Lottery Winners Don’t Get Healthier

Wealthier people are healthier and live longer. Why? One popular explanation is summarized in the documentary Unnatural Causes: Is Inequality Making us Sick?

The lives of a CEO, a lab supervisor, a janitor, and an unemployed mother illustrate how class shapes opportunities for good health. Those on the top have the most access to power, resources and opportunity – and thus the best health. Those on the bottom are faced with more stressors – unpaid bills, jobs that don’t pay enough, unsafe living conditions, exposure to environmental hazards, lack of control over work and schedule, worries over children – and the fewest resources available to help them cope.

The net effect is a health-wealth gradient, in which every descending rung of the socioeconomic ladder corresponds to worse health.

If this were true, then increasing the wealth of a poor person would increase their health. That does not appear to be the case. In important new research David Cesarini, Erik Lindqvist, Robert Ostling and Bjorn Wallace look at the health of lottery winners in Sweden (75% of winnings within the range of approximately $20,000 to $800,000) and, importantly, on their children. Most effects on adults are reliably close to zero and in no case can wealth explain a large share of the wealth-health gradient:

In adults, we find no evidence that wealth impacts mortality or health care utilization, with the possible exception of a small reduction in the consumption of mental health drugs. Our estimates allow us to rule out effects on 10-year mortality one sixth as large as the crosssectional wealth-mortality gradient.

The authors also look at the health effects on the children of lottery winners. There is more uncertainty in the health estimates on children but most estimates cluster around zero and developmental effects on things like IQ can be rejected (“In all eight subsamples, we can rule out wealth effects on GPA smaller than 0.01 standard deviations”). Overall for children:

Our results suggest that in a model of child development parameterized to match conditions in Sweden, the effect of permanent income on children’s outcomes is small. With the exception of obesity risk, we estimate precise zero or negative effects in subpopulations for which theories of child development predict larger benefits of wealth. For example, though the mechanism differs, investment models (Becker and Tomes 1979) and parental stress models (Bradley and Corwyn 2002) predict larger positive effects of wealth shocks in families with low incomes. The small impact of wealth on proxies for parenting behavior may explain why the shocks to permanent income appear to have few discernible intergenerational impacts.

One point to note is that they are looking primarily at children born prelottery although they do not find any health effects in infants born postlottery.

As the authors note, Sweden is an affluent society with an extensive social safety net. Nevertheless, there is still a significant health-wealth gradient in Sweden. We might get larger causal estimates of wealth on health elsewhere but the Swedish results bound how far we can reduce the gradient.

The bottom line: Is inequality making us sick? No.

Addendum: The methodological note below was an impressive sign of how research standards at the frontier are changing, expect to see more like this in the future:

To minimize concerns about undisclosed multiple-hypothesis testing, our intergenerational analyses were prespecified in an analysis plan posted in the public domain before running any regressions of child outcomes on the treatment variable (Cesarini et al. 2014).

Addendum 2: See the comments for useful additional information from Erik Lindqvist, one of the authors.


By "us" you mean us Swedes, with good universal healthcare?


How much did the increase in the number of insured from Obamacare reduce the death rate, anyway? It went up? Huh

Researchers at Johns Hopkins found that about 1,000 children died each year as a result of a lack of health insurance in the U.S. during the period looked at (1988-2005).

High percentages of children without access to health insurance isn't a problem in Sweden, but is in America, and it has consequences.

How much did the increase in the number of insured from Obamacare reduce the death rate, anyway? It went up? Huh

Come on, Stuart, I want to hear the inspiring story of all the lives we're seeing saved. Don't hold out on me.

Here's an estimated 50,000 lives that just one small provision of Obamacare helped save:

I have a feeling you won't be much inspired no matter what the outcomes, though. :-(

So actually Obama/Dems did not wait very long to address* the issue of uninsured children - two weeks after sworn into office, Obama signed an SCHIP expansion, something GWB had vetoed twice.

The Johns Hopkins study indicates that expansion of health insurance will prevent early deaths of childrens, but unfortunately I'm not familiar with other research studying child mortality and access to health insurance since 2009. If you know any, please let me know.

@Careless - what do you think about the GOP and Democrat's responses to children without access to health insurance? Or what is your reaction to it?

*And I consciously said the Democrats "addressed" the issue, not "solved" it since they passed nothing like universal health insurance for kids. Just trying to preempt any mistaken impressions of what I'm asserting.

Jan: erm, you get an F. We were talking about access to health insurance, and your link has literally nothing at all to do with that.

