The new OECD “Society at a glance” (paywall) report came out today. It’s part of a series of policy papers assessing the social implications of the economic crisis and its aftermath, and offers a list of policy recommendations on a yearly basis.
The picture is never good.
The financial upheaval of 2007-08 created not just an economic and fiscal crisis but also a social crisis. Countries that experienced the deepest and longest downturns are seeing profound knock-on effects on people’s job prospects, incomes and living arrangements. Some 48 million people in OECD countries are looking for a job – 15 million more than in September 2007 – and millions more are in financial distress. The numbers living in households without any income from work have doubled in Greece, Ireland and Spain. Low-income groups have been hit hardest as have young people and families with children.
The financial crash was one of the most important events that occurred within my lifetime, but still some people don’t seem to get how far reaching its impacts have been. The American Republican Party seemed to mostly bury its collective head in the sand, perfectly willing to sacrifice the welfare of poor people for the sake of a few narrow political goals.
The paper is filled with interesting data and charts, but the are some other gems here. Food security:
While federal food assistance programmes in the United States now support roughly twice as many households as in 2007, the number with inadequate access to food at some time in the year has nonetheless climbed from 13 million (11% of all households) in 2007 to 17.6 million (15%) in 2012. Rates of food insecurity were substantially higher among households with children (20% in 2012) and lone-parent families were particularly affected (35%). Forty-one percent of all food-insecure households received no support through federal food assistance programmes.
As someone who grew up in a food insecure household, I take this quite seriously. Right wingers who have a stocked fridge don’t get what it’s like to have an empty fridge. It’s easy to say that SNAP benefits foster “a culture of dependence” with a bulging stomach. Perhaps they don’t know that in food insecure households, the last people to eat are the kids. Of course, they don’t care.
To “crisis-proof” social policies and to maintain effective support throughout the economic cycle, governments must look beyond the recent downturn. First, they need to find ways to build up savings during upswings to ensure they can meet rising costs during downturns. On the spending side, they should link support more to labour market conditions – for example, by credibly reducing benefit spending during the recovery, and by shifting resources from benefits to active labour market policies. On the revenue side, they should work to broaden tax bases, reduce their reliance on labour taxes and adjust tax systems to account for rising income inequality. Second, governments need to continue the structural reforms of social protection systems begun before the crisis. Indeed, the crisis has accelerated the need for these. In the area of pensions, for example, some future retirees risk greater income insecurity as a result of long periods of joblessness during working age. In health care, structural measures that strip out unnecessary services and score efficiency gains are preferable to untargeted cuts that limit health care access for the most vulnerable.
If GWB 1 is any indication, the Republican Party dislikes savings and when they get a surplus they seem to squander it. There’s no reason to believe that the future will be any better. I’m thinking about the dichotomy of labor taxation versus capital taxation. Republicans have made it quite clear that they dislike capital taxation and prefer labor taxation. But what this does is create a gated community of capital holders, who exert vast political control without having to take responsibility for, well, much at all.
While I do advocate for a national sales tax to pay for transfers to create an income floor for American wage earners, we also need to tax the hell out of inheritances. There’s no reason that Bill Gates’ son (does he have one?) deserves a leg up any higher than he’s already got it. If America wants to foster innovation, it has to start by bolstering it’s labor classes. Forcing them to go without meals and scramble around to meet basic health needs only creates a dog eat dog culture of basic survival, and leaves little room for good ideas.
Alright, happy zombie day.
I was just reading a recent op-ed in the Journal of the American Medical Association, “The US Health Disadvantage Relative to Other High-Income Countries
Findings From a National Research Council/Institute of Medicine (NRC/IOM) Report.”
Well, at least it’s an op-ed on a paper from the afformentioned NRC/IOM. The paper digs through data from 17 OECD countries and tracks trends in disease and mortality.
Americans fare worse than other OECD countries in:
• infant mortality and low birth weight
• injuries and homicides
• adolescent pregnancy and sexually transmitted infections
• HIV and AIDS
• drug-related deaths
• obesity and diabetes
• heart disease
• chronic lung disease
We also tend to die earlier than everyone else (75.64 years) but really can expect to live about as long as Finns (75.86), Portuguese (75.87) and Danes (76.13).
I’m not surprised that we ended up on the bottom of the list. We certainly have much to be ashamed of in terms of social violence, access to means to kill one another when enraged, and a fractured and inefficient health care system (or lack thereof).
What struck me is how varied the list is. Some elements (accidents, homicides and drug-related deaths) have nothing to do with access and quality of health care. Infant mortality and birth weight shouldn’t be so low in a well fed country like the United States.
The JAMA article sums a lot of the systematic problems of US health care and its potential impact on human welfare:
What could explain a health disadvantage that involves conditions as varied as motor vehicle crashes, heart disease, preterm birth, and diabetes? The NRC/IOM panel explored this paradox and found clues in almost every class of health determinants it considered. The United States lacks universal health insurance coverage, and its health system has a weaker foundation in primary care and greater barriers to access and affordable care.4 Care coordination also is a problem. In multiple surveys of patients with chronic illnesses in up to 11 countries, The Commonwealth Fund has shown that US patients are more likely than patients elsewhere to report lapses in care quality and safety outside of hospitals.1 US patients appear more likely than those in other countries to require emergency department visits or readmissions after hospital discharge, perhaps because of premature discharge or problems with ambulatory care. Confusion, poor coordination, and miscommunication between clinicians and patients are reported more often in the United States than in comparable countries.
But we know all this. Continuing:
Health is determined by more than health care, and the NRC/IOM panel explored differences beyond health care to explain the US health disadvantage. It considered individual behaviors and found that although US adults are less likely to smoke (due to successful tobacco control efforts) and may drink less alcohol than adults in peer countries, they have a greater propensity for other unhealthy behaviors. People in the United States consume more calories per capita, are more likely to abuse drugs, are less likely to fasten seat belts, have more motor vehicle crashes involving alcohol, and own more firearms than do people in other high-income countries. US adolescents seem less likely to practice safe sex than adolescents in European countries. These problems are not products of the health care system
But what I’m seeing here is a pattern. All of these problems are concentrated in the poorest strata of the American population. Drug abuse, violence, poor diets, lack of access to health care.. these are all problems non-existent in all but the most troubled areas of the country.
This is, of course, an unforgivable condition. However, given the plurality of the United States, evaluating Americans as a group masks the true problems. Life expectancies are presented as averages. That is, all deaths are recorded, even those in the top 50% of American households, those with health insurance, those who go to the gym, those who eat relatively well, those who won’t kill one another during a family fight, those who won’t use coke, crack, heroin, meth or even abuse oxycontins. All of these households bring the average up.
If we were to only look at the bottom 50%, a much more homogeneous group than that of all Americans, we would find that the average life expectancy to be frighteningly low. We would find that the incidence of avoidable disease is extremely high, the chances of getting shot high, access to health care minimal and a general state of un-health among them all. We already know that African Americans die about four years earlier than white Americans. In total, though, we’d probably find socioeconomic worlds within the United States as different as that of countries like Somalia and Germany.
Note: Ezra Klein also wrote something on this report.
- New publication: Recurrent home flooding in Detroit, MI 2012-2020
- Do stray dogs raise risk for human infections of a skin burrowing flea in Kenya?
- Is pollen associated with suicide? New paper (from myself and colleagues) in Environmental Research
- We published a new paper on Covid-19 and ER visits for suicide attempts/self harm incidents in Epidemiology and Community Health today
- Short review of the literature on Snakebites in Kenya