The graph at right made the twitter rounds a few days ago (1.3k RTs and 2.7k likes for Noah). The graph looked off to me immediately. Between approximately 1992 and 1994 the number of administrators went up by a factor of 4? (Or, if something goes from a 500% growth since 1970 to a 2000% growth rate since 1970, is that a factor of 3? Confusing! Anyway, a big jump.) Big jumps are often a sign that definitions, not reality, have changed. Indeed, what is an administrator?
There’s another problem with this type of graph which shows not absolute numbers but percent growth since 1970. Everything in this graph depends on getting one number, the number of administrators in 1970, exactly correct! But the first number is the one that is the farthest in the past, often the hardest to find and the most suspect. But if that first number is underestimated then every other number in the chart is overestimated.
People send me this kind of thing all the time. “See,” they say, “Why are the Prices So D*mn High is wrong! It isn’t Baumol!”–and I am always reluctant to follow-up because tracking down the underlying data, figuring out what it means, if there are mistakes etc. is a huge time sink. It was the excellent Conversable Economist who go the ball rolling on the latest iteration of this graph, however, and he cites the graph to noted health economist Uwe Reinhardt’s last book, Priced Out so I thought it could be worthwhile to go deeper.
Unfortunately, Reinhardt simply calls this a “famous graph” and it’s clear that he just found it on the internet like everyone else! Oh dear. Following up further, I did find the original Woolhandler-Himmelstein analysis written in 1991 and taking the data up to 1987. WH cite the Statistical Abstract of the United States (Table 64-2, 109th edition). You can find the SA 109th edition here but it doesn’t have the data. At least, I couldn’t find it. Ok, several hours wasted.
Finally, however, I did find a number for health administrators in an earlier edition of the SA. In the 1980 edition in Table 165, Employed Persons in Selected Health Occupations, there is a number for “Health administrators,” which says 118 thousand in 1972. Aha! Now things are beginning to make sense because from that same table there were at least 3.5 million workers (physicians, nurses, technicians and others) in health occupations and 118 thousand administrators is clearly far too low. Indeed, in a later paper Woolhandler, Campbell and Himmelstein estimate that in 1969, 18.2% of health care workers were in administration which would imply a figure of 639 thousand health administrators circa 1970, a much more plausible number.
The Woolhandler, Campbell and Himmelstein piece also finds that between 1989 and 1994 the share of health care administrators as a percent of the health care workforce increased from 25.5% to….wait for it….25.7%. In other words, no big jump and inconsistent with the huge jump seen in the graph.
It was at this point that I found Kevin Drum’s excellent analysis. Drum was also suspicious of the graph and after a lot of work he concludes that the graph exaggerates by at least a factor of 3 and probably more. Drum estimates an increase in administrators of 831%; using my initial number and Drum’s end number, I estimate an increase of 682%. All numbers to be taken with a grain of salt. Is that a big increase? Compared to what? Drum gives his best takeaway of the data as this graph, administration costs as a percent of health care costs :
I agree with Drum–this way of presenting the data looks plausible, sensible and much less sensationalist than the original graph. Note that there has been an increase in administrative costs. Why? Here’s Drum’s bottom line:
Bottom line: the health care system has grown tremendously over the past 50 years, but that’s mostly not because we have a lot more doctors. It’s because we have MRI techs and ultrasound specialists and more kinds of nurses and more kinds of pills and enormous proton beams to cure cancer. (Those proton beams are massively expensive and require large staffs, but that doesn’t mean you need any more oncologists per patient.) To manage all this new stuff, we need bigger admin and support staffs. As a result, admin and support have grown about 50-100 percent on a relative basis. That’s the real number.
I believe the original graph uses a number for administrators that is too low in 1970 and includes what I suspect was a change in definitions around 1992 (project the 1970 to 1990 line forward or the 1994 to 2009 line backward and you will get a more accurate graph.) More generally, the graph is misleading because it suggests that “administrators” are to blame for high health care costs and if only we could focus on the “real producers” of medicine, the physicians, costs would be much lower. Blaming administrators for high prices is a lot like blaming “the middlemen.” It’s easy to say and easy to tweet but blaming the middlemen reflects a naive perspective on how goods and services are actually produced in a modern economy.
