Longitudinal analysis of income-related health inequality

This paper considers the characterisation and measurement of income-related health inequality using longitudinal data. The paper elucidates the nature of the Jones and Lopez Nicholas (2004) index of “health-related income mobility” and explains the negative values of the index that have been reported in all the empirical applications to date. The paper further questions the value of their index to health policymakers and proposes an alternative index of “income-related health mobility” that measures whether the pattern of health changes is biased in favour of those with initially high or low incomes. We illustrate our work by investigating mobility in the General Health Questionnaire measure of psychological well-being over the first nine waves of the British Household Panel Survey from 1991 to 1999.

Measuring Avoidable Health Inequality with Realization of Conditional Potential Life Years (RCPLY)

In a series of papers (Tang, Chin and Rao, 2008; and Tang, Petrie and Rao 2006 & 2007), we have tried to improve on a mortality-based health status indicator, namely age-at-death (AAD), and its associated health inequality indicators that measure the distribution of AAD. The main contribution of these papers is to propose a frontier method to separate avoidable and unavoidable mortality risks. This has facilitated the development of a new indicator of health status, namely the Realization of Potential Life Years (RePLY). The RePLY measure is based on the concept of a “frontier country” that, by construction, has the lowest mortality risks for each age-sex group amongst all countries. The mortality rates of the frontier country are used as a proxy for the unavoidable mortality rates, and the residual between the observed mortality rates and the unavoidable mortality rates are considered as avoidable morality rates. In this approach, however, countries at different levels of development are benchmarked against the same frontier country without considering their heterogeneity. The main objective of the current paper is to control for national resources in estimating (conditional) unavoidable and avoidable mortality risks for individual countries. This allows us to construct a new indicator of health status – Realization of Conditional Potential Life Years (RCPLY). The paper presents empirical results from a dataset of life tables for 167 countries from the year 2000, compiled and updated by the World Health Organization. Measures of national average health status and health inequality based on RePLY and RCPLY are presented and compared.

Poverty, inequality and policy since 1997

This study examines the impact of policy on poverty and inequality in Britain since 1997This research shows what effect policies introduced since 1997 have had on reducing poverty and inequality. It offers a considered assessment of impacts over a decade:How did policies change, before 1997 and since then?What evidence is there of impacts on key outcomes?What gaps or problems remain or emerged?The study covers a range of subjects, including public attitudes to poverty and inequality, children and early years, education, health, employment, pensions, and migrants. It measures the extent of progress and also considers future direction and pressures, particularly in the light of recession and an ageing society.The research draws on extensive analysis of policy documents, analysis by government departments and research bodies, published statistics and evaluations, analysis of large-scale datasets, micro-simulation modelling and a long-running qualitative study with residents of low-income neighbourhoods.��

Inequality in Healthy Life Expectancy at Birth by National Deciles of Area Deprivation: England, 2010-12

This release from the Office for National Statistics contains a reference table providing Healthy Life Expectancy (HLE) and Life Expectancy (LE) at birth for national deciles of area deprivation in England. It also provides two measures of inequality, the range and Slope Index of Inequality (SII), for the period 2010-12.Key findingsMales in the most deprived areas have a life expectancy 9.1 years shorter (when measured by the range) than males in the least deprived areas; they also spend a smaller proportion of their shorter lives in ‘Good’ health (70.8% compared to 85.0%).Females in the most deprived areas have a life expectancy 6.8 years shorter (when measured by the range) than females in the least deprived areas; they also expect to spend 17.2% less of their life in ‘Good’ health (66.1% compared to 83.2%).Males in the most advantaged areas can expect to live 19.4 years longer in ‘Good’ health than those in the least advantaged areas as measured by the Slope Index of Inequality (SII). For females this was 19.8 years.Read the release here.��

Alcohol consumption and social inequality at the individual and country levels--results from an international study.

BACKGROUND: International comparisons of social inequalities in alcohol use have not been extensively investigated. The purpose of this study was to examine the relationship of country-level characteristics and individual socio-economic status (SES) on individual alcohol consumption in 33 countries. METHODS: Data on 101,525 men and women collected by cross-sectional surveys in 33 countries of the GENACIS study were used. Individual SES was measured by highest attained educational level. Alcohol use measures included drinking status and monthly risky single occasion drinking (RSOD). The relationship between individuals' education and drinking indicators was examined by meta-analysis. In a second step the individual level data and country data were combined and tested in multilevel models. As country level indicators we used the Purchasing Power Parity of the gross national income, the Gini coefficient and the Gender Gap Index. RESULTS: For both genders and all countries higher individual SES was positively associated with drinking status. Also higher country level SES was associated with higher proportions of drinkers. Lower SES was associated with RSOD among men. Women of higher SES in low income countries were more often RSO drinkers than women of lower SES. The opposite was true in higher income countries. CONCLUSION: For the most part, findings regarding SES and drinking in higher income countries were as expected. However, women of higher SES in low and middle income countries appear at higher risk of engaging in RSOD. This finding should be kept in mind when developing new policy and prevention initiatives.

An ex-post view of inequality of opportunity in France and its regions

This paper proposes an ex-post measure of inequality of opportunity in France and its regions by assessing the inequality between individuals exerting the same effort. To this end, we define a fair income that fulfils ex-post equality of opportunity requirements. Unfairness is measured by an unfair Gini based on the distance between the actual income and the fair income. Our findings reveal that the measures of ex-post inequality of opportunity largely vary across regions, and that this is due to di_erences in reward schemes and in the impact of the non responsibility factors of income. We find that most regions have actual incomes closer to fair incomes than to average income, excepted Ile de France where the actual income looks poorly related to effort variables. Finally, we find that income inequality and inequality of opportunity are positively correlated among regions.

