Transcript Health and Wealth on the Roller- Coaster: Ireland 2003-2011 David Madden

School of Economics
Health and Wealth on the RollerCoaster: Ireland 2003-2011
David Madden
University College Dublin
Broad Outline
• Analysis of developments in income and health “poverty”
over the 2003-2011 period
• Analysis of poverty in both dimensions and also
correlation between the two
• Also analysis from time-series and cross-section
perspective
• Income poverty falls up to 2009, then increases
• Health poverty unchanged
• Evidence that health inequality decreased
• Health/income correlation amongst poor has declined
• More detail available in full version of paper (ungated
version at http://www.ucd.ie/t4cms/WP13_05.pdf)
Context (1)
• Are recessions good for your health?
• Ruhm (2000) said “yes”, but Ruhm (2013) said “maybe”
• Chang/Stuckler (2013), Great Recession led to excess
suicides
• Not consistent with Walsh and Walsh (2011) for Ireland,
also challenged by Denny (2013)
• Deaton (2011), Walsh (2011) – difficulties in relating
movements in SWB to economic cycle
• Different dimensions of health may respond differently to
economic cycle
• We look at micro-based data, self-assessed health
(SAH)
• Also issue of income-health correlation within a given
cross-section
Context (2)
• Measuring welfare/poverty across multiple
dimensions
• Intersection or union approach?
• Alkire-Foster attempt to overcome this
• Multi-dimensional indices
• Gives single index, but black box? Weights?
• Dashboard approach – provide information on 2
(at most 3) indices and summary of their
correlation
• This talk focuses on measurement – we do not
look at explanatory factors
Data
• 9 waves of Survey of Income and Living Conditions
(SILC)
• Nationally representative sample with information on
sources of income, deprivation, health
• Income measure: equivalised disposable income (i.e.
including social transfers and with taxes/pension
contributions deducted)
• Health: “in general, how good would you say your health
is?” Very bad, bad, fair, good or very good
• Good predictor of subsequent morbidities/mortality
• Analysis confined to over 16s (under 16s not asked
health question)
• Sample size c.10,000 p.a.
Pα Measures, Income, 2003-2011, Fixed Poverty Line
(2003=100)
Pα Measures, Income, 2003-2011, Relative Poverty Line
(2003=100)
Health Dominance: 2003-2011
2003
2003
2004
F
2005
2006
2007
2008
2009
2010
2011
F
2004
2005
F
2006
S
S
2007
S
S
F
2008
F
F
F
2009
S
S
S
2010
S
S
S
S
2011
S
S
F
F
F
F
F
F
F
F
Health Poverty, 2003-2011
0.2
0.18
0.16
0.14
0.12
Bad or worse
0.1
Fair or worse
0.08
0.06
0.04
0.02
0
2003
2004
2005
2006
2007
2008
2009
2010
2011
Health Poverty, 2003-2011 (with confidence
intervals)
0.2
0.18
0.16
0.14
0.12
LB
0.1
UB
Headcount
0.08
0.06
0.04
0.02
0
2003
2004
2005
2006
2007
2008
2009
2010
2011
The story so far...
• Income poverty falls up to 2009 and then
increases
• Health poverty broadly unchanged over
period
• Some evidence of marginal reduction in
overall health inequality from 2009
• What if we look at them together?
Poverty Incidence by SAH, 2003-2011
Bi-Dimensional Poverty Indices -Fixed
Income Poverty Line
0.4
0.35
0.3
0.25
Income Poverty
Health Poverty
0.2
Intersection
Union
0.15
0.1
0.05
0
2003
2004
2005
2006
2007
2008
2009
2010
2011
Measure of Correlation – All Ages
Measure of Correlation – Under 65s
Measure of Correlation – 25-49
0.3
0.25
0.2
0.15
Income Poor
0.1
Health Poor
All
0.05
0
2006
-0.05
-0.1
2007
2008
2009
2010
2011
Measure of Correlation – 50-64
0.35
0.3
0.25
0.2
0.15
All
Income Poor
Health Poor
0.1
0.05
0
2006
-0.05
-0.1
2007
2008
2009
2010
2011
Summary
• No evidence that recent recession has been
accompanied by meaningful deterioration in
health (self-assessed)
• Health inequality seems to have slightly
diminished
• Correlation between health and income within
the poor (for each cross-section) has declined
• Note these are only two dimensions of welfare
(albeit important ones)
• Other health measures?
• Also, early days – health effects of recession
could operate with a lag
Poverty Dominance Income
2003
2004
2005
2006
2007
2008
2009
2010
2011
2003
2004
WF
2005
F
WF
2006
F*
F*
WF
2007
F*
F*
F*
WF
2008
F
F*
WF
WF
2009
F
F*
F*
WF
2010
WF
WF
2011
WS
S
S
WF
WF
F
WF
F
F
F
F
Sequential Stochastic Dominance
2003
2004
2005
2006
2007
2008
2009
2010
2011
2003
2004
2005
WF
WF
2006
WF
WF
2007
WF
WF
WF
WF
2008
F
WF
WF
WF
WF
2009
F
WF
WF
WF
WF
2010
WF
2011
WF
WF
WF
WF
WF
WF
Bi-Dimensional Poverty Indices - Relative
Income Poverty Line