Stuart: if it doesn't change anything, I'm in favor of whatever's cheaper. I see no reason to support a useless feel-good measure. So again, where is the drop in death rates?

Actually, I said "healthcare."

@Careless, you give me an F because I pointed out a relevant and heakth care improvement? Ha, ok. Back to your tangent. Please design the rigorous study that could demonstrate the change in death rate linked to the ACA coverage policies under real world circumstances in five years. (Not to mention reducing death rates was never the stated intent of the law.) You obviously diverted the topic of discussion to the ACA and the mortality impact of increased coverage specifically because that is not a demonstrable outcome in a few years. Anyway, the lives saved stat is pretty great, huh?

The OP is about the effect of wealth on health, not health care administration (and the study by its own admission is an estimate of an estimate and rates were already declining). So, yes, Jan gets an "F."


Okay, so if studies showed child mortality dropped after they got health insurance, you'd favor expanding children's health insurance. I think that's reasonable. I don't think that'd be a particularly challenging thing to find. I'm sure you could see it already in data comparing Massachusetts (very low uninsured rate) with FL (very high child uninsured rate), or compare how many children die in Canada due to lacking access to health insurance (none under universal health care system) compared to the US (1k per year, under 1984-2005 system).

Buses driving around the city inundated us with messages on how important prenatal care is and how to get it for free.

The care is there. Educating parents is the far more important part of the message.

It's an interesting point, but since the US has also been getting older I think it is pretty inconclusive without looking at some actual numbers.

I thought we were talking about wealth inequality and health, no?

@Careless, please design the rigorous study that could demonstrate the change in death rate linked to the ACA coverage policies under real world circumstances in five years. (Not to mention reducing death rates was never the stated intent of the law.) You obviously diverted the topic of discussion to the ACA and the mortality impact of increased coverage specifically because that is not a demonstrable outcome in a few years. Anyway, the lives saved stat is pretty great, huh?

Jan, it's pretty simple. We were promised a reduction of deaths per year in the tens of thousands range. That's a 2% drop. You don't need to prove causation, just show that it happened. Except it didn't

What else happened alongside the passage of Obamacare that might have led to the reduction of deaths being countered? Let's think a little. Could it have been the opioid epidemic in part? Perhaps the austerity measures imposed by Republicans in part? And, perhaps not unrelated to austerity, suicide spiking among middle-aged white men and women?

I guess this is why the third world is known for their longevity.

For whom a health wealth gradient exists in the presence of said universal health care. Ok

"The bottom line: Is inequality making us sick? No."

That doesn't follow. Inequality can make both the relatively rich and the relatively poor worse off if the latter have ways to harm the former, other than through official redistribution.

stop stealing my very generic name lots of people probably use

Re: "If this were true, then increasing the wealth of a poor person would increase their health."

You can figure out what is wrong with the statement if you think for a second.

One word: Habit

If food choices in your family were made under conditions of economic stress or low income, sure you would substitute out some products if your wealth suddenly changed. You would still keep grandmas recipe for mac and cheese--a family tradition--and that low cost pizza, or doritos while watching the football game--but now you can add some expensive ice cream you couldn't afford before to your diet.

Ask yourself about the fixedness of your eating habits.

Re: “If this were true, then increasing the wealth of a poor person would increase their health.”

How about a gradual, modest increase in wealth?

"How about a gradual, modest increase in wealth?"

My first thought is that the last 40 years has qualified as that and I would consider overall health to be drastically worse than it was in 1976.

Maybe we're less healthy because we can be less healthy and still survive. Also less social pressure to be thin in the lower classes.

"One word: Habit"

Two words: doubt it.

Poor people aren't fat and diabetic because they can't afford to eat better. Pizza and fatty meats and cheese are actually pretty expensive compared to healthier alternatives like rice, beans, and canned veggies.

Which might be more relevant if people were actually getting obese and diabetic from "pizza, fatty meats and cheese" with high fat and protein content, rather than the cut price chips, white bread and sodas, and which fairly close to cheap as rice and beans.

Richer people generally don't really eat "virtuous foods" because of "superior executive function" or "time preference" or any kind of retarded concept like that. They eat foods which are flavorist modified and mass produced foods in the same way as the poor do, but get less obese because of better nutritional balance in the products, which they get because the companies selling food to them sell more expensive products with more expensive macronutrients.

Of course, yes, the poor *should* be eating rice, veggies and beans and avoiding obesity causing food if they want to stay thin. They should be doing that. But it would take more self control to do that, than the middle or upper class currently exercise in their diet.

