Health and Wealth on the Roller-Coaster: Ireland 2003-2011

1. School of Economics Health and Wealth on the Roller-Coaster: Ireland 2003-2011 David Madden University College Dublin

2. Broad Outline • Analysis of developments in income and health “poverty” over the 2003-2011 period • Analysis of poverty in both dimensions and also correlation between the two • Also analysis from time-series and cross-section perspective • Income poverty falls up to 2009, then increases • Health poverty unchanged • Evidence that health inequality decreased • Health/income correlation amongst poor has declined • More detail available in full version of paper (ungated version at http://www.ucd.ie/t4cms/WP13_05.pdf)

3. Context (1) • Are recessions good for your health? • Ruhm (2000) said “yes”, but Ruhm (2013) said “maybe” • Chang/Stuckler (2013), Great Recession led to excess suicides • Not consistent with Walsh and Walsh (2011) for Ireland, also challenged by Denny (2013) • Deaton (2011), Walsh (2011) – difficulties in relating movements in SWB to economic cycle • Different dimensions of health may respond differently to economic cycle • We look at micro-based data, self-assessed health (SAH) • Also issue of income-health correlation within a given cross-section

4. Context (2) • Measuring welfare/poverty across multiple dimensions • Intersection or union approach? • Alkire-Foster attempt to overcome this • Multi-dimensional indices • Gives single index, but black box? Weights? • Dashboard approach – provide information on 2 (at most 3) indices and summary of their correlation • This talk focuses on measurement – we do not look at explanatory factors

5. Data • 9 waves of Survey of Income and Living Conditions (SILC) • Nationally representative sample with information on sources of income, deprivation, health • Income measure: equivalised disposable income (i.e. including social transfers and with taxes/pension contributions deducted) • Health: “in general, how good would you say your health is?” Very bad, bad, fair, good or very good • Good predictor of subsequent morbidities/mortality • Analysis confined to over 16s (under 16s not asked health question) • Sample size c.10,000 p.a.

6. Pα Measures, Income, 2003-2011, Fixed Poverty Line (2003=100)

7. Pα Measures, Income, 2003-2011, Relative Poverty Line (2003=100)

8. Health Dominance: 2003-2011

9. Health Poverty, 2003-2011

10. Health Poverty, 2003-2011 (with confidence intervals)

11. The story so far... • Income poverty falls up to 2009 and then increases • Health poverty broadly unchanged over period • Some evidence of marginal reduction in overall health inequality from 2009 • What if we look at them together?

12. Poverty Incidence by SAH, 2003-2011

13. Bi-Dimensional Poverty Indices -Fixed Income Poverty Line

14. Measure of Correlation – All Ages

15. Measure of Correlation – Under 65s

16. Measure of Correlation – 25-49

17. Measure of Correlation – 50-64

18. Summary • No evidence that recent recession has been accompanied by meaningful deterioration in health (self-assessed) • Health inequality seems to have slightly diminished • Correlation between health and income within the poor (for each cross-section) has declined • Note these are only two dimensions of welfare (albeit important ones) • Other health measures? • Also, early days – health effects of recession could operate with a lag

19. Poverty Dominance Income

20. Sequential Stochastic Dominance

21. Bi-Dimensional Poverty Indices - Relative Income Poverty Line