Wealth and health

One of the tropes of the current crisis has been that to re-open the economy is to sacrifice lives on the altar of profits. It's also been widely pointed out that this is a false dichotomy. In fact, wealth and health tend go together. Economic downturns lead to deaths as predictably as viruses. In this post I just want to re-state this view one more time, since I think it's a crucial one to grasp if we want to react sensibly to this (or any other crisis).

As the above graph suggests, there's a positive association between longevity and GDP. GDP and child mortality seem to be inversely related. Deaths from the five most lethal infectious diseases have declined as the global economy has grown.

Correlations like this aren't a slam-dunk case that wealth causes health. Studies that have looked at the association in detail have found it to be a slightly complicated one. But even if the exact causal mechanisms at various stages of growth can be difficult to disentangle, the basic picture seems clear: wealth and health tend to go hand in hand. That's the case not only if you look at individual countries through time, but also if you look the set of countries at a particular point in time and compare the well-being of people in richer and poorer parts of the world (even controlling for other factors).

Moreover, unlike in the case of spurious associations (scores for M. Night Shyamalan's films going down on Rotten Tomatoes in line with newspaper sales, for example), it's not hard to think of reasons why these two variables might be linked, and why the wealth of a country might help its people be healthier. Richer countries can give more funding to health services. They can invest in better-quality housing, safer infrastructure, and a more comprehensive social safety net. Its citizens are wealthier, and they can spend more money on their well-being.

So far we've been looking at the positive side of the story, with better wealth being associated with health. But there's also a dark side to the association, with poverty being associated with disease and shorter life-spans.  You can see this effect with economic downturns even in the rich world: opioid deaths rose by 85% in parts of the US where car factories had closed down (and here too it's easy to think of how this might have happened, with unemployment leading to despair and addiction). A 1% rise in the unemployment rate makes working-age men 6% more likely to die of any cause.

And that's in the rich world. Economic growth is even more vital to the developing world, since increases in wealth just make the citizens of rich countries even healthier, whereas people in poor countries live much closer to death and disaster. They're highly dependant on trade and exchange with the rich world. It's no surprise that UNICEF is now predicting a 45% rise in child mortality because of lockdown-related disruptions.

The relationship between economic downturns and health does have its complications. Some studies suggest fewer people die in the actual course of recessions than normal (although more people die of particular causes, like suicide), but there are lasting health costs over the longer term. So even if the coronavirus lockdowns are followed by a V-shaped recovery, with locked-up demand immediately bursting out again, then we might expect our health (on average) to be slightly worse than it otherwise would have been over the next few decades.

There probably are a few people out there who would put profit for themselves ahead of other people's lives. But most of the people raising warnings about the lockdowns are probably just trying to draw attention to the harm we can do to ourselves if do too much damage to the economy. Whether Covid-19 is dangerous enough to justify the public-health costs associated with the economic downturns that are now starting to bite - that's a different question, and one that's best left for another day (and maybe even another website). But it's not a simple question.

'Your money or your life?' isn't a question that, in ordinary circumstances, anyone would want to be asked. But it's actually a much easier question to answer than the one many countries are faced with now.