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Forget Diversity; Pass the Wine and Spaghetti Please

Socioeconomic Inequalities vs. Health in 22 European Countries

An article in the New England Journal of Medicine points out that there are health outcome disparities in European countries too. I thought it would generate a lot of newspaper articles and public discussion but there has been silence as far as I can tell. Inequity in health outcome among groups of various socioeconomic status (as measured by education, occupation, and income) constitutes part of the debate about American health care.

It is unknown to what extent such inequalities are modifiable or exactly how they arise. This does not keep persons with strong political agendas from using these disparities to demand specific changes.

For example this list from the Commonwealth Fund gives a rundown of things that need to be done in order to ameliorate health care disparities in the United States.

  • Effective evaluation of disparities-reduction programs.
  • Minimum standards for culturally and linguistically competent health services.
  • Greater minority representation within the health care workforce.
  • Establishment or enhancement of government offices of minority health.
  • Expanded access to services for all ethnic and racial groups.
  • Involvement of all health system representatives in minority health improvement efforts.

But how much benefit should we expect if we do make these changes? Perhaps it would be appropriate to look at conditions in other parts of the world.

Data on mortality according to education level and occupational class in this study came from census-based mortality studies. Deaths were classified according to cause, including common causes, such as cardiovascular disease and cancer, smoking, alcohol use and causes amenable to medical intervention, such as tuberculosis and hypertension. Data were also obtained from health or multipurpose surveys given to 350,000 persons asking them about their general health. For each country, the association between socioeconomic status and health outcomes was measured with the use of regression-based inequality indexes.

Europe offered an excellent opportunities for this type of research because of the intercountry variety of political, cultural, economic, and epidemiologic histories and because good data on inequalities in health are often available.

In almost all countries, the rates of death and poorer self-assessments of health were substantially higher in groups of lower socioeconomic status, but the magnitude of the inequalities between groups of higher and lower socioeconomic status was much larger in some countries than in others.

Findings of interest included the following:

  1. Inequalities in mortality between socioeconomic groups and genders were small in some Southern European countries and very large in most countries in the Eastern European and Baltic regions.
  2. Though higher education was associated with lower mortality in all countries the ratio differed markedly between countries. In England, Wales, and Sweden lower education was associated with less than twice the mortality rate of the more educated persons. In Eastern Europe there was a four fold increase in mortality among the least educated. In the Basque country of Spain the disparities were less pronounced than anywhere else. Southern Europe seemed to be the healthiest area over all.
  3. Among men and women, smaller inequalities in the rate of death from any cause in the Southern European regions are due mainly to smaller inequalities in the rate of death from cardiovascular disease. For example, among men in the Basque country, where the education-related inequality in the rate of death from any cause is below the European average, decreased death from cardiovascular disease accounts for 45% of this difference. Larger inequalities in the rate of death from cardiovascular disease make an important contribution to larger inequalities in the rate of death from any cause in the eastern and Baltic regions as well; however, important contributions are also made by cancer in the eastern region and injuries in the Baltic region.
  4. I wonder about the effect of the Mediterranean diet on this reduction in cardiovascular mortality in men. The custom of eating a high fiber diet rich in monounsaturated fat and low in saturated fat, washed down with a little wine seems a more pleasant alternative to the Commonwealth Fund plan described above. Smaller scale studies really do show unexplained disparities in the way people are treated according to race and gender. But the reasons for this are not clear( See Below)
  5. Smoking and Drinking in Europe as whole, inequalities in mortality from smoking-related conditions, account for 21% of the inequalities in the rate of death from any cause among men and 6% of those among women. In Europe as a whole, inequalities in alcohol-related mortality account for 11% of inequalities in the rate of death from any cause among men and 6% of those among women.
  6. Deaths from conditions amenable to immediate to medical intervention account for 5% of inequalities in the rate of death from any cause when measured among social groups.

