Human Rights Promotion (5): When Human Rights Leave a Bad Taste in Your Mouth, Ctd.

Following up on a previous post, here’s one additional example of things human rights defenders normally reject but still feel forced to accept as the better one of two terrible options: in some cases, life in prison seems to be better than freedom.

Life goes on for inmates … They adapt to prison. They are able to acquire privileges through good behavior. They enjoy recreational opportunities, a social life, and family visits. They receive food, shelter, and medical care at state expense. By contrast, research on life after even relatively short stays in prison suggests that ex-inmates typically face extraordinary, long-term challenges to reintegration and a return to the level of well-being they enjoyed before prison. … [A] study [finds] that black men survive longer inside prison than outside it. (source, source, source)

None of this means that it’s good to keep people in prison – and yet, given our failure to guarantee human rights for minorities, ex-inmates and poor people, being in prison does have certain advantages. This should go some way to explaining this bizarre story:

Unemployed and without health insurance, [a] man in North Carolina has himself arrested in order to receive treatment. … It was not perhaps the most obvious way of getting a bad back, arthritis and a dodgy foot seen to. But if you’re unemployed in North Carolina with no health insurance, there is no obvious way.

So on 9 June James Verone left his Gastonia home, took a ride to a bank and carried out a robbery. Well, sort of.

What he did was hand the clerk a note that said: “This is a bank robbery, please only give me one dollar.” Then, as he later told the local NBC news station, he calmly sat in the corner of the bank having told the clerk: “I’ll be sitting right over there in the chair waiting for the police.” …

He told the paper he had lost his job after 17 years as a Coca-Cola delivery man, and with it his health insurance. He was in increasing pain from slipped discs, arthritic joints, a gammy foot and a growth on his chest.

Since being in the jail he has attained his goal: he has been seen by nurses and an appointment with a doctor is booked. (source)

It’s a sorry state of affairs that people want to be in prison because being in prison is better than their life outside.

The Causes of Poverty (48): Overpopulation

It looks like we’re about to have another large famine, and so – right on cue – we’re hearing the familiar chorus of overpopulation. Equally predictable, I promised myself that this will be the last time that I drag my feet towards yet another rebuke of the Malthusians whose visions of the human flood always seem to cloud their perception of the facts.

The world’s population is estimated to continue its current growth path and to reach 9 billion in 2050, after which stabilization and even decline are likely. Those worrying about overpopulation claim that we can’t possible feed all those new people and that a decline in the numbers, if it will come, will come too late. A Malthusian catastrophe is inevitable without strong measures to reduce the number of human beings. However, that turns out to be a very simplistic assumption. There’s no good reason why humanity can’t feed one or two billion more members:

So long as plant breeding efforts are not hampered and modern agricultural technology continues to be available to farmers, it should be possible to produce yield increases that are large enough to meet some of the predictions of world food needs, even without having to devote more land to arable agriculture. (source)

The latter point also debunks the myth that population growth will inevitably mean increased deforestation and desertification.

Likewise, an excess number of people in a certain area isn’t the cause of current food shortages, and neither was it the cause of historic famines. A combination of climate factors, bad governance and infrastructure, the failure or inability to adopt modern farming technologies and panic hoarding produced those shortages. (Read also the work of Amartya Sen if you haven’t already done so).

If food production can keep up with expected population growth, maybe the problem is water. There’s indeed a water crisis in many parts of the world, but again it’s not population numbers that create the problem, but inefficient irrigation, excessive meat consumption and careless use. Rather than trying to limit the world’s population – which is very difficult anyway because it seems to require dictatorial government and has unexpected harmful consequences – one should tackle inefficiency and waste and focus on the development and improvement of fresh water production. Those objectives are eminently doable.

So, if water and food will be OK – notwithstanding the odd local famine that is likely to occur with any given number of human beings populating the earth – maybe a general increase of the world’s population will lead to pressures on poor countries’ healthcare systems? More children without extended healthcare systems means increased child and maternal mortality. However, current population increases go hand in hand with radical improvements in child and maternal mortality rates, so why would future increases be any different?

And don’t get me started on migration flows. The supposed harm done by migration is one of the biggest lies out there, on a par with overpopulation rhetoric.

More on overpopulation here.

Measuring Human Rights (16): The Right to Healthcare

(There’s a more theoretical post here about the reasons why we should call health care a human right. But even if you think those are bad reasons, you may find the following useful).

The right to health care is one of the most difficult rights to measure. You can either try to measure people’s health directly and assume that good health means good health care, or you can measure the provision of health care and assume that there will be good health with a good health care system. Doing the latter means, for example:

  • measuring the number of health workers per capita for countries
  • measuring the quality of hospitals
  • measuring health care spending by governments
  • measuring the availability and affordability of health care
  • measuring the availability and affordability of health insurance
  • etc.

Doing the former means:

  • measuring life expectancy
  • measuring infant mortality
  • measuring maternal mortality
  • measuring calorie intake
  • measuring the incidence of certain diseases
  • measuring the survival rates for certain diseases
  • etc.

Needless to say that every single one of these measurements is fraught with problems, although some more so than others. Even if you’re able to have a pretty good measurement for a single indicator for a single country, it may be difficult to compare the measurement across countries. For example, health insurance is organized in so many different ways that it may be impossible to compare the level of insurance across different countries.

