Health and the Economy in the United States, from 1750 to the Present

The Role of Healthy Diet and Lifestyle in Centenarians

Life expectancy at birth (hereafter, life expectancy) and longevity are established indicators of population health [...].

Overweight grandsons and grandfathers' starvation exposure

Much of the increase in the prevalence of overweight and obesity has been in developing countries with a history of famines and malnutrition. This paper is the first to examine overweight among adult grandsons of grandfathers exposed to starvation during developmental ages. I study grandsons born to grandfathers who served in the Union Army during the US Civil War (1861-5) where some grandfathers experienced severe net malnutrition because they suffered a harsh POW experience. I find that male-line but not female-line grandsons of grandfathers who survived a severe captivity during their growing years faced a 21% increase in mean overweight and a 2% increase in mean BMI compared to grandsons of non-POWs. Male-line grandsons descended from grandfathers who experienced a harsh captivity faced a 22%-28% greater risk of dying every year after age 45 relative to grandsons descended from non-POWs, with overweight accounting for 9%-14% of the excess risk.

Biological Differences between Late 19th and Early 20th Century Urban and Rural Residence

Communities urbanize when the net benefits to urbanization exceed rural areas. Body mass, height, and weight are biological welfare measures that reflect the net difference between calories consumed and calories required for work and to withstand the physical environment. Individuals of African-decent had greater BMIs, heavier weights, and shorter statures. Urban farmers had lower BMIs, shorter statures, and lower weight than rural farmers. Over the late 19th and early 20th centuries, urban and rural BMIs, height, and weight were constant, and rural farmers had greater BMIs, taller statures, and heavier weights than urban farmers and workers in other occupations.

The effect of increasing health disaster risk and public spending on economy conditions: a DSGE perspective

Purpose

The main motivation of the present study is to understand the severity of the effect of health shock on Iran's oil economy and analyze the role of government under these conditions.

Design/methodology/approach

Dynamic stochastic general equilibrium (DSGE) models can show the precise interactions between market decision-makers in the context of general equilibrium. Since the duration of the virus outbreak and its effect on the economy is not known, it is more appropriate to use these models.

Findings

The results of the survey of hands-on policies scenarios compared to the state of hands-off policy indicate that the effect of government expending shocks on the economy under pandemic disease conditions has much less feedback on macroeconomic variables.

Originality/value

As a proposed policy, it is recommended that the government play a stabilizing role under pandemic disease conditions.

Key messages

The pox of politics: Troesken's tradeoff reexamined

In The Pox of Liberty, Werner Troesken details the tradeoff between liberal institutions and communicable disease. According to Troesken, individual freedom presents a danger to the public health in the face of infectious disease, while constitutional constraints restrict the government's ability to implement effective policy. Contra Troesken, I argue that decision-makers, amidst a crisis of contagion, neglect intertemporal tradeoffs, thereby discounting long run costs while favoring short run policies. These policies, once implemented, are difficult to reverse due to the path dependent nature of political institutions. Irreversible and self-reinforcing growth in political institutions established to enhance health can have an unintended negative impact on health during future crises, where political agents must operate in a more cumbersome and error-prone institutional environment. Using events from the history of public health in the U.S. as support for my theory, I conclude that Troesken's alleged tradeoff ought to be met with greater skepticism.

Are Lockdowns Effective in Managing Pandemics?

The present coronavirus crisis caused a major worldwide disruption which has not been experienced for decades. The lockdown-based crisis management was implemented by nearly all the countries, and studies confirming lockdown effectiveness can be found alongside the studies questioning it. In this work, we performed a narrative review of the works studying the above effectiveness, as well as the historic experience of previous pandemics and risk-benefit analysis based on the connection of health and wealth. Our aim was to learn lessons and analyze ways to improve the management of similar events in the future. The comparative analysis of different countries showed that the assumption of lockdowns’ effectiveness cannot be supported by evidence—neither regarding the present COVID-19 pandemic, nor regarding the 1918–1920 Spanish Flu and other less-severe pandemics in the past. The price tag of lockdowns in terms of public health is high: by using the known connection between health and wealth, we estimate that lockdowns may claim 20 times more life years than they save. It is suggested therefore that a thorough cost-benefit analysis should be performed before imposing any lockdown for either COVID-19 or any future pandemic.

