There does appear to be an unmistakable correlation between concentration
of wealth and the well-being of a nation. I copied this from the
Scientific American in 1990? I think, from an article by Amartya Sen.
Again I think he was employed by the World Bank, and he might have had
something to do with this organisation giving up on GDP as a measure of
well-being.
"In England and Wales, the decades of World War I and
World War II were characterised by the most significant increase in life
expectancy found in any decade this century. War efforts and rationing
lead to a more equitable distribution of food and the Government paid
more attention to health care - even the National health Service was set
up in the 1940's. In fact, these two decades had the slowest growth of
Gross Domestic Product per capita: indeed, between 1911 and 1921, growth
of GDP was negative. Public effort rather than personal income was the
key to increasing life expectancy during those decades".
The reference to the Word Bank giving up GDP as a measure follows. Martin
Ravallion was a former director of the World Bank.
This was mentioned in 1993 by Paul Wallich writing in the Scientific
American and his comment, or part of it, is given below.
"What measures is the World Bank using? According to
Ravallion, development planners are looking at 'what people can actually
do and be' - whether they are properly fed, clothed and housed, whether
they can read and have access to medical care - rather than how much
money the national accounts declare they have. It is perhaps paradoxical
that economists are now saying that 'money isn't everything', but the
results of their new focus may be instructive"
Is this true today? Is GDP one of the issues in the MAI? Does the World
Bank say 'money isn't everything'?
William Kirk.
Original message:
Peter Grimes wrote:
>
> >From Nichols.Nick@epamail.epa.gov Tue Feb 17 14:30:18 1998
> Date: Tue, 17 Feb 1998 10:09:02 -0500
> From: Nichols.Nick@epamail.epa.gov
> To: p34d3611@jhunix.hcf.jhu.edu, cfleming@agu.org
> Subject: Rachel #584: Major Causes of Ill health
>
> ---------------------- Forwarded by Nick Nichols/DC/USEPA/US on 02/17/98
> 10:13 AM ---------------------------
>
> peter@rachel.clark.net
> 02/06/98 03:31 AM
>
> Please respond to peter@rachel.clark.net
>
> To: rachel-weekly@world.std.com
> cc: (bcc: Nick Nichols/DC/USEPA/US)
> Subject: Rachel #584: Major Causes of Ill health
>
> =======================Electronic Edition========================
> . .
> . RACHEL'S ENVIRONMENT & HEALTH WEEKLY #584 .
> . ---February 5, 1998--- .
> . HEADLINES: .
> . MAJOR CAUSES OF ILL HEALTH .
> . ========== .
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> MAJOR CAUSES OF ILL HEALTH
> Numerous studies in England and the U.S. have shown consistently
> that a person's place in the social order strongly affects health
> and longevity.[1] It now seems well-established that poverty and
> social rank are the most important factors determining health
> --more important even than smoking.[2]
> This conclusion has been a long time in the making. A British
> study in 1840 observed that "gentlemen" in London lived, on the
> average, twice as long as "labourers." Starting in 1911, British
> death certificates have been coded for social class based on
> occupation. (In the U.S., death certificates are coded for race
> or ethnicity without reference to class or occupation.) The
> British database of deaths coded by class has allowed many
> studies, which have shown consistently that lower social status
> is associated with early death.
> For example, in 1980, Sir Douglas Black, who was then the
> President of the Royal College of Surgeons, published a study
> covering the period 1930-1970 in England. The so-called Black
> Report concluded that "there are marked inequalities in health
> between the social classes in Britain." Specifically, people in
> unskilled occupations had a two-and-a-half times greater chance
> of dying before retirement than professional people (lawyers and
> doctors).[1]
> Furthermore, the Black Report showed that the gap in death rates
> between rich and poor had widened between 1930 and 1970. In
> 1930, unskilled workers were 23% more likely to die prematurely
> than professional people, whereas in 1970 they were 61% more
> likely than professionals to die prematurely.
> Several subsequent studies confirmed the findings of the Black
> Report and demonstrated that, even within privileged groups,
> those with less status lived shorter lives. In other words,
> social rank affects health even among those who are well off.
> The so-called Whitehall studies in England examined the health of
> 10,000 British government employees (civil servants) over 2
> decades and found a 3-fold difference in death rates between the
> highest and lowest employment grades. The Whitehall studies
> showed (and later a U.S. study confirmed) that conventional risk
> factors such as smoking, obesity, physical activity, blood
> pressure and blood-levels of cholesterol could explain only 25%
> to 35% of employment-grade differences in mortality.[2] In other
> words, social rank was more important a determinant of health
> than were all the conventional risk factors. In sum, being lower
> in the pecking order makes you sick and shortens your life.
