• Inequality of Opportunity Begins at Birth

    Equality of opportunity means that we are not a caste society. Who we will become is not fixed by the circumstances of our births. Some children will do better than others, but this should result from a fair competition. Nearly every American politician espouses a commitment to equality of opportunity. For example, Majority Leader Eric Cantor wrote yesterday that

    We must continue to fight for equal opportunity to a quality education for all children.

    I wouldn’t be surprised if many American politicians said the same thing yesterday.

    But we don’t appreciate how deep inequality runs. The graph below is from a presentation by Angus Deaton which (I believe) reported data from the National Health Interview Survey. The horizontal axis is the logarithm of family income in 1982 dollars, running from about $3600 to over $80,000. The vertical axis is self-reported ill-health (higher numbers reflect worse health). The parallel lines represent different age groups of respondents.

    Screen Shot 2013-07-25 at 8.59.04 PM

    There are three important facts packed into this slide. First, the lines stack up in order of increasing age, meaning that older people reported worse health than younger people. Second, all the lines slope downward, meaning that the poorer you were, the more likely you had poor health.

    These facts are unsurprising, until you notice how powerful the income effect is. The leftmost point of the youngest (turquoise) line is above the rightmost point of the oldest (purple) line. This means that the poorest teenagers reported themselves as less healthy than rich middle-aged people.

    Lastly, notice how the age lines are much more dispersed on the left (poorest) side of the graph than the right (richest) side of the graph. This means that health deteriorates more quickly with age among the poor than among the rich.

    Jason Fletcher has a new study in which he looked at the parent-reported health of a cohort of children from kindergarten through 8th grade.

    Fletcher1

    The vertical axis is the coefficient for the regression of health on family income. Think of this number as representing the slope of one of the lines in the Deaton graph. That is, the higher the bar in Fletcher’s chart, the steeper the slope, and the greater the gap in child health between poor families and rich families. (The different bar colors reflect two different ways of measuring family income.) What you see is that the health gaps between poorer and better off children grew as these children aged. The biological damage of poverty is cumulative.

    What would we have seen if Fletcher had been able to look at these children starting at birth instead of kindergarten? Probably the health gaps between poorer and richer children would have been smaller for toddlers and infants. Nevertheless, there is substantial evidence that health inequality starts at birth, or even conception. As Janet Currie argues, there is

    huge inequality in health at birth. For example, the incidence of low birth weight (birth weight less than 2500 grams) is more than three times higher among children of black high school dropout mothers than among children of white college educated mothers.

    This may be partly a matter of genes. But the infants of the poor are also at risk because poor mothers have poorer health, are more stressed, and are more likely to be exposed to environmental toxins. Poverty gets underneath the skin, starting in the uterus.

    Poor health deriving from inequality of economic well-being begins at birth and accumulates as children develop. We are farther from equality of opportunity than most of us acknowledge.

    @Bill_Gardner

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    • The most obvious target is teen pregnancy.

      It would be interesting to control for junk food. To what extent does the worse health result from continuing less-than-healthy choices, like eating most meals at McD’s versus permanent issues, like having had low birth weight because of having an underaged mother?

      • By coincidence, my wife just showed me an article in the August ’13 _National Geographic_ on “Sugar Love (A not so sweet story).” It includes this observation from Richard Johnson, “a nephrologist at the University of Colorado Denver”:

        >>>> “It’s a tragedy that hits the poor much harder than it does the rich. If you’re wealthy and want to have fun, you go on vacation, travel to Hawaii, treat yourself to things. But if you’re poor and want to celebrate, you go down to the corner and buy an ice-cream cake.”

        A relevant book is Wilkinson and Pickett’s _The Spirit Level: Why Greater Equality Makes Societies Stronger_.

    • You mentioned that lower-income adults are more likely to be exposed to toxins.

      When some people fight against better air pollution regulations (e.g. lower limits for mercury emissions from power plants), they are directly exacerbating the problem the two graphs show.

    • Nothing new here. We’ve known for a while that IQ is correlated with health measures and that IQ is correlated with income. Explain how this demonstrates that the “system” isn’t equal.

      • Hi Richard,
        Thanks for the comment. My post didn’t mention IQ, so I am not sure how to respond. Perhaps you could rephrase the question?
        cheers
        Bill

      • And you believe IQ to be an independent variable, is that it? This is believed by the naive and the faux-naive. IQ is not a measure of intelligence (and the original tests the IQ test came from were not even intended as such)–it changes with education levels and age. The same person can score X on an IQ test and then later, with more education and experience, score X + (a bundle).
        Education is by no means the independent variable in this relationship; poverty affects IQ, not the other way around.
        I refer the interested to The Mismeasure of Man, by Stephen Jay Gould.

    • Obvious people aren’t born equal. Some individuals are dumb and make retarded decisions. Some are smart and make good decisions.

    • Nobody really believes in equality of opportunity. Those who say they do only really believe in some minimum level of opportunity.

    • It is important to realize that inequality comes from the womb and it is important for society to try to level the playing field. Societies’ job is to make sure most people have the incentives to work and the tools to work, so that there is a lot of wealth produced and spread out. Having people that are too rich won’t provide any incentives to produce and not getting the opportunities for poor households to acquire the tools to work doesn’t help society either.

    • Orwell pointed this out. Poorer people age more poorly. He suggested looking at recent draftees of similar age (in the 1940s). Of course now, the wealthier would buy their way out of any draft, Hitler or no Hitler.

    • I’ve spent some time thinking about this. It feels like you’ve had a number of posts of this sort, pointing out the problem of poverty, without much connection with a policy proposal.

      Would universal health care make a difference? A detailed comparison with the UK could be made. I tried to Google around for the percentage of babies born to teen mothers with low birth weight in the US and UK, but didn’t get any clear results.

