Tag Archives: inequality

Health effects of income inequalities

Wilkinson summarizes his group’s research on the health effects of inequality in a TED talk at http://www.ted.com/talks/lang/en/richard_wilkinson.html.  Among developed countries, those with greatest inequality have worst average outcomes on many, many measures of health and other social measures (such as % of population in prison).  The same association holds among states within the USA.

Three things that are interesting to me are that:

1. On a descriptive level, Wilkinson doesn’t show us the data of health vs. income per capita with strata of socio-economic status separated. It is possible that more unequal societies (within the developed world) have lower average health status just because they have more poor people, for whom their health is lower because their absolute conditions are worse. Clarifying whether that is the case fits under the label of avoiding the ecological fallacy.   Even if it turns out that that is not the case, it is interesting that Wilkinson did not see the need to mention that issue.  He expects his audience to be convinced by what he presents  that it is relative inequality, not absolute conditions that needs changing if health is to improve.

2. On the causal level, Wilkinson explains the effects in psychosocial terms — the accumulated effects of stress that results from status inequalities. I would be interested to see how he addresses the claims of John Lynch and other social epidemiologists (http://www.sph.umich.edu/rwjhssp/lectures/lynch.mov) that 25+ years of research into psychosocial effects of relative inequality has distracted attention from the rick factors associated with absolute health inequalities, in particular, the eminently changeable four risk factors for the major killer in developed countries, namely, heart disease.

3. On the policy level, Wilkinson promotes progressive taxation policies.  I am interested to know what he thinks should be done in the area of health while waiting for such taxation policies to occur.  Would he join Lynch in promoting health interventions around the major risk factors for heart disease, or would he join others, such as Marmot, in emphasizing the psychosocial domain?  (In light of the controversy over Hanauer’s short TED talk, we might also wonder how much TED would have promoted his talk if he had presented and discussed the facts of who has promoted tax cuts for the rich and resisted any return to earlier rates.)

How do we know we have population-environment problems? A journey from simple models to multiple points of engagement to contribute to change (Day 8 of Learning road trip)

On day 8 of the Learning road trip I led a workshop for the School for Designing a Society on “How do we know we have population-environment problems? A journey from simple models to multiple points of engagement to contribute to change.”

People consume resources and pollute the environment, so the more people, the more environmental problems we have–right? Not so fast! In this interactive workshop you will disturb that simple model. By the end you will be mapping multiple points of engagement through which you contribute to change in your particular circumstances. Along the way, you will consider how people marshall scientific knowledge to persuade others of the seriousness of the population problem, how inequalities among people qualitatively alter how “we” respond to the title question, how you can bring in social considerations to explain or interpret the directions that are taken in science, and how you can work with a perspective of being partly and jointly responsible for what is happening in society and the environment.

For more details on this workshop, see companion blog.

Variations in health care (by place, race, class, gender)

Idea: Inequalities in people’s health and how they are treated are associated with place, race, class, gender, even after conditioning on other relevant variables.

The issues here are not only variations or disparities, but also how to measure, track, and talk about those variations.
Krieger et al. started the the Public Health Disparities Geocoding Project because socioeconomic data is often lacking in US public health surveillance systems. Socioeconomic deprivation contributes to racial/ethnic health disparities in more than half of the cases studied.
Davey Smith advises against using ethnicity as a proxy for socioeconomic position and advocates for incorporating both in quantitative models.
Alter et al. conclude that despite Canada’s Universal Health Care System a individual’s socioeconomic status affected access to cardiac services and increased the prevalence of mortality.
Gawande describes how medical costs can be high even in poor areas; this results from the overuse of medicine from over-treating patients and over-prescribing tests and procedures.
Marmot and Wilkinson argue that researchers should look beyond material privation to examine psychosocial effects on variation in health outcomes, particularly relative deprivation concerning individual agency and control.
Wright et al.’s study of asthma among children in low-income urban settings found a correlation between asthma, stress, and exposure to violence that suggests the need for addressing these intervening variables. However, smoking was not found to be associated with asthma attack incidence.

The articles by Bassuk, Dunn, Egede, Roger raise additional perspectives.

(This post continues a series laying out a sequence of basic ideas in thinking like epidemiologists, especially epidemiologists who pay attention to possible social influences on the development and unequal distribution of diseases and behaviors in populations [see first post in series and contribute to open-source curriculum http://bit.ly/EpiContribute].)