Discussion: The authors state that Smoking, obesity, excessive alcohol consumption, and deficiencies in health care represent only some of the determinants of inequalities in health. Yes, Social inequality is important. Yet within Western Europe, there is little evidence that among-country inequalities in health are related to variations in government support for health care. For example, Italy and Spain have welfare policies that are less generous and less universal than those of Northern Europe but they appear to have substantially smaller inequalities in mortality. Do overriding cultural factors, such as the Mediterranean diet and the reluctance of women to take up smoking outweighing government health care activities? Evidently they do. Cultural factors seem to have prevented differences in access to material wealth and other usual health related resources in these populations from translating into inequalities in lifestyle-related risk factors for mortality.

The study also found no evidence for a leveling of health inequalities among classes in countries in Northern Europe. This was surprising, because these countries have long histories of egalitarian policies, reflected in, among other things, welfare policies. These policies provide a high level of social-security protection to all residents of the country, resulting in smaller income inequalities and lower poverty rates. The studies results suggest that although a reasonable level of social security and public services may be a necessary to prevent inequalities in health, it is not sufficient. Lifestyle-related risk factors have an important role in premature death in high-income countries and also appear to contribute to the persistence of inequalities in mortality in Northern Europe.

New York Times Story June 5,2008


This kind of news report
is typical of media hype but is this where the real problem is?

“Race and place of residence can have a staggering impact on the course and quality of the medical treatment a patient receives, according to new research showing that blacks with diabetes or vascular disease are nearly five times more likely than whites to have a leg amputated and that women in Mississippi are far less likely to have mammograms than those in Maine.

The study, by researchers at Dartmouth, examined Medicare claims for evidence of racial and geographic disparities and found that on a variety of quality indices, blacks typically were less likely to receive recommended care than whites within a given region. But the most striking disparities were found from place to place.

For instance, the widest racial gaps in mammogram rates within a state were in California and Illinois, with a difference of 12 percentage points between the white rate and the black rate. But the country’s lowest rate for blacks — 48 percent in California — was 24 percentage points below the highest rate — 72 percent in Massachusetts. The statistics were for women ages 65 to 69 who received screening in 2004 or 2005.

In all but two states, black diabetics were less likely than whites to receive annual glycolated hemoglobin testing.( a test that monitors long term diabetic control) But blacks in Colorado (66 percent) were far less likely to be screened than those in Massachusetts (88 percent).

The study was commissioned by the nation’s largest health-related philanthropy, the Robert Wood Johnson Foundation, which on Thursday planned to announce a three-year, $300 million initiative intended to narrow health care disparities across lines of race and geography.
Such variations may be partly explained by regional differences in education and poverty levels, but researchers increasingly believe that variations in medical practice and spending also are factors.

“In U.S. health care, it’s not only who you are that matters; it’s also where you live,” wrote the study’s authors, led by Dr. Elliott S. Fisher.”

The fact that there are marked state to state variations seems to argue against racism as the cause of these disparities unless Colorado is more racist than Massachusetts. If the European study sited in the first part of the post holds true in the United States, changes in welfare and medical care should be expected to have only marginal effects on mortality as compared to life style and cultural changes. Perhaps the Johnson Foundation would get more bang for the buck by distributing cases of olive oil and wine to the disadvantaged.


Why Are High Housing Prices Good?

Have you ever read a news story like this?

“In other reports, sales gasoline rose in May, although prices continued to drop, according to the Petroleum Institute Sales rose 2 percent to a pace of 499 million gallons. The median sales price per gallon, however, fell to $3.75, down 6.3 percent from a year ago. That was the fifth biggest year-over-year price decline in records that go back to 1999. Many analysts think gasoline prices need to stop falling or start rising for the ailing petroleum market to get back its health.”

This is a slightly doctored version of the story below.

The Associated Press:
“In other reports, sales of previously owned homes nudged up in May, although prices continued to drop, the National Association of Realtors said. Sales rose 2 percent to a pace of 4.99 million units. The median sales price, however, fell to $208,600, down 6.3 percent from a year ago. That was the fifth biggest year-over-year price decline in records that go back to 1999. Many analysts think housing prices need to stop falling or start rising for the ailing housing market to get back its health.”