But let’s focus on another measure. Life expectancy is often used as a proxy for health. And indeed, when people live longer, on average, we can reasonably assume that they are healthier and that their health care system is better. It’s also something that is relatively easy to measure, compared to other indicators, since even developing countries usually have reasonably good data based on birth and death certificates. And yet, I say “relatively” because there are some conceptual and definitional problems:

  • Exceptional events such as a natural disasters or a war can drag down life expectancy numbers, but those events need not influence health in general or the quality of health care.
  • Wealthy countries may have more deaths from car accidents than poorer countries, simply because they have more cars. This will pull their relative life expectancy down somewhat, given that younger people are more likely to die in car accidents. And if you use life expectancy to measure health you’ll get a smaller health gap compared to poorer countries than is the case in reality (at least if life expectancy is not corrected for this and if it’s not supplemented with other health indicators).
  • How are miscarriages counted? If they are counted as child mortality, they drag down life expectancy rates compared to countries where they are not counted.
  • What about countries that have more homicides? Or suicides? Although the latter should arguably count since suicides are often caused by bad mental health. If a country’s life expectancy rate is pulled down by high suicide rates, life expectancy rates are still a good indicator of health and of the quality of health care, assuming that health care can reduce suicide rates and remove, to some extent, the underlying health causes of suicide. However, homicides are different: a country with a very good health care system, a very high level of health and a high murder rate can have its health rating pulled down artificially when only life expectancy is used to measure health.
  • Differences in diet and other types of risky behavior should also be excluded when comparing health and life expectancy across countries. It’s wellknown, for instance, that obesity is more of a problem in the U.S. than in many countries that are otherwise comparable to it. Obesity drags down life expectancy and reduces the average level of health, so life expectancy rates which are not corrected for obesity rates are still a good measure for health, but they are not a good measure for the quality of the U.S. health care system. If you want to use life expectancy rates to compare the quality of health care systems you’ll have to correct for obesity rates and perhaps for other types of risky behavior such as smoking or the absence of exercise. Maybe the U.S. health care system, even though it “produces” somewhat lower life expectancy rates than in comparable countries, is actually better than in other countries, yet still not good enough to offset the detrimental effects of high average obesity.

Hence, uncorrected life expectancy rates may not be such a good indicator of national health and of the quality of a national health care system. If we return to the case of the U.S., some of this may explain the strange fact that this country spends a lot more on health and yet has somewhat lower life expectancy rates than comparable countries.

Or maybe this discrepancy is caused by a combination of some misuse and waste at the spending side – more spending on health doesn’t necessarily result in better health – and some problems or peculiarities with the measurement of life expectancy. Let’s focus on the latter. As stated above, some cultural elements of American society, such as obesity, pull down life expectancy and worsen health outcomes. But there are other peculiarities that also pull down life expectancy, and that have nothing to do with health. I’m thinking of course of the relatively high levels of violence in the U.S. Death by assault is 5 to 10 times higher in the U.S. than in comparable countries (although those numbers tend to go down with the passing of time). This affects younger people more than older people, and when more young people die, life expectancy rates drop sharper than when more old people die.

However, even if you correct U.S. life expectancy rates for this, the rates don’t move up a lot (see here). The reason is that the numbers of deaths caused by homicide pale in comparison to other causes. Obesity levels, for instance, are a more important cause. But correcting life expectancy rates for obesity levels doesn’t seem appropriate, because we want to measure health. If you leave out all reasons for bad health from life expectancy statistics, your life expectancy rates go up, but your average health doesn’t. Obesity isn’t the same as homicide. Correcting life expectancy statistics for non-health related deaths such as homicide makes them a better indicator of health. Removing deaths from obesity doesn’t. If you have life expectancy rates without obesity, they may be a fairer judgment of the health care system but not a fairer judgment of health: a health care system in a country with a lot of obesity may be equally good as the one in another country and yet result in lower life expectancy. The former country does not necessarily have lower life expectancy because of its underperforming health care system – we assumed it’s of the same quality as elsewhere – but because of its culture of obesity.

However, if you really want to judge health care systems, you could argue that countries plagued by obesity should have a better quality system than other countries. They need a better quality system to fight the consequences of obesity and achieve similar life expectancy rates as other countries that don’t need to spend so much to fight obesity. So, life expectancy is then reinstituted as a good measure of health.

Racism (10): Race and Health

African Americans in the U.S. are more likely to die of cancer. It seems that a similar disparity exists for strokes and lead poisoning.

Many ethnic groups have a higher death rate from stroke than non-Hispanic whites. Although the death rate from stroke nationwide dropped 70% between 1950 and 1996, minorities the decline was greatest in non-Hispanic whites. The greatest number of stroke deaths compared to whites occurred in African-Americans and Asians/Pacific Islanders. Excess deaths among racial/ethnic groups could be a result of a greater frequency of stroke risk factors, including obesity, hypertension, physical inactivity, poor nutrition, diabetes, smoking and socioeconomic factors such as lack of health insurance. (source)

Lead poisoning causes, i.a., cognitive delay, hyperactivity, and antisocial behavior.