Health Inequality in the US | Hacker News Reader

Health Inequality in the US

libertystreeteconomics.newyorkfed.org

70 pointsAmorymeltzer21 comments

The tricky bit is that most of this is probably NOT due to access to health care - most studies show minimal impact of variation in health care. E.g., the Amish live a long time.

http://www.plosone.org/article/fetchObject.action?uri=info:d...

https://www.nber.org/oregon/

If anyone has a real plan to make poorer people and southeasterners do some cardio and eat unfried vegetables, it would be awesome to hear it.

Healthy food is substantially more expensive than junk food in the US, esp. at the amount required to get full. No wonder the poor generally eats less well than the well-off.

If the government subsidizes veggies and less sweet fruits, more consumption is likely esp among the poor and lower-middle class (even though habit change could take time). The savings in the healthcare system and social safety nets could more than pay back the full amount spent on these subsidies.

As a bonus: de-subsidize agricultural products used to produce non-complex carbs, soda, and sweets, e.g. corn and wheat. Subsidies contribute to cheaper prices, excessive consumption, and worse health. To do that directly might be politically difficult, taxing the end products more could be a plausible compromise.

https://en.wikipedia.org/wiki/Agricultural_subsidy#United_St...

Healthy food is more expensive per calorie. If you are overeating (i.e., if you can pinch more than an inch) you can reduce calories and increase quality without spending anything extra. Most poor folks can pinch far more than an inch.

Living healthy is neither difficult nor expensive. Last night I made a stew of tomatoes, collard greens and beans: total cost maybe $5-6 for 2-3 meals. In a short while I'm walking to a public park for a workout - unlike poor people I can afford to use the pullup bar ($0), the parallel bars ($0), the basketball court ($0) and a jump rope ($7).

(Google ATUS stats on TV watching before claiming poor folks don't have time to do the same thing.)

The problem is willingness, not ability. Some people just don't like vegetables or pushups and don't find the health gains worthwhile. If you want to improve their health, you need to coerce them into changing their lifestyle.

That said, I'm all in favor of reducing agricultural subsidies. I just don't think it's going to have a significant effect on health.

I'd say that energy, rather than time, could be a limiting factor when you're poor. Working minimum wage jobs is often repetitive, soul-crushing, and/or physically demanding. By the time you leave work, you might want to buy finished products (e.g. fast food) instead of spending time shopping for and cooking healthy food.

Middle-class jobs more often feel meaningful or at least allow for more self-determination during tasks which might be helpful for replenishing lost energy.

I agree though that habits and familiarity with the diet one grows up with contribute a greal deal. Many poorer parents may not be able to break their own habits, esp when economic incentives push them otherwise. Kids imitate the way their parents eat. That is why some nudging, through economic incentives, PR, or other means, is necessary to break the inter-generational vicious cycle.

If the job is physically demanding, you should be getting plenty of exercise. When I was tearing down houses, I definitely didn't need an additional workout [1]. Cook a healthy meal - not particularly physically taxing - and you should be good!

Of course, this theory makes the (incorrect) assumption that poor folks are working. Most are not, and very few of the remainder work full time.

I think part of the problem might be our modern culture of victimhood; it's become socially acceptable to make excuses for being fat, weak, unhealthy and lazy, so why bother trying to change it?

[1] I'd amend this a bit; I didn't need an additional workout to maintain a base level of fitness. Specific goals - quad/ham separation, 6 pack, surviving 5 rounds in the ring - do of course require additional training.

> Of course, this theory makes the (incorrect) assumption that poor folks are working.

Most poor are working. Not sure what your point was, but don't try to pull the "their poor because they're lazy" argument.

Reposting of another comment on this thread. YF never mentioned the reasons they didn't work - just that the fact they were working cannot be linked to their health.

~%40 of the poor work and ~%28 work full time according to the below article.

> Of course, this theory makes the (incorrect) assumption that poor folks are working. Most are not, and very few of the remainder work full time. Would you mind supporting this factual claim with evidence? Here's the most detailed examination of this I could quickly find http://www.epi.org/publication/poor-people-work-a-majority-o.... * 35.2 percent of the poor (18 - 64) are NOT ELIGIBLE to work (retired, going to school, or disabled) * 64.8 percent of working-age poor ARE CURRENTLY ELIGIBLE to work * 62.6 percent of eligible workers are working * 44.3 percent of eligible workers are working full-time * 37.4 percent of working age poor eligible for employment are not working (this includes 3.3 million unemployed poor people currently seeking a employment)

> Of course, this theory makes the (incorrect) assumption that poor folks are working. Most are not, and very few of the remainder work full time.

Would you mind supporting this factual claim with evidence? Here's the most detailed examination of this I could quickly find http://www.epi.org/publication/poor-people-work-a-majority-o...

* 35.2 percent of the poor (18 - 64) are NOT ELIGIBLE to work (retired, going to school, or disabled)

* 64.8 percent of working-age poor ARE CURRENTLY ELIGIBLE to work

* 62.6 percent of eligible workers are working

* 44.3 percent of eligible workers are working full-time

* 37.4 percent of working age poor eligible for employment are not working (this includes 3.3 million unemployed poor people currently seeking a employment)

edit -- in light of iak8god's post below, deleting this since while accurate it doesn't particularly contribute to the discussion in a positive way.