I hope prices of houses go up enough so I can afford to buy one.


One Upping

I'll try to top David Masten's post. The Senate majority leader in my home state of Minnesota, Larry Pogemiller (DFL), recently had this to say:

I think it is simplistic and naive to say that people can spend their money better than government... The notion that everybody can individually spend their money better than government, I just think is trite wrong-headed and anti-democratic.

Video here.


Time for Show Trials

I wish I could come up with something insightful to say about this, but I'm drawing a blank. I had thought the issue of show trials for heresy had been settled, but once again I've been proven wrong. From the Guardian, here are the latest ramblings from Chief Defender of the Faith James Hansen:

James Hansen, one of the world's leading climate scientists, will today call for the chief executives of large fossil fuel companies to be put on trial for high crimes against humanity and nature, accusing them of actively spreading doubt about global warming in the same way that tobacco companies blurred the links between smoking and cancer.

Hansen will use the symbolically charged 20th anniversary of his groundbreaking speech (pdf) to the US Congress - in which he was among the first to sound the alarm over the reality of global warming - to argue that radical steps need to be taken immediately if the "perfect storm" of irreversible climate change is not to become inevitable.

Speaking before Congress again, he will accuse the chief executive officers of companies such as ExxonMobil and Peabody Energy of being fully aware of the disinformation about climate change they are spreading.

In an interview with the Guardian he said: "When you are in that kind of position, as the CEO of one the primary players who have been putting out misinformation even via organisations that affect what gets into school textbooks, then I think that's a crime."


Did Anyone Else Catch This?

I was watching one of the CSPAN channels last week when a member of the ACLU said, straight faced (and there were no chuckles from the audience nor did he crack a smile or give much of a pause), that more rich white people should be falsely indicted (a la the Duke case) to help expose prosecutorial misconduct. I was pretty stunned, but everyone on stage with the guy didn't seem phased at all.

Getting crapped on by the government sucks for all involved. If prosecutorial misconduct is given greater scruitiny as a result of the Duke case, I'm very glad such a silver lining exists, but yikes, man. I don't even wish that kind of stuff on Scott Scheule.

I tried googling to find out the name of the ACLU employee, but there is so much with Duke case and ALCU I didn't get far.


You say yes, I say no

Looks like Amit and his near miss in yesterday's primary election is the subject of some more cosmo-/paleo- libertarian bickering. The cosmos seem to take the higher ground this time; I get the feeling that Lew just had to vent his disappointment without thinking too carefully about which "side" Amit was supposed to be on.

There must be a numerical term that measures how large a social group gets before it splits into warring factions. I would have thought that with all the discussion of polycentric market solutions that libertarianism would have a much larger number. Guess not.


What Can be Done About the Knife Culture?

A phenomenon first reported in the British Isles is now gaining in strength in Japan. What can the government do? The Brits have launched a massive education program and started sentencing people caught carrying knives over 3 in. in length to up to four years in prison after having 16 knife deaths.
Google Link

In Japan a 25 year old anime watching, Internet using mad man killed seven with a large sports knife. One legislator called for banning sports knives with long blades. These weapons which might be labeled assault knives include knives with blades over five inches in length.

A quick check of the kitchen shows ten knives that would be affected by the ban, some with blades up to 10 inches in length. Some of them were owned by my dear mother. Oh well ,I guess we are already all felons anyway.

Link

Yes,The links work,now get ready to rummble!


Dept. of Jokes I Wish I'd Thought Of

Because I can't not pass on a joke that combines neurology, politics, and bad taste all in one shot:

Did you hear about Senator Kennedy's left-parietal glioma? Apparently it was giving him such a bad case of hemineglect that he couldn't perceive the right side of the political spectrum.


Definition of Sabotage

The Cato blog linked here and the following caught my eye:

The Cato Institute will present this student, Yon Goicoechea, with the "2008 Milton Friedman Prize for Advancing Liberty" at a dinner costing $500 per person.
The student movement against the Bolivarian Revolution in Venezuela has been receiving money from different agencies of the United States, such as the National Endowment for Democracy, USAID, and other U.S. and international agencies.

