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Income, Health, and Payday Deaths

March 1, 2012 2 comments
Posted on March 1, 2012
NOTE: This is reposted from a piece that was originally written on the Inequalities blog, at http://inequalitiesblog.wordpress.com – thanks to Ben Baumberg for allowing us permission to repost it here”.

It’s hardly news that poorer people have worse health on average – but teasing apart the link of income and health is harder. The income-health gradient could be because people lose income when they have health problems, or it could be due to common causes (e.g. education) rather than income itself. In fact, the relationship is more complex than you might guess; and having recently stumbled over three wonderful studies that help unpick this, I thought I’d share them with you and see what you thought.

Short-run effects: payday deaths

Probably my favourite of these studies is a lovely paper in press by Evans and Moore, using US data. Their reasoning is that if we want to know the SHORT-RUN impact of income and health, we can look at the first day of the month when most people get paid or receive welfare payments, and see if people are more or less likely to die on payday.  The results are staggering.

In the chart below, you can see how murder rates vary across the month.  The relate daily mortality risk is about 10% higher on payday than it is for the rest of the month, and a little bit higher for 4 days after payday.

What’s particularly striking is that this is only found for causes of death that are related to drink in the short-term.  So for example, if we look at leukemia deaths in the chart below, we see absolutely no change over the month at all.

In other words, people drink more on payday, and this raises the chances of them dying. Otherwise there’s no short-run impact of payday on health.

Long-run effects: lottery winnings

Does this mean that higher incomes are actually bad for health?  Well, not so fast.  The deaths-by-payday charts are good for showing the very short-run impacts of income on health, but they don’t show what happens to a change in permanent income, nor do they show the longer-run impacts. The best way of getting at the causal impact of income here is to look at lottery winnings, which (unlike most sources of income) are completely random within any particular lottery.

In the UK, a paper by Apouey & Clark 2009 looks at the impact of lottery winnings on health. Like Evans and Moore, they find that this source of extra income leads to more smoking and drinking (perhaps unsurprisingly, if you think about how you personally would spend a lottery winning (or me anyway), and also the fact that people who play the lottery are going to have a different attitude to risk than other people).

Yet we also see noticeable improvements in mental health among people who win on the lottery – suggesting that financial problems genuinely cause mental health problems.

The net effect of these two patterns in Apouey & Clark is that there’s no effect of lottery winnings on self-reported general health – but while self-reported health can be useful, it also has lots of problems as a measure. A more objective measure of general health is mortality, and for this we have to turn to some Swedish data analysed by Lindahl 2005 (free version here). Lindahl finds that about £1,000 worth of lottery winnings reduce the probability of dying by 2-3% over the next five years. With this design, it’s pretty unarguable that this shows a genuine causal impact of income.

Back full circle

So this takes us right back to where we started – poor people have worse health, and this is (at least partly) because lower incomes genuinely cause worse health. But through these three very nicely-designed studies, we get a glimpse into the complexity of this pattern across different aspects of health over different time periods – and it’s this that I thought made them particularly worth sharing.

Desperately Working to Stay Afloat

February 20, 2012 Leave a comment


President, Children’s Defense Fun
Posted: 02/17/2012 5:20 pm

Levi Nation, age 12, and his sister Katherine, eight, eat Sunday dinners at their grandparents’ house in rural Kalkaska County, Michigan. They live with their parents, James and Lois, in an old trailer next door. Though both parents work, they can’t afford a better place—or health insurance or outings with the children. “Sometimes I wish we could go someplace like down to a water park or, like, the zoo,” Levi said.

At one time, the Nations owned a home. But like so many other American families, their standard of living has declined over the past decade even though they are a two-parent working family.

James’s family employment story echoes the Michigan story, as Pulitzer Prize-winning journalist Julia Cass learned when she met the family while on assignment for the Children’s Defense Fund. His father worked for General Motors in Flint until it offered him “a golden handshake and he took the check.” James said. James considers himself a member of “probably the last generation to be able to walk out of high school and get a decent job,” though he and his brother came too late to find well-paying work at GM and move up into the middle class.