References

Alter, D. A., C. D. Naylor, et al. (1999). “Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction.” New England Journal of Medicine 341: 1359-1367.
Bassuk, S. S., L. F. Berkman, et al. (2002). “Socioeconomic Status and Mortality among the Elderly: Findings from Four US Communities.” American Journal of Epidemiology 155: 520-533.
Davey-Smith, G. (2000). “Learning to live with complexity: Ethnicity, socioeconomic position, and health in Britain and the United States.” American Journal of Public Health 90: 1694-1698.
Dunn, J. R. and S. Cummins (2007). “Placing health in context.” Social Science & Medicine 65: 1821-1824
Egede, L. E. and D. Zheng (2003). “Racial/Ethnic Differences in Adult Vaccination Among Individuals With Diabetes.” American Journal of Public Health 93(2): 324-329.
Gawande, A. (2009). “The cost conundrum: What a Texas town can teach us about health care.” The New Yorker (1 June).
Krieger, N., J. T. Chen, et al. (2005). “Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: The Public Health Disparities Geocoding Projec.” American Journal of Public Health 95: 312-323.
Marmot, M. and R. G. Wilkinson (2001). “Psychosocial and material pathways in the relation between income and health: a response to Lynch et al ” British Medical Journal 322: 1233-1236.
Roger, V. L., M. E. Farkouh, et al. (2000). “Sex Differences in Evaluation and Outcome of Unstable Angina.” Journal of the American Medical Association 283: 646-652.
Wright, R. J., H. Mitchell, et al. (2004). “Community Violence and Asthma Morbidity: The Inner-City Asthma Study ” American Journal of Public Health 94: 625-632.

An (imaginary) exchange with Eysenck about meritocracy

Taylor [T]: Why are you so concerned about genetic determination of mental ability?

Eysenck [E]: If abilities are determined by birth and society can predict who will be naturally talented, then it can allocate its resources more efficiently, for example, through separation of school children into separate tracks.

T: Why not test young people and use the results to make such predictions—then we can forget the issue of where their abilities originate?  You have, after all, been a life-long proponent of mental testing.

E: If abilities are biologically inherited and society is meritocratic, then elites are biological elites.

T: And so…?

E:  Rather than wait until children are old enough to be tested for intelligence, we can allocate resources from birth onward according to their parents’ status.

T:  High status parents already do that.  Wouldn’t someone who does not believe in meritocracy—someone who prefers a system that perpetuates privilege—also support the practice you propose?

E: The difference is that I would use intelligence tests at eleven, sixteen, and so on to check that the right children have been placed on the advanced tracks.

T:  Then, again, why not simply use such testing and forget the heredity issues?—especially given that parental intelligence is an imperfect predictor of offspring intelligence.

E:   Even if starting to track children at an early age leads to some errors, it is probably a more efficient allocation of educational resources.

T:  Efficient for whom?—You must know that tracking in practice means more than providing different kinds of education;  time and again it has resulted in unequal allocation of resources (Oakes 2005).

E:  That does not have to be the case.

T:  Maybe not, but unless you can show that unequal allocation has never been the case in the past, how could you show that the current “pyramidal structure” of society is due to “inherited inequalities in mental ability”?

Extracted fromTaylor, P. “Why was Galton so concerned about ‘regression to the mean’? -A contribution to interpreting and changing science and society” DataCritica, 2(2): 3-22, 2008, http://www.datacritica.info/ojs/index.php/datacritica/article/view/23/29.

Reference

Oakes, J. (2005) Keeping track: How schools structure inequality. New Haven: Yale University Press.

What if I think that everything is already unruly complexity?

What if I think that everything is already unruly complexity? What do I do?

First, I need to define for whoever is reading what I mean by that term. Unruly complexity refers to situations that
1. consist of heterogeneous components
2. are built up over time and subject to ongoing restructuring
3. are embedded in wider dynamics
Equivalently, for such situations:
1. definite boundaries are lacking
2. what goes on “outside” continually restructures what is “inside”
3. diverse processes come together to produce change

Definitions are best accompanied by an illustration. This is provided the case of soil erosion in a mountainous agricultural region in Oaxaca, Mexico.

Back to the question. What if everything is already unruly complexity?
My first Answer is there’s a Qualitative difference in analysis of causes and in implications drawn from such an analysis.
This answer is well illustrated by the two islands scenario regarding population growth.

