Consequences and predictors of new health events

There is renewed interest in why people of lower socio-economic status (SES) have worse health outcomes. No matter which measures of SES are used (income, wealth, or education), the evidence that this association is large is abundant (Marmot (1999), Smith (1999)). The relation between SES and health appears also to be pervasive over time and across countries at quite different levels of economic development (Kitagawa and Hauser (1973), Townsend et al. (1988)). Considerable debate remains about why the relation arises and what the principal directions of causation might be ((Smith (1999), Adams et al. (2003), Deaton (2003)). However, many analytical difficulties exist when one tries to understand its meaning. These difficulties include the complex dimensionality of health status that produces considerable heterogeneity in health outcomes, the two-way interaction between health and economic status, and the separation of anticipated from unanticipated health or economic shocks.

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Unraveling the SES-Health Connection

While a debate rages on about competing reasons why SES may affect health, there is little recognition that the so-called reverse causation from health to economic status may be pretty fundamental as well. Even if the direction of causation is that SES mainly affects health, what dimensions of SES actually matter—the financial aspects such as income or wealth or non-financial dimensions like education? Finally, is there a life course component to the health gradient so that we may be mislead in trying to answer these questions by only looking at people of a certain age—say those past 50. This paper, which is divided into four sections, provides my answers to these questions. The first section examines the issue of reverse causation or whether a new health event has a significant impact on four dimensions of SES—out-of-pocket medical expenses, labor supply, household income, and household wealth. The next section switches the perspective by asking whether the so-called direct causation from SES to health really matters all that much. If the answer is yes and it will be, a sub-theme in this section concerns which dimensions of SES—income, wealth, or education—matter for individual health. Since the answer to that question turns out to be education, Section 3 deals with the very much more difficult issue of why education matters so much. The evidence in these first three sections relies on data for people above age 50. In the final section of the paper, I test the robustness of my answers to these basic questions of the meaning of the SES-health gradient using data that span the entire life-course.

The impact of demographic change on U. S. labor markets: discussion

As its title indicates, the paper by Jane Little and Robert Triest deals with the impact of some upcoming demographic changes on the U. S. labor market. The two changes highlighted are the well-documented population aging and immigration. According to the paper, the challenges raised by these changes are rising and high old-age dependency ratios because of declining numbers of workers to retirees, and slower productivity growth, since migrants tend to have less education than the native-born. ; I would only have quibbles, not quarrels, with their clear and balanced description of these future demographic trends, which relies mainly on Census projections. On both immigration and population aging, however, I believe that better estimates are available than those of the Census. But these superior estimates would still project a future labor force much like the one foreseen in the Little/Triest paper.Demography ; Economic conditions ; Labor market

The Changing Economic Circumstances of the Elderly: Income, Wealth, and Social Security

How is the economic status of the elderly changing and what are their prospects for the future? My portrait tells us how well off they are on average, but also about the vast disparities that exist among them. This description includes an often neglected measure of their economic well-being--the amount of wealth they control. Amazingly little is known about howmuch personal wealth older people have and how and what determines its distribution. But the conventional definition of household wealth ignores two critical components of wealth: the expected income flows from pensions and Social Security. For some elderly households, Social Security represents the largest part of their wealth. I conclude with some thoughts on one of the most sensitive and critical public policy issues--the necessity of reforming Social Security.

THE IMPACT OF SES ON HEALTH OVER THE LIFE-COURSE

In this paper I evaluated the new health information that has recently become available in the PSID to assess whether or not it can serve a constructive role in the ongoing SES-health debate. There are two types of information that appear to be promising—the self-reports of general health status that were first introduced in 1984, and the prevalence and incidence of new chronic conditions that were first added in 1999. In this evaluation, I place particular emphasis on the possibility of using the retrospective information on incidence of chronic conditions. The paper also offers several substantive conclusions. First, across the life course SES impacts future health outcomes although the primary culprit appears to be education and not an individual’s financial resources in whatever form they might be received. That conclusion appears to be robust to whether the financial resources are income or wealth or to whether the financial resources represent new information such as the largely unanticipated wealth that was a consequence of the recent stock market boom. Finally, this conclusion appears to be robust across new health outcomes that take place across the short and intermediate time frames of up to fifteen years in the future

Re-Constructing Childhood Health Histories

This paper provides evidence about the quality of retrospective childhood health histories given to respondents in the HRS and the PSID. Even though information on early life health events is critical, there is legitimate skepticism about the ability of older respondents to remember specific health problems that they had as a child. The evidence presented in this paper suggests that this is too negative a view. Respondents appear to remember salient childhood events about themselves such as the illnesses they had as a child quite well. Moreover, these physical and psychological childhood health events are important correlates of adult health during middle age.recall, childhood health

The Convergence to Racial Equality in Women's Wages

Twenty years ago the average black woman employed full time was earning approximately half the wage rate of a similarly employed white woman. By 1975 almost complete racial parity in female wages had been achieved. Although this remarkable advance in the economic status of black women has accelerated in the last few years, it has received little serious analytical attention. In contrast, the significant but smaller income gains of black males during the 1960s generated considerable research attempting to disentangle possible sources of this improvement. Real wage changes of the magnitude observed for black females are so rare that it seems unlikely conventional explanations will suffice. In this article, I explore several potential reasons for the rise in the relative wage of black women.