Administrative costs in the United States are high compared to other countries like Canada. (Helland and I discuss this in Why are the Prices So D*mn High.) We might even be able to lower administrative costs by moving to a single-payer, universal system. But there is no free lunch and there is no returning to an administrative free Eden.
We are now well into another housing boom but as shown by Aasteveit, Albuquerque and Anundsen this boom is in some ways worse than the previous 1996-2006 boom because the supply response has been lower. The first figure, for example, shows that since the trough in 2012 house prices have risen a little bit faster in this boom than in the 1996-2006 boom and they have risen much faster relative to income (HPI is housing price index).
Over the same time, however, the number of new building permits and housing starts has been lower than in the previous boom (top two panels of figure 2 below). If prices have gone up as much as before but quantity has not, it follows that the elasticity of housing supply has fallen. Occasionally it’s suggested that there is an “overhang” of housing from the previous boom but that is not true. If anything, as shown in the bottom left panel, there is a decline in the housing stock relative to population.
The authors suggest that one reason why the elasticity of housing supply has fallen is that developers are fearful of being hit in another bust. I find that implausible. Developers don’t hold onto their stock for very long and often sell even before completion so they worry at most about a year or so forward. A better explanation is that housing supply remains especially constrained in the coastal cities by regulation and limited land capacity and those constraints are becoming more binding over time–in other words, the previous boom filled the infill. It may also be the case that fear of the bust is increasing regulation as people worry even more about downward fluctuations in the price of their primary asset.
Either way, housing continues to eat the world.
In an insightful paper with human interest but also public policy implications Jasmin Barman-Aksözen writes:
My parents and I searched throughout my entire childhood for an explanation of why I frequently had unbearable burning pain after spending even short periods of time outdoors on a sunny day. This pain was incapacitating and often left me in agony for days, during which I was unable to go to school, to sleep, to tolerate even weak light exposure, or the body heat of my parents as they tried to comfort me. Not a single pain killer provided any relief, and the only option for me was to wait alone in a darkened and cooled room until the pain sub-sided. Of course, we tried everything that physicians recommended; still, not even high sun protection factor sunscreens helped prevent the symptoms despite the fact that they were obviously caused by sunlight. It must have been hard for my parents to see me in such a painful state without being able to alleviate or prevent it. What’s more, the worst thing was that classmates, teachers, and even physicians did not believe me when I told them about the symptoms; I even brought photographs showing myself with swollen and burnt hands and face. Yet, this didn’t stop some from making fun of me when I wore long clothing, hats, or used an umbrella on sunny days to protect myself from the sun’s rays. Eventually, after I was sent to see a psychologist for my “made-up symptoms,” I could no longer tolerate the derision and being treated with such condescension, and decided to stop sharing my experiences with healthcare professionals altogether.
Finally, a full 26 years after the first symptoms, Dr Google provided the answer! In April 2006, I found myself yet again unable to sleep because, despite all precautionary measures taken, I had burnt myself in the strong sunlight of spring. I entered the combination of my symptoms in the Google search mask and, surprisingly, there was a new link in Wikipedia with an expression I had not encountered before “Erythropoietic Protoporphyria.”
The made-for-tv aspect continues as Barman-Aksözen earns a PhD, moves to Switzerland to join the world’s leading lab studying these issues and, yes, develops the first effective treatment!
Afamelanotide was approved for the treatment of adult EPP patients in the European Union (EU) at the end of 2014.
But now is where reality and public policy step back in.
In April 2019, most EPP patients in Europe, however, still do not have access to the only treatment for their condition and are still unnecessarily suffering from fre-quent excruciating pain, social isolation, and impaired life choices. What went wrong? Before a newly approved medicine reaches patients, most European countries per-form a Health Technology Assessment (HTA) to evaluate the benefits in relation to the costs of the new product in order to support decisions on whether it should be reimbursed by the respective national health systems.
