inequality

No, the Coronavirus is not an “Equalizer”

Published by Anonymous (not verified) on Wed, 08/04/2020 - 2:40am in

Experts say that the nation’s unwillingness to publicly track the virus by race could obscure a crucial underlying reality: It’s quite likely that a disproportionate number of those who die of coronavirus will be black, reports ProPublica. Continue reading

The post No, the Coronavirus is not an “Equalizer” appeared first on BillMoyers.com.

The Social Determinants of Health in the Age of COVID19

Published by Anonymous (not verified) on Tue, 07/04/2020 - 10:05pm in

Tags 

Health, inequality, UK

With the ongoing pandemic and economic crisis, there is much to discuss. To inform the debates taking place in the YSI community, Luisa Scarcella and Aleksandar Stojanović have kicked off a special webinar series in which to unpack some of the accompanying challenges. For the first session, Luisa invited Professor Sir Michael Marmot, Professor of Epidemiology and Public Health at University College London, Director of the UCL Institute of Health Equity, and Past President of the World Medical Association. His work reveals the interrelated nature of health and socioeconomic inequality; a highly relevant topic today.

When economists talk about health, they usually talk about the healthcare system. They don’t often talk about what makes people sick in the first place. But Marmot does, and he finds that our people’s health is closely tied to the socio-economic conditions they are in; lower socio-economic conditions lead to worse health, and increasing socioeconomic inequality yields a widening health gap. His findings are compelling:

In the developed world, general life expectancy has stagnated since WW2; that is unprecedented for peacetime. But for the lower economic classes, it’s even worse. In the UK, the life expectancy of the poor has been decreasing for a decade now. It’s no coincidence, Marmot argues, that this trend emerged in a context of harsh austerity measures. Having reduced the purchasing power of the underprivileged, healthy living is increasingly out of reach.

Other advanced economies, the US in particular, show similar trends. There, too, structural inequalities give rise to job insecurity, housing insecurity, food insecurity, racism, and violence. These disadvantages translate into worse health for the poor. So, to improve the health of the American people, a better healthcare system would only be the beginning. To actually improve public health, the US would need to address the socio-economic inequalities that underlie it.

These insights offer a fresh take on the national responses to the COVID-19 outbreak, too. Many governmental remedies are receiving criticism for ‘treating the symptom and not the cause,’ echoing Professor Marmot’s plea. On top of that, most nations’ stimulus packages do not sufficiently alleviate the economic despair of the most vulnerable groups, leading to a worsening of the socio-economic conditions that are associated with bad health. The issues Marmot points out may only accelerate during this crisis. 

Marmot’s work demonstrates the interconnected nature of many of the societal challenges we study in YSI: socioeconomic inequality, societal fragmentation, the concentration of economic and political power, and ultimately human despair. As Rob Johnson commented: “We must continue trying to understand how and why the political economy produces these conditions and tolerates them.”

A recording of Professor Marmot’s webinar is available here. Marmot’s book, the Health Gap, provides a more detailed account of his findings.

The post The Social Determinants of Health in the Age of COVID19 appeared first on Economic Questions .

Pluralistic: 05 Apr 2020

Published by Anonymous (not verified) on Mon, 06/04/2020 - 12:01am in

Today's links

  1. Socioeconomics of coronavirus: Everything bad is now worse.
  2. How to drain your lungs: Knowledge is power.
  3. Bookshop: a local, indie alternative to Amazon: What could booksellers find to buy one-half so precious as the stuff they sell.
  4. This day in history: 2010, 2019
  5. Colophon: Recent publications, upcoming appearances, current writing projects, current reading


Socioeconomics of coronavirus (permalink)

Here's a bit of neo-Gatsby*: an Axios-Ipsos poll from last week showing that the richer you are, the more likely you are to be working from home, and the less intact your mental wellbeing is likely to be.

https://www.axios.com/axios-ipsos-coronavirus-index-rich-sheltered-poor-shafted-9e592100-b8e6-4dcd-aee0-a6516892874b.html

Working in an "essential industry" is correlated with lower wages and educational attainment. IOW: if you're risking your life working with the public, it's likely that you are so economically precarious as to have no choice.

3% of people with high-school educations and <$15K household incomes are working from home.39% of people with Masters' and >$200k household incomes are working from home. However, the former group reports better mental health outcomes than the latter.

*"Let me tell you about the very rich.They are different from you and me. They possess and enjoy early. It does something to them, makes them soft where we are hard, cynical where we are trustful, in a way that, unless you were born rich, are very difficult to understand."


How to drain your lungs (permalink)

Chest Physiotherapy: AKA, the art of clearing fluid out of sick peoples' lungs. A lot of the work here is "postural" – arranging the patient in a series of postures that allows lobe-by-lobe drainage.

https://www.respiratorytherapyzone.com/chest-physiotherapy-positions/

You can assist the process with "vibration and percussion," if ordered by a physician.

Postures should be held for 3-5 minutes each.

Intended to treat "Cystic Fibrosis, bronchiectasis, chronic bronchitis, aspiration pneumonia, ciliary dyskinetic syndrome, and COPD."

Indications for CPT: "More than 25–30 mL sputum production per day."

Possible adverse reactions: "Hypoxemia, increased ICP, acute hypotension, pulmonary hemorrhage, pain, vomiting, aspiration, bronchospasm, and arrhythmias."

"Stop the treatment and put them back in the normal position; then notify the physician."


Bookshop: a local, indie alternative to Amazon (permalink)

Amazon is an "essential business" because it sells things like sex toys and hammer drills (don't mix these up!). But they also sell books. Your local indie bookseller is likely NOT an essential business, so they are now fighting Amazon with both hands tied behind their backs.

Some bookstore owners – like San Francisco's Borderlands Books – are allowed to pack and ship existing inventory, and are shipping nationally. If your local bookstore can do this, order from them, for all our sakes.

https://pluralistic.net/2020/04/02/eff-livestream-today/#sf-in-sf

If not, try Bookshop.org , an affiliate system for indie booksellers. Bookshop has its own warehouse and shipping, but you can nominate a local bookseller to get 10% of your purchases (that rises to 25% if you follow a link from your local).

https://bookshop.org/

(If you want an audiobook version of this, try http://Libro.fm , the DRM-free indie-supporting alternative to Audible, Amazon's monopolistic, DRM-mandatory audiobook store).

https://libro.fm/

Bookshop also offers affiliate links for authors:

https://public-production.bookshop.org/documents/Bookshop%20Author%20Brochure.pdf

Ideally, I'd like to see all publishers allow their authors to sell their own ebooks, the way Tor Books allows me to do. When you buy my ebooks from me, I keep the 30% Amazon skims, then send 70% to my publisher, who send me 25% of that as a royalty.

https://craphound.com/shop/

There's nothing more commodity than an ebook, they're identical no matter where you buy 'em. Authors' orgs could set up hubs to search for direct-purchase options, and these would double authors' ebook revenues in one go.

(Image: Martin Cathrae, CC BY-SA)


This day in history (permalink)

#10yrsago Alternate cover for Down and Out in the Magic Kingdom https://web.archive.org/web/20100410031930/http://www.orangeopossum.com/downandout.html

#10yrsago Shirky: What "people must pay for content" really means https://web.archive.org/web/20100404013927/http://www.shirky.com/weblog/2010/04/the-collapse-of-complex-business-models/

#10yrsago Bruce Sterling's State-of-the-Spime address https://vimeo.com/10256403

#1yrago The Internet Archive has recovered 500,000+ of the 50,000,000 songs Myspace "accidentally" deleted during a server migration https://www.techspot.com/news/79511-internet-archive-recovers-half-million-lost-myspace-songs.html

#1yrago Ontario's low-budget Trump-alike wants to eliminate sedation for people getting colonoscopies https://toronto.citynews.ca/2019/04/04/exclusive-changes-proposed-to-ohip-coverage/

#1yrago Colorado's net neutrality law will deny grant money to ISPs that engage in network discrimination https://coloradosun.com/2019/04/05/colorados-own-net-neutrality-bill-gets-some-teeth/

#1yrago The New York Times's chilling multimedia package on China's use of "smart city" tech to create an open-air prison https://www.nytimes.com/interactive/2019/04/04/world/asia/xinjiang-china-surveillance-prison.html

#1yrago Googler uprising leads to shut down of AI ethics committee that included the president of the Heritage Foundation https://www.vox.com/future-perfect/2019/4/4/18295933/google-cancels-ai-ethics-board

#1yrago Most paint-spatters are valid perl programs https://docs.google.com/document/d/1ZGGNMfmfpWB-DzWS3Jr-YLcRNRjhp3FKS6v0KELxXK8/preview


Colophon (permalink)

Today's top sources: Naked Capitalism (https://nakedcapitalism.com/, Alice Taylor (https://twitter.com/wonderlandblog/).

