Dr. Andy

Reflections on medicine and biology among other things

Saturday, April 08, 2006

Absolute versus relative poverty

You often hear how well off the poor are in the US:
Overall, the typical American defined as poor by the government has a car, air conditioning, a refrigerator, a stove, a clothes washer and dryer, and a microwave. He has two color televisions, cable or satellite TV reception, a VCR or DVD player, and a stereo.
Yet this absolute affluence (in the face of relative poverty) doesn't seem to translate into health and well-being. According to a recent commentary in JAMA (no free full text) by Michael Marmot:
blacks in the United States have about 4 times the income of men in Costa Rica or Cuba, but about 9 years’ shorter life expectancy.
The article goes on to demonstrate that simple explanations such as poor diet or sedentary life style don't explain the entire discrepency and that a health effect of status (as opposed to income) exists in every society studied and at every level of status. For example
In egalitarian Sweden, Erikson showed that individuals with a PhD have lower mortality than those with a master’s degree, who have lower mortality than those with a bachelor’s degree, and so on down the educational hierarchy. “Greater poverty,” or material deprivation, is not a helpful answer to the question of why someone with a master’s degree should have higher mortality than someone with a PhD.
While omnipresent, the status effect is more pronounced in some societies (e.g. the United States) than others (Sweden). Marmot proposes some reasons (stress, social participation) but there doesn't seem to be much data backing those up.

Here's a research idea for an enterprising epidemiologist. There seems to be a trend toward US citizens retiring in Mexico, where the cost-of-living is lower. My hypothesis is that the higher social status middle income US retirees in Mexico enjoy should lead to better health and longer lives compared to similar retirees who remain in the US despite similar or decreaseds access to quality medical care in Mexico. Call it status arbitrage.


At 1:41 AM, Anonymous jb said...

This may kill my chances for being selected President of Harvard, but I will suggest that some groups of humans have better genes than others. American blacks have a higher incidence of several major risk factors for premature death, including hypertension and prostate cancer. They are also burdened by lower education levels overall, which the Swedish study indicates is associated with shorter lifespan. Possibly higher educational achievement is a marker for self-discipline, delayed gratification, goal orientation, or some other behavior that also contributes to longer life.

Your suggested study of Americans retiring in Mexico will be difficult to control for the likelihood that these folks self select for good health. The senior citizen with afib who needs protimes every 2 weeks or a small AAA who gets an ultrasound every few months is unlikely to put himself beyond the Medicare safety net, even if he can locate a high quality physician and hospital.

At 3:40 PM, Blogger ollie said...

The article:

(December 2005, Scientific American) discusses these findings (about relative poverty)

At 9:23 AM, Anonymous Happystance said...

I was recently involved in a carers' workshop that sparked a discussion about relative and absolute poverty - and led to someone sending me an interesting (although unsourced) quotation from Terry Pratchett (I'd be grateful if anyone knows the source).

Ben Friedman offers a fascinating discussion about relative and absolute poverty in The Moral Consequences of Economic Growth. He has some provocative ideas about going beyond income levels and comparing the emotional state of sufficiency at different life-points, and the influence of that on our well-being.

Best - Tony

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