      The UK is much more centralized than the US, so education funding through local taxes does to Whitehall and is doled back to the counties based on need, making it much fairer than the US method of direct local funding, where the wealth of the town greatly influences the school funding. However, since the richer UK towns can’t direct higher taxes into better schools, the parents who want better schools are far more likely to send their kids to private schools and then complain they can’t afford tax increases. They also have a national curriculum and much better testing, but I don’t think they produce better results than the US.

      • Good question, SAO. Here are a few thoughts.
        - Universal health care is a good thing, but it will not solve the problem of inequality at birth. It hasn’t solved it in the UK or Canada.
        - Poor families need more resources. I would support an increase in the minimum wage and an increase in the earned income tax credit.
        - We need better and more comprehensive child care and maternity leave policies.
        - We need more extensive child protection services to address the problem of child maltreatment.
        - We need better population health measures to address environmental pollution.
        - We need more effective mental health services for parents and kids…

        As you can see, I don’t think it’s any single thing. There are many things to do.

        • To me, raising the minimum wage so that every job pays a living wage and places like Walmart don’t get subsidized by Gov’t services and subsidies allowing their workers to live on a too-small salary is good policy and addresses some inequality. The EITC is redistribution and I hate it. If I have to pay more to eat out so the restaurant’s dishwasher can earn a decent wage, that’s fair. If I have to pay more taxes so the dishwasher’s salary is enhanced by a tax credit, I resent it.

          I think teen pregnancy has to be the top of the agenda. I get so frustrated that an inexplicable global move towards fundamentalism of all types has taken birth control out of the equation. Less than 40% of women who give birth before age 18 get an HS diploma.

          Global warming and immigration are two other issues strongly affected by population growth and no where is it mentioned.

          • SAO,
            I guess we will have to agree to disagree about redistribution. But I certainly agree with that interventions to help poor girls control their fertility and stay in school are an essential reform.

          • “To me, raising the minimum wage so that every job pays a living wage and places like Walmart don’t get subsidized by Gov’t services and subsidies allowing their workers to live on a too-small salary is good policy and addresses some inequality. The EITC is redistribution and I hate it. If I have to pay more to eat out so the restaurant’s dishwasher can earn a decent wage, that’s fair. If I have to pay more taxes so the dishwasher’s salary is enhanced by a tax credit, I resent it.”

            Both are types of redistribution. The former would arguably redistribute money from business owners to low-income workers. You won’t have to pay more in taxes, but you could have to pay higher prices for goods and services.

            The latter redistributes from taxpayers to low-income workers. You arguably have to pay more taxes to enable this.

            That seems to be me to be the only major distinction between the two. I am not sure that the distinction is so great as you make it out to be. The government has to act in either case.

        • The Canadian Medical Association released a report on Canadian health care “What makes us sick?” following townhall meetings in a number of Canadian cities. It makes uncomfortable reading as it reports directly on many of the issues you’ve described, despite universal access to high quality health care. The report sets out a set of recommendations to deal with the issues identified. http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Advocacy/HCT/What-makes-us-sick_en.pdf

          As a taste of the report’s tone, here’s the first bullet point in the Executive Summary:
          “Poverty is the most important issue and must be addressed.”

          The first step is recognizing you have a problem….

    • The title and the notion that inequality begins at birth because of low birth rate is misleading and specious. What is the difference between permanent and current income based upon ECLS data in graph 2?

      • As I understand it, permanent income is an estimate of what the family typically makes, as opposed to what they made in a given year. Milton Friedman argued that it was permanent rather than current income that really drives household decision making. Fletcher looks at various ways of estimating permanent income. He finds that they do not make any substantial difference in the results.

        The birth outcome data in the quote from Currie is just an example. There is more evidence suggesting that poor children have poorer health at birth. See Currie’s articles (here is a good place to start: http://www.princeton.edu/~jcurrie/publications.html).

    • You write, “Inequality of Opportunity Begins at Birth”. What if inequality began BEFORE birth? That might be a fact learnable from data (such as adoption studies). What would you conclude then?

      • Jon,
        I agree with you. Folks on Twitter pointed out immediately that I should have titled the post “Inequality of Opportunity Begins Before Birth.” After all, if poor mothers have worse birth outcomes, and they do, that the adversity of poverty affects gestation.

    • I hope this wasn’t made with R or I seriously need to brush up on my graphing skills. :)

      Anyhow – the correlation is uncanny. I’m curious to drill into causation. Could there be a relationship between being saddled with healthcare bills effectively driving a family into poverty? An aside, if that were the case, then it is fair to say “at birth” instead of “before birth”.

      We could also be looking at a situation whereby the worst cases really stand out. For example, many genetic diseases that require a degree of expensive medical treatments also result in the child dieing shortly after reaching adulthood. If the sample size is large enough, that could skew the results. If ICD-9 or ICD-10 codes are available (probably not), then the data could be normalized to control for this – though the larger point of health/income is still valid, it might provide a glimpse into severity.

    • “This may be partly a matter of genes. But the infants of the poor are also at risk because poor mothers have poorer health, are more stressed, and are more likely to be exposed to environmental toxins. Poverty gets underneath the skin, starting in the uterus.

      Poor health deriving from inequality of economic well-being begins at birth and accumulates as children develop. We are farther from equality of opportunity than most of us acknowledge.”

      Does anyone have any doubt that most, if not all, of the statistical associations between disadvantage at birth and long term correlates of health and well-being could be eliminated if the children were adopted at birth and raised by loving, conscientious, responsible parents who emphasize education? Conversely, does anyone doubt that most if not all of the benefits associated with being born to loving, conscientious, and responsible parents would likely disappear if their children were given to indifferent, irresponsible, and negligent parents who couldn’t care less about education?