So, I'm not a nutritionist or anything, but I doubt that. What micronutrients are you referring to that are present in the prepared foods of the higher income folks enjoy? Were these nutrients available and common forty years ago when everyone was a lot thinner, both rich and poor?

"Macronutrients", not micro.

Here are a couple resources, the first of which speaks directly to your question about why the poor and higher-income people have differing rates of obesity--turns out this is true even when they eat the same exact things. I have a feeling the second article may more closely mirror your views on this topic, with perhaps a bit more empathy and optimism.

@M: It's hardly surprising if richer people have more ways to mitigate some of the bad effects of bad food/eating habits. Still, tap water and rice are cheaper and healthier than soda and chips (fortified with macronutrients).

@Jan: The rich are also less likely to do harmful things like have children out of wedlock (and have nannies even when they do), which sets children up for more of the maladies imputed, of course, to conservative policies.

OK, I guess have to cite you some literature on social determinants of food choice, income, habit etc., and will await your cross citation that habit formation and habits have no effect on persistence and initial food choice.

Start chewing on this: If you look at the initial conditions that determine food choice listed in the article (aside from palatability) listed are: cost and accessibility, knowledge and level of education, influence of social class, cultural influences, social contexts and settings, stress.

The Swedish study changed only wealth, so the question is: what about habit formed from the above initial conditions

"Dietary change is not easy because it requires alterations in habits that have been built up over a life-time. Various settings such as schools, workplaces, supermarkets, primary care and community based studies have been used in order to identify what works for particular groups of people. Although results from such trials are difficult to extrapolate to other settings or the general public, such targeted interventions have been reasonably successful, illustrating that different approaches are required for different groups of people or different aspects of the diet."


I guess my initial comment was too short and snarky. I agree with you that habit plays a role in people making lousy diet choices. My point was that income is not the determining factor in forming good or bad habits. Healthy foods simply aren't any more expensive, generally speaking, than the bad for you stuff you cited. Diet soda costs the exact same amount as regular soda. To take an example unrelated to diet: cigarettes are expensive pretty much everywhere these days, but smoking is still a lot more common among lower SES strata.

"Fatty meats and cheese" don't make people fat, carbohydrates, like rice and pasta do.

Yet the Japanese and Italians have very low obesity rates.

Calories make people fat

rice, beans, and vegetables require cooking skill to make them taste good, along with spices and other ingredients, a well-stocked kitchen with an array of pots and pans, etc. and it requires time and effort to learn to cook well.

if you're poor, you often are in a disruptive home environment. so your easiest option after a hard day isn't to spend an hour cooking - it's to buy a pizza or other premade food, and at most heat it up in the microwave. and you probably didn't invest several hundred bux buying spices and kitchen equipment, and you likely didn't have the time or stability in life needed to cultivate the sort of cooking skills needed to make vegetables and such taste good.

Not to mention that the Middle Classes and the rich don't, particularly cook from cheap, fresh, vegetable ingredients more than the poor, so much as eat heavily engineered convenience foods and restaurant meals, just ones which are made from fresh ingredients with higher nutrition content. Which are more expensive.

I have never really understood the argument that poor people are more short on time than middle class or rich people. My personal experience is the opposite, richer people seem to work many more hours than poorer people, who in addition to having generally fixed hour jobs as opposed to essentially unlimited free overtime demanded of the typical middle class worker, also don't tend to have the requirement to study for professional qualifications in their spare time.

On the OP I think all think can be explained by differing future time orientations between rich and poor people - which is almost a tautology as an explanation as to why some people are richer than others and more wealthier than others. Whether genetic or environmental (or both) it would be amazing if people all had the same preference in this area, like any human trait there will be a bell curve. What is silly is to make a morality play out of this as both right and left leaning people do. Both left and right claim a short FTO horizon is bad for some reason, the only thing they differ on is whether it can be changed and whether or not people can be chastised for not changing their FTO.

But why is a short FTO considered bad? Why shouldn't people live for the moment - is it really true that a long life of asceticism is better than a short life spent indulging your appetites? We glorify asceticism in the West perhaps too much.

Sounds like terrible news for people who like the idea of private healthcare and the idea of a free market in goods promoting health - higher wealth to be shunted into market options, keeping all else equal, does not make people healthier!

(So harder for the wealthy to argue they need their wealth to keep their families in good health - apparently that private healthcare you can afford doesn't do anything).

lol, as if that was an argument anyone was making

Seems 'keeping your wealth' should be the default position. This study shows redistributing it does no good.

