Life and Death and Income
You know where it ends, yo, it usually depends on where you start.
~Everlast, “What It’s Like”
Would You Rather Be Black & Rich or White & Poor?
Would you rather be Black and rich or White and poor? If you are a pregnant mother-to-be, and your priority is the health of your child, then statistically speaking, you should pick White and poor.
A recent New York Times article covering a study sponsored by the U.S. Census Bureau spells out two disturbing facts relating circumstances of birth and infant mortality. Regarding income and a baby’s health, “[r]ich and poor mothers were equally likely to have high-risk pregnancies, but the poor mothers were three times as likely to die...” Indeed, the main thrust of this post is that income predicts the quality of health care.
More specifically, in terms of infant mortality, it is twice as bad to be poor than rich…for White mothers. But the other disturbing finding in the study cited above is that it is even worse to be rich and Black.
If you are as male, pale, and stale as I am, you might notice a temptation to skitter away from this little factoid. What White old man in the U.S. wants to square up with the idea that life might be unfair for non-male non-Whites? Such a notion implies that we did not earn our accolades all by our “independent” Caucasian selves.
The easiest path along which to skitter is “it must be genetics,” because then the problem wouldn’t be anything to do with us. Well, here’s what public health economist Tiffany L. Green is quoted as saying in the NYT article: “It’s not race, it’s racism. The data are quite clear that this isn’t about biology. This is about the environments where we live, where we work, where we play, where we sleep.”
As I read it, she is calling out systemic racism — the intergenerational inertia behind perpetually unfair circumstances like living environments. This raises questions about the difference between systemic racism and personal racism. I will get into that, but not in this post. Here, I want to acknowledge that for a mother whose baby is not getting the help she deserves, the difference between systemic racism and personal racism is moot. In the case of pre- and perinatal health care, at least, the effects of racism — whether personal, systemic, or “who cares?” — are extreme. Let’s face it, racism plays a part in what it feels like to be a citizen of any color in the United States.
OK, back to somewhat safer ground. Inequity would exist without racism. And inequity’s effect on economic growth would exist without racism. Therefore, this newsletter does not focus on racism. It’s just that racism makes inequity worse. Also, inequity makes people angry and some angry people need other people to be angry at, so I suspect that generalized inequity makes racism worse. Another problematic causal loop.
Life and Death and Income
For every county in the U.S., the above graph shows life expectancy and infant mortality versus the median household income. There are two trendlines for each dot cloud, one for the bottom half of the income scale, the other for the top half. I did it this way because a single unbroken trendline doesn’t follow the main mass of the dot cloud well. The trendlines are best logarithmic fits, in alignment with the way economists usually view income. A logarithmic fit depicts how each health metric changes given a percentage change in income, whereas a straight line would show how a metric changes given a dollar change.
Life expectancy and infant mortality are visibly correlated. Nevertheless, as I will explain in a later post with only a tiny bit of math, these two healthcare metrics are not redundant. For now, some thoughtful reflection suggests a sensible explanation. The two metrics tell different stories. The life expectancy factors we can influence as a society (i.e., not genetics) are mainly about self-care. Infant mortality, on the other hand, is related to other-care — families and the health care system are supposed to care for babies.
It is true that higher income buys better health insurance and makes it easier to afford health care not covered by insurance. But Harvard scholars conclude that the situation is more complex than that: “At the root of [health care inequities] are unequal economic opportunities, unequal education, and despair.”
Economic opportunities and education are linked, and I discuss how in a previous post. My next post will dive further into deaths of despair — suicide and drug deaths. In this post, I point out that despair may also influence life expectancy in subtler ways, through smoking, obesity, and less exercise. Unhealthy lifestyles, brought on in part by pessimism about one’s prospects, lead, on average, to earlier deaths but do not count as deaths of despair. In short, the link between income and life expectancy is reinforced by the links among income, education, and despair.
Infant mortality in the U.S., according to the Centers for Disease Control and Prevention (CDC), has five leading causes: birth defects, early births, sudden infant death syndrome (SIDS), injuries, and pregnancy complications. I found it instructive to peel another layer of this onion. The CDC’s advice for preventing birth defects involves health care (like folic acid supplementation and check-ups) and healthy lifestyle choices. Preterm babies need (expensive) medical care. SIDS is still a mystery, but the CDC points to the American Academy of Pediatrics (AAP) for a list of techniques intended to minimize deaths of sleeping babies. Parents can minimize injuries to their babies by eliminating a few unnecessary risks. The CDC’s recommendations for minimizing the chance of maternal complications amount to professional health care and healthy lifestyle choices.
The common themes among recommendations for minimizing infant mortality are health care and lifestyle. Like life expectancy, infant mortality is also linked to education and despair, and thus income. But in the case of infant mortality, it is of course the parent’s income that matters, which leads to an intergenerational effect.
To summarize, two systems, both favoring high incomes, influence health: the healthcare/insurance industry and the education system. Furthermore, since a mother’s health influences her baby’s health, and that baby’s health influences the health of the adult she grows into, and then that adult’s health influences her baby’s health, systemic unfairness in health care has been perpetuated through generations.
Next up: Income can’t buy happiness, we’re told, so why is low income strongly correlated with deaths of despair?