Currently writing: I'm getting geared up to start work my next novel, "The Lost Cause," a post-GND novel about truth and reconciliation.

Currently reading: Just started Lauren Beukes's forthcoming Afterland: it's Y the Last Man plus plus, and two chapters in, it's amazeballs. Last month, I finished Andrea Bernstein's "American Oligarchs"; it's a magnificent history of the Kushner and Trump families, showing how they cheated, stole and lied their way into power. I'm getting really into Anna Weiner's memoir about tech, "Uncanny Valley." I just loaded Matt Stoller's "Goliath" onto my underwater MP3 player and I'm listening to it as I swim laps.

Latest podcast: Author's Note from Attack Surface https://craphound.com/podcast/2020/03/30/authors-note-from-attack-surface/

Upcoming appearances:

Upcoming books: "Poesy the Monster Slayer" (Jul 2020), a picture book about monsters, bedtime, gender, and kicking ass. Pre-order here: https://us.macmillan.com/books/9781626723627?utm_source=socialmedia&utm_medium=socialpost&utm_term=na-poesycorypreorder&utm_content=na-preorder-buynow&utm_campaign=9781626723627

(we're having a launch for it in Burbank on July 11 at Dark Delicacies and you can get me AND Poesy to sign it and Dark Del will ship it to the monster kids in your life in time for the release date).

"Attack Surface": The third Little Brother book, Oct 20, 2020. https://us.macmillan.com/books/9781250757531

"Little Brother/Homeland": A reissue omnibus edition with a new introduction by Edward Snowden: https://us.macmillan.com/books/9781250774583

This work licensed under a Creative Commons Attribution 4.0 license. That means you can use it any way you like, including commerically, provided that you attribute it to me, Cory Doctorow, and include a link to pluralistic.net.

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Quotations and images are not included in this license; they are included either under a limitation or exception to copyright, or on the basis of a separate license. Please exercise caution.

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When life gives you SARS, you make sarsaparilla -Joey "Accordion Guy" DeVilla

Gross inequalities in a time of pandemic

Published by Anonymous (not verified) on Sun, 05/04/2020 - 5:53am in


Here is a stunning juxtaposition in the April 2 print edition of the New York Times. Take a close look. The top panel updates readers on the fact that the city and the region are enduring unimaginable suffering and stress caused by the COVID-19 pandemic, with 63,300 victims and 2,624 deaths (as of April 4) — and with hundreds of thousands facing immediate, existential financial crisis because of the economic shutdown. And only eight miles away, as the Sotheby’s "Prominent Properties" half-page advertisement proclaims, home buyers can find secluded luxury, relaxation, and safety, for residential estates priced at $32.9 million and $21.5 million. In case the reader missed the exclusiveness of these properties, the advertisement mentions that they are "located in one of the nation's wealthiest zip codes". And, lest the prospective buyer be concerned about maintaining social isolation in these difficult times, the ad reminds prospective buyers that these are gated estates -- in fact, the $33M property is located on "the only guard gated street in Alpine".

Could Friedrich Engels have found a more compelling illustration of the fundamental inhumanity of the inequalities that exist in twenty-first century capitalism in the United States? And there is no need for rhetorical exaggeration — here it is in black and white in the nation’s "newspaper of record".

There are many compelling reasons that supported Elizabeth Warren’s proposal for a wealth tax. But here is one more: it is morally appalling, even gut-churning, to realize that $33 million for a home for one’s family (35,000 square feet, tennis court and indoor basketball court) is a reasonable “ask” for the super-wealthy in our country, the one-tenth of one percent who have ridden the crest of surging stock markets and finance and investment firms to a level of wealth that is literally unimaginable to at least 95% of the rest of the country.

Here is the heart of Warren's proposal for a wealth tax (link):

Rates and Revenue

  • Zero additional tax on any household with a net worth of less than $50 million (99.9% of American households)
  • 2% annual tax on household net worth between $50 million and $1 billion
  • 4% annual Billionaire Surtax (6% tax overall) on household net worth above $1 billion
  • 10-Year revenue total of $3.75 trillion

Are we all in this together, or not? If we are, let’s share the wealth. Let’s all pay our fair share. Let’s pay for the costs of fighting the pandemic and saving tens of millions of our fellow citizens from financial ruin, eviction, malnutrition, and family crisis with a wealth tax on billionaires. They can afford it. The "65' saltwater gunite pool" is not a life necessity. The revenue estimate of the Warren proposal is roughly proportionate to the current estimate of what it will cost the US economy to overcome the pandemic, protect the vulnerable, and restart the economy -- $3.75 trillion. Both equity and the current crisis support such a plan.

Here is some background on the rising wealth inequalities we have witnessed in recent decades in the United States. Leiserson, McGrew, and Kopparam provide an excellent and data-rich survey of the system of wealth inequalities in the United States in "The distribution of wealth in the United States and implications for a net worth tax" (link). Since 1989 the increase in wealth inequality is dramatic. The top 10% owned about 67% of all wealth in 1989; by 2016 this had risen to 77%.


The second graph is a snapshot for 2016 (link). Both income and wealth are severely unequal, but wealth is substantially more so. The top quintile owns almost 90% of the wealth in the United States, with the top 1% owning about 40% of all wealth.

The website Inequality.org provides an historical look at the growth of inequalities of wealth in the US (link). Consider this graph of the wealth shares over a century of the top 1%, .1%, and .01% of the US population; it is eye-popping. Beginning in roughly 1978 the shares of the very top segments of the US population began to rise, and the trend continued through 2012 -- with no end in sight. The top 1% in 2012 owned 41% of all wealth; the top 0.1% owned 21%; and the top 0.01% owned 11%.


We need a wealth tax, and Elizabeth Warren put together a pretty convincing and rational plan. This is not a question of “soaking the rich”. It is a question of basic fairness. Our economy and society have functioned as an express elevator for ever-greater fortunes for the few, with essentially no improvement for 60-80% of the rest of America. An economy is a system of social cooperation, requiring the efforts of all members of society. But the benefits of our economic system have gone ever-more disproportionately to the rich and the ultra-rich. That is fundamentally unfair. Now is the time to bring equity back into our society and politics. If Mr. Moneybags can afford a $33M home in New Jersey, he or she can afford to pay a small tax on his wealth.

It is interesting to note that social scientists and anthropologists are beginning to study the super-rich as a distinctive group. A fascinating source is Iain Hay and Jonathan Beaverstock, eds., Handbook on Wealth and the Super-Rich. Especially relevant is Chris Paris's contribution, "The residential spaces of the super-rich". Paris writes:

Prime residential real estate remains a key element in super-­rich investment portfolios, both for private use through luxury consumption and as investment items with anticipated long-­ term capital gain, often untaxed as properties are owned by companies rather than individuals. Most of the homes of the super-­rich are purchased using cash, specialized financial instruments and/or through companies, and ‘the higher the price of the property, the less likely buyers were to arrange traditional mortgage financing for the home acquisition. Whether buyers are foreign or domestic, cash transactions predominate at the higher end of the market’ (Christie’s, 2013, p. 14). Such transactions, therefore, never enter ‘national’ housing accounting systems and play no part in many accounts of aggregate ‘national’ house price trends. For example, the analysis of house price trends in the Joseph Rowntree Foundation UK Housing Review is based on data relating to transactions using mortgages or loans, and EU and OECD comparisons between countries are based on the same kinds of data (Paris, 2013b).

Also fascinating in the volume is Emma Spence's study of the super-rich when at sea in their super-yachts, "Performing wealth and status: observing super-­yachts and the super-­rich in Monaco":

In this chapter I focus upon the super-­yacht as a key tool for exploring how performances of wealth are made visible in Monaco. A super-­yacht is a privately owned and professionally crewed luxury vessel over 30 metres in length. An average super-­ yacht, at approximately 47 metres in length, costs around €30 million to buy new, operates with a permanent crew of ten, and costs around €1.8 million per year to run. Larger super-­yachts such as Motor Yacht (M/Y) Madame Gu (99 metres in length), or the current largest super-­yacht in the world M/Y Azzam (180 metres in length) cost substantially more to build and to run. The price to charter (rent) a super-­yacht also varies considerably with size, age and reputation of the shipyard in which it was built. For example, a typical 47-­metre yacht can range between €100 000 to €600 000 per week to charter, plus costs. At the most exclusive end of the super-­yacht charter industry costs are much higher. M/Y Solange, for example, is an 85-­metre newly built yacht (2013) from reputable German shipyard Lürssen, which operates with 29 full-­time crew, and is priced at €1 million plus costs to charter per week.  The super-­yacht industry is worth an estimated €24 billion globally (Rutherford, 2014, p. 51).

