The Gravity of Health Disparities

Walker Evans, Migrant Woman

This is my first post on Inequalities, and I thank Brendan and Ben for inviting me in, and Paul for months of great blogging, to be continued here.

To introduce myself, I will try to convey something about the gravity — or perhaps ‘mass’ — of social inequalities relating to health. I won’t try to convince you that health disparities matter. I am sure that you believe that they do. I want you to think about how much they matter.

Consider health disparities associated with education. Life expectancy at age 25 for US women who do not complete high school is 51.7 years (that is, such 25-year-olds can expect to live until they are 76.7 years old). A 25-year-old American woman with a college degree can expect to live an additional 60.3 years (that is, until she is 85.3). So the life-expectancy disadvantage for less-educated women is 8.6 years. US 25-year-old men without high school degrees have 47.1 years of additional life expectancy, compared to 56.4 years for those with college degrees. So the disadvantage for less-educated men is 9.3 years.

These are large differences. By comparison, the advantage in life expectancy at birth for non-hispanic whites over non-hispanic blacks is 4.8 years — and that disadvantage is anything but trivial. There are 12.5 million men and 5.5 million women who lack high school degrees (2011 data). This cohort of Americans is expected to collectively lose, across their lifetimes, more than 164 million years of life, relative to college-educated peers.

Perhaps this number is enough to convey the enormity of this loss. But let’s think about it another way. There is no uncontroversial method to measure how important these health disparities compared to other things. Nevertheless, let’s accept the premise of cost-benefit analysis that we can price the value of life by examining our willingness to trade-off risks of death against other goods. If we accept the very conservative estimate that a year of life is worth $50,000, then the years of life that will have been lost by the current cohort of less-educated Americans are worth more than $8 quadrillion. This is more than an order of magnitude greater than total annual US gross domestic product or current total US corporate assets.

As I learned from Kevin Murphy, human life is the most important thing an economy produces. Of course, there is no inexpensive, simple, or near-term policy to fully remediate disparities in life expectancy conditional on education. The causal relations between health and education are complex and interdependent: for example, poor health is itself an obstacle to educational attainment. However, I didn’t calculate the value of life-years lost associated with disparities in education to provide specific policy guidance. I just wanted to communicate something about the magnitude of what is at stake.

Moreover, looking at the magnitude and value of health disparities helps us see how much we could gain by reducing them.  Cost-effective investments to improve the health and education of disadvantaged persons is not just a drain on national budgets. It is also a tremendous opportunity, the opportunity being the colossal value of the life-years and human capital that could be saved.

Similar to what Robert Lucas once said about international differences in economic development, once you begin to think about health disparities, it is hard to think about anything else.

About Bill Gardner

A health care researcher and a child and quantitative psychologist by training. I am an American living in Canada and am Professor of Paediatrics, Obstetrics & Gynaecology, and Community Health & Epidemiology at Dalhousie University; and Professor of Pediatrics, Psychology, and Psychiatry at The Ohio State University. I also blog at The Incidental Economist (theincidentaleconomist.com) and you can follow me @Bill_Gardner on Twitter.
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