A Literature Review of Pandemics and Development: the Long-Term Perspective

Pandemics have been a long-standing object of study by economists, albeit with declining interest, that is until COVID-19 arrived. We review current knowledge on the pandemics' effects on long-term economic development, spanning economic and historical debates. We show that all economic inputs are potentially affected. Pandemics reduce the workforce and human capital, have mixed effects on investment and savings, but potentially positive consequences for innovation and knowledge development, depending on accompanying institutional change. In the absence of an innovative response supporting income redistribution, pandemics tend to increase income inequalities, worsening poverty traps and highlighting the distributional issues built into insurance-based health insurance systems. We find that the effects of pandemics are asymmetric over time, in space, and among sectors and households. Therefore, we suggest that the research focus on the theoretical plausibility and empirical significance of specific mechanisms should be complemented by meta-analytic efforts aimed at reconstructing the resulting complexity. Finally, we suggest that policymakers prioritize the development of organizational learning and innovative capabilities, focusing on the ability to adapt to emergencies rather than developing rigid protocols or mimicking solutions developed and implemented in different contexts.

Disease, downturns, and wellbeing: Economic history and the long-run impacts of COVID-19

How might COVID-19 affect human capital and wellbeing in the long run? The COVID-19 pandemic has already imposed a heavy human cost-taken together, this public health crisis and its attendant economic downturn appear poised to dwarf the scope, scale, and disruptiveness of most modern pandemics. What evidence we do have about other modern pandemics is largely limited to short-run impacts. Consequently, recent experience can do little to help us anticipate and respond to COVID-19's potential long-run impact on individuals over decades and even generations. History, however, offers a solution. Historical crises offer closer analogues to COVID-19 in each of its key dimensions-as a global pandemic, as a global recession-and offer the runway necessary to study the life-course and intergenerational outcomes. In this paper, we review the evidence on the long-run effects on health, labor, and human capital of both historical pandemics (with a focus on the 1918 Influenza Pandemic) and historical recessions (with a focus on the Great Depression). We conclude by discussing how past crises can inform our approach to COVID-19-helping tell us what to look for, what to prepare for, and what data we ought to collect now.

SES inequalities in cause-specific adult mortality: a study of the long-term trends using longitudinal individual data for Sweden (1813-2014)

Higher socioeconomic status (SES) is associated with lower mortality, and this correlation has been confirmed using different indicators across several geographical settings. Nevertheless, the timing of the emergence of the SES gradient remains unclear. We used individual-level longitudinal data for a regional population in southern Sweden covering the period between 1813 and 2014, and we applied a cause-specific proportional hazard model. We estimated SES differences in all-cause, nonpreventable, preventable, and cause-specific adult mortality in four subperiods (1813–1921, 1922–1967, 1968–1989, 1990–2014) by gender adjusting for birth year, place of residence, marital status, and migration status. The SES gradient in mortality present today for both genders emerged only around 1970, and with few exceptions, it emerged at approximately the same time for all causes of death. It emerged earlier for women than for men, particularly in infectious diseases. In the nineteenth and early twentieth centuries, we found a positive association between SES and mortality from circulatory diseases for men. SES has not always been a fundamental cause of mortality; it only emerged as such in the second half of the twentieth century. We argue that habits and behaviors embedded in the different social strata played a major role in the emergence of the SES gradient.

