NBER Working Papers by Samuel H. Preston

Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have b...

This paper reviews the major social and demographic forces influencing American fertility levels with the aim of predicting changes during the next three decades. Increases in the Hispanic population and in educational attainment are expected to have modest and offsetting effects on fertility levels. A cessation of the recent pattern of increasing ages at childbearing will at some point put upward pressure on period (but not cohort) fertility rates. Higher relative wages for women and better contraception have empowered women and fundamentally altered marriage and relations between the sexes. But women's childbearing has become less dependent upon stable relations with men, and educational differences in intended fertility have narrowed. One explanation of higher fertility in the U.S. than...