The Social Costs of Childhood Lead Exposure in the Post–Lead Regulation Era

Objective: To estimate the benefits that might be realized if all children in the United States had a blood lead level of less than 1 μg/dL. Design: Data were obtained from published and electronic sources. A Markov model was used to project lifetime earnings, reduced crime costs, improvements in health, and reduced welfare costs using 2 scenarios: (1) maintaining the status quo and (2) reducing the blood lead level of all children to less than 1 μg/dL. Participants: The cohort of US children between birth and age 6 years in 2008, with economic and health outcomes projected for 65 years. Interventions: Increased primary prevention efforts aimed at reducing lead exposure among children and pregnant women. Main Outcome Measures: Societal costs and quality-adjusted life years (QALYs) gained. Results: Reducing blood lead levels to less than 1 μg/dL among all US children between birth and age 6 years would reduce crime and increase on-time high school graduation rates later in life. The net societal benefits arising from these improvements in high school graduation rates and reductions in crime would amount to $50 000 (SD,$14 000) per child annually at a discount rate of 3%. This would result in overall savings of approximately $1.2 trillion (SD,$341 billion) and produce an additional 4.8 million QALYs (SD, 2 million QALYs) for US society as a whole. Conclusion: More aggressive programs aimed at reducing childhood lead exposure may produce large social benefits

Health Selection vs. Causation in the Income Gradient: What Can We Learn from Graphical Trends?

Income produces health, and sickness negatively affects earnings. These two factors likely explain the income gradient in health, but each has very different policy implications. In this paper, I examine graphical trends in mortality risk between low-income and higher-income people by age and gender. These trends suggest that forward causality (income affecting health) is more important than reverse causality (health affecting income) in the income-health gradient. However, there is some evidence to suggest that reverse causality plays an important role for younger men

Can universal pre-kindergarten programs improve population health and longevity? Mechanisms, evidence, and policy implications

Recent research has found that children who attended pre-kindergarten programs in childhood were more likely to be healthy as adults. One intuitive way of improving population health and longevity may therefore be to invest in pre-kindergarten programs. However, much of the research linking pre-kindergarten programs to health is very recent and has not been synthesized. In this paper, I review the mechanisms linking pre-kindergarten programs in childhood to adult longevity, and the experimental evidence backing up these linkages. I conclude with a critical exploration of whether investments in pre-kindergarten programs could also serve as investments in public health

Redistribution and Health

In their evocative thought experiment, Woolf et al. demonstrate that reducing racial disparities might result in greater gains in life expectancy than investments in medical technology.1 In calculating reductions in mortality attributable to medical technology, the authors conservatively assumed that medical technology was responsible for 100% of the observed reduction in mortality over the study period. Unfortunately, there is a catch to this assumption that renders it less conservative. Over the 1991–2000 study frame the authors used, increases in the Gini coefficient occurred.2 This suggests that socioeconomic disparities for the overall population (not just African Americans) worsened. If disparities are causing declines in health, they will hide a portion of the observed gains in life expectancy owing to medical technology

The body politic: the relationship between stigma and obesity-associated disease

Background: It is commonly believed that the pathophysiology of obesity arises from adiposity. In this paper, I forward a complementary explanation; this pathophysiology arises not from adiposity alone, but also from the psychological stress induced by the social stigma associated with being obese. Methods: In this study, I pursue novel lines of evidence to explore the possibility that obesity associated stigma produces obesity-associated medical conditions. I also entertain alternative hypotheses that might explain the observed relationships. Results: I forward four lines of evidence supporting the hypothesis that psychological stress plays a role in the adiposity-health association. First, body mass index (BMI) is a strong predictor of serological biomarkers of stress. Second, obesity and stress are linked to the same diseases. Third, body norms appear to be strong determinants of morbidity and mortality among obese persons; obese whites and women – the two groups most affected by weight-related stigma in surveys – disproportionately suffer from excess mortality. Finally, statistical models suggest that the desire to lose weight is an important driver of weight-related morbidity when BMI is held constant. Conclusion: Obese persons experience a high degree of stress, and this stress plausibly explains a portion of the BMI-health association. Thus, the obesity epidemic may, in part, be driven by social constructs surrounding body image norms