Not many Swedes use private healthcare, even if they are rich.

That seems rather inconsistent with what is reported here [1], where a bit of extra income works wonders.


That was a weird piece to read, and unsurprisingly, largely full of shit. They're talking about eliminating poverty by increasing household income from $15000 a year to $21,000, leaving most of them in poverty. I note that the main study they're looking at here doesn't agree with them: "This increase moved 14% of study families out of poverty, while 53% remained poor, and 32% were never poor." The study also does not support what the article claims about mental health effects: " Anxiety and depression symptoms [in the ex-poor children] were unaffected. "

They're talking about a program that would have lifetime costs of about $270,000 "paying for itself" by returning $50-100k in lifetime income per child and $10-20k in taxes. And that's not including the $270k per child they'd wind up spending on them as adults.

" According to economist Matt Bruenig's calculations, eradicating poverty would cost $175 billion." which works out to about $3,500 per person in poverty, which means it's nonsense.

Seems pretty reasonable to me: the character traits that tend to make people wealthier, also make them healthier. Funny to watch the low-information commenters struggle against common sense.

For sure, impulse control is an easy one, affecting both.

But when a nation goes obese that is a change. What happened? Did impulse control decline on a national scale?

Not for everyone, but certainly for the lower class. Note the increasing rates of illegitimacy; no waiting for marriage there.

Hasn't obesity enjoyed great growth in the middle classes?

Why, if it is a morality play?

If the middle class is increasinly bad at health, it puts a bad spin on "money can't solve it." It means money is misapplied, public and private.

Life expectancy increased dramatically over past century... and still getting better.

The obesity fixation misses the big picture of overall well being. And obesity is just a negative side effect of increased wealth across the population -- there's a lot more food readily available to eat.... human evolutionary biology is wired to eat when food is plentiful. America has the fattest poor people in the world.

This Marxist ideological fixation on "inequality" is unhelpful and silly-- humans are born unequal; and the 'natural' state of all human beings is abject poverty. In all of human history only one method thus far has been discovered to reliably increase the standard of living, health, and well-being of the great masses of people -- free market exchange, voluntary organization/cooperation and division of labor.

Nature ultimately equalizes everyone, rich & poor, in inevitable death. We all share the same destination after our very brief existence.

I understand this argument. It is straightforward "revealed preference." If people are fat, they want to be.

I understand it, but I also think it is a perfect example of economic stupidity - making a bad fit to reality to support choice theories.

I don't suppose you can explain why a weight loss industry shows another preference?

A quick Google shows that 89% of women are unhappy with their weight, maybe if you call them Marxists ...

Life expectancy increased dramatically over past century… and still getting better.

Life expectancy fell for the U.S. white population in 2014 and remained flat for all population groups combined, according to data released Wednesday by the Centers for Disease Control and Prevention

Improvement in standard measures is good, but is there a missing counterfactual?

Could we live longer and be happier about our weight or general fitness?

@anon revealed preference does not imply that people will with their choice. The revealed preference of most people is that they don't want to save money, yet most people now wish that they had saved more money. The sour grapes is about not being able to have both options.

I think the paper is more narrow than 'character traits', though I suppose there some inter-lap between your interpretation and the simple fact that poor people have bad habits (such as eating too much junk food) that are not erased when they suddenly get rich.

However, this might be a b.s. click-bait junk science study that is simply an anomaly of the 95% statistical significance field (5% error leaves a lot of room for papers like this). The sentence that indicates this might be junk science: "One point to note is that they are looking primarily at children born prelottery although they do not find any health effects in infants born postlottery."

I suppose you can argue away re the last sentence that adults have their health trajectories determined when they are younger, rather than older.

All in all, a junk science provocative article of the kind AlexT likes to cite.

You can always count on Ray for bizarre interpretations. A Scandinavian population study with no significant findings based on n=439,234 is... an artifact of 95% statistical significance and is junk science? Whatever dude.

I guess this thread is what triggered my thoughts in the other, on quantification.

Health is one of the worst areas for economics, where it adds least.

Now the perverse thing is that while econ can't say what makes Colorado healthy, it does want to tell us that money doesn't matter.

Seriously? I think you need an actual recipe for improving health before you can say that. You can't just watch us get fatter, and go on more continuing medications, and say "winning!"

You have to write a little clearer to make your point. You cite Colorado and 'fatter' in the same paragraph, which confuses things. Economics can say why Colorado is healthy: CO has a lot of young people attracted to Boulder and the Rocky Mountains, and you are generally fit if you are younger and like to hike. It's the same reason Austin Texas is probably more healthy than Brownsville Texas I imagine.