Santé buccale: déterminants sociaux d'un terrain majeur des inégalités [Oral health: social determinants of a health inequality]

The oral health of disadvantaged social groups is worse at all the ages than that of the favored groups. If tooth decay prevalence decreases, this disease is still unequally distributed: 20% of the children, those with the weakest socio-economic statute (SES), concentrate 60% of the decays. Edentulism strikes significantly more people with weak SES. The inequalities of oral health reflect those of general health. Evidence of the inequalities in oral health is exposed even in the developed countries. Different models of intervention are presented: risk groups identification and targeting by specific programs; oral health community approach which includes socio-economic and public health measures aiming all the population; insurance approach to be combined with the preceding ones.

Measurement and explanation of socioeconomic inequality in health with longitudinal data

This paper presents a method for the measurement of changes in health inequality and income-related health inequality over time in a population.For pure health inequality (as measured by the Gini coefficient) andincome-related health inequality (as measured by the concentration index),we show how measures derived from longitudinal data can be related tocross section Gini and concentration indices that have been typicallyreported in the literature to date, along with measures of health mobilityinspired by the literature on income mobility. We also show how thesemeasures of mobility can be usefully decomposed into the contributions ofdifferent covariates. We apply these methods to investigate the degree ofincome-related mobility in the GHQ measure of psychological well-being inthe first nine waves of the British Household Panel Survey (BHPS). Thisreveals that dynamics increase the absolute value of the concentrationindex of GHQ on income by 10%.

Wage inequality and economic growth in Mexican regions

Only a few studies have analysed the relationship between intraregional inequality and growth, although several studies have measured inequality at the regional level. The objective of this paper is to analyse the relationship between income (wage) inequality and economic growth in different regions of Mexico. We also try to identify factors that explain the variation of intra-regional inequality across Mexican regions and over time. Using macroeconomic databases and publicly available microdata, we apply techniques used in the fields of statistics and econometrics to obtain robust evidence on the relationship between growth and inequality. Our aim is to provide policy recommendations to support the design and implementation of growth-promoting measures thatavoid the exclusion of certain social groups. This paper provides reasons to use a spatial approach and an analysis of particular regions to avoid «one size fits all» policy recommendations.

Spatial Inequality in Chile

Despite success in reducing poverty over the last twenty years, inequality in Chile has remained virtually unchanged, making Chile one of the least equal countries in the world. High levels of inequality have been shown to hamper further reductions in poverty as well as economic growth and local inequality has been shown to affect such outcomes as violence and health. The study of inequality at the local level is thus crucial for understanding the economic well-being of a country. Local measures of inequality have been difficult to obtain, but recent theoretical advances have enabled the combination of survey and census data to obtain estimators of inequality that are robust at disaggregated geographic levels. In this paper, we employ this methodology to produce consistent estimators of inequality for every county in Chile. We find a great deal of variation in inequality, with county-level Gini coefficients ranging from 0.41 to 0.63.

Income inequality in a job-search model with heterogeneous discount factors: (revised version, forthcoming 2006, Revista Economia)

This paper investigates the income inequality generated by a jobsearch process when di§erent cohorts of homogeneous workers are allowed to have di§erent degrees of impatience. Using the fact the average wage under the invariant Markovian distribution is a decreasing function of the discount factor (Cysne (2004, 2006)), I show that the Lorenz curve and the between-cohort Gini coe¢ cient of income inequality can be easily derived in this case. An example with arbitrary measures regarding the wage o§ers and the distribution of time preferences among cohorts provides some insights into how much income inequality can be generated, and into how it varies as a function of the probability of unemployment and of the probability that the worker does not Önd a job o§er each period.

On the positive correlation between income inequality and unemployment

Several empirical studies in the literature have documented the existence of a positive correlation between income inequalitiy and unemployment. I provide a theoretical framework under which this correlation can be better understood. The analysis is based on a dynamic job search under uncertainty. I start by proving the uniqueness of a stationary distribution of wages in the economy. Drawing upon this distribution, I provide a general expression for the Gini coefficient of income inequality. The expression has the advantage of not requiring a particular specification of the distribution of wage offers. Next, I show how the Gini coefficient varies as a function of the parameters of the model, and how it can be expected to be positively correlated with the rate of unemployment. Two examples are offered. The first, of a technical nature, to show that the convergence of the measures implied by the underlying Markov process can fail in some cases. The second, to provide a quantitative assessment of the model and of the mechanism linking unemployment and inequality.

Income inequality: the role of impatience in a job-search process

This paper investigates the income inequality generated by a jobsearch process when di§erent cohorts of homogeneous workers are allowed to have di§erent degrees of impatience. Using the fact the average wage under the invariant Markovian distribution is a decreasing function of the time preference (Cysne (2004)), I show that the Lorenz curve and the between-cohort Gini coe¢ cient of income inequality can be easily derived in this case. An example with arbitrary measures regarding the wage o§ers and the distribution of time preferences among cohorts provides some quantitative insights into how much income inequality can be generated, and into how it varies as a function of the probability of unemployment and of the probability that the worker does not Önd a job o§er each period.

Growth, poverty and inequality in Central America

Includes bibliography

Income inequality in Brazil: What has changed in recent years?

Includes bibliography.