. . . in two parts. First, let me clean up one more small point about the bogosity of economics as taught to freshmen and believed by pundits and politicians everywhere. This is the assertion that the "free market" allocates resources "efficiently." This statement is not even wrong. It is meaningless, even assuming (as economists are wont to do) that the "free market" actually exists or could exist.
The concept of efficiency only makes sense if you first specify what it is you are trying to achieve. If I stipulate that I want to build a 1,400 foot house with a full basement, two bathrooms, two bedrooms, with 2x6 framing, an 800 square foot sunroom, two woodstoves, passive solar design, etc., it then makes sense to talk about how to get it done in the least amount of time or for the least amount of money, or both assuming the goals are not incompatible.
If I want to claim that a market is efficient, I first have to simulate what results I want from it. If you believe that the market should deliver you a Mercedes Benz, or feed all the hungry kids in Africa, and those things aren't happening, then the market is not efficient, no matter what anybody else tries to tell you. End of discussion. There is absolutely no argument from the theory of the idealized market to any conclusion that its results must be proper, good, just, appropriate, moral, Christian, natural, or any other assertion about values. If you don't like the result, then you don't have to, and any claim about "efficiency" is utter balderdash.
Whoo. Now that I've cleared the air about that, let us move on to the determinants of health. (Don't worry, this is all part of one logical, coherent argument. Give me time.) Although these categories are somewhat arbitrary and in fact they are mutually interpenetrating, as we say, it is conventional to think about the determinants of health in three parts:
- the social and economic environment,
- the physical environment, and
- the person’s individual characteristics and behaviors.
To keep this post to a conventionally blogistic length, I will deal only with the social environment today. Important components include people's income and social status -- which of course can vary by gender, ethnicity and caste as well as occupation and position in formal hierarchies; level of formal education; social supports from family, friends and community; the person's culture with its accompanying customs and traditions; exposure to interpersonal violence; and all that sort of thing.
One of the most interesting observations social scientists have made, and this is now pretty well established, is that the level of inequality in a society is an independent predictor of population health, regardless of the absolute level of wealth. In other words, a person with an income of 500 bars of gold-plated latinum per year will tend to be healthier and live longer, all other things being equal, in a society with low inequality, in which most people have an income not very different, than in a society in which most people get only 200 bars of latinum per year and a small number get 10 million. The latter society, by the way, is kind of like ours, which is one reason why we are less healthy than the Europeans and Canadians.
I will get on with the rest of it tomorrow. Meanwhile, stay efficient.