connecticut association of human services income, health...

Income, health and race: Two Connecticuts

Connecticut Association of Human Services

Agenda:

• The rise of inequality: – Nationally – In Connecticut – Not just about income –

race. • Why the rise of inequality

should worry us when talking about health.

• Do we really want this?

So…

What are the social determinants of health?

World Health Organization: “The social determinants of health are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems. ”

First: the rich are living longer

• Based on a new Brookings study.

• All men are living longer – but top 10% is adding years faster than the rest.

• For low income women, life expectancy is getting shorter.

First: the rich are living longer

We need to answer: 1. Is inequality increasing? 2. How does inequality

affect health? 3. What can we do about

it?

THE RISE OF INEQUALITY

Inequality: a brief history

• Rampant inequality is a fairly

recent event. • The US was pretty similar to

other countries up to the 1980s • Important: inequality does not

necessarily mean a rise in poverty

Can you spot the outlier? • The US is a

fairly normal country up to the 1980s.

• Top 10% income explodes after that.

Again, this is new: • Real income gains

were very similar to all groups before the 1980s, with the poorest actually doing better.

• Since then… Wealth is going in just one direction.

It is not just the top quintile – It is the top 1%

Wages are stagnant, and have been for some time:

Inequality has increased poverty

War on poverty largely worked for seniors, but wage stagnation and the rise of inequality has really hurt working age adults and kids.

INEQUALITY IN CONNECTICUT

Connecticut is performing worse

• Since 1977, income gains have gone to the wealthiest 1 percent: – Top 1%’s share of total state Adjusted Gross

Income (AGI): 17% to 28%. • Distance from top to bottom quintiles:

– Gap between top and bottom quintile was 3rd smallest in the country.

– In 2007, it was the 46th worst. • Median hourly wages in CT are the same

today as in 1996. • Connecticut is now the 2nd most unequal

Connecticut is performing worse

Connecticut is performing worse

A closer look – who is poor?

White, non Hispanic

African-American

Hispanic

Overall

3

16

6

24

Annie E. Casey Foundation’s “Race for Results” report: • Compares how children are

progressing on key milestones across racial and ethnic groups at the national and state levels.

• The index is based on 12 indicators that measure a child’s success in each stage of life, from birth to adulthood.

Spoiler: Connecticut doesn’t fare too well.

Race and poverty in Connecticut

28%

33%

6%

55%

62%

16%

Black

Hispanic

WhiteChildren below 200% poverty

Children living below poverty level

Where are the poor?

33.2% 45.0%

31.2% 37.4% 36.0%

13.4%

30.1%

30.1%

30.4% 24.0% 24.0%

15.1%

BRIDGEPORT HARTFORD NEW BRITAIN NEW HAVEN WATERBURY CONNECTICUT

< 100% FPL 100-200% FPL

Making things worse: Connecticut’s concentrated poverty

• Connecticut is very income segregated: poor families tend to live in places where a lot of people are poor.

• Harford/West Hartford/East Hartford: – 22.3% live in concentrated poverty

areas, 15th worst in the country. • New Haven/Milford metro area:

– 17.9% live in concentrated poverty areas, 25th worst in the country.

• Bridgeport/Stamford/Norwalk

57%

61%

97%

85%

Black

Hispanic

White

Total

C HILDREN THAT L IVE IN LOW POVERTY AREAS

Concentrated poverty in

Connecticut

Example: Hartford

Hartford: an island of low opportunity surrounded by a sea of “progressive” communities.

How do poor families look like?

7.5%

3.0%

22.9%

12.4%

4.1%

31.3%

All families Married-couple families Female householder, no husband present

FAMILIES IN POVERTY, BY LIVING ARRANGEMENT Families With related children under 18 years

How do poor families look like?

5.30%

17.50%

3.00%

27.40%

15.30%

25.00%

3.50%

2.50%

6.00%

2.40%

11.30%

9.30%

10.70%

1.90%

18.10%

28.20%

5.10%

45.00%

28.80%

44.80%

11.70%

White

Black or African American

Asian

Some other race

Two or more races

Hispanic or Latino origin (of any race)

White alone, not Hispanic or Latino

POVERTY, BY RACE, L IV ING ARRANGEMENT

Female householder, no husband present Married-couple families All families

WHY SHOULD WE WORRY?