We Need Class, Race, and Gender Sensitive Policies to Fight the COVID-19 Crisis

Published by Anonymous (not verified) on Fri, 03/04/2020 - 5:57am in
Luiza Nassif-Pires, Laura de Lima Xavier, Thomas Masterson, Michalis Nikiforos, and Fernando Rios-Avila

 

Disproving the belief that the pandemic affects us all equally, data collected by New York City Department of Health and Mental Hygiene and a piece published today in the New York Times shows that the novel coronavirus is “hitting low-income neighborhoods the hardest.”[1] In a forthcoming policy brief, we share evidence that this pattern would be the case and provide a solid explanation as to why (Nassif-Pires et al., forthcoming). Moreover, as we argue, the death tolls are also likely to be higher among poor neighborhoods and majority-minority communities. This inequality in health costs is in addition to an unequal distribution of economic costs. In short, poor and minority individuals are disproportionately feeling the impacts of this crisis. A concise version of our evidence is presented here.

The toll of social inequality in healthcare is well known. A clear relationship has been repeatedly demonstrated between social determinants — such as income, education, occupation, social class, sex, and race/ethnicity — and the incidence and severity of many diseases. This association holds true for infectious respiratory illnesses such as influenza, SARS and also for COVID-19, as figure 1 shows. The consequences of this imbalance are particularly catastrophic when there is a massive disease outbreak. The precise mechanisms by which social determinants drive unequal disease burden during these outbreaks is harder to assess. On the one hand, there is a strong association of social determinants with clinical risk factors for respiratory illnesses such as chronic diseases, on the other, social aspects of poverty increase the risks of individuals contracting infectious diseases.

To establish the relationship between poverty and the clinical risk of a severe case of COVID-19, we estimate a health risk index as a function of poverty and percentage of minority population in neighborhoods of 500 cities. We use data from the 500 Cities project and from the American Community Survey. The risk index accounts for the incidence of chronic obstructive pulmonary disease, diabetes, coronary disease, cancer,  asthma,  kidney disease, high blood pressure, percentage of smokers, proportion of individuals with poor physical health and the proportion of the population that is above 65 years old. All data is available at the census tract level and results are presented in figure 1 and figure 2[2].

As figure 1 shows, the incidence of risk factors is much higher in poor communities. In neighborhoods with a higher percentage of the population living below two times the poverty line, the risk factor index is above the national average, while neighborhoods where no one lives under poverty present risk below average. At least one of these chronic diseases included in our risk index were reported in one fourth of COVID-19 cases and were even more prevalent in cases requiring intensive care and resulting in death. Chronic obstructive pulmonary disorders for instance have been shown to raise this risk of severe COVID-19 in 2.6-fold, and diabetes and hypertension by about 60% (Guan, W., Liang et al, 2020). Not surprisingly, these comorbidities also disproportionately affect socioeconomic minorities, making these populations alarmingly vulnerable to COVID-19, as illustrated in figure 2.

 

Figure 1- Estimated Health Risk by Share of Population in Poverty by Census Tract (US, 2017)

Source: Authors calculation using American Community Survey data retrieved from IPUMS (2020) and from the 500 cities Project (2019).

 

Furthermore, there is reason to believe that the health effects of being socioeconomically disadvantaged extend far beyond these clinically recognized risk factors. Studies that combine data from previous infectious respiratory pandemics provide strong evidence that the increased risk in this population might be largely driven by factors such as disproportionate access to healthcare and other differences in living and work conditions (Lowcock et al., 2012; Mamelund, 2017). Uninsured people are less likely to seek early treatment, making the lack of health insurance in the US another risk of severe cases of COVID-19. The lack of health insurance, another aspect of poverty, is also more prominent in areas where the population has higher health risk indexes (figure 3) adding yet one more layer of vulnerability for the population in poor communities. Similarly, during the 2009 H1N1 pandemic, socially disadvantaged populations showed increased prevalence of hospitalization, illness severity, and mortality both in the US and abroad (Tricco et al., 2012). In the US, however, neighborhood disadvantage, absence of sick leave policies in the workplace, and opposition to school closings were shown to be key social determinants of influenza transmission and illness with clinical risk only partially mediating this effect (Lowcock et al., 2012; Cordoba and Aiello, 2016). Similar imbalances were also found during the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS-CoV) which is genetically related to the current SARS-CoV-2 causing COVID-19. In Hong Kong, the most severely hit city, an investigation on the influence of socioeconomic status and the spread of of SARS found a significant negative correlation between the incidence of SARS and median income levels (Bucchianeri, 2010). This correlation was primarily driven by differences in living conditions such as living in housing complexes with higher usage of public transportation, communal facilities and a higher number of floors and therefore elevator sharing. Investigations in the US and in Sweden during the 1918 influenza pandemic also demonstrated that the education, occupation, and home ownership were related to mortality (Grantz et al., 2016; Bengtsson, Dribe and Eriksson, 2018). At the extreme end of vulnerability, homeless people are at increased risk of contracting infectious diseases in crowded spaces, and more likely to develop severe symptoms because of underlying medical conditions and limited access to health care. In cities with a large population of homeless people, the effects of COVID-19 could be disastrous. https://nyti.ms/2IA1j5r

The prevalence of chronic respiratory disorders— an identified risk factor for severe COVID-19— is also sharply higher among the poor and in African American communities. This imbalance is present in both children and adults, and is predominantly attributed to environmental exposures, such as exposure to tobacco smoke, crowding and stress (Margolis et al., 1992; Hedlund, Eriksson and Rönmark, 2006; Pawlińska-Chmara and Wronka, 2007). In the state of New Jersey, asthma rates in African American children can be twice as high as their peers, and are determined by whether children live in a “black” zip code, with racial differences in incidence of asthma completely disappearing when correcting for their address (Alexander and Currie, 2017). These studies demonstrate a clear relationship between respiratory health problems and socioeconomic inequalities such as environmental segregation and residential racism, and serve as a warning of the devastating effect of that inequality during viral respiratory pandemics. Unfortunately figure 2 indicates that similar perverse results are likely to happen during a covid-19 epidemic.

Gender inequalities also result in unequal health and economic vulnerability, with women being at higher risk than men. Although initial reports from China suggested higher death ratios in men, women are both more likely to be exposed to viruses and to be responsible to care for those infected. Another worrisome piece of evidence from China is the observed increase in domestic violence[3] during the lockdown, which is already higher in lower income communities[4].

 

Figure 2 Estimated Health Risk by Minority Share of Population by Census Tract (US, 2017)

Source: Authors calculation using American Community Survey data retrieved from IPUMS (2020) and from the 500 cities Project (2019).

 

In summary, people who are socioeconomically disadvantaged are at increased risk of acquiring COVID-19 and of having worse outcomes, but are also the least likely to seek medical attention due to high out-of-pocket healthcare costs in the US. Approaches to tackling the health and economic effects of the pandemic that do not acknowledge and articulate with these factors will necessarily fail.

 

Figure 3 Estimated Health Risk by Lack of Health Insurance Among Adults Aged 18–64 Years by Census Tract (US, 2017)

Source: Authors calculation using American Community Survey data retrieved from the 500 cities Project (2019).

 

Policy Implications

Policies aimed at avoiding the uncontrolled spread of new pathogens in crowded and underserved areas start with our ability to develop tests and use them early on to identify infected people including mild cases in order to isolate them and track close contacts. For cities such as New York, Los Angeles and Seattle, it is far too late, but for many places, widespread testing integrated with social distancing policies are crucial. Such an approach was taken early on by South Korea and Hong Kong, but not in the United States. The failure in accurately tracking the spread of the virus is likely the reason for the high number of cases in New York. Data from China suggests that the disease is most easily spread between family members who are in frequent contact with one another (Huang et al., 2020). Moreover, the efforts of lockdown do not protect from infections within households, which also have a higher impact in poorer communities where more people share smaller spaces. Thus, the home quarantine model makes poor households even more vulnerable. Repurposing spaces such as hotels, gymnasiums and dorms to give individuals with mild infections or that have been in contact with cases the option of quarantining and recovering outside their homes can protect the lives of their families. This is especially important for individuals living in small apartments or houses and sharing space with vulnerable populations.

Two other distribution-sensitive policies that have potentially very large macroeconomic consequences at the moment are the provision of paid sick leave and access to healthcare. The recent stimulus bill includes provisions for paid sick-time, family, and medical leave. However, these provisions do not apply to employers with more than 500 employees, while small businesses with less than 50 employees can also ask for an exemption. As a result, only 25 percent of private sector employees are covered.[5] Access to paid leave decreases the rate of spread as it will keep individuals from going to work despite being ill. Therefore, we need to guarantee paid sick leave for everyone (part-time and gig-economy included), which should be subsidized by the government in the case of small businesses.