Getting the drug approved is only the first step. Now they have to get the medical authorities to pay for it and that means they have to show the drug is not only effective but cost effective given the disability. Barman-Aksözen goes on to describe her efforts to get the drug approved for actual use. She doesn’t put it this way but essentially she has to solve the collective action problem and form a lobbying group to make the case that patients with her disease, EPP, face a serious disability. It’s easy to measure death, however, but hard to measure the “disability weight” on say blindness. The WHO says blindness has a disability weight of .195 today, but in 2004 they gave it a weight of 0.594. Hmmm. One study of Afamelanotide suggests it has a cost of £373,000 per DALY averted, which is high, even though the article recommends adoption. Many meetings ensue in which the case for and against Afamelanotide is made. The process is slow. Years go by. Much depends on seemingly minor choices in how to present the data.
I was reminded of Mancur Olson’s discussion in the Rise and Decline of Nations:
Distributional coalitions make decisions more slowly than the individuals and firms which they comprise [and] tend to have crowded agendas and bargaining tables…The accumulation of distributional coalitions increases the complexity of regulation, the role of government, and the complexity of understandings, and changes the direction of social evolution.
In other words, socializing health care means socializing decisions about how to allocate health care. A difficult tradeoff.
Addendum: The FDA has yet to approve Afamelanotide.
Hat tip: Joe P.
In a story beloved by economists it’s said that Milton Friedman was once visiting China when he was shocked to see that, instead of modern tractors and earth movers, thousands of workers were toiling away building a canal with shovels. He asked his host, a government bureaucrat, why more machines weren’t being used. The bureaucrat replied, “You don’t understand. This is a jobs program.” To which Milton responded, “Oh, I thought you were trying to build a canal. If it’s jobs you want, you should give these workers spoons, not shovels!”
A funny story but one I was reminded of by Greta van Susteren’s not so funny tweet.
Bear in mind that Van Susteren has 1.2 million followers and, according to Forbes, is the 94th most powerful woman in the world.
Of course, there is something odd about using advanced technology to do a job that could be done by millions of immigrants who would be quite happy for the work, but Van Susteren is also against immigration.
Is there anything to be said for banning automation in low-skilled work? Let’s be charitable and assume that there is a problem with not enough work for low-skill workers. It’s unlikely that the best way to address this problem is by banning improvements in productivity. Which sectors are to be artificially restrained and by how much? Should fast checkout workers be banned? Should we prevent customers from walking the aisles and filling their own shopping carts? Remember, self-selection of goods was also once an innovation. As Friedman pointed out, it’s all too easy to reduce productivity.
To the extent that low-skill workers can’t find work (i.e. ZMP workers) the appropriate policy is a wage subsidy as Nobelist Edmund Phelps has suggested (see also the MRU video and Oren Cass on wage subsidies). A wage subsidy is better targeted than the Luddite smashing of machines and because it doesn’t prevent productivity from growing it makes for greater wealth to support the subsidy.
Well north of Iceland there is a island archipelago that is governed by Norway but because of a peculiar treaty it has entirely open borders:
When you land in Longyearbyen, the largest settlement in the Norwegian archipelago of Svalbard, you can step off the plane and just walk away. There’s no passport control, no armed guard retracing your steps, no biometric machine scanning your fingers. Svalbard is as close as you can get to a place with open borders: As long as you can support yourself, you can live there visa-free.
In an excellent piece in The Nation, Atossa Araxia Abrahamian describes the history and what it is like to visit:
Formally, Svalbard—known as Spitsbergen until the 20th century—belongs to Norway, which writes the laws, enforces order, builds infrastructure, and regulates hunting, fishing, and housing. Last year, when a Russian man was caught trying to rob a bank in town, a Norwegian judge sentenced him under Norwegian law to a Norwegian jail. But Norway’s control over Svalbard comes with obligations outlined by an unusual 1920 treaty signed as part of the Versailles negotiations ending World War I.
Written in the aftermath of the war, the Svalbard Treaty is both of and ahead of its time. Its architects stipulated that the territory cannot be used for “warlike” purposes. They included one of the world’s first international conservation agreements, making Norway responsible for the preservation of the surrounding natural environment. The treaty also insists that the state must not tax its citizens more than the minimum needed to keep Svalbard running, which today typically amounts to an 8 percent income tax, well below mainland Norway’s roughly 40 percent.