Yon Goicoechea has made it clear that the $500,000 from the Cato Institute will be used for further attempts to sabotage the Bolivarian Revolution.

Emphasis mine. My guess (and it is just a guess, I know nothing about Goicoechea)is that sabotage in this context means to hold a contrary opinion and speak out on it.

Note to the New York City Independent Media Center: The Venezuelan government's price controls will take care of the sabotage of the Bolivarian Revolution. If that is the goal of Goicoechea and Cato, either would be better off keeping the cash.


Small Picture Thinking and the Left

As best I can tell Hillary’s greatest passion is to develop government programs to help women and children who are not wealthy. You would think all the left would love her.

It is interesting to examine the cognitive dissonance in leftist minds. Here are some quotes from commenters reacting to Ampersands post on Alas. It is all about the pervasive racism theme and they are not about to let up.

Here is what Hillary actually said. “Well, Kathy you know there was just an AP article posted, uhh, that … found how … Senator Obama’s …uh… support…among, um…, working…uh hard working Americans, uh, white Americans, is, um…weakening again, uhh and how, uhh … the … whites in both states who had not completed college were supporting me and, in independents, umm, I was running even with him, and…doing even better with Democratic-leaning independents. I have a much broader base to build a winning coalition on.”

So evidently it was just an off the cuff remark, just the kind certain sports announcers and TV personalities have made to their everlasting regret. She appears to have just been commenting on some AP article. Translated and condensed by the press it comes out sounding like a prepared statement pandering to white racists.

It is interesting that some on the leftist are as intolerant of her gaffe as they were of Don Imus and other unfortunates. Examples of negative reactions include-- “this is part of a larger pattern and an apparent strategy to use race as a weapon against Obama. At this point, it doesn’t matter how much she hems and haws or “didn’t mean it” as she says it, any whiff of racist tactics from her will now appear to be part of that strategy.”

“--- many working-class people that I know who support Obama but don’t count because they’re for the most part not White. And it’s not like the White working class people are all gravitating to Hillary.” They are mostly republicans.

“Clinton is still a fool though: whether or not she meant A or B, she’s supposed to be smart enough to avoid insults. Accidental insults are still insults.”

“But Clinton’s running a campaign that for the most part has been implemented by White male Republicans.
It’s crap like this that makes me question feminists willingness to dismantle patriarchy or simply change who’s in charge of it and why “patriarchy” itself is a problematic term for many women.”

“It’s not just one off-the-cuff statement that’s being misunderstood; it’s like her entire campaign. And if appealing to White Americans as if they’re the only votes that matter is necessary to “win” an election or a nomination, then our country’s in an even sadder state than I thought.” So sorry, but Blacks are a minority and have placed themselves in the Democrat’s pocket already.

“I agree that it is entirely possible that Clinton was not intentionally trying to connect “hard-working Americans” with “white Americans”. However, if she wasn’t that almost makes it worse. She either revealed an implicit association between “hard-working” and “white” or she made a cynical statement designed to appeal to racists.”

“Look, racism is not just personal prejudice. If you encourage racist views, it does not matter whether you personally believe what you are pushing or not. It is racist either way.”

The message seems to be that intentions don’t matter. Words have a life of their own for which you will be held infinitely responsible. Is it any wonder that we will never reach the desired level of linguistic and moral purity so that these fanatics will someday say “Mission accomplished; now let’s move on to something more interesting and fun.” That goal has been placed perpetually out of reach meaning that the left must just enjoy being tiresome, scolds.


If you thought seasteading was crazy...

I've been catching up on the Econlib podcasts lately, and recently listened to Edward Castronova on Virtual Worlds. He makes a number of striking claims during the podcast, but in particular, Edward thinks that there is a very real possibility that virtual worlds will provide competitive pressure on governments. I know what you are thinking, doesn't the virtual world have to be hosted in meatspace where a government can get to it? Sure it does, but that doesn't mean it has to be centralized. Castronova points out that file sharing networks have to be hosted in meatspace, yet they are extremely difficult for governments to get a handle on.