Access to healthcare has similar benefits. With the spread of the pandemic it has become abundantly clear that lack of access to healthcare can have important negative spillovers. People without access to healthcare not only get sick themselves (which is obviously important in its own right) but are also more likely to spread the virus to others. At this point, because of the structure of the US healthcare system, we face the paradox of people losing access to healthcare (mostly because they lose their jobs) at the time when they—but also the society and the economy as a whole—need it most. In order to mitigate the impact and the duration of the COVID shock, we need to have broad open access to testing for the coronavirus and treatment regardless of immigration and insurance status which should be cost-free to patients and without hidden costs. It is also important to extensively publicize to undocumented and uninsured individuals how to access free testing and treatment and encourage them to seek assistance as soon as needed to avoid an unnecessary increase in the risk of severity and in the rate of spread.

In addition to a freeze on foreclosures, there needs to be a nation-wide moratorium on eviction for at least the duration of the crisis. People are more likely to lack the funds to pay rent and so we would observe an increase in the homeless population, one of the most vulnerable groups. Furthermore, for individuals whose income were affected by Covid-19 and small businesses that closed, rent and utilities forgiveness should be granted, so we do not observe an increase in household indebtedness.

We need to provide child-care and/or school lunches at home for essential but low-paid workers whose children are now not going to school. A direct transfer payment of the kind contained in the stimulus package is a useful supplement to the above, but it should be on a monthly basis for the duration of the crisis rather than a one-time payment. All of these policies are necessary to ensure that those that are likeliest to be vulnerable to both the disease itself and the economic impacts, immediate and medium-term, are shielded from this disaster that they had no part in creating.

There needs to be an effort to map and design specific policies to protect highly vulnerable groups such as undocumented immigrants, the homeless population, inmates, victims of domestic violence, and the nursing home population, only to cite a few. Each of these groups requires a task force of its own to design appropriate policies.

This crisis also teaches us some lessons regarding policies for the medium run that would make us less vulnerable to crises. The lack of adequate access to healthcare for many Americans needs to be addressed. Some form of single-payer insurance, such as Medicare for all, would go a long way to removing the reluctance of individuals to seek care (anxiety about out-of-pocket costs, searching for in-network care providers, etc.), slowing the spread of future pandemics, as well as relieving budgetary pressure on states during crises resulting from their responsibility for funding Medicaid.

Finally, the increasingly high income inequality is one of the main structural problems of the US economy, and one of the main reasons for its recent poor macroeconomic performance (Nikiforos 2016, 2020). The stagnation of the wages over the last forty years is also one of the major explanations for the slowdown of productivity growth over the same period; labor being relatively cheap implies a weaker incentive to innovate and introduce labor-saving techniques of production. Unfortunately, neoliberal policies such as the financial deregulation, tax cuts to the wealthy, cuts on social spending by the Federal government and attacks on worker protections only reinforced this problem. Reverting these policies and strengthening our labor laws and unions can go a long way in addressing this issue.

A reduction in income inequality is one of the most important–if not the single most important—structural changes that needs to be implemented so that the US economy returns to a sustainable growth path in the medium run. Had these issues been addressed already, the impacts on the US of this pandemic would have been less severe. Maybe this time we can at least learn from our mistakes.

 

Luiza Nassif-Pires
Research Fellow, Levy Economics Institute. The author would like to thank Isabella Weber for insightful conversations and comments.

Laura de Lima Xavier
Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA
Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
Harvard Medical School, Boston, MA, USA

Thomas Masterson
Research Scholar, Levy Economics Institute

Michalis Nikiforos
Research Scholar, Levy Economics Institute

Fernando Rios-Avila
Research Scholar, Levy Economics Institute

 

References

500 Cities Project. https://www.cdc.gov/500cities/

Alexander D, Currie J. Is it who you are or where you live? Residential segregation and racial gaps in childhood asthma. J Health Econ. 2017 Sep;55:186–200.

Bengtsson T, Dribe M, Eriksson B. Social Class and Excess Mortality in Sweden During the 1918 Influenza Pandemic. Am J Epidemiol. 2018 Dec 1;187(12):2568–76.

Bucchianeri GW. Is SARS a Poor Man’s Disease? Socioeconomic Status and Risk Factors for SARS Transmission [Internet]. Vol. 13, Forum for Health Economics & Policy. 2010. Available from: http://dx.doi.org/10.2202/1558-9544.1209

Cordoba E, Aiello AE. Social Determinants of Influenza Illness and Outbreaks in the United States. N C Med J. 2016 Sep;77(5):341–5.

Department of Labor (DOL), News release: Unemployment Insurance Weekly Claims.  March 26, 2020. https://www.dol.gov/ui/data.pdf, Accessed 12:00 March 26, 2020.

Fazzari, S. 2020. “The COVID-19 Recession: Unprecedented Collapse and the Need for Macro Policy”, Institute of New Economic Thinking Blog.

Grantz KH, Rane MS, Salje H, Glass GE, Schachterle SE, Cummings DAT. Disparities in influenza mortality and transmission related to sociodemographic factors within Chicago in the pandemic of 1918. Proc Natl Acad Sci U S A. 2016 Nov 29;113(48):13839–44.

Guan, W., Liang, W., Zhao, Y., Liang, H., Chen, Z., Li, Y., Liu, X., Chen, R., Tang, C., Wang, T., Ou, C., Li, L., Chen, P., Sang, L., Wang, W., Li, J., Li, C., Ou, L., Cheng, B., … He, J. (2020). Comorbidity and its impact on 1,590 patients with COVID-19 in China: A Nationwide Analysis. MedRxiv, 2020.02.25.20027664. https://doi.org/10.1101/2020.02.25.20027664

Hedlund U, Eriksson K, Rönmark E. Socio-economic status is related to incidence of asthma and respiratory symptoms in adults. Eur Respir J. 2006 Aug;28(2):303–10.

Huang, R. et al. (2020) ‘A family cluster of SARS-CoV-2 infection involving 11 patients in Nanjing, China’, The Lancet infectious diseases. doi: 10.1016/S1473-3099(20)30147-X.

IPUMS NHGIS, University of Minnesota, www.nhgis.org.

Lowcock EC, Rosella LC, Foisy J, McGeer A, Crowcroft N. The social determinants of health and pandemic H1N1 2009 influenza severity. Am J Public Health. 2012 Aug;102(8):e51–8.

Mamelund S-E. Social inequality – a forgotten factor in pandemic influenza preparedness [Internet]. Tidsskrift for Den norske legeforening. 2017. Available from: http://dx.doi.org/10.4045/tidsskr.17.0273

Margolis PA, Greenberg RA, Keyes LL, LaVange LM, Chapman RS, Denny FW, et al. Lower respiratory illness in infants and low socioeconomic status. Am J Public Health. 1992 Aug;82(8):1119–26.

Nassif-Pires, L., L. de Lima Xavier, T. Masterson, M. Nikiforos, and F. Rios-Avila. Forthcoming. “Pandemic of Inequality.” Public Policy Brief No. 149. Annandale-on-Hudson, NY: Levy Economics Institute of Bard College.

NY Times (2020) https://www.nytimes.com/2020/03/12/us/women-coronavirus-greater-risk.html

________(2020) https://nyti.ms/2IA1j5r

NY Times (2020)  https://www.nytimes.com/interactive/2020/04/01/nyregion/nyc-coronavirus-cases-map.html?referringSource=articleShare

Oliveira, AN, Sages, L, Silva, G, Nassif-Pires, L. 2020 “Home Quarantine, Confinement with the abuser?” Multiplier Effect Blog.

Pawlińska-Chmara R, Wronka I. Assessment of the effect of socioeconomic factors on the prevalence of respiratory disorders in children. J Physiol Pharmacol. 2007 Nov;58 Suppl 5(Pt 2):523–9.

Tricco AC, Lillie E, Soobiah C, Perrier L, Straus SE. Impact of H1N1 on socially disadvantaged populations: systematic review. PLoS One. 2012 Jun 25;7(6):e39437.

 

[1] https://www.nytimes.com/interactive/2020/04/01/nyregion/nyc-coronavirus-...

 

[2] For this exercise we perform a local polynomial regression between an estimated health risk index, constructed through principal component analysis, and the percentage of population living below two times the poverty line in census tracts, for figure 1, and between the health risk index and percentage of non-white population for figure 2. For details on the methodology or on the data please contact lnassifpires@levy.org.

