The Causes of Poverty (45): Bad Luck

Some of the poor are victims of bad luck. That’s not something which is sufficiently understood. Agreed, others dig their own grave or get their graves dug by crooked capitalists, unfair international rules, overly optimistic financial institutions causing a global economic crisis, heartless politicians etc. However, there are cases in which the link between someone’s actions or intentions – self-regarding or other-regarding – and someone’s poverty is very weak indeed and in which it’s better to say that it’s a good dose of bad luck that drives people over the brink. And I’m not just thinking about the guy losing his job because of illness or accident.

The data are very clear. In essence, if you have the bad luck of being

then you’ll earn less, sometimes a lot less than average, and you’ll run a higher risk of becoming poor.

Maybe you would reply that people with some of these characteristics don’t earn less because they had the bad luck of being born like that – e.g. black, female, short etc. – but because employers are racist or prejudiced against women or short people. True, but not always. Poverty rates among blacks in the U.S. are a lot higher than average, but only part of this gap can be explained by racist employers. Other parts of the explanation, such as education levels, statistical discrimination etc., can’t be linked immediately or exclusively to racial bias.

Or maybe you would reply that some people have themselves to blame for some of their harmful characteristics, e.g. being obese or a single mother. That, in other words, these characteristics are chosen and self-inflicted and not a matter of bad luck. That is also only partly true. Obesity can be genetically determined, and single parenthood can be the result of misguided policies such as the war on drugs.

More posts in this series are 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.

The Causes of Poverty (29): Overview

Our research shows that if you want to avoid poverty and join the middle class in the United States, you need to complete high school (at a minimum), work full time and marry before you have children. If you do all three, your chances of being poor fall from 12 percent to 2 percent, and your chances of joining the middle class or above rise from 56 to 74 percent. (We define middle class as having an income of at least $50,000 a year for a family of three). Isabel V. Sawhill and Ron Haskins (source, source)

However, that seems to be a bit reductionist. There are many other possible causes of poverty. Some more convincing than others. For example, here’s Montesquieu according to whom people in hot places are simply too lazy to become rich:

In Europe there is a kind of balance between the southern and northern nations. The first have every convenience of life, and few of its wants: the last have many wants, and few conveniences. To one nature has given much, and demands but little; to the other she has given but little, and demands a great deal. The equilibrium is maintained by the laziness of the southern nations, and by the industry and activity which she has given to those in the north. (source)

According to Thomas Malthus, poverty is caused by overpopulation. Food and other resources are limited, and a population growth that exceeds a certain pace will inevitably hit a resource ceiling, and will result in decreasing standards of living, poverty, conflict over scarce resources, famine etc.

Max Weber believed that protestant work ethic put protestant nations at an advantage compared to other nations. Certain values, such as the opinion that God will reward those who work hard and save money, or the belief in predestination—getting rich is a sign of God’s approval—make some nations rich and others, that lack these values, poor.

Jeffrey Sachs focuses on geography and weather. In the poorest parts of the world, the soil is nutrient-starved, making it difficult to produce food. Moreover, tropical climates foment disease, particularly malaria. The UK, on the other hand, the country where the Industrial Revolution started, has a fertile soil, a lot of coal, and good waterways.

Daron Acemoglu states that nations are not like children — they are not born rich or poor. Their governments make them that way.

People need incentives to invest and prosper; they need to know that if they work hard, they can make money and actually keep that money. And the key to ensuring those incentives is sound institutions — the rule of law and security and a governing system that offers opportunities to achieve and innovate. … if you wish to fix institutions, you have to fix governments. [People should be able to] enjoy law and order and dependable government services — they can go about their daily activities and jobs without fear for their life or safety or property rights. (source)

There are obviously many more explanations of poverty, both “exotic” and sensible ones. And regarding the latter, it’s extremely difficult to say which ones are more important. Poverty is surely one of the most complex and intractable problems facing humanity. However, if we look at the country that has been most successful in the reduction of poverty – China – then the last quote above seems to be the most convincing one. China still has institutional and legal weaknesses today, but it did start to develop only after it abandoned the follies of the Cultural revolution and communist rule in general, and started to protect property rights and build its government institutions. Which doesn’t mean that institutions are a “silver bullet” solution to the problem of poverty. There’s no such thing, unfortunately.

The Causes of Poverty (26): Hereditary Poverty, Another Poverty Trap

For you always have the poor with you, and whenever you wish you can do good to them; but you do not always have Me. Mark 14:7

For the poor will never cease to be in the land; therefore I command you, saying, “You shall freely open your hand to your brother, to your needy and poor in your land”. Deuteronomy 15:11

As a result of having parents who are poor, children

  • receive substandard education because they enroll in substandard schools (if at all)
  • may be forced to quit school early and start working
  • do not receive quality healthcare (because of the costs)
  • are more likely to be obese, with negative consequences for their health
  • have a lower birth weight, something which also has a negative impact on health.

Growing up in poor families has negative effects on children’s education and health, and these effects in turn make it more likely that these children grow up to become poor as well. And their children will go through the same process, and so on. Hence the concept of hereditary poverty.

Just a few more words on the effect of substandard education. The quality of schools (or better the cost of good schools) and the element of child labor aren’t the only factors limiting the education levels of children in poor families. An interesting article in The Economist points to effects discovered by neuroscience. It seems that stress, induced by poverty, lowers memory capacity, and this lowered memory capacity makes it more difficult to learn and to obtain a good education as a means to escape poverty traps. It’s been well known for a while that stress lowers memory capacity (it reduces the volume of the prefrontal cortex and the hippocampus, parts of the brain associated with memory). However, Evans and Schamberg (see the paper here) showed that stress caused by poverty reduces memory capacity. First they showed that poverty is correlated with higher stress, and then that higher stress is correlated with lower memory capacity. Comparisons of the memory capacities of poor and middle class people showed indeed a difference in memory capacity, and this is caused by poverty induced stress rather than other elements of poverty. Poverty causes stress, which reduces memory, which in turn makes it harder to learn, which in turn makes it more difficult to escape a poverty trap. How does poverty cause stress? Well, there’s the obvious cause: financial insecurity. But low self-esteem caused by poverty (including for children in poor families) also seems to contribute. See this paper for instance.

The poor indeed will always be with us. At least if we don’t help them to get out of the traps in which they find themselves.