Is that economics? Why did some move from Minnesota to Vail, and some to Las Vegas? Or a life of what one hopes is only mild degeneracy in Asia?

@anon - you're too clever by 0.4999.... How did we end up in MN --> Vail (I guess you're saying rich do this) and MN--> Vegas (rich gamblers) and mild degeneracy in Asia from my post? Keep up the good work anon. A promising career as a poet awaits you.

I was responding to "Economics can say why Colorado is healthy: CO has a lot of young people attracted to ..."

If economics observes that some young people go to CO, it is after the fact. It isn't saying "why" at all.

Economics is bad at desires, and bad at understanding the roll of self-control in achieving those desires. It is kind of going to the well to say that econ just thinks it is "utility" and that people are "optimizing," but I think that's what you are claiming about skiers and gamblers. Both rational optimizers?

For Colorado I assume you're talking about obesity rate? The last several years it's been at the top of the list, but in 1990 it was #45 with the exact same obesity rate.

Low obesity, ranks in most "healthiest states" lists.

For my purposes it just shows that lifestyle isn't just wealth.

That is obviously a typo. Did you look at the obesity rates and rankings for the states in 1990?

The correct figures are: CO had a 6.9% obesity rate in 1990 and a 21.3% rate in 2014.

CO's obesity rates can't be explained by "young people attracted to Boulder and the Rocky Mountains." But they can perhaps be explained, in the models, by a population living at altitude.

It is an interesting hypothesis, but in reality there are probably a combination of factors that all significantly contribute to its relatively low obesity rate. It's a very well-educated population. It has low rates of poverty and high incomes. It has great weather with lots of sun and strong sports and outdoor recreation culture, so people get a lot of exercise. It's also a relatively young state--even if stats adjust for age, more younger people can contribute to a more active and generally healthier culture (I know this one sounds squishy, but I think there something there).

Do cultures arise from thin air to instruct individuals? Does a PhD in english poetry teach nutrition? Jan, my reading of your comment is that the people in Colorado are simply different than other people and that you are suggesting absurd causal relationship between culture-education and obesity. The simple answer and the common sense is that the people who earned good grades, are healthy and fit, achieved success in higher education, and have a culture that places a high value on the things that make people successful, are just much more responsible and future-oriented than those who don't.

Come on. Who is going to spend their lottery winnings on better health care? Talk about a super-responsible buzzkill. "Honey, we've just won $100,000! Think what we can do now!" "Yeah, now you can go for more health screenings! Ooh, ooh I can join that fancy gym, WITH a personal trainer! And kids - wait for it - organic produce from now on! YAAAAAAY!"

Actually, in the mid-1980's, my family won the Gillette Superbowl Sweepstakes. The prize was $50,000. The first thing my parents did was put $10,000 in each of their three children's college savings accounts. That's at least as responsible and forward-thinking as upgrading to a healthier lifestyle.

It's just one anecdote, it's an anecdote that changed my life.

Super-responsible! Stll, less of a buzzkill than prostate screenings.

That's because your parents were responsible Mormons, which makes your upbringing unique and lucky compared to what the average child in modern America. Your parents weren't remotely close to the stereotypical lottery ticket buyer.

First, let's deconstruct your sentences. Health screenings will not make you healthier, they just raise your awareness. Second a fancy gym does not matter as much as diet. Third, a Personal Trainer, while trendy, generally is a waste of money. And organic produce has been found not to decrease your chances of getting cancer.

Other than that, good post.

A trainer is a reinforcement mechanism.

Of course we get into complex nudges. Most gyms would like you to have a membership, but not come.

that inaccurate conclusion.

possession of cash ( from lottery ) is just one aspect of wealth / status. there might be other mechanism that prevent lottery winner to rise in status ( public perception, self perception, stress of situation change, home location ) .

to truly prove inequality not affect health you need three generation or more data from rich-rich, declining rich, poor-poor, poor raise to rich slowly, etc. lottery winner is extremely unusual data that unreliable as inequality study. they often mismanage cash, didn't have reliable wealth producing asset, still live in poor neighborhood, have poor friend and family etc.

i think difference between usa black military family ( good neighborhood, middle class circle of friend, some in force for 2-3 generation ) and black in ghetto in health/ death rate/ education might be better resource for study. another alternative is between various immigrant communitieswith different level of health wealth. it might be you need to live in 'rich' environment with family, friejd and career. raising personal wealth might be ineffective unless surrounding wealth also increase.