 

[3]  https://www.sixthtone.com/news/1005253/domestic-violence-cases-surge-during-covid-19-epidemic

http://multiplier-effect.org/home-quarantine-confinement-with-the-abuser/

 

[4]  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486977/

 

[5] From Bureau of Labor Statistics’ National Business Employment Dynamics Data by Firm Size Class, Table F. https://www.bls.gov/web/cewbd/table_f.txt, accessed March 30, 2020.

 

We Need Class, Race, and Gender Sensitive Policies to Fight the COVID-19 Crisis

Published by Anonymous (not verified) on Fri, 03/04/2020 - 5:57am in
Luiza Nassif-Pires, Laura de Lima Xavier, Thomas Masterson, Michalis Nikiforos, and Fernando Rios-Avila

 

Disproving the belief that the pandemic affects us all equally, data collected by New York City Department of Health and Mental Hygiene and a piece published today in the New York Times shows that the novel coronavirus is “hitting low-income neighborhoods the hardest.”[1] In a forthcoming policy brief, we share evidence that this pattern would be the case and provide a solid explanation as to why (Nassif-Pires et al., forthcoming). Moreover, as we argue, the death tolls are also likely to be higher among poor neighborhoods and majority-minority communities. This inequality in health costs is in addition to an unequal distribution of economic costs. In short, poor and minority individuals are disproportionately feeling the impacts of this crisis. A concise version of our evidence is presented here.

The toll of social inequality in healthcare is well known. A clear relationship has been repeatedly demonstrated between social determinants — such as income, education, occupation, social class, sex, and race/ethnicity — and the incidence and severity of many diseases. This association holds true for infectious respiratory illnesses such as influenza, SARS and also for COVID-19, as figure 1 shows. The consequences of this imbalance are particularly catastrophic when there is a massive disease outbreak. The precise mechanisms by which social determinants drive unequal disease burden during these outbreaks is harder to assess. On the one hand, there is a strong association of social determinants with clinical risk factors for respiratory illnesses such as chronic diseases, on the other, social aspects of poverty increase the risks of individuals contracting infectious diseases.

To establish the relationship between poverty and the clinical risk of a severe case of COVID-19, we estimate a health risk index as a function of poverty and percentage of minority population in neighborhoods of 500 cities. We use data from the 500 Cities project and from the American Community Survey. The risk index accounts for the incidence of chronic obstructive pulmonary disease, diabetes, coronary disease, cancer,  asthma,  kidney disease, high blood pressure, percentage of smokers, proportion of individuals with poor physical health and the proportion of the population that is above 65 years old. All data is available at the census tract level and results are presented in figure 1 and figure 2[2].

As figure 1 shows, the incidence of risk factors is much higher in poor communities. In neighborhoods with a higher percentage of the population living below two times the poverty line, the risk factor index is above the national average, while neighborhoods where no one lives under poverty present risk below average. At least one of these chronic diseases included in our risk index were reported in one fourth of COVID-19 cases and were even more prevalent in cases requiring intensive care and resulting in death. Chronic obstructive pulmonary disorders for instance have been shown to raise this risk of severe COVID-19 in 2.6-fold, and diabetes and hypertension by about 60% (Guan, W., Liang et al, 2020). Not surprisingly, these comorbidities also disproportionately affect socioeconomic minorities, making these populations alarmingly vulnerable to COVID-19, as illustrated in figure 2.

 

Figure 1- Estimated Health Risk by Share of Population in Poverty by Census Tract (US, 2017)

Source: Authors calculation using American Community Survey data retrieved from IPUMS (2020) and from the 500 cities Project (2019).

 

Furthermore, there is reason to believe that the health effects of being socioeconomically disadvantaged extend far beyond these clinically recognized risk factors. Studies that combine data from previous infectious respiratory pandemics provide strong evidence that the increased risk in this population might be largely driven by factors such as disproportionate access to healthcare and other differences in living and work conditions (Lowcock et al., 2012; Mamelund, 2017). Uninsured people are less likely to seek early treatment, making the lack of health insurance in the US another risk of severe cases of COVID-19. The lack of health insurance, another aspect of poverty, is also more prominent in areas where the population has higher health risk indexes (figure 3) adding yet one more layer of vulnerability for the population in poor communities. Similarly, during the 2009 H1N1 pandemic, socially disadvantaged populations showed increased prevalence of hospitalization, illness severity, and mortality both in the US and abroad (Tricco et al., 2012). In the US, however, neighborhood disadvantage, absence of sick leave policies in the workplace, and opposition to school closings were shown to be key social determinants of influenza transmission and illness with clinical risk only partially mediating this effect (Lowcock et al., 2012; Cordoba and Aiello, 2016). Similar imbalances were also found during the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS-CoV) which is genetically related to the current SARS-CoV-2 causing COVID-19. In Hong Kong, the most severely hit city, an investigation on the influence of socioeconomic status and the spread of of SARS found a significant negative correlation between the incidence of SARS and median income levels (Bucchianeri, 2010). This correlation was primarily driven by differences in living conditions such as living in housing complexes with higher usage of public transportation, communal facilities and a higher number of floors and therefore elevator sharing. Investigations in the US and in Sweden during the 1918 influenza pandemic also demonstrated that the education, occupation, and home ownership were related to mortality (Grantz et al., 2016; Bengtsson, Dribe and Eriksson, 2018). At the extreme end of vulnerability, homeless people are at increased risk of contracting infectious diseases in crowded spaces, and more likely to develop severe symptoms because of underlying medical conditions and limited access to health care. In cities with a large population of homeless people, the effects of COVID-19 could be disastrous. https://nyti.ms/2IA1j5r

The prevalence of chronic respiratory disorders— an identified risk factor for severe COVID-19— is also sharply higher among the poor and in African American communities. This imbalance is present in both children and adults, and is predominantly attributed to environmental exposures, such as exposure to tobacco smoke, crowding and stress (Margolis et al., 1992; Hedlund, Eriksson and Rönmark, 2006; Pawlińska-Chmara and Wronka, 2007). In the state of New Jersey, asthma rates in African American children can be twice as high as their peers, and are determined by whether children live in a “black” zip code, with racial differences in incidence of asthma completely disappearing when correcting for their address (Alexander and Currie, 2017). These studies demonstrate a clear relationship between respiratory health problems and socioeconomic inequalities such as environmental segregation and residential racism, and serve as a warning of the devastating effect of that inequality during viral respiratory pandemics. Unfortunately figure 2 indicates that similar perverse results are likely to happen during a covid-19 epidemic.

Gender inequalities also result in unequal health and economic vulnerability, with women being at higher risk than men. Although initial reports from China suggested higher death ratios in men, women are both more likely to be exposed to viruses and to be responsible to care for those infected. Another worrisome piece of evidence from China is the observed increase in domestic violence[3] during the lockdown, which is already higher in lower income communities[4].

 

Figure 2 Estimated Health Risk by Minority Share of Population by Census Tract (US, 2017)

Source: Authors calculation using American Community Survey data retrieved from IPUMS (2020) and from the 500 cities Project (2019).

 

In summary, people who are socioeconomically disadvantaged are at increased risk of acquiring COVID-19 and of having worse outcomes, but are also the least likely to seek medical attention due to high out-of-pocket healthcare costs in the US. Approaches to tackling the health and economic effects of the pandemic that do not acknowledge and articulate with these factors will necessarily fail.

 

Figure 3 Estimated Health Risk by Lack of Health Insurance Among Adults Aged 18–64 Years by Census Tract (US, 2017)

Source: Authors calculation using American Community Survey data retrieved from the 500 cities Project (2019).

 

Policy Implications

Policies aimed at avoiding the uncontrolled spread of new pathogens in crowded and underserved areas start with our ability to develop tests and use them early on to identify infected people including mild cases in order to isolate them and track close contacts. For cities such as New York, Los Angeles and Seattle, it is far too late, but for many places, widespread testing integrated with social distancing policies are crucial. Such an approach was taken early on by South Korea and Hong Kong, but not in the United States. The failure in accurately tracking the spread of the virus is likely the reason for the high number of cases in New York. Data from China suggests that the disease is most easily spread between family members who are in frequent contact with one another (Huang et al., 2020). Moreover, the efforts of lockdown do not protect from infections within households, which also have a higher impact in poorer communities where more people share smaller spaces. Thus, the home quarantine model makes poor households even more vulnerable. Repurposing spaces such as hotels, gymnasiums and dorms to give individuals with mild infections or that have been in contact with cases the option of quarantining and recovering outside their homes can protect the lives of their families. This is especially important for individuals living in small apartments or houses and sharing space with vulnerable populations.