Instead I'll summarize in a slightly more polite way by saying this: every discussion I have seen between these two viewpoints -- the one who blames the poor for being poor and the other supporting the notion that there's more going on than individual personal failings -- one of these two interlocutors provides data and evidence and the other provides only anecdotes, and the roles are NEVER switched.

Just trying to be polite and open-minded.

I have met a lot of well-intentioned folks who are blind to the roles of chance and circumstance in their own lives because they correctly perceive that they've had to work very hard to get where they are. And though I don't agree, I can at least understand the appeal in just assuming that anyone who's less successful is just not trying hard enough.

This supports exactly what yf just said.

Only 64.8*62.6 = ~40% of the poor are working at all. And only 29% have full time work.

EDIT: And in comparison with other cultures and times throughout history being weak and out of shape has never been more in fashion than in America. There are entire stores dedicated to fashion for obese men and women and songs specifically designed to appeal to their sense of worth.

In a discussion about what kind of time consuming and physically demanding things the poor ought to be doing with their copious free time, it's hardly fair to consider those who are ineligible to work because of disability, etc. And if the point is to cast the poor as a bunch of lazy layabouts, it doesn't make much sense either to include those who are currently poor, unemployed, AND seeking employment.

The point isn't to cast them as anything. It's to use data to solve problems.

Some people live comfortably and healthily on less than minimum wage - some don't. Some very wealthy people live unhealthily and save less than the poor.

And it is fair to consider all people who may be unhealthy because they would suffer as well. Does my friend on disability for autism and Asperger's not deserve consideration?

Your tone and argument goes far beyond the scope of what has been said. The fact is that even among non-working poor health is still an issue - meaning that the reason for the lack of health is unlikely to be the necessity of work.

Scroll up - we are discussing why people are unhealthy. I claimed lack of free time is not the reason poor people don't cook healthy meals, eat a healthy number of calories, and get some exercise. All the cited numbers support this point.

I'm confused - your phrasing suggests you disagree with me, yet your numbers fully support my claims. There is no reason a student, a retired person, or a part time worker can't exercise and cook healthy food. I recently learned how to do a clutch flag from a retired person who always seems to make time for his health.

I would have brought up a different citation [2] but it wouldn't have differed significantly.

You also bring up an important additional point - disability. Folks who are truly disabled (as opposed to engaging in disability fraud [1]) have unfixable reasons for being unhealthy and the same unfixable reason for being poor (a person unable to work is poor by definition - most wealth transfers are excluded from poverty calculations). The solutions here are a) cracking down on disability fraud and b) figuring out how to cure all the different disability types.

(Of course, some types of disability are also caused, in part, by the actions of the disabled person; consider a diabetic person who lost their feet. )

[1] http://apps.npr.org/unfit-for-work/

[2] My numbers count people who worked 27+ weeks in a year, rather than a point in time snapshot. No major disagreement though: http://www.bls.gov/opub/reports/cps/a-profile-of-the-working...

You seem to be making the point that differences in health outcomes between the poor and wealthy are due to culture factors. That they lack a "can do attitude" which keeps them from being able to take care of themselves and live a healthy lifestyle. If the "can do attitude" could be instilled into poor people then their health outcomes would improve substantially.

It seems that the evidence you have provided is

1. Some poor people have free time

2. Given free time people can improve their health outcomes.

3. Medicaid did not improve health outcomes substantially in 2 years.

It seems to me that while these are all true. They do not provide a good deal of evidence for you working model. Many things could lead to these problems.

1. Poor lack "can do attitude" which affects both job prospects and health.(YF theory of health inequality)

2. Being poor is stressful and cognitively demanding. This reduces the poor's ability to make healthy long term choices.(There is some evidence for this)

3. People who have problems with executive function(ADHD) tend to become both poor, and make unhealthy choices.( I would imagine this is true to some degree)

4. When a person becomes ill they have a much greater likelihood of being poor.(I imagine this is also true to some degree)

I don't think the fact the first three are true has any influence on how much of the health inequality is explained by your theory vs other possibilities.

>Working minimum wage jobs is often repetitive, soul-crushing, and/or physically demanding. By the time you leave work, you might want to buy finished products (e.g. fast food) instead of spending time shopping for and cooking healthy food.

This. People just can't seem to understand how much cognitive stress that puts on a person. Its so easy to be diligent when you're not under so much cognitive stress.

It is possible to test my proposal above and potentially improve the situation in the article.

Try introducing subsidy for healthy food and taxes for unhealthy stuff in a few diverse geographical areas. Track eating habits and health indicators (triglycerides, LDLs, blood pressure, etc.) of the population samples for 3-10 years or longer if warranted, compared with those in comparable areas which serve as control groups.

With statistical techniques, we may even be able to estimate the cost savings in healthcare systems and DALY improvement from the policy.

DALY: https://en.wikipedia.org/wiki/Disability-adjusted_life_year

This entire article seems to carry the premise that lifestyle decisions are a thing to adjust with social policy, as if people are children of the bureaucracy.

And you think current lifestyle decisions aren't a function of social policy? Or rather, antisocial policy?

lifestyle decisions are a function of immediate material conditions.

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