In a rich environment does health and responsibility fall like manna from the sky? Is your argument anything more than, "it helps to have other responsible and healthy people around"? That argument does not even begin to show that inequality causes poor health.

Or perhaps lottery winnings are not like other wealth in any number of ways?

Dare I say Alex is engaging is some mood affiliation in his response to these studies?

Might I suggest you provides some idea of what difference is you believe there are between lottery winnings and other dollar bills?

Everything is wrong with this story. First of all the number of lottery winners is to small a sample to draw any conclusions. Secondly our natural bias blinds us to facts. Think about the numbers of rich people who die young. But we don't we simply look at a few rich people who are in the public eye and assume they represent all rich people. Many more problems with this kind of amateurish statistical analysis but I'll just point out one more; most people will automatically pick their favorite dead horse to beat and that would be food. Sure diet is important but if you are eating all of your daily requirements (which most of us in the West are) they latest fad foods or foods to avoid don't have any positive effects on your health. It's fun to claim that being a vegan is healthy or avoiding gluten is anything but a Hollywood fad but all you need to do is eat a balanced diet. Whole foods is a fad as is organic and fear of GMO. MOST serious health issues are genetic, you get them from your parents and not your food.

Many more problems with this kind of amateurish statistical analysis

You really, really should not be writing things like that.

Anyone who understands statistics would know that a few hundred lottery winners out a population of 320 million could have no value in a statistical analysis. Furthermore the very fact that someone would back into a conclusion like this and then try to prop it up with amateurish statistics makes the entire article suspect. Almost without exception these articles are generated by a minority group of activists who are vegans, vegetarians, whole food bigots or anti GMO or something. Believers in magic foods or foods that somehow "kill" you pump this BS out on a regular basis and for some reason they all seem uneducated in math and science.

A) Sweden does not have 320 million people.

B) Anyone who understands statistics would know that a few hundred lottery winners out a population of 320 million could have no value in a statistical analysis Well, no, it's the opposite

C) I don't see numbers for the first of the three lottery data sets, but the two I do see have about 6300 winners

Table V in the paper shows the distribution of lottery wins. 2,140 people win more than 1M dollars ($150,000). Speaking of statistical analysis, the precision of the estimates are of course reported in the paper. Compared to previous literature, the estimates are precise.

A typo in my comment above: "more than 1M dollars" should have been "more than 1M SEK". 1M SEK corresponds to about 150,000 dollars.

This is great news! We can soak the rich and it won't affect their well-being!

But it would affect our well-being. The rich don't seek retribution the same way you or I do--when they hit back, the poor and middle class feel it for a generation. They employ those methods so as to serve as a deterrent.

Sure, you could also soak the poor and it wouldn't affect their well being. Tax rates on the middle class in the U.S. are incredibly low. But raising taxes on the rich probably wouldn't generate much revenue and would harm economic growth. So which one makes more sense?

It's not expensive to be healthy, but it does take discipline. Minority guys in prison are in pretty good shape. I wonder if there is data on their health outcomes in and out of prison?

I would definitely eat at nicer places if I won the lottery but I doubt I'd start eating salads.

The biggest problem I see is that we are looking at people who play the lottery. That is a self-selected lot of people who: do not understand probability, have extremely high implicit discount rates in their valuation of the future, have poor impulse control, or many other possible behaviors. Certainly it suggests that just blindly throwing money at health will not improve outcomes much, but I would love to see another control: socio-economically matched lottery players who played the lottery at the same rate as the winners, but never won vs either people who played the lottery less frequently or not at all (but still socio-economically matched).

I could certainly see there being some sort of selection effect where lottery players have personalities and habits that would not be applicable to the general population.

I don't feel like looking for the citation, because it's Saturday, but I seem to recall evidence that a lottery winner is more likely to end up bankrupt than a person of similar SES who didn't win the lottery. So yeah, I'd say that a lottery is probably not the right natural experiment here.

Figure I in the paper shows lottery winners retain about 30% of the lottery wealth 10 years after the lottery. This, and other types of behavior we discuss in the paper appears inconsistent with the view that lottery Winners squander their wealth.

Sure, but then you have to assume that the rich and the poor are in the same socioeconomic class. The in equality mongers claim that simply giving the poor more money will improve their health. If nothing else this study demonstrates that is not true, unless we assume rich and poor alike have equal intelligence and time preference.

Suppose you have two types of poor people. Those who play the lottery (often) and those who do not play the lottery (much). Given that the lottery is an objectively net loss of money, we should expect there to be some selection basis for people being of the type who play the lottery vs those who do not play the lottery.

