Do peer effects have inegalitarian implications?

by on May 20, 2013 at 7:14 am in Medicine | Permalink

By now it is well known that hanging out with healthy peers predicts (causes?) good health, and unhealthy peers predict (cause?) bad health, for instance as it applies to weight and diet.  So what might that mean?

But perhaps medical care should indeed be given preferentially to those who, in receiving such care, will yield a better return on the investment? Maybe people with families, or people who are merely very popular, should get more care?

That is from Nicholas A. Christakis, who also notes:

Taking network effects seriously means that we should value socially connected people more. From a policy perspective—if not from a moral perspective—the connected should get more healthcare attention.

That is a speculation and a question, so I don’t think you should read him as necessarily endorsing that as a final conclusion.  There is more here, as pointed out by the still under-followed @jflier.

Indeed, once you take peer effects seriously, the popular become very busy people indeed, adding to their already-existing popularity-related busyness.  All sorts of things must be done to help them and to improve them, and for the same reason that people worried about Charles Barkley as a role model.  Of course on average the well-connected are successful and relatively well known or even famous, so the medical attention is not going to the poor or for instance to those unemployed whose weaker networks make it harder for them to get jobs.

I would stress the general point that utilitarian theories are less egalitarian than we often like to think.  The differential marginal utility of money point is very popular, and often true, and it does generally point in an egalitarian direction.  You hear somewhat less about many of the other implications of utilitarianism.

Jim May 20, 2013 at 7:40 am

As the Government takes over more and more of US healthcare, you can expect to hear a lot more of this question: “What kind of people really deserve to see the doctor, anyway?”

[Hint: Not Tea Party members.]

Andrew' May 20, 2013 at 8:07 am

Let’s also forget that healthy people don’t need medical interventions…because medical interventions are not healthcare. Have any of you people actually tried to talk to your doctor about health?

Andrew' May 20, 2013 at 7:54 am

Charles Barkley wasn’t even that good of a basketball role model.

Steve Waldman May 20, 2013 at 8:02 am

Reminds me of The Unit, by Ninni Holmqvist (which I enjoyed).

Luis Pedro Coelho May 20, 2013 at 8:10 am

My favorite (if that’s the word) abhorrent implication of utilitarianism+behavioralism is the following:

The value of money for you is highly dependent on how much you had before. It is much better to win a little than to lose a lot. Therefore, people who are born to wealthy families should get more later in life.

I actually hear this argument a lot nowadays wrt Southern Europe (“yes, we are richer than many Eastern EU states, but we were always richer while they are used to poverty; therefore, it is morally just that more EU funds flow our way instead of attacking more dire poverty in rural Romania”).

Frederic Mari May 20, 2013 at 8:29 am

What do they teach us about projects with a positive NPV? Go after all of them, iirc?

Go Kings, Go! May 20, 2013 at 1:49 pm

I often think to myself, “What would an economists say” when hanging around my kids’ school. To paraphrase the above quote: “But perhaps K-12 education should indeed be given preferentially to those who, in receiving such education, will yield a better return on the investment? Maybe smart kids, kids with potential to create valuable innovations, jobs, or advance knowledge should get more educational spending and attention then the autistic or mentally limited?” The public schools do the opposite, spending more per-child on the slow-to-keep up (and/or athletically inclined).

I’m curious about an economist’s approach. If your discipline leads to a conclusion that comes off as cruel-ish, contrary and likely to upset parents and special instructors, will you publicly argue that those kids need to be moved to the end of the line for scarce resources? (Personally, I don’t formulate opinions on any issue unless I have to, so I have none here.)

Bill May 20, 2013 at 5:15 pm

We do that already when we put the smart kids in the smart kid classes, presumably taught by better teachers and with the benefit of positive peer effects.

Go Kings, Go! May 20, 2013 at 6:17 pm

What public school spends more on smart kids and smart classes on a per-pupil basis? I’ve never seen it around here, where challenged kids have smaller teacher/student ratios, specialist teachers that earn more, and also free pre-school.

mike May 21, 2013 at 3:12 pm

Yes GKG, this seems to be a widely held belief that smarter kids get better/more expensive teachers and other better funding. The reality seems to be the opposite. It’s easy to see why when you look at it from the teacher’s perspective – all things being equal, would you rather teach the smart nice well-behaved kids or the dumb surly out-of-control kids? Which one do we have to pay you more to do?

Steven Kopits May 20, 2013 at 8:11 am

Well, yes, a (classically) liberal or egalitarian ideology puts the onus on the individual. But these argue against either hierarchy or specialization.