Poverty affects social mobility

• A kid born on the bottom quintile has a 1 in 2 chance of growing up to be poor or near poor, even with a high school diploma.

• If they don’t finish HS, 4 in 5 on remaining poor or near poor.

• Unmarried mother: 3 in 4 of remaining poor or near poor.

• Race matters: African American kids have 3 in 4 chance of remaining poor or near poor

Why is this relevant?

Why is this relevant? The characteristics of the place you live in affects mobility.

Positive factors

• Social capital • Two-parent

households • Quality Schools

Negative factors

• Income inequality • Income segregation

by neighborhood: All else being equal, upward

mobility tended to be higher in metropolitan areas where poor families were more dispersed

among mixed-income neighborhoods.

Side note: Barely any effect on social mobility

• High taxes on wealthy • Racial composition • Tax credits • Number of wealthy

people • Cost of higher education

Toxic stress and the cycle of scarcity

• “Scarcity” by Sendhil Mullainathan, a Harvard economist, and Eldar Shafir, a psychologist at Princeton.

• Why the poor are less future-oriented than those with more money?

• Scarcity — not of money, but of what the authors call bandwidth: the portion of our mental capacity that we can employ to make decisions.

Toxic stress and the cycle of scarcity

• Low income families are forced to take decisions under stress constantly.

• They do so in communities without many choices.

• Concentrated poverty becomes

self-reinforcing.

Inequality and health

• It turns out (surprise) that where you are born has big implications in health outcomes.

• Although Connecticut has a very robust* safety net for children, human services can only do so much.

• The economic disparities in childhood linger – and so do health disparities.

• Note of caution: – some health disparities might be due to genetics. – I am a policy guy, not a doctor!

So back at the beginning: the rich are living longer

Why the divergence? • Inequality is

indeed increasing • Access to health

care • Smoking • Obesity • Drug use

Health insurance caveats

• There is some debate on how effective health insurance really is to improve health care.

• “Doesn’t do much” – The Oregon Medicaid Experiment – Natural experiment with Medicaid lottery, two years of data. – Self-reported health improved, lower levels of depression… – … but no impact in indicators like blood pressure or cholesterol.

• “It saves lives” – Romneycare in Massachusetts – Comparing mortality rates between MA and similar counties

elsewhere. – Expanded insurance access prevented 320 deaths a year since 2006. – For each 830 people insured, one life is saved – 2,9% decrease in

li

Risk factors, compared

OECD data, comparing US to other advanced countries regarding risk factors

Indicator Smoking in adults Alcohol consumption

Obesity in adults

Overweight and obesity in children

Australia 4 22 30 * 20 Canada 6 11 29 * 21 Denmark 12 17 10 23 France 30 30 11 13 Germany 23 28 25 * 3 Ireland 16 26 24 * 11 Italy 24 4 4 31 Japan 17 7 1 * 15

Netherlands 13 14 6 7

New Zealand 8 16 32 * 27 Norway 7 5 3 1 Spain 29 20 15 26 Sweden 1 7 7 9

Switzerland 21 22 4 11

United Kingdom 20 19 27 * 32

United States 5 13 34 * 29

Side note: opioids

The big change: white working poor

• Ann Case and Angus Deaton, from Princeton: – As you would expect, every

age and ethnic/racial grouping has continued to see a steady reduction of disease and increase in lifespans for decades.

– One major exception: middle aged (45-54) white people. Since roughly 1998, disease

The big change: white working poor

• Ann Case and Angus Deaton, from Princeton: – As you would expect, every

age and ethnic/racial grouping has continued to see a steady reduction of disease and increase in lifespans for decades.

– One major exception: middle aged (45-54) white people. Since roughly 1998, disease

In case you were wondering…

70.9

73.3

70.6 71.2

71.9

73.7

71.5

72.9

74.4 74.8

70.8

72.2 72.0 73.1

72.0 72.0

78.8 80.4 80.9 81.1 81.1 81.4 81.4 81.5 81.8 82.0 82.2 82.3 82.8 82.9 83.2 83.4

1970 2013

Life expectancy at birth, select OECD countries

In case you were wondering…

Healthy Life Expectancy, Select OECD countries

83 82

80

82 81 81

83 84

81 82 82

83 82

83

81

79

73 72

70

72 71 71

73

75

71 72

71

73 72 72

71

69

Life expectancy at birth (years)Healthy life expectancy (HALE) at birth (years)

So how about Connecticut?