Two other distribution-sensitive policies that have potentially very large macroeconomic consequences at the moment are the provision of paid sick leave and access to healthcare. The recent stimulus bill includes provisions for paid sick-time, family, and medical leave. However, these provisions do not apply to employers with more than 500 employees, while small businesses with less than 50 employees can also ask for an exemption. As a result, only 25 percent of private sector employees are covered.[5] Access to paid leave decreases the rate of spread as it will keep individuals from going to work despite being ill. Therefore, we need to guarantee paid sick leave for everyone (part-time and gig-economy included), which should be subsidized by the government in the case of small businesses.

Access to healthcare has similar benefits. With the spread of the pandemic it has become abundantly clear that lack of access to healthcare can have important negative spillovers. People without access to healthcare not only get sick themselves (which is obviously important in its own right) but are also more likely to spread the virus to others. At this point, because of the structure of the US healthcare system, we face the paradox of people losing access to healthcare (mostly because they lose their jobs) at the time when they—but also the society and the economy as a whole—need it most. In order to mitigate the impact and the duration of the COVID shock, we need to have broad open access to testing for the coronavirus and treatment regardless of immigration and insurance status which should be cost-free to patients and without hidden costs. It is also important to extensively publicize to undocumented and uninsured individuals how to access free testing and treatment and encourage them to seek assistance as soon as needed to avoid an unnecessary increase in the risk of severity and in the rate of spread.

In addition to a freeze on foreclosures, there needs to be a nation-wide moratorium on eviction for at least the duration of the crisis. People are more likely to lack the funds to pay rent and so we would observe an increase in the homeless population, one of the most vulnerable groups. Furthermore, for individuals whose income were affected by Covid-19 and small businesses that closed, rent and utilities forgiveness should be granted, so we do not observe an increase in household indebtedness.

We need to provide child-care and/or school lunches at home for essential but low-paid workers whose children are now not going to school. A direct transfer payment of the kind contained in the stimulus package is a useful supplement to the above, but it should be on a monthly basis for the duration of the crisis rather than a one-time payment. All of these policies are necessary to ensure that those that are likeliest to be vulnerable to both the disease itself and the economic impacts, immediate and medium-term, are shielded from this disaster that they had no part in creating.

There needs to be an effort to map and design specific policies to protect highly vulnerable groups such as undocumented immigrants, the homeless population, inmates, victims of domestic violence, and the nursing home population, only to cite a few. Each of these groups requires a task force of its own to design appropriate policies.

This crisis also teaches us some lessons regarding policies for the medium run that would make us less vulnerable to crises. The lack of adequate access to healthcare for many Americans needs to be addressed. Some form of single-payer insurance, such as Medicare for all, would go a long way to removing the reluctance of individuals to seek care (anxiety about out-of-pocket costs, searching for in-network care providers, etc.), slowing the spread of future pandemics, as well as relieving budgetary pressure on states during crises resulting from their responsibility for funding Medicaid.

Finally, the increasingly high income inequality is one of the main structural problems of the US economy, and one of the main reasons for its recent poor macroeconomic performance (Nikiforos 2016, 2020). The stagnation of the wages over the last forty years is also one of the major explanations for the slowdown of productivity growth over the same period; labor being relatively cheap implies a weaker incentive to innovate and introduce labor-saving techniques of production. Unfortunately, neoliberal policies such as the financial deregulation, tax cuts to the wealthy, cuts on social spending by the Federal government and attacks on worker protections only reinforced this problem. Reverting these policies and strengthening our labor laws and unions can go a long way in addressing this issue.

A reduction in income inequality is one of the most important–if not the single most important—structural changes that needs to be implemented so that the US economy returns to a sustainable growth path in the medium run. Had these issues been addressed already, the impacts on the US of this pandemic would have been less severe. Maybe this time we can at least learn from our mistakes.

 

Luiza Nassif-Pires
Research Fellow, Levy Economics Institute. The author would like to thank Isabella Weber for insightful conversations and comments.

Laura de Lima Xavier
Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA
Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
Harvard Medical School, Boston, MA, USA

Thomas Masterson
Research Scholar, Levy Economics Institute

Michalis Nikiforos
Research Scholar, Levy Economics Institute

Fernando Rios-Avila
Research Scholar, Levy Economics Institute

 

References

500 Cities Project. https://www.cdc.gov/500cities/

Alexander D, Currie J. Is it who you are or where you live? Residential segregation and racial gaps in childhood asthma. J Health Econ. 2017 Sep;55:186–200.

Bengtsson T, Dribe M, Eriksson B. Social Class and Excess Mortality in Sweden During the 1918 Influenza Pandemic. Am J Epidemiol. 2018 Dec 1;187(12):2568–76.

Bucchianeri GW. Is SARS a Poor Man’s Disease? Socioeconomic Status and Risk Factors for SARS Transmission [Internet]. Vol. 13, Forum for Health Economics & Policy. 2010. Available from: http://dx.doi.org/10.2202/1558-9544.1209

Cordoba E, Aiello AE. Social Determinants of Influenza Illness and Outbreaks in the United States. N C Med J. 2016 Sep;77(5):341–5.

Department of Labor (DOL), News release: Unemployment Insurance Weekly Claims.  March 26, 2020. https://www.dol.gov/ui/data.pdf, Accessed 12:00 March 26, 2020.

Fazzari, S. 2020. “The COVID-19 Recession: Unprecedented Collapse and the Need for Macro Policy”, Institute of New Economic Thinking Blog.

Grantz KH, Rane MS, Salje H, Glass GE, Schachterle SE, Cummings DAT. Disparities in influenza mortality and transmission related to sociodemographic factors within Chicago in the pandemic of 1918. Proc Natl Acad Sci U S A. 2016 Nov 29;113(48):13839–44.

Guan, W., Liang, W., Zhao, Y., Liang, H., Chen, Z., Li, Y., Liu, X., Chen, R., Tang, C., Wang, T., Ou, C., Li, L., Chen, P., Sang, L., Wang, W., Li, J., Li, C., Ou, L., Cheng, B., … He, J. (2020). Comorbidity and its impact on 1,590 patients with COVID-19 in China: A Nationwide Analysis. MedRxiv, 2020.02.25.20027664. https://doi.org/10.1101/2020.02.25.20027664

Hedlund U, Eriksson K, Rönmark E. Socio-economic status is related to incidence of asthma and respiratory symptoms in adults. Eur Respir J. 2006 Aug;28(2):303–10.

Huang, R. et al. (2020) ‘A family cluster of SARS-CoV-2 infection involving 11 patients in Nanjing, China’, The Lancet infectious diseases. doi: 10.1016/S1473-3099(20)30147-X.

IPUMS NHGIS, University of Minnesota, www.nhgis.org.

Lowcock EC, Rosella LC, Foisy J, McGeer A, Crowcroft N. The social determinants of health and pandemic H1N1 2009 influenza severity. Am J Public Health. 2012 Aug;102(8):e51–8.

Mamelund S-E. Social inequality – a forgotten factor in pandemic influenza preparedness [Internet]. Tidsskrift for Den norske legeforening. 2017. Available from: http://dx.doi.org/10.4045/tidsskr.17.0273

Margolis PA, Greenberg RA, Keyes LL, LaVange LM, Chapman RS, Denny FW, et al. Lower respiratory illness in infants and low socioeconomic status. Am J Public Health. 1992 Aug;82(8):1119–26.

Nassif-Pires, L., L. de Lima Xavier, T. Masterson, M. Nikiforos, and F. Rios-Avila. Forthcoming. “Pandemic of Inequality.” Public Policy Brief No. 149. Annandale-on-Hudson, NY: Levy Economics Institute of Bard College.

NY Times (2020) https://www.nytimes.com/2020/03/12/us/women-coronavirus-greater-risk.html

________(2020) https://nyti.ms/2IA1j5r

NY Times (2020)  https://www.nytimes.com/interactive/2020/04/01/nyregion/nyc-coronavirus-cases-map.html?referringSource=articleShare

Oliveira, AN, Sages, L, Silva, G, Nassif-Pires, L. 2020 “Home Quarantine, Confinement with the abuser?” Multiplier Effect Blog.

Pawlińska-Chmara R, Wronka I. Assessment of the effect of socioeconomic factors on the prevalence of respiratory disorders in children. J Physiol Pharmacol. 2007 Nov;58 Suppl 5(Pt 2):523–9.

Tricco AC, Lillie E, Soobiah C, Perrier L, Straus SE. Impact of H1N1 on socially disadvantaged populations: systematic review. PLoS One. 2012 Jun 25;7(6):e39437.

 

[1] https://www.nytimes.com/interactive/2020/04/01/nyregion/nyc-coronavirus-...

 

[2] For this exercise we perform a local polynomial regression between an estimated health risk index, constructed through principal component analysis, and the percentage of population living below two times the poverty line in census tracts, for figure 1, and between the health risk index and percentage of non-white population for figure 2. For details on the methodology or on the data please contact lnassifpires@levy.org.