Most radically, the treaty’s architects held Norway to what’s known as the nondiscrimination principle, which prevents the state from treating non-Norwegians differently from Norwegians. This applies not just to immigration but also to opening businesses, hunting, fishing, and other commercial activities. Other countries could not lay formal claims on Svalbard, but their people and companies would be at no disadvantage.
Some 37 percent of Svalbard’s population is foreign born and there is an abandoned Soviet town with statues of Vladmir Lenin. Tyler will also be pleased to know that there are puffins.
I can’t say that I am tempted to move, but given global climate change it’s good to know that I could.
Hat tip: The Browser.
The German government could today borrow billions of Euro and in a decade they could give back to investors less than they borrowed and the investors would be happy. Does the German government have no net positive investments to make?
The global savings glut which drives asset prices higher and makes them more volatile is very much still with us. Around the world there is now over 15 trillion in negative interest debt.
Anthony Kronman, former Dean of the Yale Law school, writes in the WSJ:
The politically motivated and group-based form of diversity that dominates campus life today discourages students from breaking away, in thought or action, from the groups to which they belong. It invites them to think of themselves as representatives first and free agents second. And it makes heroes of those who put their individual interests aside for the sake of a larger cause. That is admirable in politics. It is antithetical to one of the signal goods of higher education.
…Grievance is the stuff of political life…Academic disagreements are different. Important ones are often inflamed by passion too. But the goal of those involved is to persuade their adversaries with better facts and arguments—not to bludgeon them into submission with complaints of abuse, injustice and disrespect to increase their share of power. Today, the spirit of grievance has been imported into the academy, where it undermines the common search for truth by permeating it with a sense of hurt and wrong on the part of minority students, and guilt on the part of those who are blamed for their suffering.
…For college students, the search for truth is important not because reaching it is guaranteed—there are no such guarantees—but as a discipline of character. It instills habits of self-criticism, modesty and objectivity. It strengthens their ability to subject their own opinions and feelings to higher and more durable measures of worth. It increases their self-reliance and their respect for the values and ideas of those far removed in time and circumstance. In all these ways, the search for truth promotes the habit of independent-mindedness that is a vital antidote to what Tocqueville called the “tyranny of majority opinion.”
…Tocqueville was an enthusiastic admirer of America’s democracy. He thought it the most just system of government the world had ever known. But he was also sensitive to its pathologies. Among these he identified the instinct to believe what others do in order to avoid the labor and risk of thinking for oneself. He worried that such conformism would itself become a breeding ground for despots.
As a partial antidote, Tocqueville stressed the importance of preserving, within the larger democratic order, islands of culture devoted to the undemocratic values of excellence and truth. These could be, he thought, enclaves for protecting the independence of mind that a democracy like ours especially needs.
Today our colleges and universities are doing a poor job of meeting this need, and the idea of diversity is at least partly to blame. It has become the basis of an illiberal and antirational academic cult—one that undermines the spirit of self-reliance and the commitment to truth on which not only higher education, but the whole of our democracy, depends.
Erik Torenberg, co-founder of the VC firm Village Global, interviews me in a wide-ranging podcast. Here is one bit from a series of questions on what do you disagree about with ____. In this case, Paul Krugman.
AT: …Krugman and I are almost in perfect agreement. Only marginally different. Paul says ‘Republicans are corrupt, incompetent, unprincipled and dangerous to a civil society’. I agree with that entirely. I would only change one word. I would change the word Republicans to the word politicians. If Paul could only be convinced of doing that, coming over to the libertarian side, we would be in complete agreement. But he is much more partisan than I am and even though I worry about Republicans more than Democrats at this particular point in time I think the larger incentive is that we all need to be worried about politicians rather than any one particular party.
Although I agree with Paul a lot of the time, sometimes he does just drive me absolutely batty. He just says things which I think are so wrong. In his latest column which to be fair was written as a column fifty years in the future so maybe it was a bit tongue in cheek. The column was pretending that Elon Musk and Peter Thiel were a hundred years of age and fit and fiddle and still major players in society. And Krugman wrote:
Life extension for a privileged few is by its nature a socially destructive technology and the time has come to ban it.