The two islands scenario also illustrates an expository or conceptual theme, namely, the use of simple themes or scenarios that are readily digested but undermine simple, system-like formulations (such as population growth leads to environmental degradation). Instead, these themes or scenarios open up issues, pointing to greater complexity and to further work needed in particular cases (such as the case of soil erosion in a mountainous agricultural region in Oaxaca, Mexico). These “opening-up themes” call for or invite work based on dynamics that develop over time among particular, unequal agents whose actions implicate or span a range of social domains.

Back to the question: What if everything is already unruly complexity? and the first Answer that there’s a Qualitative difference in analysis of causes and in implications drawn from such an analysis. This leads to a new Question: Qualitative difference in analysis of causes and implications… for whom? See next post.

Dynamics of Inequality: A Critical Thinking Theme

A conversation that introduces critical thinking theme about environment, science, and society, namely: The analysis of causes and the implications of the analysis change qualitatively if uniform units are replaced by unequal units subject to further differentiation as a result of their linked economic, social and political dynamics.
—-
Philoso (who asks how you support your claims): [The] dynamic relations among unequal individuals may qualitatively change our understanding of population growth.

Ecolo (natural and human ecologist): Really? How might that be so?

Reso (a researcher who analyzes natural resources issues): I can help here. Consider this simple scenario (Taylor 1997). There are two countries. Each has the same amount and quality of arable land, the same population size, the same level of technical capacity, and the same population growth rate, say 3% per year. Country A, however, has a relatively equal land distribution, while country B has a typical 1970s Central American land distribution: 2% of the people own 60% of the land; 70% own just 2%. Both countries double their populations very rapidly, but five generations (120 years) before anyone is malnourished in country A, all of the poorest 70% in country B would already be-unless they act to change their situation.
Ecolo: But sooner or later in both countries everyone reaches the carrying capacity of their land.

Reso: This is not just an issue of when the crisis occurs in the two countries. B’s poor would probably first experience what others call population pressure in the form of food shortages. They would link these shortages to inequity in land distribution (see Durham 1979; Vandermeer 1977). They might attempt to take over the underutilized land of the wealthy. The wealthy, anticipating this possibility, might fund paramilitary operations that target leaders of campaigns for land reform. Or build factories that employ the land-starved poor. The availability and nature of foreign aid would influence the actual choices in specific instances. And so on.

Activo (who asks what one can do on the basis of claims): Does this mean that we should support land reform and abandon population control programs? Or are you saying that we should back up these programs by boosting military aid to countries like B?

Reso: I would have to ask to whom “we” refers. People are never all part of a uniform “we;” no real country is like country A. The important thing to understand is that the crises to which actual people have to respond come well before and in different forms from the crises predicted on the basis of aggregate population growth rates and ultimate biological and physical limits to growth. Indeed, in a country like B the poor would be justified in viewing anyone who focuses on population control policies as taking sides with those who benefit from the inequitable access to productive resources.

Ecolo: I have always stressed that affluent countries and people have disproportionate effect on the environment because of their higher per capita consumption of resources and the corresponding higher production of pollutants.

Reso: But I’m not just saying that in any district, country, or ecosphere there are richer and poorer people. My point is that groups with different wealth and power exist, change, and become involved in crises because of their dynamic interrelations.

Ecolo: OK, but even if the dynamics of population growth are more complex, it is still true that the greater the population, the greater the environmental effects.

Reso: Not necessarily. [The] case of soil erosion in a mountainous agricultural region in Oaxaca, Mexico [presents a different picture].

Excerpted from “How do we know there is a population-environment problem?” http://www.faculty.umb.edu/peter_taylor/popdialogue.html

See also teaching activity based on the two islands scenario, http://www.faculty.umb.edu/peter_taylor/island.doc

References

Durham, W. D. (1979). Scarcity and survival in Central America: Ecological origins of the soccer war. Stanford, CA: Stanford University Press.

Taylor, P. J. (1997) “How do we know we have global environmental problems? Undifferentiated science-politics and its potential reconstruction,” in P. J. Taylor, S. Halfon & P. Edwards (eds.), Changing Life: Genomes, Ecologies, Bodies, Commodities. Minneapolis: University of Minnesota Press, 149-174.

Vandermeer, J. (1977). “Ecological Determinism,” in Science for the People (Eds.), Biology as a Social Weapon. Minneapolis: Burgess, 108-122.