The Social Costs Of Lead Poisonings

The lead poisoning of children in Flint, Michigan, discussed by David Rosner (May 2016), has created a new awareness of a public health crisis that has never left us because the investment needed to remove lead from pipes in high-risk areas was never made. But what is the cost of inaction

Healthier and Wealthier: Decreasing Health Care Costs by Increasing Educational Attainment

In the past, states spent more on K–12 education than on any other budget item. However, in recent years, rising medical costs have changed this pattern; in 2003, health care expenses surpassed education as the largest item in states’ budgets. In fiscal year 2006, Medicaid alone is estimated to account for approximately 22 percent of total state spending, while all health care costs will account for about 32 percent of states’ expenditures (National Governors Association & National Association of State Budget Officers, 2006). These costs keep going up, and absent some drastic change, there is every indication that they will continue to outpace most states’ economic growth (Pew Research Center, 2006)

How Education Produces Health: A Hypothetical Framework

Background: High school graduates live six to nine years longer than high school dropouts. Those with less education are more likely to die prematurely of cardiovascular disease, cancer, infectious disease, diabetes, lung disease, and injury than those with more education. Although there is growing evidence that the education-health relationship is causal, and some mechanisms linking education to health have been proposed, there is no gestalt for thinking about the health production function of education. Purpose: The purpose of this article is to outline the mechanisms through which education may produce health. Design: I explore the health risk factors that are more prevalent among those with lower educational attainment to ascertain whether such risk factors plausibly cause the diseases for which the less educated are at risk. To examine these relationships, I conduct a review of the public health, economics, endocrinology, sociology, neurosciences, and other literatures. Conclusions: A remarkably clear path can be drawn between what we now believe to be the risk factors for disease and the primary causes of death among those with lower attainment. Although hypothetical, the pathways outlined in this article can be used as a basis for thinking about the health production function of education. These mechanisms may better allow policy makers to understand the relationship between education and health. They may also be used to guide future research on the health benefits of education. Finally, although the proposed pathways are hypothetical, there is good overall evidence that education produces health. Therefore, health benefits should be included as core outcome measures in future education research

Consequences in Health Status and Costs

People with more education typically live longer and healthier lives. High school graduates, for example, live about six to nine years longer than high school dropouts. They also are less likely to suffer from illness or disability in a variety of forms. In this chapter I seek to measure these benefits in dollar terms. I focus on the association between educational attainment and (1) reductions in morbidity and mortality and (2) reductions in government spending on health care. I examine these effects using a large, comprehensive health data set, the Medical Expenditure Panel Survey, covering the non-institutionalized civilian population in the United States. On the basis of conservative assumptions, I conclude that each additional high school graduate represents a health-related gain to the government of at least $39,000 in discounted lifetime medical expenditures. Monetized gains in health and longevity amount to an additional$183,000. I also discuss the limitations of this analysis

Cost-Effectiveness of Vaccination versus Treatment of Influenza in Healthy Adolescents and Adults

At present time, there is uncertainty regarding whether influenza-like illness in healthy adults is best managed by preventive efforts that use the trivalent influenza vaccine, administration of neuraminidase inhibitors at the onset of illness, or recommendation of supportive care alone at the onset of illness. We conducted a cost-effectiveness analysis that examined these 3 strategies for managing influenza-like illness. Vaccination with inactivated trivalent vaccine would save approximately $25 per person while resulting in a net gain of ∼3.2 quality-adjusted hours relative to providing treatment with the neuraminidase inhibitor oseltamivir. A quality-adjusted hour is a fraction of a quality-adjusted life-year, which is the equivalent of 1 year lived in perfect health. Treatment with oseltamivir was associated with an incremental cost-effectiveness of approximately$27,619 per quality-adjusted life-year gained relative to providing supportive care. Vaccination is cost-saving relative to providing either treatment with oseltamivir or providing supportive care alone