Now to me this is just evil. This is like something out of Ayn Rand’s Anthem, that it is evil to live longer than your brothers and all must be sentenced to death so that none live more than their allotted time. I think it is evil if we accept even the premise of his argument that these technologies are very expensive. Even on that ground it’s evil to kill people just so that they don’t live longer than average. But perhaps even a bigger point is that I think these technologies of life extension are some of the most important things that people are working on today. And the billionaires are doing an incredible service to humanity by investing in these radical ideas and pushing the frontier and that is going to have spillover effects on everyone. If we are to reach the singularity it will because the billionaires are getting us there earlier and faster and they are the ones pushing us to the singularity and everyone will benefit from these life extension technologies.
So I agree with Paul quite a bit, more than you might expect, but sometimes he just says things which are absolutely evil.
We cover open borders, whether capitalism and democracy are compatible, the Baumol effect and more. Listen to the whole thing.
Joshua Benton at the LA Times illustrates average is over for newspapers. On the left the print circulation of major newspapers in 2002. The NYTimes is the leader but other newspapers follow closely behind in a slowly decaying curve likely related to city size. On the right, 2019 digital subscriptions. The NYTimes dominates. Only the Washington Post is even in the same league (The Wall Street Journal, however, should also have made Benton’s list at 1.5 million digital subscribers.) Without classified ads and other local information, for which there are now multiple online substitutes, there isn’t a big demand for local newspapers. News is now national and only a handful of newspapers can survive at national scale. Moreover, the few who can survive at national scale are now so much better than their competitors precisely because they can afford to be better.
The latest outrage cycle was started by April Glaser in Slate who is outraged that some online delivery companies apply tips to a worker’s base pay:
My first DoorDash order is probably my last because, as journalist Louise Matsakis put it on Twitter, “I don’t believe that a single person intends to give a tip to a multibillion dollar venture-backed startup. They are trying to tip the person who delivered their order.”
You will probably not be surprised, however, that Slate is also outraged at tipping.
Tipping is a repugnant custom. It’s bad for consumers and terrible for workers. It perpetuates racism.
But one way for a firm to get rid of tipping is to guarantee a payment per delivery. Many delivery workers may prefer such a system because tips are often perfunctory and therefore from the point of view of the worker random or they vary based on factors over which the delivery person has little control (e.g. worker race but also the customer’s online experience and whether other workers got the pizza into the oven on time). In other words, the no-tip system reduces the variance of pay. Moreover, it won’t reduce pay on average. Delivery workers will earn what similarly skilled workers earn elsewhere in the economy whether they get to keep “their” tips or not. The outrage over who gets the tip is similar to complaining about who pays the tax, the supplier or the demander.
There are exceptions. In some industries, such as bartending, the quality of the service can vary dramatically by worker and tips help to reward that extra quality when it is difficult to observe by the firm. In these industries, however, both the workers, at least the high quality workers, and the firms want tips. If the firms themselves are removing tips that is a sign that they think that the worker has little control over quality and thus tips serve no purpose other than to more or less randomly reward workers. Since random pay is less valuable than certain pay and firms are less risk averse than workers it makes sense for the firm to take on the risk of tips and instead pay a higher base (again, with the net being in line with what similar workers earn elsewhere).
In short, a job is a package of work characteristics and benefits and it’s better to let firms and workers choose those characteristics and benefits to reach efficient solutions than it is to try to move one characteristic on the incorrect assumption that all other characteristics will then remain the same, to do so is the happy meal fallacy in another guise.
The young will experience the effects of policies passed today for the greatest length of time but this is not reflected in their voting power. Put differently, the time-horizon of (self-interested) older voters is short so perhaps this biases the political system towards short time-horizon policies such as deficit spending or kicking the can down the road on global warming. Philosopher William MacAskill offers an alternative, age-weighted voting.