CT: babies born at normal birthweight

88%

92%

93%

92%

BLACK HISPANIC WHITE TOTAL

Social services work ! The state has made a very strong effort on this.

CT: Infant mortality

13.4

12.1 11.9

10.5

8.6 7.7

6.5 7.1

6 6.1

4.2

5.8

3.8 3.8 3.6

2005 2007 2009 2011 2013

Black or African American Hispanic or Latino Non-Hispanic White

Deaths occurring to infants under 1 year of age per 1,000 live births.

Connecticut: Children without health insurance, by poverty level

9%

5% 5%

4%

6%

4% 4%

5%

7% 7%

8%

4%

7%

5%

2%

1%

3% 3%

2009 2010 2013 2014

Below 100% poverty 100 to 149% poverty 150 to 199% poverty

200 to 299% poverty 300% poverty or above

Connecticut: Children without health insurance, by race

4%

6% 6%

5%

9%

6%

5%

6%

4%

1%

3% 3%

2008 2010 2012 2014

Black or African American Hispanic or Latino Non-Hispanic White

Do disparities come back? 32

34

16

21 24

20

14

26 22

16 20 19

16 17 16

0

5

10

15

20

25

30

35

40

2005 2007 2009 2011 2013Black or African American Hispanic or Latino Non-Hispanic White

Connecticut data: Child And Teen Death Rate By Race And Ethnicity (age 1-19, per 100,000)

Do disparities come back?

18% 17%

22%

30%

25%

30%

8% 8% 7%

2003 2007 2011 - 2012

Black or African American Hispanic or Latino Non-Hispanic White

Connecticut data: Children Who Are Not In Excellent Or Very Good Health By Race And Ethnicity

Do disparities come back?

Connecticut data: Children Who Are Not In Excellent Or Very Good Health By Race And Ethnicity

20.2 19.2

15.8 14.3

20.1 18.1

12 11.1

0

5

10

15

20

25

Connecticut State average

LIFE EXPECTANCY AT HEALTHY LIFE EXPECTANCY AT 65

LE, White HLE. White LE, Black HLE, Black

Why the persistent disparities?

A hint: • where you live

matters • Black, Hispanic

kids more likely to live in urban areas with higher pollution.

Poverty takes its toll

• Food insecurity – low income children are much more likely to live in food insecure households.

• Obesity: – 31% of Hispanic children are overweight or obese, 44% black. – 22.1% Whites are overweight and obese. – For Kindergarten: 26.8% Whites, 41% Blacks, 43% Hispanic. – WIC evens out this number considerably, but doesn’t reach everyone.

• Lead poisoning, exposure to chemicals: – Blacks are twice as likely to be exposed to lead, Hispanics 50% more. – “Thankfully”, mostly due to paint, dust, soil – not water.

WHAT CAN WE DO?

Ensuring opportunity for all

What are the policy and program solutions? Place: • Urban agenda to attract jobs, reform

schools and taxes, and improve safety • Build affordable housing in suburbs

and market-rate housing in cities

Ensuring opportunity for all

Education: • Quality, accessible early education • K-12 reform: funding, integration,

leadership, teaching; grade-level reading and HS graduation

• Accessible, affordable post-secondary education

Ensuring opportunity for all

Jobs, Income, and Wealth: • Make work pay with minimum wage,

EITC; build job base and skills training • Facilitate access to SNAP, WIC, health

and other benefits • Provide financial education and

coaching

Ensuring opportunity for all

• “collective impact” to close opportunity gap; focus on jobs, education, income

• “Integrated service delivery” at DSS and nonprofits: jobs, benefits, financial education

• Result-Based Accountability: OUTCOMES

ONE FINAL NOTE: AMERICA’S SELF IMAGE PROBLEM

Survey: perceived inequality

Dan Ariely asked Americans in a survey what percentage of the country’s wealth each quintile of the population had.

That is, how much wealth the 20% of poorest households have, how much wealth the 20 to 40% group has, and so on.

Comparing perceived inequality with reality: • The U.S. is vastly

more unequal than most people think.

Also, vastly more unequal than most people would like the country to be. • Ideal distribution

is very similar for democrats and republicans.

• Ideal is most egalitarian than Sweden.

Any questions?

• Contact information: – Roger Senserrich –

rsenserrich@cahs.org 860.951.2212 ext. 247