Tag Archives: income

NYT maps how high health gaps lower the odds

Institute for Health Metrics and Evaluation (IHME). US Health Map. Seattle, WA: IHME, University of Washington, 2014. Available from http://vizhub.healthdata.org/us-health-map. (Accessed 4/14/2015)

Image: Institute for Health Metrics and Evaluation (IHME). US Health Map. Seattle, WA: IHME, University of Washington, 2014. (Accessed 4/14/2015)

The impact of “income inequality” has been given a closer examination since the recession and is teeing up as a potential catchphrase in the 2016 election.

While poorer pockets of the United States is a well-known factor that can lead to poor health (among other issues), less clear has been the ramifications of living somewhere home to both the wealthy and those the low-income, thus creating a gap. Continue reading

Complaints about dental benefits provider mounting

The rumblings in Tennessee started earlier this year, after a new company took over the contract to provide dental services to the state’s children covered by Medicaid.

Now the state dental association, a number of black dentists, a youth-home operator and at least one angry grandmother are weighing in against the Boston-based dental benefits giant DentaQuest. They claim the company is making it harder for poor kids in the state to get dental care.

The Tennessean’s Tom Wilemon captured the mood in a June 6 story, “Complaints Mount about TennCare Dental Provider:”    Continue reading

A ‘birth lottery’ still determines who gets to live longest, healthiest life

“Since when in America do we have classes? Since when in America are people stuck in areas or defined places called a class? That’s Marxism talk.”

– Rick Santorum, former U.S. senator

Unlike most other wealthy countries, the United States doesn’t keep good records on social class, so it’s taken longer here than in other wealthy countries to understand the profound impact of social class on people’s health.

“As a nation, we are uncomfortable with the concept of class. Americans like to believe that they live in a society with such potential for upward mobility that every citizen’s socioeconomic status is fluid,” Stephen L. Isaacs and Steven A. Schroeder observed a decade ago in an essay that has only become more relevant.

The latest data suggest that lack of social mobility remains as significant a problem as it was decades ago. In the generation entering the U.S. workforce today, those who started life in the bottom fifth of income distribution have about a 9 percent chance of reaching the top fifth. That compares with an 8.4 percent chance for kids born in 1971, according to research by economists Raj Chetty of Harvard, Emmanuel Saez of the University of California, Berkeley, and colleagues.

What’s astonishing are the huge differences in mobility depending on where you grow up, The odds of escaping poverty and gaining prosperity are less than 3 percent for kids in many places across the South and Rust Belt states. But in some parts of the Great Plains, more than 25 percent of kids born to the poorest parents move into the upper-income strata as adults, the economists found. The datasets are available here.


Source: Where is the Land of Opportunity? The Geography of Intergenerational Mobility in the United States, by Raj Chetty, Nathaniel Hendren, Patrick Kline, UC-Berkeley and Emmanuel SaezThe probability that a child born in the bottom fifth of the income distribution will reach the top fifth of the income distribution, based on data for those born from 1980-85. To look up statistics for your own area, use the New York Timesinteractive version of this map.

I don’t think it’s a coincidence that the places on this map with the lowest social mobility also tend to have the worst health outcomes. Lack of mobility is strongly correlated with worse segregation, greater income inequality, poor local school quality, diminished social capital, and broken family structure – factors that are also linked to poor health.

Even when poor children manage to escape poverty, a “birth lottery” may still determine who gets to live longest and healthiest. Exposure to adverse conditions during fetal development and early infancy appears to be capable of causing irreversible consequences decades later, such as increased vulnerability to weight gain, diabetes, heart disease, and premature death.

The U.S. made steady progress reducing socioeconomic and racial/ethnic health disparities during the 1960s and 70s. (This period, in fact, was the only time in modern U.S. history when the health of African Americans improved more rapidly than the health of whites, occurring with civil rights and anti-poverty programs that narrowed the black-white income gap.)