…one way of extending political time horizons and increasing is to age-weight votes. The idea is that younger people would get more heavily weighted votes than older people, very roughly in proportion with life expectancy. A natural first pass system (though I think it could be improved upon) would be:
- 18–27yr olds: 6x voting weight
- 28–37yr olds: 5x voting weight
- 38–47yr olds: 4x voting weight
- 48–57yr olds: 3x voting weight
- 58–67yr olds: 2x voting weight
- 68+yr olds: 1x voting weight
Note that, even with such heavy weights as these, the (effective) median voter age (in the US) would go from 55 to 40. (H/T Zach Groff for these numbers). Assuming that the median voter theorem approximately captures political dynamics of voting, weighting by (approximate) life-expectancy would therefore lengthen political horizons somewhat, but wouldn’t result in young people having all the power.
… In this scenario, all citizens get equal voting weight, it’s just that this voting power is unequally distributed throughout someone’s life.
MacAskill asks the right questions:
- Do younger people actually have more future-oriented views?
- Does extending political horizons by 20 years provide benefits from the perspective of much longer timescales?
- Are younger people less well-informed, and so apt to make worse decisions?
- Is this just a way of pushing particular (left-wing) political views?
- What would actually happen if this were put in place, and how good or bad would those effects be?
- What’s the best mechanism for implementing age-weighting voting?
- What would be the best plan for making age-weighting voting happen in the real world?
See the whole thing for some brief suggestions on answers.
I don’t have a major objection to the proposal, I just don’t think it would improve politics very much. Rational ignorance means that voters don’t know much and rational irrationality means that they don’t care to know more. The problem is collective decision making per se rather than the time-horizon of the non-existent median voter. Still the space of possible governance designs is far larger than the space that we have investigated, let alone used, so I applaud exploration in the design space.
In recent years I have substantially increased my estimate of the deadly nature of air pollution. It’s not that I had a contrary opinion earlier but the number and range of studies showing surprisingly large effects has raised this issue in relative importance in my mind. I would not have guessed, for example, that the introduction of EZ Pass could reduce pollution near toll booths enough to reduce the number of premature and low birth weight babies. I also find the following result hard to believe yet also hard to dismiss given the the accumulating body of evidence. Diane Alexander and Hannes Schwandt find that Volkswagen’s cheating diesel cars increased the number of low birth weight babies and asthma rates. Here are some details:
In 2008, a new generation of supposedly clean diesel passenger cars was introduced to the U.S. market.These new diesel cars were marketed to environmentally conscious consumers, with advertising emphasizing the power and mileage typical for diesel engines in combination with unprecedented low emissions levels. Clean diesel cars won the Green Car of the Year Award in 2009 and 2010 and quickly gained market share. By 2015, over 600,000 cars with clean diesel technology were sold in the United States. In the fall of 2015, however, it was discovered that these cars covertly activated equipment during emissions tests that reduced emissions below official thresholds, and then reversed course after testing. In street use, a single “clean diesel” car could pollute as much nitrogen oxide as 150 equivalent gasoline cars.Hereafter, we refer to cars with “clean diesel” technology as cheating diesel cars.
We exploit the dispersion of these cheating diesel cars across the United States as a natural experiment to measure the effect of car pollution on infant and child health. This natural experiment provides several unique features. First, it is typically difficult to infer causal effects from observed correlations of health and car pollution, as wealthier individuals tend to sort into less-polluted areas and drive newer, less-polluting cars. The fast roll-out of cheating diesel cars provides us with plausibly exogenous variation in car pollution exposure across the entire socio-economic spectrum of the United States. Second, it is well established that people avoid known pollution, which can mute estimated impacts of air pollution on health (Neidell, 2009). Moderate pollution increases stemming from cheating diesel cars, a source unknown to the population, are less likely to induce avoidance behaviors, allowing us to cleanly estimate the full impact of pollution. Third, air pollution comes from a multitude of sources, making it difficult to identify contributions from cars, and it is measured coarsely with pollution monitors stationed only in a minority of U.S. counties. This implies low statistical power and potential attenuation bias for correlational studies of pollution (Lleras-Muney, 2010). We use the universe of car registrations to track how cheating diesel cars spread across the country and link these data to detailed information on each birth conceived between 2007 and 2015. This setting provides rich and spatially detailed variation in car pollution.