 

[3]  https://www.sixthtone.com/news/1005253/domestic-violence-cases-surge-during-covid-19-epidemic

http://multiplier-effect.org/home-quarantine-confinement-with-the-abuser/

 

[4]  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5486977/

 

[5] From Bureau of Labor Statistics’ National Business Employment Dynamics Data by Firm Size Class, Table F. https://www.bls.gov/web/cewbd/table_f.txt, accessed March 30, 2020.

 

A Generational Crisis: Restructuring America’s Social Insurance System to Better Protect Young People

Published by Anonymous (not verified) on Wed, 01/04/2020 - 5:04am in

In the last three weeks, it has become clear that millennials are going to experience a second major recession in their working lives before they turn 40. Even before the COVID-19 crisis, it was widely documented that this generation—ages 24 to 39 and the most racially diverse adult cohort in history—was experiencing long-term harms from the 2009 financial crisis. The economic scars of the last recession were already affecting young people’s ability to save, invest, and start families; now, those scars are reopened wounds. And, unless the government takes a very different approach to our current crisis than it did in 2009, the class of 2020 can look to millennials for what their economic future holds. 

The generational crisis that millennials face (and Gen Z appears to be teetering on the brink of) should spur us to think about how we can restructure the social insurance system to protect young people from macroeconomic shocks to their working lives. Typical responses to economic downturns focus on seniors’ lost savings and the lost wages of the newly unemployed. But a comprehensive safety net should cushion the long-term blow of entering the job market in a bad economy just as it does for injury and illness. Far from making this kind of structural change, the policy response to the last recession exacerbated the downturn’s long-term effects on millennials by pushing them to take on huge amounts of student debt. If legislators write policies that factor labor market conditions at job-market entry into the social insurance system now, they could rectify this past failure and ensure that future generations do not suffer a similar fate.     

At this point, we have quite a bit of data on the effects of recessions on job market entrants. One leading study on this topic, by economist Lisa Kahn (no relation), found that for every percentage increase in the unemployment rate, the wages of college graduates entering the labor market were reduced by 3 to 4 percent a year. Eighteen years after graduation, the effect was still roughly 2.5 percent. This amounts to a loss of nearly $80,000 over the first 20 years of a person’s career. Furthermore, a study for the National Bureau of Economic Research (NBER) showed that the labor market entrants hardest-hit by the unfortunate timing of entering the labor market during a recession are those with the lowest predicted earnings (namely non-white and non-college graduate workers). Additionally, cohorts that enter the workforce in a recession have low employment rates even after the recession ends. This compounds into significant wealth effects for these disadvantaged cohorts, exacerbating existing—and persistent—racial and gender wealth gaps. According to a 2016 report from the St. Louis Fed, the Great Recession reduced wealth levels for people born in the 1980s by 34 percent. 

Despite these stark facts, relatively little aid is targeted at these cohorts. Unemployment insurance (UI), the existing social insurance program designed to protect workers from macroeconomic shifts, does not protect against the bad luck of entering the workforce during a recession as opposed to a period of growth. Unemployment benefits are not available to new job-market entrants, nor do they make up for the lifetime of lower wages for those who are able to find a job. As a society, we have never considered the long-term impact of macroeconomic conditions at labor-market entry important enough to address through social insurance. Millennials’ experience should change this.  

To their credit, Democratic members of Congress made attempts in the recent stimulus package to address the needs of young people. In addition to proposing to cancel some student debt, they included a “job entrant compensation payment” for individuals whose work history is insufficient to qualify for unemployment insurance, but who would be entering the workforce were it not for the pandemic. This provision did not make it into the final package. Broadening the unemployment insurance system to include new labor-market entrants is important, as a recent report on a 21st century UI system made clear, but it does not address the long-term wealth effects of entering the labor market in a recession. 

We need big ideas that address the long-term earnings effects of recessions on young workers. For example, the Social Security formula could be changed to increase the benefit of those who enter the labor market during a recession. Right now, Social Security benefits are calculated as a percentage of a person’s average indexed monthly earnings (AIME) during their 35 highest-earning years. This formula could be changed to increase the percentage of the AIME a person receives based on the national unemployment rate early in their career. Ultimately, building economic conditions at labor-market entry into the Social Security formula could compensate for the wealth effects of entering the labor market in a recession. 

Another idea might be creating a job-market entrants’ tax credit triggered by employment numbers dipping below a preset level. The tax credit could be structured to last 15-20 years—the typical length of recession wage effects on job-market entrants—tapering as recipients spent longer in the labor market. Structured in this way, a tax credit would directly address the long-term wage loss job-market entrants experience in a recession, allowing them to build wealth at a similar rate to more-advantaged cohorts. It could also be increased if the same cohort faced another recession, as millennials now are. 

The social insurance system exists to protect individuals from economic events beyond their control, but it insufficiently protects new labor-market entrants. The ideas proposed here should be considered, though they alone are not necessarily the answer. As millennials face the second major recession of their early working lives, it’s time to figure out how to build progressive, comprehensive protections for young workers into our social insurance system. 

The post A Generational Crisis: Restructuring America’s Social Insurance System to Better Protect Young People appeared first on Roosevelt Institute.

Corporate America Owes Black Women A Lot. We All Do.

Published by Anonymous (not verified) on Tue, 31/03/2020 - 11:01pm in

Janelle Jones, the managing director of policy and research at Groundwork Collaborative, has coined what she calls a personal motto and economic ideology: “Black women best.” She means that if Black women—who, since our nation’s founding, have been the most disadvantaged by the rules that structure our society—can one day thrive in the economy, then it must finally be working for everyone.

A new Roosevelt report by Michelle Holder, assistant professor of economics at John Jay College, adds to the chorus of research showing that today’s economy isn’t working for Black women—and is actually robbing them of economic security. 

This was true before the COVID-19 crisis began, and it’s especially true now—given that tens of millions of people are out of work. “We know from the last recession that the Black workers are often the first fired,” notes Rebecca Dixon, executive director of the National Employment Law Project. And NBC’s Janelle Ross warns that “people of color make up a disproportionate share of workers in the industries where layoffs are the most intense and only expected to get worse.” Imagine if Black women had more of what they earned to rely on during this time of economic stress. Where’s their unconditional bailout?

When it comes to work, Black women are confronted with both the gender wage gap and the racial wage gap. In measuring what she has dubbed the “double gap,” Holder estimates that these two trends in pay discrimination cost Black women—and saved (already profitable) US companies—$50 billion in involuntarily forfeited wages in 2017 alone. “Since profit is equal to revenue [minus] expenditures, the implication is that the double gap faced by African American women has been beneficial for corporate profits,” she notes. 

We are living in an era of record-high corporate profits, and the growth in worker productivity over time deserves a lot of credit. The problem: Worker pay has barely budged—for decades. “Since 1979, pay and productivity have diverged,” shows the Economic Policy Institute. In fact, productivity rose six times more than pay from 1979 to 2018. “This means that although Americans are working more productively than ever, the fruits of their labors have primarily accrued to those at the top and to corporate profits, especially in recent years.” Guided by a shareholder-first mentality, this is the result of corporate executives who are encouraged to cut costs and boost revenue, choosing to neglect the very people, including workers—of all races—who deserve a greater share of and more of a say over the value they help create.

Though Black women have historically had the highest national workforce participation rate “among major female demographic groups in the US,” as Holder notes, centuries of exploitation and crowding into low-wage occupations have left them particularly vulnerable to labor market discrimination, outsized employer power, and corporate attempts to hoard profits—all of which carry consequences that manifest well beyond the workplace. 

“The findings from [my] research suggest that African American women’s labor power is largely undercompensated by employers, with tangible implications for income and asset-building in the Black community,” writes Holder. For TIME, my Roosevelt colleague Andrea Flynn elaborates: “Nationally, Black women earn 61 cents for every dollar earned by white men . . . These wage disparities take an extraordinary toll over the course of an individual’s life, and one 2017 study shows that over a 40-year career, women overall lose $418,800 as a result of the wage gap, with women of color losing almost $870,000.” 

Ultimately, pay inequality is very real for far too many, and corporations are choosing to be complicit. Holder points to potential solutions, including rethinking salary and promotion negotiations, but the reality is that Black women can’t do this alone. 

Like most of our problems today, the double gap is a structural issue that requires a rebalance of power. Expecting US companies to pay workers, especially Black women, what they’re worth ignores the reality of who our economy is working for and who it is working against. Until Black women are made whole, none of us are. 

The post Corporate America Owes Black Women A Lot. We All Do. appeared first on Roosevelt Institute.