If there is hierarchy, then the leader is responsible for the follower. Thus, smart or powerful people tell less smart or powerful people what to do. And this is, to the extent the position of power is not abused, socially optimal. In some sense, this is Charles Murray’s point. The elite are not liberal or egalitarian with their own families, but have become so with respect to the broader community. If poor people want to live on welfare and have children out of wedlock, well, so be it. We have no social norms to impose upon them. Murray might argue that the elite have abandoned their leadership role to the detriment of society.

As regards specialization: Could it be that your wife nagging you is socially optimal? That men living like bears is not a good thing? But men, on the other hand, are good at combat and interacting with the external world, on average. If everyone’s egalitarian in the household, then men will be insufficiently outgoing, on the one hand, and poorly looked after, on the other. Thus, specialization argues against egalitarianism and very possibly against liberalism, and yet is economically optimal under a certain set of conditions.

So, yes, there are three ideologies here, and all of them have a place.

Andrew' May 20, 2013 at 8:27 am

“If poor people want to live on welfare and have children out of wedlock, well, so be it”

That sentence does not compute.

Andrew' May 20, 2013 at 8:41 am

Apropo of nothing and of everything, I just dropped off a new batch of all-natural dye-free snacks at my kid’s school and sitting on the shelf RTF next to their special snacks is the big tub of neurotoxic ant poison.

Go Kings, Go! May 20, 2013 at 2:20 pm

I bet union rules prevent a teacher from moving one, but not the other.

Apropos of your “Apropo of nothing and of everything”, did you know that a 120 mile long batholith in what is modern Cornwall was mostly emptied of tin by the time Caeser arrived; the tin migrated to the Mediterranean where it was alloyed with copper to produce bronze; much of the bronze was sent north in return for nearly all of the Amber in Jutland (by 300 B.C. Jutish Amber was exhausted and Baltic Amber substituted)? During the same periods, one of the largest silver mines on Earth, in Tartessos (modern Spain), was mostly emptied into the Levant and Near East.

None of that activity came by conquest. The Babylonians and Assyrians never visited Tartessos, only one Greek, a Massalian at that, visited the offshore trading entrepots of Armorica and Land’s End, no Roman Centurion confiscated Amber. The goods traveled by short haul, cabotage, rivers and portage, a method often dismissed as mere gift exchanges. (As if today’s merchants wouldn’t recognize as “cost of goods” a gift to local muscle, for transport, shelter, for introduction, for a parcel to set up facilities, etc.)

Contemporaries noted the effects of trade, how it civilized. Traders expanded knowledge of astronomy, geography, culture, etc., they distributed stories, technology and methods. Elites traded for luxury goods to pay entourages instead of obtaining them by raid. Trading sites were established on neutral ground, without any jurisprudence or power, except Ebay ratings and relationships (one of those may not be true). And then a bunch of thugs rode out of the hills & sailed out of the islands and destroyed all the wealth (stupid Celts, Sards, Sea Peoples).

Finch May 20, 2013 at 11:14 am

I interpreted that sentence as describing how the elite behave: they don’t seem to be standing in the way of poor folk ruining their lives in aggregate, but they do prevent (or try to prevent) that within their own families. Steven isn’t saying Steven doesn’t care; Steven is saying that Charles observes the rich care only within their own families. Sorry about that sentence; avoiding pronouns can be tricky.

Andrew' May 20, 2013 at 11:36 am

My point is that giving people money to smooth out the rough edges of ruining their lives isn’t being neutral.

My second point is that when I interact with these people, I can’t even get them to not store brain-destroying chemicals next to food unless I go apeshit about it. We can’t save the world.

Finch May 20, 2013 at 1:17 pm

> My point is that giving people money to smooth out the rough edges of ruining their lives isn’t being neutral.

Okay, that’s an understandable critique of what rich people are doing. Your point is that providing welfare for bad behavior encourages bad behavior; it isn’t neutral. But what do rich people do in with their own kids? Surely there’s plenty of subsidization of bad decisions? But the rich kids turn out okay and the poor kids don’t.

Mark Thorson May 20, 2013 at 7:49 pm

If you want action, tell them the ant poison contains peanuts.

Andrew' May 20, 2013 at 11:39 am

Incidentally, after I go talk to the administrator, I’ll report back on how easy it is for an involved parent to change school behavior and rescue the kids of the slacker parents. Who wants to bet that what I really get is attitude and pushback?