> Researchers have examined the opposite hypothesis, that perhaps
> health status determines social class --that being sick makes you
> poor, instead of the other way around. They have found that this
> explains only about 10% of the health disparities between social
> ranks.[1]
> In the U.S., a study in Chicago during 1928-1932 examined death
> certificates in relation to place of residence at time of death.
> Chicago was categorized into 5 socioeconomic levels based on
> average monthly rental payments. The study showed a fairly
> smooth curve: the higher the rent, the lower the death rate for
> people of similar ages.
> This study was redone in 1973, looking at changes between 1930
> and 1960. There had been "no relative gain" in recent decades
> for those paying the lowest rents. So even though the general
> standard of living may rise, those lower on the income scale die
> at younger ages.
> In 1986, researchers at the National Center for Health Statistics
> showed that Americans with annual incomes of $9000 or less had a
> death rate 3 to 7 times higher (depending on gender and race)
> than people with annual incomes of $25,000 or more. Furthermore,
> they showed that this situation had worsened between 1960 and
> 1986.[1]
> In the U.S., within groups of people having similar incomes,
> African-Americans have worse (and worsening) health status,
> compared to whites, for many diseases including asthma, diabetes,
> hypertension (high blood pressure), major infectious diseases,
> and several cancers.[3] Among researchers who have studied these
> problems, the basis of these health differences is thought to be
> racism, not genetics.[1]
> As we have reported previously (REHW #497), several studies have
> now revealed two important facts about the relationship of wealth
> to health:
> 1. Between countries, there is no relationship between gross
> domestic product (GDP) --a conventional measure of wealth --and
> health. In other words, comparing countries at similar levels of
> industrialization, it is quite possible for people in poorer
> countries to be healthier than people in richer countries. The
> absolute level of income does not determine health or longevity.
> 2. On the other hand, within individual countries there is a
> consistent relationship between health and the size of the gap
> separating rich from poor. Countries with the longest life
> expectancy at birth are those with the smallest spread of incomes
> and the smallest proportion of people living in relative poverty.
> Such countries (for example, Sweden) generally have longer life
> expectancy than countries that are richer but tolerate larger
> inequalities, such as the U.S.
> Within the U.S., comparisons between states have come to similar
> conclusions: it is not the average level of income in a state
> that determines health status --it is the size of the gap between
> rich and poor in a state that determines health.
> George Kaplan and his colleagues at the University of California
> at Berkeley measured inequality in the 50 states as the
> percentage of total household income received by the less well
> off 50% of households.[4] It ranged from 17% in Louisiana and
> Mississippi to 23% in Utah and New Hampshire. In other words, by
> this measure, Utah and New Hampshire have the most EQUAL
> distribution of income, while Louisiana and Mississippi have the
> most UNEQUAL distribution of income.
> This measure of income inequality was then compared to the
> age-adjusted death rate for all causes of death, and a pattern
> emerged: the more unequal the distribution of income, the greater
> the death rate. For example in Louisiana and Mississippi the
> age-adjusted death rate is about 960 per 100,000 people, while in
> New Hampshire it is about 780 per 100,000 and in Utah it is about
> 710 per 100,000 people. Adjusting these results for average
> income in each state did not change the picture: in other words,
> it is the gap between rich and poor within each state, and not
> the average income of each state, that best predicts the death
> rate.
> Inequality is growing throughout the world, both between
> countries and within countries. As of 1996, 89 countries (out of
> 174) were worse off, economically, than they had been a decade
> previously. In 70 developing countries, incomes are lower now
> than they were in the 1960s and 1970s.[5] And the level of
> inequality is already astonishing. For example, in 1996, 358
> billionaires controlled assets greater than the combined annual
> incomes of countries representing 45 percent of the world's
> population (2.5 billion people).[5] Between 1961 and 1991, the
> ratio of the income of the richest 20% of the world's population
> to the poorest 20% increased from 30-to-1 to 61-to-1.[2]
> Within the U.S., inequality is wider than it has been for 50
> years, and it is getting worse. The U.S. now finds itself among
> a group of countries, including Brazil and Guatemala, in which
> the national per capita income is at least four times as high as
> the average income of the poorest 20 percent.[5] In the U.S.
