A commentary on “Neo-materialist theory and the temporal relationship between income inequality and longevity change”

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Those confounded confounders

One of the most empirically nettlesome issues in this literature is the role of confounders—those attributes of states (or other political units) that may be associated with both income inequality and health outcomes but that are not directly related to their relationship with each other. Appropriately controlling for confounders is an essential—but underappreciated—part of arguing for an effect of inequality on health.

One example is individual income, which has been shown to confound the

A literature at an empirical impasse

A suggested above, the importance of difference or fixed-effects models is that researchers don't have to agree on what potential confounders are, only that they are time-invariant, because if they are time-invariant they can be controlled. If there are time-varying confounders, however, then the empirical challenge is far greater. Consider that if:Ginisi=Gsi*+Zsi,then differencing as in Eq. (4) yields:LEsjLEsi=(α0+α1(Gsj*+Zsi)+α2Xsj+ɛsj)(α0+α1(Gsi*+Zsi)+α2Xsi+ɛsi)orLEsjLEsi=α1(Gsj*Gsi*+Zsi

The conceptual impasse: a long, rubbery stick

Kawachi and Kennedy (1999) have articulated an excellent starting point in understanding how income inequality might affect individual health. They propose that high levels of income inequality might:

  • 1.

    reduce social capital, which then leads to poor individual and community health;

  • 2.

    lead the rich to withdraw support for public services, leading to a decline in individual and community health;

  • 3.

    increase the opportunity for invidious comparisons, which increase people's stress levels, leading to a

The novelty trap

The literature on income inequality and health has accordingly reached a conceptual impasse to match its empirical one. By itself, it offers neither convenient policy levers nor scientific insights about the determinants of population health. Any future analyses in this literature should be asked squarely to confront this conceptual limitation.

It sometimes happens that a literature generates some promising, but not definitive results. As scholars try to refine their analyses, not all can agree

Economic structure and individual health

Income inequality has been used as a convenient empirical stand-in for the concentration of economic power: it is an umbrella term for inequalities inherent in economic structure. Underlying the literature on economic structure and health is a profoundly fascinating question of tremendous public health relevance: Is individual health best understood as merely the product of individual genes, individual exposures to physical toxins, individual healthcare utilization, and individual behavior? Or

Concentration of control in labor markets

Economic theory argues that the economic output arises from the clever combination of three canonical factors: land, labor, and capital. Of these, the structure of the market for labor arguably has the greatest effect on population health. Yet, although the structure of the labor market has been plumbed at great depth for its influence on economic outcomes, far less attention has been paid to its influence on psychosocial and physical health outcomes.

One of the most important features of

Control over markets for goods and services

In a world with potentially infinite wants and only finite resources, there must be systems for rationing access to resources. The rationing of access to healthcare in the United States is very different from that of most other developed countries, a point whose implications for health need no elaboration. Consider then access to the Internet. In the days of dial-up Internet, the Federal Communications Commission forced the phone companies to act as common carriers for dial-up Internet,

Controls over framing

Cognitive frames are conscious or unconscious systems of belief that enable people to understand and assimilate novel or complex information and ideas (D'Andrade, 1995, Elliott et al., 2003, Lakoff, 2004, Lakoff and Johnson, 2003, Vygotsky, 1986). An example of a cognitive frame is the notion that markets unfettered by government regulation are efficient, and, therefore, to be desired. (The power of this frame is evidenced in the use of the word “unfettered” in the previous sentence, as if

Toward an institutional health economics

The study of economic institutions, or “institutional economics,” has a long and rich tradition within economics. Institutional economics dominated the field in the first half of the 20th century, but was replaced by mathematical economics beginning in the 1950s. Since then, institutional economics has been neglected and almost forgotten, although it is now being rediscovered—or more accurately, reinvented—by behavioral economics.

The sidelining of institutional economics arose out of a shift in

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