Progress stalled around 1980. Since then, health inequities have grown wider between members of the lowest and highest social classes. Life expectancy, for instance, has changed very little among the less-educated and virtually all gains in life expectancy occurred among highly educated groups, one study found. If everyone in the U.S. attained the longevity of the highest-income one-fifth of the white population, we would have seen 14 percent fewer premature deaths among whites, and 30 percent fewer deaths among non-whites between 1960 and 2002, another study calculated.

Ten years ago, Isaacs and Schroeder argued for what is now called “health in all policies.” That’s the idea that we should explicitly consider the health impact of the priorities we set in education, taxes, recreation, transportation, and housing. A handful of state and local governments have taken steps in this direction.

A development worth watching is the growing use of health impact assessment to scrutinize the effects that a government program or project may have on the health of a population. The systematic assessment is supposed to help policy makers avoid unintended harmful effects and take advantage of opportunities to promote health.

After a health impact assessment in Alaska, for example, the Bureau of Land Management in 2007 withdrew part of an oil and gas development lease that threatened the health of native populations, and the approved lease required new pollution monitoring and controls. In Boston last year, the regional transit agency held off imposing steep fare increases and service cuts after a health impact assessment concluded that it would lead to significant health and financial costs because of increased automobile use.

The number of health impact assessments has mushroomed from a few dozen in 2007 to more than 240 completed or in progress in 35 states, Washington, D.C., Puerto Rico, and at the federal level as of last year, according to a recent Institute of Medicine report.

But big hurdles do pop up. The Robert Wood Johnson Foundation recently analyzed 23 health impact assessments completed between 2005 and 2013. Most weren’t given enough time or money, the authors concluded. People doing the assessments struggled to find relevant, neighborhood-level data. And they found it tough to make headway in politically charged situations. In some cases, agencies moved ahead on project decisions without waiting for completion of the health impact assessment. The behind-the-scenes maneuvering strikes me as something journalists might want to dig into.

Drilling down into numbers uncovers Marketplace glitch

Don Sapatkin

Ten days before the (expected) close of open enrollment, The Philadelphia Inquirer reported that the federal exchange’s window-shopping tool – the one that the administration encourages everyone to check before applying for Marketplace insurance – was using the wrong year’s poverty-level guidelines. Neither the Obama administration nor any health-care consultants or policy experts that reporter Don Sapatkin could find had noticed it and the site was corrected within hours after the story was posted.

In theory, almost anyone going on the site got slightly incorrect information for 35 days. Most seriously affected, however, were people just above the poverty line in states that have not expanded Medicaid. When they put their information into the tool, it responded: “Not eligible for help paying for coverage.” Many of them may have given up right there and not submitted the actual applications (which were using the correct poverty stats and were assessed correctly). It’s impossible to tell from the notification letter whether errors were made.

Read about how Sapatkin uncovered the error and what the response was from the Centers for Medicare and Medicaid Services.

Uncovering the real drivers of obesity in young people

Image by phalinn via flickr.

Image by phalinn via flickr.

It’s great that the rapid rise in youth obesity since the 1980s has started to level off. But there’s an unsettling trend hidden in the data: Progress has largely been limited to kids from more educated and higher income families, according to a recent analysis that got less news coverage than it should have.

Robert Putnam and colleagues at the Harvard Kennedy School compared outcomes by education and income using data from two nationally representative health surveys (the 1988–2010 National Health and Nutrition Examination Surveys and the 2003–2011 National Survey of Children’s Health).

Among teenage children of parents with a college degree, they found that the prevalence of obesity began to drop about 10 years ago, while it continued to climb among the teenagers of parents who have at most a high school degree. They found the same trend when they used estimates of family income, rather than education, to measure socioeconomic status. (The growing gap is not merely a reflection of racial or ethnic differences, they say, because it persisted even when they limited the analysis to non-Hispanic whites.)

Los Angeles Times reporter Melissa Healy raised an important point in her coverage: Continue reading