> between 1980 and 1990, inequality of income increased in all
> states except Alaska.[1] Inequality in the distribution of income
> and wealth[6] has been increasing in the U.S. for about 20
> years.[7,8,9,10] In 1977 the wealthiest 5% of Americans captured
> 16.8% of the nation's entire income; by 1989 that same 5% was
> capturing 18.9%. During the 4-year Clinton presidency the
> wealthiest 5% have increased their take of the total to over 21%,
> "an unprecedented rate of increase," according to the British
> ECONOMIST magazine.[11]
> Inequality in the distribution of wealth in the U.S. is even
> greater than the inequality in income. In 1983, the wealthiest
> 5% of Americans owned 56% of all the wealth in the U.S.; by 1989,
> the same 5% had increased their share of the pie to 62%.[10,pg.29]
> These tremendous inequalities translate directly into sickness
> and death for those holding the short end of the stick.
> As Dr. Donald M. Berwick, a Boston pediatrician, said recently,
> "Tell me someone's race. Tell me their income. And tell me
> whether they smoke. The answers to those three questions will
> tell me more about their longevity and health status than any
> other questions I could possibly ask."[3]
> Isn't it time that the public health community --physicians,
> public health specialists, and environmentalists --recognized
> that poverty, inequality and racism cause sickness and death?
> Given what science now tells us, medical policy --including
> medical training --should aim to combat and eliminate poverty,
> inequality, and racism just as it now aims to combat and
> eliminate infectious diseases and cancer.[2] With U.S. health
> care costs now exceeding $1 trillion each year, anti-poverty and
> anti-racism initiatives would be economically efficient as well
> as humane.
> --Peter Montague
> (National Writers Union, UAW Local 1981/AFL-CIO)
> ===============
> [1] Oliver Fein, "The Influence of Social Class on Health Status:
> American and British Research on Health Inequalities," JOURNAL OF
> GENERAL INTERNAL MEDICINE Vol. 10 (October, 1995), pgs. 577-586.
> [2] Andrew Haines, Michael McCally, Whitney Addington, Robert S.
> Lawrence, Christine Cassel, and Oliver Fein, "Poverty and Health:
> The Role of Physicians," ANNALS OF INTERNAL MEDICINE (in press).
> [3] Peter T. Kilborn, "Black Americans Trailing Whites in Health,
> Studies Say," NEW YORK TIMES January 26, 1998, pg. A16.
> [4] George A. Kaplan and others, "Inequality in income and
> mortality in the United States: analysis of mortality and
> potential pathways," BRITISH MEDICAL JOURNAL Vol. 312 (April 20,
> 1996), pgs. 999-1003.
> [5] Barbara Crossette, "U.N. Survey Finds World Rich-Poor Gap
> Widening," NEW YORK TIMES July 15, 1996, pg. A3.
> [6] Wealth is the net worth of a household, calculated by adding
> up the current value of all assets a household owns (bank
> accounts, stocks, bonds, life insurance savings, mutual fund
> shares, houses, unincorporated businesses, consumer durables such
> as cars and major appliances, and the value of pension rights),
> then subtracting the value of all liabilities (consumer debt,
> mortgage balances, and other outstanding debt).
> [7] Sheldon Danziger and others, "How the Rich Have Fared,
> 1973-1987," AMERICAN ECONOMIC REVIEW Vol. 79 (May, 1989), pgs.
> 310-314.
> [8] McKinley L. Blackburn and David E. Bloom, "Earnings and
> Income Inequality in the United States," POPULATION AND
> DEVELOPMENT REVIEW Vol. 13, No. 4 (December, 1987), pgs. 575-609.
> [9] Johan Fritzell, "Income Inequality Trends in the 1980s: A
> Five-Country Comparison," ACTA SOCIOLOGICA Vol. 36 (1993), pgs.
> 47-62.
> [10] Edward N. Wolff, TOP HEAVY; A STUDY OF THE INCREASING
> INEQUALITY OF WEALTH IN AMERICA (New York: Twentieth Century
> Fund, 1995). Although this is a study of wealth inequality,
> chapter 6 deals with income inequality.
> [11] "Up, down and standing still," THE ECONOMIST February 24,
> 1996, pgs. 30, 33.
> Descriptor terms: u.s.; uk; poverty and health; income and
> health; wealth and health; inequality; longevity; morbidity
> statistics; race and health; african americans; la; nh; ut; ms;
> chicago; medical policy; equity; environmental justice; black
> report; whitehall studies; brazil; guatemala;
> ################################################################
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