A second post on Angus Deaton’s The Great Escape. Here I discuss the epidemiological transition that he notes. There is a general movement in the way disease tends to afflict a country (and indeed across the whole world). The problems of disease, what the diseases are, and who they target, have a distinct pattern.
The epidemiological transition that Deaton notes represents a change in where the main problems of disease occur. He is keen to say that old people’s lives aren’t worth less than young people’s and I definitely think we should be protecting both. (Especially as I am much closer to old than young). That said, the transition to afflicting older people is a good news story. Or at least as good a news story as can be had when discussing the problems caused by disease.
One way in which the transition is sometimes summarized is to say that diseases move out of the bowels and chests of infants into the arteries of the elderly.Deaton, 2013, page 31
The good news is that across the world children are receiving more protection from infectious diseases. We have seen great progress against a lot of diseases that take the lives of many children. The diseases that are increasingly a problem are diseases, e.g., heart disease, that typically take a while to build up. As more people survive to older ages these diseases come to the forefront. As I said, this can be seen positively. At least people are living long enough to see the problems that typically face the elderly, however awful these problems are.
There are plenty of things we do to hurt our health. That said, it is worth remembering that harming our health isn’t something new. Deaton tells us the story of the Surgeon General who gave up smoking only a few minutes before introducing a damning report on the dangers of smoking. The Surgeon General took a lot of time to persuade himself to give up smoking; it isn’t a surprise it has taken so long to persuade some other people.
Deaton notes the problem with healthcare spending. The healthcare market isn’t the sort of market studied in introductory economics. People don’t really choose how much to spend. Things happen and you just have to spend money. As an English person I knew the US system was bad, but I never cease to be surprised at just how bad US healthcare is now that I am living here. You get random mysterious bills with little explanation. My favorite thing is the insurer sends emails regularly telling me the good news that they have actually covered something. In their emails, healthcare insurers seem genuinely excited, and somewhat surprised, that they have paid for your medical expenses. I always assumed that was an insurer’s job but I’ve learned to be pathetically grateful whenever something is paid for.
As the risk of understatement, I’m not 100% sure Americans are getting value for the money they spend on healthcare. See the graph taken from Our World In Data. Note the US is spending a lot more on healthcare and still dying noticeably earlier than rich comparator nations.
Deaton’s The Great Escape has details on the challenges of measuring poverty. It certainly is a tough problem. Sharp cutoffs can occur when a small change in income makes a massive change in how you are treated. For example, when earning an extra dollar makes you not eligible for social programs. Sharp cutoffs are bad enough, but when they are based upon imperfect measures there are even more problems. I guess we need smart policies that don’t just deem people as poor — and so needing government support — or not — and so being left completely to their own devices. It makes sense but I also sympathize with those in government who, hopefully, are trying to create the perfect policy in a world of imperfect information.
Read: Angus Deaton (2013) The Great Escape: Health, Wealth, and the Origins of Inequality, Princeton University Press