IJE Advance Access originally published online on March 21, 2007
International Journal of Epidemiology 2007 36(2):470-471; doi:10.1093/ije/dym015
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Letters to the Editor |
Do all benefit from economic growth?
1 Universal Corporation: Alpha and Beta Division (Australia).
2 Australian Red Cross: Blood Service, Australia.
3 University of South Australia, Australia.
* Corresponding author. Universal Corporation: Alpha and Beta Division (Australia), GPO Box 2233, Adelaide, South Australia, 5001, Australia. E-mail: iajacobs{at}optusnet.com.au
For over 80 years researchers have been perplexed regarding the association between economic cycles and mortality fluctuation.1 During this time, research results have given rise to two main health-economy findings. On the one hand, studies have shown that mortality rates rise during economic downturns and fall during economic upturns (often with long-term lags).2–9 On the other hand, research has also shown that economic expansions are associated with worse health outcomes and recessions synonymous with lower morbidity and mortality rates.10–15
Between these two health-economy findings, there has been an intellectually adversarial relationship that has now spanned around 30 years,2,3,5,6,10–13,16–18 with the most recent exchange taking place in the International Journal of Epidemiology.19–24 In response to Tapia Granados19 short-term pro-cyclical health-economy findings, Brenner20 highlights that economic growth has been the main driver to mortality decline in the 20th century. We importantly do not support Brenner's general assertion that economic growth reduces ‘poverty through the elevation of real incomes’ (p. 1216).20
Whilst, economic growth has the potential to reduce poverty, history records that not all American citizens have necessarily benefited from ‘economic growth reducing poverty by the elevation of real incomes’.20 Yates had identified that for American working class persons, real hourly wages were lower in the 1990s than in 1970s25 and that between 1977 and 1990 the real family income fell for the poorest 60% of all families but increased by a third for the wealthiest 20% of families.26 These figures are more recently supported by Dooley and Prause who reveal that American males in the 25th percentile earned less in real terms in 1997 (a year of supposedly ‘good’ economic times) than their 25th percentile peers did in 1967 (p. 3).27 To further illustrate that employment need not contribute to poverty reduction for all members of society, thereby better health for all, Figure 1 illustrates the annual income of a full-time worker in America, single with two qualifying children, working at minimum wages and receipt of Earned Income Tax Credit (EITC) from 1970 till 2004.28 From this graph it is evident that although working on a full-time basis, such families have not been able to maintain living above the poverty level, even after receiving the EITC. This reinforces findings by others27,29 that not all individuals in societies necessarily benefit from economic development, hence not all are able to benefit from ‘economic status improvement’ as a result of (official) economic growth, consequently such subpopulations would not experience better health (lower morbidity and mortality rates) as implied by Brenner (p. 1215).20
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Given that not all members of society necessarily benefit from economic growth, it is not surprising that there is widening in life expectancy between socioeconomic groups in US,30,31 which reconciles the vast literature on socioeconomic status23,32,33 and supports Wilkinson's34 observation that ‘among the rich developed countries, health is indeed related to relative rather than absolute income, and that, as a consequence, health may not be strongly related to economic growth’ (p. 257). As a result of such environmental factors operating in most western countries, and given that inadequately employed workers may reflect similar health outcomes as the unemployed,35 future health-economy research should consider utilizing more comprehensive labour market measures.
Notes: Real Dollars (2004). Potential credits other than the Earned Income Tax Credit (EITC) are not shown, nor are liabilities such as payroll taxes. The official poverty definition uses cash income before taxes (and the EITC) and does not include capital gains or non-cash benefits.
Sources: House Committee on Ways and Means; Census Bureau; Department of Labor.
Conflict of interest: None declared.
References
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