"Connected Access": Titrating the Right Dose of Access in the Digital Age

The concept of access to health care has been dominated by the visit-based paradigm. However, with the advent of telehealth, wearables, and mobile applications, much of the information that is exchanged at the time of the provider encounter can be transmitted virtually. This calls for a reconceptualization of access that is not so heavily reliant on "the visit." We have proposed a concept of connected access that is "dose related," based on the expertise of the provider and the channel through which a patient and a provider communicate. Particularly relevant to chronic care, the intensity of access can be titrated according to the needs of the patient at different points in time as clinical needs change. To function optimally, this model requires value-based payment and a new care model that occurs at the intersection of team medicine, virtual care, self-care, and traditional visit-based care. Made possible through connected technologies, "Connected access" fulfills the vision articulated in the "Crossing the Quality Chasm" report (2001) that care is based on continuous healing relationships; hence, the health care system should be available at all times.

Patient blood management during the COVID-19 pandemic: a narrative review

As COVID-19 disease escalates globally, optimising patient outcome during this catastrophic healthcare crisis is the number one priority. The principles of patient blood management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and healthcare authorities with information regarding how to apply established principles of patient blood management during the COVID-19 pandemic. In particular, this review considers the impact of the COVID-19 pandemic on blood supply and specifies important aspects of donor management. We discuss how preventative and control measures implemented during the COVID-19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient blood management of critically ill patients with known or suspected COVID-19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID-19. Finally, we address special considerations pertaining to supply-demand and cost-benefit issues of patient blood management during the COVID-19 pandemic.

Does adult height predict later mortality?: Comparative evidence from the Early Indicators samples in the United States

In this paper, I supplement widely used demographic data on white veterans of the Union Army with large and newly collected data on blacks and urban white veterans to explore the question of whether adult height predicts late-life mortality at the individual level. The data are partitioned into four demographic groups based on individual characteristics at the time of enlistment: white veterans enlisting in rural areas, mid-size cities, and large cities, and African-American veterans of the U.S. Colored Troops (USCT). Across the three groups of white veterans, mean height is positively associated with life expectancy at age 60, while both mean height and life expectancy for black veterans are very close to levels measured among the highly urbanized white veterans. I examine whether these group-level differences are robust to individual-level analysis by estimating two types of models, separately for each group: 1) 10-year mortality at age 60 using a linear probability model with company-level fixed effects and 2) a Cox proportional hazard that tracks veterans from age 60 to death. For rural whites, I find a significant U-shaped relationship between height and 10-year mortality, with both the short and the tall at significantly higher risk of death. This pattern becomes more pronounced when excluding younger recruits (under aged 24) from the analysis. But this relationship does not extend to urban whites or to blacks, where no significant height effects are found, and in which the height-mortality relationship among the highest mortality groups (whites from the largest cities and blacks) appears to be a generally positive one. Overall, the robust positive relationship between height and life expectancy at the group level does not exist at the individual level.

Parental human capital and child health at birth in India

Health at birth shapes an individual's well-being over her life cycle. We categorize the Indian states into high and low infant mortality regions to capture the diverse disease environment and analyze the nature of the association between parental human capital and child survival and nutrition measures at birth. We restrict our analysis only to firstborns to avoid confounding from a number of factors including sex-selective abortions in the higher birth orders. We broadly find that parental human capital, especially maternal health, is a strong and significant predictor of a child's birth outcomes under adverse disease environment. In the rural areas of the high infant mortality states, a 10-centimeter increase in maternal height is associated with 1.7% lower probability of a child dying as a neonate and 5% increase in birth weight around the mean. These estimates suggest that an investment in human capital of the mothers from this region could accompany large gains in survival and nutrition outcomes of their children.

