I show
that quality of the clinics or doctors is not the underlying reason for racial differences in black and
white mortality….Differences in patient self-management trigger a racial mortality gap even
when access and treatment are equalized.
But does that paper arrive at a sensible conclusion?
Considerable reductions in medical costs could be achieved
by instructing patients about the importance of strictly following the therapy regimen. A special
emphasis on educating minorities will have the added benefit of reducing the black-white mortality gap
by at least two-thirds.
I am more likely to think that peer effects from the early years of life are difficult to reverse by education and persuasion alone. Here is the paper. That’s from Emilia Simeonova, who is on the job market this year from Columbia.
It has been established for decades that the best general predictor for mortality and morbidity is the amount of education someone has received. It dominates over race by a mile, and is very clearly more important than income or wealth. This commonsensical and competent lady is pointing out that the medical treatment option that needs clinical testing is tutoring people who have not received education to see if acquiring knowledge and self-care skills later in life can substitute for the education that people did not receive when young. People with acute conditions have a strong incentive to respond to such tutoring; they make a very suitable group for initial trials.
and health probably has significant effects on intelligence.
Thanks BCG. I had not picked up this work on Health and measured Intelligence. When somebody does the does the studies it will be very interesting to see the relative independent influences on health of intelligence and education; though I suspect the practical finding will be that Intelligence + Education has a massive effect.
However, I did NOT say that Emilia Simeonova made a mistake in not controlling for education. This is a paper seeking a job; many prospective employers will not like the idea that education is a major influence on health outcomes. The concept threatens their professional territoriality.
tom s. needs to be less touchy. The message of the paper is that a lot of people die young because they are ignorant ,and (implicitly because many elderly US blacks were only offered very poor educations)a greater proportion of elderly blacks are significantly ignorant for these purposes than are elderly whites. (This language is way off-beam. Has anyone ever seen a person with a white or a black skin? I have seen everything from lightly pink albino to dark chocolate; but black and white is newsprint, not humanity.)
Every 11 year old child in Scotland took an IQ test in 1932. In recent years, that old data has been used to study the impact of IQ on health. For example:
“Childhood IQ, Social Class, Deprivation, and Their Relationships with Mortality and Morbidity Risk in Later Life: Prospective Observational Study Linking the Scottish Mental Survey 1932 and the Midspan Studies” by Deary, et al.
RESULTS: The risk of dying in 25 years was 17% higher for each standard deviation disadvantage in childhood IQ. Adjustment for social class and deprivation category accounted for some, but not all, of this higher risk, reducing it to 12%. Analysis by IQ quartile showed a substantial increased risk of death for the lowest-scoring quarter only. Structural equation modeling indicated that the effect of childhood IQ on mortality was partly indirectly influenced by social factors. Cause-specific mortality or hospital admission showed that lower IQ was associated with higher risks for all cardiovascular disease and coronary heart disease. Cause-specific mortality or cancer incidence risk was higher with decreasing IQ for lung cancer.
CONCLUSIONS: Lower childhood IQ was related to higher mortality risk and some specific causes of death or morbidity. Childhood IQ may be considered as a marker for risk of death or illness in later life in similar and complementary ways to social class or deprivation category.
http://www.psychosomaticmedicine.org/cgi/content/abstract/65/5/877?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=glasgow&searchid=1066737614321_221&stored_search=&FIRSTINDEX=0&journalcode=psychmed
“One of the strongest general argument of libertarians and conservatives is that the left believes people are too stupid to make their own decisions. Implicitly, the idea is that libertarians and conservatives are “of the people” – they trust us all as consumers, as citizens, to make good choices for ourselves and we don’t need a nanny state to make us do so.”
I’m a libertarian and I think most people are too stupid to make decisions — which is exactly why I don’t want to give them the power to make decisions about other people’s lives and choices.
As someone about to head out to New Orleans to interview a few dozen job market prospects, I like job papers with good analysis and questionable policy implications — makes for a lively interview. nb — We’re not interviewing Simeonova.
The racial gap in mortality won’t vanish completely even if you control for education / IQ because the black male homicide rate is so enormous. From the federal Bureau of Justice Statistics website:
In 2005, homicide victimization rates for blacks were 6 times higher than the rates for whites. …
In 2005, offending rates for blacks were more than 7 times higher than the rates for whites
http://www.ojp.usdoj.gov/bjs/homicide/race.htm
(By the way, the federal government lumps Hispanics in under “whites” for crime statistics but for almost nothing else, so the black to non-Hispanic white ratio is even larger than this. The Hispanic to non-Hispanic white ratio is around 3 to 1. Asian-Americans, in contrast, are imprisoned only about 1/4th to 1/5th as much as non-Hispanic whites, or about 1/33 as much as blacks.)
By all means, let’s have affirmative action when it comes to life and death. If every race does not have equal lifespans and equal disease rates and equal outcomes, we will just have to make them equal. If as claimed here blacks aren’t following their prescriptions as well as whites, we will give them more instruction, and if that doesn’t work we will give them more treatment. Good white folk won’t mind waiting longer in the waiting room and paying more for their health care while we fight the good fight of affirmative action.
But we can make affirmative health care even more efficient. Let us round up some white people and send them to the gas chambers. That’s a very affirmative and much more efficient way to ensure that blacks live as long as whites.
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