For instance, suppose only the innumerate poor play the lottery. Perhaps there troubles with math extend to things like weighing the risks of smoking, risky sexual behavior, and delaying health care. Giving money to the innumerate poor may well simply have this poor risk/reward calculations offset a health benefit that might accrue to the numerate poor. E.g. The innumerate poor cannot measure the risks of smoking so giving them money means they can afford to smoke more; the numerate poor, if given the money, might be willing to spend a significant sum on smoking cessation (e.g. check into a detox program) that they otherwise cannot afford.

Forget the rich for the moment. The question is are poor people who play the lottery (often) representative of poor people generally? I would suspect not; they would almost certainly have some different habits, personal traits, or information than people who do not play the lottery. Is this enough to matter? I have absolutely no idea.

I just think it is not a wise idea to base a lot of broad ascertions when there is highly likely to be these other variables in play.

Table IV in the paper compares lottery winners to the general population. The difference with respect to education, income and family status are all quite small. The basic reason is that all three lotteries were very popular in Sweden, with approximately 50% of Swedes participating in one lottery.

"If this were true, then increasing the wealth of a poor person would increase their health." Oh, come on, Alex; it means nothing of the sort.

Two posts before this one TC discussed how badly economics measures culture. The behavior of poor people likely has a strong cultural component.

This seems like a good example of "because we can't measure it, we'll just ignore it."

So now we have "the bottom line" from Alex. QED!

"Those on the top have the most access to power, resources and opportunity – and thus the best health."

Quite a leap there. This seems to be the gist of the inequality argument though. Substitute anything for 'health'.

Generally, leaving aside the truthiness (and of course, it goes without saying leaving aside the actual accuracy), ideologically, it's a strange finding to see posted without interpretative comment for a libertarian economics blog. Withough interpretative comment other than "Inequality doesn't make us sick".

I mean, this is a blog that is positively inclined towards and focused, even, on the great power of positive incentives for people to improve their lives by seeking and using personal wealth. So I'd expect some gloom about a finding that for people (in this case poor people) to individually get wealthier does nothing for their health status.

The libertarian assumption on health is, generally, as I've experienced it, that to maximise population health, individuals should seek to increase their wealth, then as they get wealthier, they'll be able to reinvest their wealth in ways that are salutory to their health.

And this seems to blow that apart. Personal wealth does nothing. It's a very pessimistic finding for the programme of social improvement (global increase in the utility function) by individual wealth accumulation! And that indirectly strengthens the case for communitarian programmes to use pooled wealth to improve health.

Meanwhile, no one here seems to be able to support the assertion that "communitarian programmes to use pooled wealth to improve health" work.

Hah, not my area, so I couldn't say whether public vaccination and sanitation programs, for instance, or forms of public provision of care and drugs, actually work or don't. You're perhaps free to be a skeptic here, that they basically do nothing.

And there are other options. Perhaps medium population health simply improves wholly randomly, and tracks the overall GDP per cap or income of a population without any individual level correlation or any need for public health measures whatsoever.

However, as stated, if the finding's true, it significantly weakens the case that by allowing people to pursue wealth individually, that they can then reinvest their wealth in health and that this is a workable means to improve population health. And it's curious (to me) that Alex does not comment on that.

Who is making that case? The reality is that technology and lifestyle drive health outcomes, only one of which is affected by GDP, and that only by the overall size of the market, not individual wealth.

That's only true if you assume the people who independently pursue wealth in the market are identical to the people who play lottery. For all the hand-wringing by The Usual Suspects on this blog, responsibility, discipline, future orientation, just like hours worked per year, trend upward with income, and are the cause of income not the effect.

I think M spotted the weak link in Careless's worry.

If inoculations are good, can buying them the wrong way make them bad again? Can the virii know the funding?

("It's OK boys, these are communitarian antibodies!")

Are vaccines not provided by the current non-communitarian system?

What current non-communitarian system?

I was actually vaccinated in California public schools. I think they do it differently now, but it is still free for many, perhaps even most.

This reminds me of the observation about the pro-life movement: life begins at conception and ends at birth. Health care, good health care, is a lifetime commitment: it begins at conception and doesn't end at birth but continues on throughout one's lifetime. Decades of inadequate health care can't be magically made up by an abundance of health care later on.

Knew it. You're an ACA supporter.

What an odd comment, Jan. He's been an openly left-wing poster here for years making that obvious over hundreds of walls of text.

Hence the sarcastic comment.

