Economic Human Rights (28): The Health Consequences of the Recession and of Unemployment

The Economist called it the “unsurprising research finding of the day“, but I think it’s a useful confirmation of an existing intuition: this paper finds that the recession can have a beneficial effect on the health of some people who lose their job because of it, namely those people spending their new leisure time in a healthy way. Other people, however, spend their leisure time cultivating some of their pre-existing unhealthy habits, or find themselves depressed and without employer-provided healthcare (especially in the U.S.). Because their healthcare has become more expensive now that they are unemployed, they decide to go without treatment or tests.

Results showed the body mass of the average laid-off food-lover increasing by the equivalent of more than 7 pounds for a 5-foot, 10-inch man weighing 180 pounds during unemployment. Similarly, frequent drinkers on average doubled their daily alcohol intake after losing their jobs and before finding another one. (source)

Elsewhere in the world, and especially sub-Saharan Africa, it seems that the health consequences of the global recession are more dramatic:

The financial crisis will kill between 28,000 and 50,000 babies in sub-Saharan Africa this year, according to this paper. The reasoning here is straightforward. For people on subsistence incomes, a fall in GDP can be fatal. The paper’s authors, Jed Friedman and Norbert Schady, estimate that a one percentage point fall in per GDP across sub-Saharan Africa is associated with a rise in infant (defined as under-ones) mortality of between 0.34 and 0.62 per 1000. If we multiply this increase by the number of births this year and by the 2.4 percentage point difference between GDP growth this year and last (a reasonableish estimate of the effect of the crisis), we get a figure of between 28,000 and 50,000. … Of course, you can quibble with the numbers. But the general story holds. For the poor, income is a matter of life or death. Which brings me to my question. If one-in-seventeen British babies were to die this year because of the financial crisis, it would be the biggest media story for years and there’d be rioting in the streets until the government did something. So, why the silence? Chris Dillow (source)

Income Inequality (9): Absolute and Relative Poverty

The problem of poverty and related problems such as income inequality have received a lot of attention on this blog, because I consider poverty to be one of the most urgent human rights problems. Now and again, I’ve also mentioned the possibility of distinguishing between different types of poverty, and one such possibility in particular, namely the difference between absolute and relative poverty. Absolute poverty meaning the lack of basic resources, and relative poverty meaning income inequality.

I’ve taken the view that absolute poverty is a more urgent priority than relative poverty, and that therefore measurements of income inequality – such as the Gini coefficient – are less relevant than measurements of absolute poverty – such as the $1 a day measure. It’s the absolute income of people that matters, not the fact that other people are richer than you are and can afford more luxuries, at least from a human rights point of view (the absence of a certain minimum amount of basic resources is a human rights violation in itself and renders many other human rights meaningless).

Inequality of wealth or income is less urgent than the fight against absolute poverty, and a lot of opposition to income inequality can be easily categorized as the politics of envy. If inequality really matters it is the inequality of opportunity and other types of inequality not related to wealth (<discrimination for example).

But this is perhaps putting it too strongly. There are negative effects of high levels of income inequality, for example on the adequate functioning of democracy. There is also a correlation between relative poverty and absolute poverty: countries with relatively unequal income distribution don’t score well on absolute poverty measures either.

Richard Wilkinson has pointed out, some time ago already, that relative poverty matters. Once economic growth has pushed up absolute (albeit average per capita) income levels and done away with penury, people tend to be more healthy and live longer if levels of income inequality are relatively low. Countries with lower per capita income levels but also lower income inequality, can do better in terms of public health than high income countries with higher levels of income inequality. Poorer countries with a more equal wealth distribution are healthier and happier than richer, more unequal ones. There’s also a link between inequality (measured not by Gini but by way of the concentration of wealth in the 10% richest people) and both life expectancy and child mortality.

Some of the reasons for this are the stress of living at the bottom of the pecking order, the stress of disrespect and the lack of esteem and respect (including self-respect).

Economic Human Rights (14): Health

Health is a human rights issue in two respects. First, people have a right to health care and health insurance. Article 25 of the Universal Declaration states that

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

The International Covenant on Economic, Social and Cultural Rights is more specific. Article 7 guarantees the rights to safe and healthy working conditions. Article 10 deals with child labor:

The employment of children in work harmful to their morals or health or dangerous to life or likely to hamper their normal development should be punishable by law.

Article 12 states:

1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: (a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; (b) The improvement of all aspects of environmental and industrial hygiene; (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.

The second way in which health is a human rights issue is the fact that good health is a precondition for the enjoyment of all human rights. In this way, bad health is similar to poverty. You have to be healthy and without pain in order to be able to use freedom rights and political rights. A sick, suffering or toiling person is thrown back upon himself and unable to relate to the outside world, just as a person who concentrates exclusively on his or her body for pleasurable reasons. Intense bodily sensations of any kind – positive and negative – shut us off from the world, because they make it impossible to perceive anything except our own body. In other words, they make the use of our classical rights impossible or undesirable.

Children’s Rights (1): Infant Mortality

Infant mortality is the number of deaths of children aged one year or younger, per 1000 live births. This gives the Infant mortality rate (IMR). The rates have significantly declined over the last centuries, mainly due to improvements in basic health care, and in all regions of the world.

However, there’s still a long way to go, especially in developing countries. In several African countries as well as in India, 1 in 10 babies die before they reach the age of 1. That’s horrendous.

Inequalities are extreme: Angola had the highest IMR in 2007: 184. And Sweden the lowest: 2.8. In a country like Bangladesh, 153,000 newborns die each year. Multiply this with the number of non-newborns death before the age of 1, and with a number of similar countries, and with a number of consecutive years, and you have an enormous massacre.

The most common causes in developing countries are pneumonia and dehydration from diarrhea. The latter cause is a real scandal given the ridiculously easy remedy: Oral Rehydration Solution, or ORS, a mixture of salts, sugar, and water. In developed countries the causes are congenital malformation, birth defects, extreme prematurity, disease, and Sudden Infant Death Syndrome (SIDS). Neglect, abuse or outright murder are also important causes.

The infant mortality rate is an indicator of state failure. As the IMR indicates the level of a country’s health, health care system or development, an extremely high IMR can corroborate the statement that a particular state is a “failed state” in the sense that it fails in its basic responsibilities to its citizens. Not surprisingly, wealthy countries – wealthy in the commonly accepted sense of high GDP per capita – have a lower IMR because they have the means to invest in healthcare, sanitation, drugs etc.

I guess it’s obvious why this is a human rights issue: you can hardly say that people can enjoy their human rights when they die before they are 1. Of course, it’s not as if someone is directly violating these children’s right to life. Infant mortality is in most cases not a deliberate act. But rights can be violated by act as well as omission. In many cases, it’s easy to prevent the child from dying, and those who have the power to do something about it also have the responsibility.

Economic Human Rights (8): Poverty

Poverty is a violation of human rights. Article 25 of the Universal Declaration states:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

And we all know the devastating effects of poverty on other human rights.