We find that counties with increasing shares of cheating diesel cars experienced large increases both in air pollution and in the share of infants born with poor birth outcomes. We show that for each additional cheating diesel car per 1,000 cars—approximately equivalent to a 10 percent cheating-induced increase in car exhaust—there is a 2.0 percent increase in air quality indices for fine particulate matter (PM2:5) and a 1.9 percent increase in the rate of low birth weight. We find similar effects on larger particulates (PM10; 2.2 percent) and ozone (1.3 percent), as well as reductions in average birth weight (-6.2 grams) and gestation length (-0.016 weeks). Effects are observed across the entire socio-economic spectrum, and are particularly pronounced among advantaged groups, such as non-Hispanic white mothers with a college degree. Effects on pollution and health outcomes are approximately linear and not affected by baseline pollution levels. Overall, we estimate that the 607,781 cheating diesel cars sold from 2008 to 2015 led to an additional 38,611 infants born with low birth weight. Finally, we also find an 8.0 percent increase in asthma emergency department (ED) visits among young children for each additional cheating diesel car per 1,000 cars in a subsample of five states.
Another surprising result is that on a global scale air pollution reduces life expectancy more than smoking. In part, because a single individual can’t quit air pollution.
Globally, the AQLI reveals that particulate pollution reduces average life expectancy by 1.8 years, making it the greatest global threat to human health. By comparison, first-hand cigarette smoke leads to a reduction in global average life expectancy of about 1.6 years. Other risks to human health have even smaller effects: alcohol and drugs reduce life expectancy by 11 months; unsafe water and sanitation take off 7 months; and HIV/AIDS, 4 months. Conflict and terrorism take off 22 days. So, the impact of particulate pollution on life expectancy is comparable to that of smoking, twice that of alcohol and drug use, three times that of unsafe water, five times that of HIV/AIDS, and more than 25 times that of conflict and terrorism.
Is it too hot to walk around the block? Sure, blame global warming, but in many parts of the country there is also a noticeable absence of shade. Why? As Nolan Gray, a city planner in New York, argues one reason is that shade has been zoned out.
…vernacular architecture in the U.S. was often designed around natural climate control. In the humid Southeast, large windows and central corridors encouraged airflow. In the arid Southwest, thick facades and small windows kept cool air inside. In both cases, most houses were packed tightly together to cast shadows over streets, with awnings, balconies, and roof overhangs used to protect indoor spaces from direct sunlight.
These design elements survive and thrive in cities built before air conditioning, like New Orleans, but are conspicuously absent from most modern Sun Belt metros. With houses sitting squat and far back from the street, and most commercial spaces sitting behind a veritable desert of parking, shade in cities like Phoenix and Atlanta is few and far between.
…The irony here is that the cities that most need shade are the least likely to have it…Older, urban cities with mild summers—think Boston—have shade in spades, while our newer Sun Belt cities —think Las Vegas—have virtually no shade at all, resulting in an unhealthy dependence on air conditioning.
Why did this happen? A big reason is the way we started planning cities in the twentieth century. Beginning in the 1910s, planners declared a war on shade as a means of responding to slum conditions and high-rises. As described by researcher Sonia Hirt, early land-use planners were inspired by the vision of the detached single-family house on a large lot—a development pattern that’s fine for cloudy Massachusetts, but spells trouble for sunny Florida. Assuming no shade as the ideal, the framers of modern zoning set out to design a system of regulations that make many naturally cooling design elements practically illegal.
…In most suburbs, for example, houses are legally prevented from sitting close to the lot line by setbacks, which prevent any shade from being cast on sidewalks or neighboring homes.
Strict rules surrounding building heights and density cap most suburban buildings at a standard height of 35 feet, well below what could potentially cast a cooling shadow. And shadows from high-rises are treated as an unambiguous evil in planning hearings, even in otherwise dense urban environments like San Francisco.
The criminalization of shade goes beyond land-use regulations; it extends to the way we design public spaces. Despite more and more cities encouraging street trees as a valuable source of shade, many state transportation offices continue to ban them, privileging ease of maintenance over outdoor comfort.
Trees in particular would not only create more shade but also reduce air pollution.