Finch May 20, 2013 at 1:14 pm

Good luck with that. I mean that both sincerely and sardonically, if that’s possible.

Millian May 20, 2013 at 10:00 am

If that’s really Murray’s point, it’s dire. “The elite treat their children like children, but they don’t treat poor people like children, quels hypocrites!”

Sam May 20, 2013 at 8:51 am

How big is Angelina Jolie’s social network? Not just her peers but people who respect and listen to her. Her endorsement of genetic screening and preventative surgery will save more than a few lives.

Becky Hargrove May 20, 2013 at 9:12 am

This reasoning is also the problem I have with some time banks for services, which presumably exist to make services exchanges possible that otherwise might not have happened. Just the same I have heard the reasoning, “It is best to seek the time of someone who is already quite busy” (i.e. “connected”).

UserGoogol May 20, 2013 at 10:02 am

This would still imply a sort of egalitarianism, just of a sort of Rawlsian flavor. Intrinsically valuing socially connected people is obviously not utilitarian at all, so the idea is that benefiting the connected will have spillover effects. But then all you’re saying is that inequality is justified if the connected having more money benefit the rest of the world more than if the rest of the world had the money distributed to them. That’s still pretty egalitarian.

And more practically, the way that social networks actually work is probably not all that well suited to singling out the highly connected people.

zbicyclist May 20, 2013 at 10:19 am

Read those first two paragraphs again: In the second (quoted) one, we have “Maybe people … who are merely very popular, should get more care”

In the first (Tyler) paragraph, we have “hanging out with healthy peers predicts (causes?) good health, and unhealthy peers predict (cause?) bad health”.

There’s a big contradiction here. As we remember from high school (or our kids going through high school), the popular people aren’t necessarily good influences.

Andrew' May 20, 2013 at 11:09 am

“the popular people aren’t necessarily good influences.”

The popular people ARE NECESSARILY bad influences.
http://www.nytimes.com/2010/06/19/your-money/19shortcuts.html?pagewanted=all&_r=0

More generally, can’t find the link and Google astonishingly fails me, but popular kids use a bi-strategic passive aggressive approach to obtain their popularity. What amazes me is that even the teachers are taken in.

Dangerman May 20, 2013 at 11:24 am

Ah yes… once the free market is removed… there are a limitless number of different ways that central planners could allocate the goods and services.

It must be truly burdensome for the central planners to have to philosophize about this.

JCW May 20, 2013 at 11:51 am

Is it really a surprising observation that utilitarianism, pushed too far in some direction, can lead to ethically dubious places?

Pro tip: Any -ism (to repeat: ANY -ISM), pushed far in enough in some direction or under certain circumstances, can lead to ethically dubious places. Yes, that includes your -ism, whatever it is. Seriously.

This lesson should not be news to any well-ready adult.

ChrisA May 20, 2013 at 9:06 pm

Actually it really shows that you cannot do moral calculations. Our moral intuition comes from genes, not from logical thinking about morals. The genes were formed to allow us to cooperate in smallish hunter gather groups, they are a programming kludge. There were not handed down to us from a magician in the sky wanted us to be nice to each other. So it is not surprising that when we try to expand our moral intuition into a set of general principals (like Utilitarianism) it fails.

Even given what I say above, it is surprising that Utilitarianism remains so popular when it so quickly comes up with repugnant conclusions. For instance utilitarianism could be used to justify genocide of a particular group (lets say Jews or Gypsies) since their existence annoys a lot people and they weren’t very happy anyway being hated and living in the ghetto.

KLO May 20, 2013 at 12:24 pm

It seems wholly unnecessary to force a health care system to provide more care to the well-connected. Under any set of conditions, the well-connected are among the best served.

Bill May 20, 2013 at 5:53 pm

If well connected people are healthier, and medical procedures’ effects on health are subject to diminishing marginal returns, then wouldn’t this justify spending more on poor, less well connected people? I don’t get it. A well connected person who never gets sick might only need expensive end-of-life care, but an unconnected person might only need an inexpensive intervention to treat diabetes to prolong life many years.

Now if you make the argument that well connected people will enrich the lives of others (they are well connected after all so this ought to be true), then that might justify spending more on the healthier.

Bill May 20, 2013 at 6:07 pm

Woops I screwed up. For given level of health, then spending more on the better connected would be more efficient, because the marginal productivity of healthcare would be higher. Better connections and popularity shift the curve; it doesn’t move you along the curve.

So if two people come in with diabetes, it’s more efficient to spend more on the person who is more popular.

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