-pocket costs. Taking a page from France’s book, the United States could expand its own safety net programs, such as Medicaid, Medicare, and the Supplemental Nutrition Assistance Program (formerly called food stamps) to improve Americans’ longevity. 

But France has been less successful in reducing smoking rates than the United States. France has a high rate of cancer and other smoking-related deaths. Schwandt suggests the French could look to the Americans’ more aggressive anti-tobacco policies for inspiration on how to improve French longevity.

According to Schwandt, while many people frustrated by the challenges of globalization and other structural changes are calling for the overhaul of social programs, those same programs can soften the impact of diverging incomes and break the link between economic inequality and health.

“It’s important to make clear to people that these programs work, and we don’t want less—we actually want more,” Schwandt said.

Hannes Schwandt is assistant professor of economics and an IPR fellow.

Top photo: Flickr / Alex Proimos

Published: August 23, 2018.