ECONOMIC INEQUALITIES IN HEALTH

ECONOMIC INEQUALITIES IN HEALTH

Aim of Master Class Gain a better understanding of the causal relationships between economic factors on health over time

Plan of attack Kristie Carter Overview of economic inequalities Tim Hazledine Taking The Spirit Level Seriously: Determinants of Health Outcomes across the US states Kristie Carter Income, poverty, deprivation and health using NZ longitudinal data (SoFIE) Rebecca Bentley, Emma Baker Housing, tenure employment, and health using Australian longitudinal data (HILDA) Discussion, Policy implications

Social Determinants of Health

Living Standards Current HH income (last 12 months) - adjusted for HH size and composition - poverty Govt services and subsidies Budgeting knowledge, and skills Income, gifts, etc received in earlier years Financial and physical assets Living standards (material wellbeing) Contributions to assets and current budget not picked up by income eg - HH production - help from outside the HH Differences in prices for different geographical areas Special demands on the budget (especially for those with low current incomes and limited financial assets) eg - health/disability costs - accommodation costs - high debt servicing - unexpected bills Source: Perry, B. (2009). Non-income measures of material wellbeing and hardship: first results from the 2008 New Zealand Living Standards Survey, with international comparisons. Wellington: Ministry of Social Development.

ECONOMIC INEQUALITIES

Income Inequality - GINI The Gini coefficient is the ratio of the area enclosed by the Lorenz curve and the perfect equality line (A) to the total area below that line (A+B). It ranges from 0 (perfect equality, A=0) to 1 (perfect inequality B=0).

Income Inequality (NZ) Source: Perry 2014.Household incomes report. Ministry of Social Development

Income Inequality (OCED) Source: OECD Statistics 2014

Wealth Inequality Inequality in wealth is much higher than in income The Wealth Gini coefficient is: NZ 0.693 (SoFIE) Aust 0.61-0.64 (HILDA) In NZ the top 10 percent of wealthy individuals own over half (51.8%) of total net worth. Over 16 % of total net worth is owned by the top 1% of wealthy individuals. The bottom 50% own 5% of total net worth. In Australia 2011-12 the bottom 20% of households with the lowest net worth accounted for only 1% of total household net worth, with an average net worth of $31,205 per household. The wealthiest 20% of households in Australia account for 61% of total household net worth, with an average net worth of $2.2 million per household.

Trends in top incomes Picketty US Top 10% UK Top 10% AU Top 10% NZ Top 10% US Top 1% UK Top 1% AU Top 1% NZ Top 1%

Income (NZ)

percentage Poverty (NZ) 60 50 40 30 20 10 0 01 12 23 43 45 56 76 87 Number of years in poverty NZ European Maori

Intergenerational Social Mobility

Regional Inequalities Auckland Wellington http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=11254032 70 60 50 40 30 20 10 0 NZDep 2001 by ethnicity in children Pakeha Maori Pacific NZDep1,2 NZDep3,4 NZDep5,6 NZDep7,8 NZDep9,10

HEALTH INEQUALITIES

All-cause mortality rates by income NZ Census Mortality Study 19

All cancer rates by income NZ Census Mortality Study 20

Life Expectancy at Age 0 Trends in Life Expectancy 90 NZ Life Expectancy 1981 to 2001 85 80 75 70 nm Hi Inc nm Med Inc nm Low Inc M Hi Inc M Med Inc M Low Inc Australian Life Expectancy 2010/12 Male Indigenous 69.1 Male non-indigenous 79.7 Female Indigenous 73.7 Female non-indigenous 83.1 65 60 1981 1986 1991 1996 2001 Carter 2010 NZMJ Cohort

Unmet need for primary care NZ Experienced unmet need for primary health care in the past 12 months Quintile 5 (most deprived) Quintile 4 Quintile 3 Quintile 2 Quintile 1 (least deprived) European/Other Asian Pacific Māori Australia 0 10 20 30 40 The most common reason for unmet need in terms of seeing a GP or filling a prescription is due to cost.

Regional Inequalities Worse health outcomes with higher levels of area deprivation 50 45 40 35 30 25 20 15 10 5 0 Smoking smoking Obesity Obesity NZ AU NZ AU Quintile 1 (least deprived) Quintile 2 Quintile 3 Quintile 4 Quintile 5 (most deprived)

Child Health Inequalities There are high rates of poverty related diseases in Māori and Pacific and Indigenous Australian Children. Hospital admissions for these have been increasing over time. 16 14 12 10 8 6 4 2 0 Asthma Australian Child Health Low Birth Weight Source: New Zealand Child and Youth Epidemiology Service Skin infections Indigenous non-indigenous

INCOME INEQUALITY AND HEALTH

It s that simple...? Problems Income Inequality

Mechanisms Inequality is divisive and socially corrosive Increased Income Inequality leads to: increased social stratification greater social dysfunction reduced social cohesion low levels of trust increased feelings of superiority and inferiority

BUT...

Is it REALLY that simple...? Problems Income Inequality

Other Literature Lynch 2004 - There is little support for the idea that income inequality is a major, generalizable determinant of population health differences within or between rich countries. Kondo 2009 - A modest adverse effect of income inequality on health Kondo 2012 - Between-country studies were likely to show stronger association between income inequality and health compared with within-country studies.

Plan from here Tim Hazledine Taking The Spirit Level Seriously: Determinants of Health Outcomes across the US states Kristie Carter Income, poverty, deprivation and health using NZ longitudinal data (SoFIE) Rebecca Bentley, Emma Baker Housing, tenure employment, and health using Australian longitudinal data (HILDA) Discussion, Policy implications