The SES Health Gradient on Both Sides of the Atlantic
Looking across many diseases, average health among mature men is much worse in America compared to England. Second, there exists a steep negative health gradient for men in both countries where men at the bottom of the economic hierarchy are in much worse health than those at the top. This health gradient exists whether education, income, or financial wealth is used as the marker of one's SES status. These conclusions are maintained even after controlling for a standard set of behavioral risk factors such as smoking, drinking, and obesity and are equally true using either biological measures of disease or individual self-reports. In contrast to these disease based measures, health of American men appears to be superior to the health of English men when self-reported general health status is used. The contradiction most likely stems instead from different thresholds used by Americans and English when evaluating health status on subjective scales. For the same "objective" health status, Americans are much more likely to say that their health is good than are the English. Finally, feedbacks from new health events to household income are one of the reasons that underlie the strength of the income gradient with health in England.
Paper prepared for NBER conference on the economics of aging, Carefree, Arizona. The authors are grateful for the very helpful suggestions made by participants at the conference and in particular to our discussant Dan McFadden. Angus Deaton provided detailed written comments on the first draft which were very constructive. Helpful comments were also received from Meena Kumari, of UC London especially regarding the biological markers.
The authors are respectively Professor of Economics at University College London and Institute of Fiscal Studies, Professor of Epidemiology and Public Health at University College London, Senior Research Economist at the Institute of Fiscal Studies, and Senior Economist RAND. The expert programming assistance of Iva Maclennan is gratefully acknowledged.
The English Longitudinal Study of Ageing has been supported by grants from the National Institute on Aging, US, NIH (2RO1AG7644-01A1, 2RO1AG017644) and several British Government departments, specifically: Department for Education and Skills, Department for Environment, Food and Rural Affairs, Department of Health, Department of Trade and Industry, Department for Work and Pensions, HM Treasury, Inland Revenue, Office of the Deputy Prime Minister and Office for National Statistics. Funding for the Health and Retirement Study was provided by grant NIA U01AG009740.
Michael Marmot is supported by an MRC Research Professorship. James Banks and Zoe OldfieldÂ's research was supported by the National Institute on Aging through grant number ((P01 AG008291-13) with co-funding from the Economic and Social Research Council through the Centre for the Microeconomic Analysis of Public Policy at IFS (grant number: M544285003). James P. SmithÂ's research was supported by the National Institute on Aging, US, NIH (P01 AG008291-13).
The views expressed herein are those of the author(s) and do not necessarily reflect the views of the National Bureau of Economic Research.
Wise, David A. (ed.) Developments in the Economics of Aging, A National Bureau of Economic Research Conference Report. Chicago and London: University of Chicago Press, 2009.
The SES Health Gradient on Both Sides of the Atlantic, James Banks, Michael Marmot, Zoe Oldfield, James P. Smith. in Developments in the Economics of Aging, Wise. 2009