During the earlier years of their marriage, when they were able to afford to buy a home, James and Lois lived in Durand, near Flint. He worked for 14 years in a family-owned machine shop that made tools for the aluminum wheel industry. Lois, who’d taken some junior college classes, worked as a bank teller. When Levi was born, she wanted a career she could base around a child’s schedule and went to a school for massage therapy. In 2004, they sold their house and moved to Kalkaska County, where Lois grew up. They wanted to raise their children in a safer place, and planned to live in a trailer on property Lois’s parents owned and build a home there later.

Levi Nation, 11
Levi Nation, age 12, and his sister Katherine, eight, live with their parents, James and Lois, in an old trailer in rural Kalkaska County, Michigan. Though both parents work, they can’t afford a better place—or health insurance or outings with the children. James says, “You can work your butt off and still not get ahead.”

Kalkaska and neighboring Grand Traverse County on Lake Michigan are, in part, resort areas with second homes and luxury condos. James started a handyman service and Lois had massage clients. “Then the economy kind of fell apart and I had to get a job to be sure the bills were paid,” James said. He worked as a mechanic at a farm equipment store for a few years and recently moved to a part-time job with the Village of Kalkaska as a wastewater operator. “It’s a little less money, but the commute is shorter, so it evens out,” James said. “Also, I’m hoping it will turn into a full-time job with benefits.” James earns $13 an hour and works 30 hours a week. He earns a little more than $19,000 a year.

Lois didn’t have enough clients in her massage business so she took a job at McDonald’s. “I’ve worked there four years and am just now breaking over the $8 an hour mark,” she said.

That job, too, is part-time. She says the company keeps hiring new people and spreading out the hours so that if someone leaves or doesn’t show up, they have other employees who can fill the shifts. “They think you can just come in whenever they need you, but a lot of people can’t do this because they have family,” she said. “My kids are too young to leave by themselves.” She works 15 to 25 hours a week and earns between $10,000 and $15,000, depending on how many hours she gets.

The family is working so desperately to stay afloat, Lois recently began training for a second part-time job at a credit union. She will be a fill-in person working from 20 to 30 hours a week and earning $8.50 an hour. The number of hours will vary from week to week at both jobs, but she expects to wake up at 3:30 a.m. to work at McDonald’s from 4:15 till 8 a.m. and to work at the credit union from late morning until 5 or 6 p.m. on Mondays and Fridays and half-days on Saturdays, the credit union’s three busiest days. “I’ll miss the kids’ soccer games,” she said, “but we need the money.” Because both jobs are part-time, she will receive no benefits.

Their children Levi and Katherine are covered by Medicaid, a critical safety net support for their family. But James and Lois make too much to be eligible for Medicaid themselves, but not enough to buy health insurance. James recently needed $2500 in dental work and Lois had $1200 in medical tests, for which they reluctantly used CareCredit cards; with this method, if they pay off the doctor and dental bills within 18 months, they pay no interest, but if they don’t, James said they will be charged 24 to 36 percent interest retroactive to date of service, adding, “We will pay them off somehow because we’ve worked hard to keep good credit”—to be able, someday, to get another home for themselves and their children.

The Nations receive about $80 a month in food stamps. When their children were younger they were eligible to attend Head Start. It helped a lot with the children’s development. “We couldn’t afford to pay for preschool, and if it hadn’t been for Head Start, we wouldn’t have gotten Levi diagnosed [with mild attention deficit hyperactivity disorder]. And the teacher taught me ways to work with him.” Katherine, she said, is going into third grade and already reads on the fifth grade level, “and they have to challenge her in math too because of Head Start. Every week they were sending something home on how to challenge your child’s brain and make it fun.”

Lois said they applied to Habitat for Humanity for a house but “they turned us down. They said we had more opportunities than other people because we have land and good credit.” James commented, “We’re kind of between a rock and a hard place” of being somewhat poor but not poor enough. “The way grocery and gas prices keep going up, I don’t see where we’re making that much money that we should be in between. You can work your butt off and still not get ahead.” For now, they keep going—not yet getting ahead, but working as hard as they can, and never giving up.

Follow Marian Wright Edelman on Twitter: www.twitter.com/ChildDefender

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