Actually, I'm not an ACA supporter: it combines the worst features of markets and the worst features of government regulation and, surprise, produces a result that satisfies hardly anyone. Could ACA be improved? Yes, but those opposed to ACA prefer a highly inefficient ACA to a more efficient ACA. Is that irrational? I suppose not if one's goal is to prove that government is incompetent and to prove it by being incompetent.

Why is it that your politicians passed an inefficient law given that they required 0 votes by Republicans to pass it?

Mainly because they had only a few months with enough votes to get it done.

Basically no health care is consumed during childhood. What healthcare consumed during your youth has in impact on you in later years?

" What healthcare consumed during your youth has in impact on you in later years?"

I don't understand why there is so much confusion on something that is very simple. Who are the type of people who regularly buy lottery tickets? Personality traits usually don't change once someone reaches the middle of their twenties. Health is something that is generally earned or squandered over years of decision making. Nutrition science hasn't really advanced beyond the observations of Galen and Hippocrates.

What percentage of people even play the lottery? How are they different from the general population?

If Sweden, which by many measures is literally the least unequal society in the world, is not the absolute worst country in which to study this topic, then it has to be close to it.

What percentage of people even play the lottery?

More than half of Americans, last I heard. No idea how much of that is regular ticket purchasing

Why? It has a health-wealth gradient just like everywhere else.

As we (I am one of the co-authors) show in the paper, the health-wealth gradient is approximately the same in Sweden and the US. Regarding the question who plays the lottery: All three lotteries we study were widespread in Sweden, with about 50% of Swedes participating in one of the lotteries. Winners and non-winners look quite similar with respect to pre-win socioeconomic characteristics.

There have been recent research purporting to show that poor people make short-sighted, self-destructive decisions (like eating a lot of junk food) only because being poor gives them short time horizons and poor impulse control. The implication is that if the were made wealthy, they'd start to behave like the wealthy, if the wealthy were made poor, they'd start to show the same lousy decision-making. The behavior of lottery winners is seriously inconsistent with that thesis.

The best thing that cpuld happen to a leftist would be tp do the repairs for apartment turnover. Compare a middle-class apt which needs minor maintainence to your average section 8 apt; stained carpet, holes in the walls, all window coverings destroyed, an oven thst hasn't been cleaned during the tenure of the tenant, encrusted food in the microwave, a stinky refrigerator, railings broken on the stairs. Somehow, despite universally working more hours than section 8 tenants, the middle-class manage to maintain their homes. Maybe that's why they are middle-class and not on section 8?

Much as we progressives don't want to admit it, the best predictor over a large population for health and longevity *and* wealthy is IQ. (See, of course, The Bell Curve).

So give someone money, and it won't solve a fundamental problem if they just don't have the mental power to succeed.

I see an experiment we can run concerning the persistence of habit and a change in income.

The experiment:

Look at eating behavior of people who came off food stamps.

My bet: Habit persists based on diet established during the period of low income.

Ask yourself: while you were in school as a student, with little money, did your menu of food choices change after you got a job.

My wife still makes that lasagna. it took about 5 years before we started adding more meat protein (beef, fish (except fish sticks)) and substituting out chicken and pasta.

I can't say we ate healthier either. Ate out more.

Conduct the study in a country where you pay for your own healthcare. Then it'll mean something.

In a single-payer system there is no way for your wealth level to affect the part of your health level that is determined by the medical care you receive.

I was recently surprised to learn that Madison County, the wealthiest county in Mississippi, has a short life expectancy relative to many other MS counties (71.1 years; income per capita $23,469; 60 % white, 37 % African American). The Other two counties in the tri-county (Jackson) area are Rankin (75.2; $20,412; 81,17) and Hinds (71.7; $17,785; 28.69). Many MS counties have greater longevity than its wealthiest county. Shelby county, TN (Memphis) (72.1; $20,856; 41.52), also does better.

The study shows only the effects of added wealth to individuals, not a shift in social inequality, a complicated matter including education, class association, class culture, identity and social prestige, all induced by wealth inequality but extending far beyond it. Also, the study looks at items like hospitalizations post-lottery, which may not indicate health but choice and time flexibility.
Quoting the study itself, "Sweden has a publicly funded and universal health care system, and an educational system under which schools are prohibited from charging tuition and required to follow a national curriculum." Why would anyone expect that added individual wealth would increase health where the gov't mitigates the inequalities? The question is why there should be any health-wealth gradient in Sweden. IOW, the study shows that social inequality is has far greater impact than mere individual shifts in wealth.

This is fantastic news!

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