Health and economic development since 1900

The 20th century has brought unprecedented gains in health. While these have improved citizens' lives worldwide, progress has been uneven and have in turn led to substantial cross-country health inequalities. This article looks at the effects of these inequalities on between-country economic inequality since 1900 using a level accounting framework that includes life expectancy as an important part of human capital besides education. The main results show that health has been a historically important source of cross-country income variation. In 1900 and 1955, differences in life expectancy accounted for almost 20 percent and a quarter of between-country income inequality. In addition, I find that the reduction of cross-country health differentials between mid-20th century and 1990 was an important source of income convergence. In a counterfactual exercise, I show that between-country income inequality would have been almost 20 percent higher nowadays, had the process of health convergence after 1955 not taken place. Finally, I find that the relative importance of health for income levels has stayed constant in the last three decades due to a deceleration in the rate of health convergence.

Health and weight - gender-specific linkages under heterogeneity, interdependence and resilience factors

Many studies have shown that obesity is a serious health problem for our society. Empirical analyses often neglect a number of methodological issues and relevant influences on health. This paper investigates empirically whether neglecting these items leads to systematically different estimates. Based on data from the German Socio-Economic Panel, this study derives the following results. (1) Many combinations of weight and height lead to the same health status. (2) The relationship between health and body mass index is nonlinear. (3) Underweight strengthens individual health and severe obesity has a clear negative impact on health status. Underweight women are more affected than men but obese men are hit harder than women. (4) The hypothesis has to be rejected that weight has an exogenous influence on health. (5) A worse health status is linked with weight fluctuations and deviations between desired and actual working hours. (6) A healthy diet and long but not too long sleeping contribute to a good health status. Moreover, a good parental education and a high parental social status act favorably on health as does personal high income. (7) Four of the big five components of personality, namely openness, extraversion, conscientiousness and agreeableness, contribute to resilience against health problems.

The Educational Gradient in Health in China

It has been well established that better educated individuals enjoy better health and longevity. In theory, the educational gradients in health could be flattening if diminishing returns to improved average education levels and the influence of earlier population health interventions outweigh the gradient-steepening effects of new medical and health technologies. This paper documents how the gradients are evolving in China, a rapidly developing country, about which little is known on this topic. Based on recent mortality data and nationally representative health surveys, we find large and, in some cases, steepening educational gradients. We also find that the gradients vary by cohort, gender and region. Further, we find that the gradients can only partially be accounted for by economic factors. These patterns highlight the double disadvantage of those with low education, and suggest the importance of policy interventions that foster both aspects of human capital for them.

Population health in an era of rising income inequality: USA, 1980-2015

Income inequality in the USA has increased over the past four decades. Socioeconomic gaps in survival have also increased. Life expectancy has risen among middle-income and high-income Americans whereas it has stagnated among poor Americans and even declined in some demographic groups. Although the increase in income inequality since 1980 has been driven largely by soaring top incomes, the widening of survival inequalities has occurred lower in the distribution-ie, between the poor and upper-middle class. Growing survival gaps across income percentiles since 2001 reflect falling real incomes among poor Americans as well as an increasingly strong association between low income and poor health. Changes in individual risk factors such as smoking, obesity, and substance abuse play a part but do not fully explain the steeper gradient. Distal factors correlated with rising inequality including unequal access to technological innovations, increased geographical segregation by income, reduced economic mobility, mass incarceration, and increased exposure to the costs of medical care might have reduced access to salutary determinants of health among low-income Americans. Having missed out on decades of income growth and longevity gains, low-income Americans are increasingly left behind. Without interventions to decouple income and health, or to reduce inequalities in income, we might see the emergence of a 21st century health-poverty trap and the further widening and hardening of socioeconomic inequalities in health.

Union Army Veterans, All Grown Up

This paper overviews the research opportunities made possible by a NIA-funded program project, Early Indicators, Intergenerational Processes, and Aging. Data collection began almost three decades ago on 40,000 soldiers from the Union Army in the US Civil War. The sample contains extensive demographic, economic, and medical data from childhood to death. In recent years, a large sample of African-American soldiers and an oversampling of soldiers from major US cities have been added. Hundreds of historical maps containing public health data have been geocoded to place soldiers and their family members in a geospatial context. With newly granted funding, thousands of veterans will be linked to the demographic information available from the census and vital records of their children.