I think seasteading has more promise, but this is an interesting possibility.


Italy Publishes Every Citizen's Income

Here's a shocking new low for personal privacy in a developed country:

There has been outrage in Italy after the outgoing government published every Italian's declared earnings and tax contributions on the internet.

The tax authority's website was inundated by people curious to know how much their neighbours, celebrities or sports stars were making.

The Italian treasury suspended the website after a formal complaint from the country's privacy watchdog.

I think my favorite part of the article was this:

Deputy Economic Minister Vincenzo Visco said he could not understand what all the fuss was about.

"I can't understand what the problem is," he is quoted as telling Italy's Corriere della Sera newspaper.

I'm in a hurry to hand over my medical files to the government, let me assure you.


Missouri is #1

Today Dave Roland from the Show-Me Institute gave a talk on eminent domain abuses in Missouri at my school, Lindenwood University. He has previously worked for the Institute for Justice on, among other cases, Kelo vs. New London, so we were pretty excited to have him. One interesting thing I found out was that Missouri has the dubious distinction of having the worst laws on this issue in the country, at least in terms of how they are interpreted, and of having the highest number of eminent domain abuses per capita among the 50 states. And I thought San Francisco was the home of socialism. Apparently St. Louis holds its own in this battle.


Housing Becomes More Affordable

I'm not a macro person, but I tend to regard this as quite good news, and not just because Dean Baker disagrees.

Home prices have posted another record decline, as most of the nation's largest markets suffered double-digit drops over last year, a survey released Tuesday shows.

The S&P Case/Shiller Home Price Index, which tracks 20 of the largest housing markets, showed prices plummeting by 12.7% in the 12 months ending February. That's the biggest fall since the index began tracking prices in 2000.

I tend to think a quick adjustment, wringing out the bubble and bringing housing back to its natural level would be the best thing that can happen. Thoughts?


Walking pharmacies

Commenting on this entry.

Athletes start out with greater and worse physical endowments. One man's body may simply produce more testosterone than another man's body. What is, in principle, wrong with the second man artificially topping up his testosterone to match the first man's? What, for that matter, is wrong with the first man's artificially increasing his testosterone even further? If his unusual natural endowment is okay and presumably would be okay if it were even more unusual, then why wouldn't it be okay for him to use artificial means to achieve the same end?

The question - is it a competition between athletes or a competition between drug companies - has an analogous question - is it a competition between athletes or is it a competition between parents/grandparents/great grandparents, who supply the genetic code? When parents start consciously enhancing the genetics of their offspring, then this will be just as artificial as an athlete shooting up before a contest. But now compare this scenario to the present: how is the genetically manipulated offspring of parents any less worthy of participating in an athletic competition than the unmanipulated offspring?

Yes, I know that shooting up is unhealthy for the athletes, but that's a separate objection. I'm addressing the objection I see here.

I do have an idea what's going on, why the objection. It's not that athletes are hurting themselves with drugs. Sports injuries have always been the price of participation in sports. Sporting is dangerous and it can destroy lives. Always has been, for the simple reason that sports stretch people to their limit.

And it's not that people who shoot up are "cheating". It is cheating, after all, only because it's against the rules, and it's against the rules only because people are uncomfortable with it. So it's the discomfort that makes drug users into cheaters; it's not some pre-existing fact that it's cheating that makes people uncomfortable with it.

People object to it because people who shoot up are no longer human, or no longer merely human. The same would be true of genetically enhanced athletes. People who are perfectly happy to acknowledge the greatness of an athlete who has obviously superior inborn genetic endowments to their own, are less happy to acknowledge the greatness of an athlete whose superior "endowments" were purchased from a laboratory, because the mystical bond of common humanity is lost once the enhanced ability comes from a needle rather than from the parents' gametes.

And meanwhile, Americans cheer on other Americans because of the mystical bond of common Americanness.

It's the same reason in both cases. To be more specific, in both cases it's a question of origin. Where do the enhanced abilities originate? Where does the athlete hail from?