Cartoon: Choose your pandemic plan

Published by Anonymous (not verified) on Tue, 31/03/2020 - 10:50pm in

The virus is, of course, infecting rich and poor alike. And it's just a fantasy that you can buy private insurance against a pandemic. But America's class divide is still manifesting itself in predictable ways. There is, according to this NYT article, a healthcare concierge service for the very rich and sick that costs $80,000 every six months.

The firm has helped clients arrange tests in Los Angeles for the coronavirus and obtained oxygen concentrators for high-risk patients.



“We know the top lab people and the doctors and nurses and can make the process efficient,” said Leslie Michelson, the firm’s executive chairman.

The fourth panel touches on the insane Trump tweets and pressers, where he has implied he's withholding medical supplies from states with governors he feels are not sufficiently deferent.

As some of my newspaper clients are shrinking or shutting down right now, if (and only if) you are able, please consider joining the Sorensen Subscription Service

Follow me on Twitter at @JenSorensen

Book Review: The Meritocracy Trap by Daniel Markovits

Published by Anonymous (not verified) on Mon, 30/03/2020 - 10:52pm in

In The Meritocracy Trap, Daniel Markovits argues that rather than aiding social mobility, the concept of meritocracy has become the single greatest obstacle to equal opportunities in the United States today. This provocative book marshals extensive evidence to show the tenacity of meritocracy’s narrative pull and how easy it is to get entangled in its logic, writes Phil Bell, yet its diagnosis is more compelling than its proposed solutions. 

The Meritocracy Trap. Daniel Markovits. Penguin Press. 2019.

Meritocracy is a reliable story. In The Meritocracy Trap, Daniel Markovits argues that this endlessly repeated cultural script is damaging partly because it is so consistent. The term ‘meritocracy’, where society is governed based on achievement, was coined by Michael Young in 1958 as a warning. Since then it has become the overwhelming organising principle of our education system and job market, leading to a proliferation of testing, a premium on college education and a fetishisation of credentials. Markovits’s The Meritocracy Trap is a radical critique of this logic and the institutions it has created. Meritocracy is seen by many as fair but, according to Markovits, it is more than counterproductive. Indeed, ‘meritocracy has become the single greatest obstacle to equal opportunities in America today.’  

The Meritocracy Trap is based on the author’s long-time personal experience of meritocracy as a Professor at Yale Law School and he sees the US as an extreme example of a broader global phenomenon. He marshals extensive evidence, from both interviews and academic research from numerous disciplines, referenced in detailed endnotes, to make a polemical case.

Markovits lays out substantial evidence to show that parenting and the education system are stacked in favour of the elites, guaranteeing their offspring human capital. This, he argues, is now more important than inheriting property or financial assets, because it reaps even more significant dividends. An elite education, which involves admission to a top preschool, a private secondary school, university and then graduate school, will likely confer an elite job with a six-figure salary. This investment in education, Markovits calculates, should earn an individual $10 million over their lifetime.

Markovits’s heroes are the middle class, the people who defined mid-century American social mobility but are now expelled from the ‘charismatic centre of economic and social life’ by meritocracy. In contrast to the British usage of this term, he uses middle class to encompass ‘working people without formal degrees or professions’: for example, a ‘unionised auto worker.’ Education is the key division between the middle class and elites. The middle class have not benefited from the substitution of in-work training by college education and the proliferation of job applications and job interviews, which have served to fetishise credentials and to benefit elites. St Clair Shores, a town in Michigan, was a microcosm of Markovits’s mid-century middle-class ideal. In this suburban town near Detroit, 18-year-olds were once hired by one of three big automakers for $100 per week (equivalent to $40,000 a year now). Without needing a degree from high school, a college degree or endless job applications, they were given unionised jobs and trained as tool and die makers. They could expect salaries to rise to up to $100,000 per year, with benefits. Meritocracy now suppresses this sort of opportunity and aspiration, Markovits argues.

However, in contrast to traditional analyses of inequality, Markovits sees highly skilled people on high incomes as equally consumed by meritocracy’s trap. Markovits talks to corporate lawyers who work 120-hour weeks and are under high pressure to maintain their place in the meritocratic system. Elites are really ‘high class conscripts’. However, Markovits goes further, arguing that ‘8 of 10 richest Americans today owe their wealth [ …] to compensation earned through entrepreneurial or managerial labor.’ Though these meritocrats primarily gain their wealth through wages, the extraordinary size of their salaries fuels inequality. Markovits’s analysis differs from other analyses of inequality, such as the equation at the heart of Thomas Piketty’s Capital in the Twenty-First Century: ‘R>G’ (when return on investment is greater than economic growth, this creates runaway inequality). Markovits does not emphasise the fact that, though high wages are earned, they are also multiplied through the mechanism Piketty articulates, creating inordinate wealth.

Crucially, though, the extraordinary work ethic of elites has changed the way inequality is justified. Meritocracy ‘frames disadvantage in terms of individual defects of skill and effort’ which serves to ‘dissolve resistance’ and leads to a ‘politics of humiliation’, where an inability to get a job or pay the rent is seen as a personal failure rather than a structural flaw. The suppressed anger this generates, in turn, opens the door to reactionary populist narratives that vilify meritocratic elites for self-serving hypocrisy and ‘in particular [… their] embrace of a multi-cultural elite’, given their unwillingness to acknowledge the unfairness of a credentialised meritocratic system. Cue Donald Trump’s famous line: ‘I love the poorly educated.’ Markovits also takes a different tack to those scholars who have written that the so-called ‘skills biased technological change’ will mean an inevitable hollowing out of middle-income jobs. This is all part of the plan, Markovits provocatively argues:

The appearance of super-skilled finance workers induced the innovations that then favoured their elite skills. A rising supply of meritocrats stimulates its own demand.

In other words, meritocrats are bending the skills needed for elite jobs in their favour.

Markovits shows the tenacity of meritocracy’s narrative pull and how easy it is to get entangled in its logic. He also demonstrates that our university and job admissions processes are in a bind. They simultaneously respect merit, but also recognise that merit is not a fair assessment. Markovits writes of groups of underrepresented university students that ‘meritocracy possesses such ideological power that these groups cannot decide whether to aim to bring down the class structure or to ease their members’ paths into the elite’. His analysis forces us to ask challenging questions: is education really a force for social mobility? Is affirmative action actually feeding into meritocracy’s all-pervasive logic?

Given how radical Markovits’s critique is, his solutions are surprisingly tame. The first reform dimension Markovits proposes is to make the education system fairer. Education ‘must become open and inclusive’, admissions ‘less competitive’ and ‘training less all-consuming’. Private schools and universities should lose tax-exempt status and Ivy League schools should be ‘doubling enrolments (drawing new students mostly from outside the elite)’. Secondly, ‘a parallel agenda’ would seek to rebalance the economy back in favour of ‘mid-skilled production’: for example, boosting jobs for ‘nurse-practitioners’ rather than doctors. This would involve wage subsidies for middle-class jobs and tax incentives, especially getting rid of the payroll tax (the 12.4 per cent tax on a person’s first $132,900 of wages that funds social security), which makes middle-class labour more highly taxed. These two prongs of policy show that ‘the rich and the rest cannot escape the meritocracy trap except jointly’.

This prognosis does not seem to follow from the analytical diagnosis offered in the preceding chapters. Markovits powerfully lays out that meritocracy itself is the trap. He argues that the knowledge economy is being curated by elites to exclude the middle class. However, none of these solutions decisively breaks with the power of meritocracy’s narrative. Indeed, it is not enough to provide policy solutions alone. Markovits has pointed out the power relations that shape the structural nature of meritocratic inequality, but his theory of how to change this offers no comment on power. He observes that ‘Policymakers [should…] always attend to how their choices will impact the balance between elite and middle-class jobs’, but he provides no explanation of the political forces necessary to make this change.

He does point out in the postscript to the UK edition that the UK Labour Party, under Jeremy Corbyn, shifted from talking about social mobility to social justice. But Markovits does not go into detail about what this may mean, or comment on the steps necessary to make this happen. How can we, as a society, compose non-meritocratic cultural scripts about self-worth, when the institutions which shape these narratives are run by meritocrats? Though Markovits provides a compelling list of policies, this is just solutionism that evades the problem so persuasively detailed in the book: that meritocracy is a system deliberately designed to prevent social mobility.

The Meritocracy Trap is a provocative book that views inequality and social mobility through a wide-ranging and interdisciplinary perspective. It offers challenging arguments to the traditional way in which the inequality story is told. Given how compelling this is, therefore, it is disappointing that a path to transforming meritocracy is not investigated with the author’s own theoretical framework in mind.

Note: This review gives the views of the author, and not the position of the LSE Review of Books blog, or of the London School of Economics.

Image Credit: Image by mohamed Hassan from Pixabay.

 


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