Comments on “Inequality in Health at Birth: Why is it Falling in the U.S.?” by Janet Currie Markus Jäntti1 1 Swedish Institute for Social Research, Stockholm University June 12, 2014 What we now know I summary of very large body of research What we now know I summary of very large body of research I Janet Currie has hugely furthered our understanding of both what affects infant health / low birth weight and how infant health / low birthweight affects future outcomes What we now know I summary of very large body of research I Janet Currie has hugely furthered our understanding of both what affects infant health / low birth weight and how infant health / low birthweight affects future outcomes I health at birth linked to parental socio-economic status – also causally What we now know I summary of very large body of research I Janet Currie has hugely furthered our understanding of both what affects infant health / low birth weight and how infant health / low birthweight affects future outcomes I health at birth linked to parental socio-economic status – also causally I living environments matter quite a bit What we now know I summary of very large body of research I Janet Currie has hugely furthered our understanding of both what affects infant health / low birth weight and how infant health / low birthweight affects future outcomes I health at birth linked to parental socio-economic status – also causally I living environments matter quite a bit I inequality of economic status increased across past few decades [which is not, in fact, very clearly documented; there may be better sources than the CIA World Factbook; (Aizer and Currie, 2014)] What we now know I summary of very large body of research I Janet Currie has hugely furthered our understanding of both what affects infant health / low birth weight and how infant health / low birthweight affects future outcomes I health at birth linked to parental socio-economic status – also causally I living environments matter quite a bit I inequality of economic status increased across past few decades [which is not, in fact, very clearly documented; there may be better sources than the CIA World Factbook; (Aizer and Currie, 2014)] I but inequality of health at birth has declined What we now know I summary of very large body of research I Janet Currie has hugely furthered our understanding of both what affects infant health / low birth weight and how infant health / low birthweight affects future outcomes I health at birth linked to parental socio-economic status – also causally I living environments matter quite a bit I inequality of economic status increased across past few decades [which is not, in fact, very clearly documented; there may be better sources than the CIA World Factbook; (Aizer and Currie, 2014)] I but inequality of health at birth has declined I public policy most likely accounts for (part of) the improvements Why should we care? I from what perspective is health at birth a matter of public concern? Why should we care? I from what perspective is health at birth a matter of public concern? I from what perspective is the inequality of health at birth a matter of public concern? The ethical background I egalitarian theory: the equality of opportunity (Roemer, 1998) The ethical background I egalitarian theory: the equality of opportunity (Roemer, 1998) I different rights – privacy, meritocracy, equality of opportunity – can and do conflict (Fishkin, 1983) The ethical background I egalitarian theory: the equality of opportunity (Roemer, 1998) I different rights – privacy, meritocracy, equality of opportunity – can and do conflict (Fishkin, 1983) I associations vs. causation – causation matters but so do associations from the ethical perspective The ethical background I egalitarian theory: the equality of opportunity (Roemer, 1998) I different rights – privacy, meritocracy, equality of opportunity – can and do conflict (Fishkin, 1983) I associations vs. causation – causation matters but so do associations from the ethical perspective I it is useful (but not necessary) to have causal evidence for policy The ethical background I egalitarian theory: the equality of opportunity (Roemer, 1998) I different rights – privacy, meritocracy, equality of opportunity – can and do conflict (Fishkin, 1983) I associations vs. causation – causation matters but so do associations from the ethical perspective I it is useful (but not necessary) to have causal evidence for policy I but the fact of the association constitutes an unjust inequality for the children affected regardless of the cause The Great Gatsby curve The association of intergenerational earnings persistence and cross-sectional income inequality; Source: Corak (2013, Figure 1) Is the US different? (Ermisch, Jäntti, and Smeeding, 2012) −0.2 Cognitive US 0.2 ● UK Physical ● ● ● Italy 0.4 ● ● Sweden Country 0.0 Economic ● ● ● ● ● Germany ● France ● ● ● Finland ● Denmark ● Canada ● ● ● Australia ● ● −0.2 0.0 0.2 ● 0.4 −0.2 0.0 Predicted correlation + 95% confidence interval 0.2 0.4 High vs. low inequality country (Björklund, Jäntti, and Nybom, 2012) A. Mean (and standard deviation) Birthweight Men Sweden UK 3.56 3.38 Women Sweden UK 3.42 3.27 (0.54) (0.54) (0.52) (0.50) Low birthweight 0.03 0.05 0.04 0.06 (0.17) (0.23) (0.19) (0.23) B. Parental income gradient BW Low BW Men UK 0.081 F-test 9.7 F-test 15.8 (0.000) β (0.006) (0.019) (0.002) (0.006) (0.019) ρ 0.018 0.076 10.6 0.024 0.110 18.8 (0.005) (0.018) (0.001) (0.005) (0.019) (0.000) −0.008 −0.016 1.0 −0.010 −0.034 10.4 (0.002) (0.008) (0.325) (0.002) (0.009) (0.001) −0.023 −0.035 0.2 −0.024 −0.074 6.7 (0.005) (0.018) (0.622) (0.005) (0.019) (0.009) β ρ Sweden 0.027 Women UK 0.109 Sweden 0.021 Birth weight vs. low birth weight Birth weight vs. low birth weight Income and life expectancy in Finland Questions I low birth weight gradient has diminished, but what are the key dimensions (in this context) along which economic inequality has increased? Questions I low birth weight gradient has diminished, but what are the key dimensions (in this context) along which economic inequality has increased? I what are the omitted factors that twin/sibling FE control for? Are they important for understanding overall inequality in child outcomes? Can they be affected? Questions I low birth weight gradient has diminished, but what are the key dimensions (in this context) along which economic inequality has increased? I what are the omitted factors that twin/sibling FE control for? Are they important for understanding overall inequality in child outcomes? Can they be affected? I role of selection on unobservables? (Both among “advantaged” and “disadvantaged” groups? After all, a key component in why FE resorted to to begin with?) Questions I low birth weight gradient has diminished, but what are the key dimensions (in this context) along which economic inequality has increased? I what are the omitted factors that twin/sibling FE control for? Are they important for understanding overall inequality in child outcomes? Can they be affected? I role of selection on unobservables? (Both among “advantaged” and “disadvantaged” groups? After all, a key component in why FE resorted to to begin with?) I do the effects need to be causal to be of concern? Questions I low birth weight gradient has diminished, but what are the key dimensions (in this context) along which economic inequality has increased? I what are the omitted factors that twin/sibling FE control for? Are they important for understanding overall inequality in child outcomes? Can they be affected? I role of selection on unobservables? (Both among “advantaged” and “disadvantaged” groups? After all, a key component in why FE resorted to to begin with?) I do the effects need to be causal to be of concern? I non-linearities: low birth weight discontinuity? Questions I low birth weight gradient has diminished, but what are the key dimensions (in this context) along which economic inequality has increased? I what are the omitted factors that twin/sibling FE control for? Are they important for understanding overall inequality in child outcomes? Can they be affected? I role of selection on unobservables? (Both among “advantaged” and “disadvantaged” groups? After all, a key component in why FE resorted to to begin with?) I do the effects need to be causal to be of concern? I non-linearities: low birth weight discontinuity? I the exact comparisons matter: probability of post neotatal mortality in California, Pr(D|B) : .095 → .06; Pr(D|W ) : .06 → .03 but log odds ratio .62 → .79 (slide 31; but in south, log odds ratio fell from 1.6 to .096) Aizer, Anna and Janet Currie (2014). “The intergenerational transmission of inequality: Maternal disadvantage and health at birth”. In: Science 344.6186, pp. 856–861. DOI: 10.1126/science.1251872. eprint: http://www. sciencemag.org/content/344/6186/856.full.pdf. URL: http://www.sciencemag.org/content/344/ 6186/856.abstract. Björklund, Anders, Markus Jäntti, and Martin Nybom (2012). “Parental education gradients over the life cycle”. In: From Parents to Children: The Intergenerational Transmission of Advantage. Ed. by John Ermisch, Markus Jäntti, and Timothy Smeeding. New York: Russell Sage Foundation. Chap. 17, pp. 422–440. Corak, Miles (2013). “Income Inequality, Equality of Opportunity, and Intergenerational Mobility”. In: Journal of Economic Perspectives 27.3, pp. 79–102. Ermisch, John, Markus Jäntti, and Timothy Smeeding (2012). “Socioeconomic Gradients in Children’s Outcomes”. In: From Parents to Children: The Intergenerational Transmission of Advantage. Ed. by John Ermisch, Markus Jäntti, and Timothy Smeeding. New York: Russell Sage Foundation. Chap. 2, pp. 32–52. Fishkin, James S (1983). Justice, equal opportunity, and the family. New Haven [Conn.]: Yale University Press. Roemer, John E (1998). Equality of Opportunity. New York: Harvard University Press.