Zachary Goldfarb of the Washington Post reports on an extremely encouraging development. Drawing on the work of Janet Currie, an economist at Princeton, and her collaborators, Goldfarb observes that across the United States, poor women are giving birth to healthier babies:
In a recent study on birth weights, a leading indicator of infant health, Currie and a co-author compared black, unmarried, high school dropouts with white, married, college graduates — two groups statistically on opposite sides of the income scale.
They found a large disparity, but a shrinking one. The study found that in 1989, one in six babies born to the economically challenged group weighed less than the 51 / 2 pounds doctors consider healthy — compared with one in 32 babies born to the more advantaged group.
Over the following 20 years, the study found improvements for the less advantaged group, with the odds of having an unhealthy baby falling close to 1 in 8. The rate was essentially unchanged for more advantaged women. Currie also found that even if race is taken out of the equation, birth weights follow the same pattern.
What I find peculiar about Goldfarb’s article, however, is that he frames it around wealth inequality. Researchers track race, marital status, and education as proxies for income, and they find that wealthy people, or rather people they assume to be wealthy (for perfectly good reasons), fare better along a number of dimensions than poor people, e.g., the poor are more likely to suffer from diabetes, obesity, and high blood pressure, and they tend to have shorter lifespans. Of course, marital status and educational attainment have a complicated relationship to income and wealth. Social and human capital are transmitted from one generation to the next, yet not everyone chooses to maximize their earning potential. That is, it’s not obvious that income and wealth inequality are what is at issue. It seems just as plausible that, say, people raised in chaotic households are consistently worse off than those who aren’t, or that social isolation is a major driver of poor health outcomes. Goldfarb notes that women earning less than $25,000 are 2.5 times as likely to be victims of domestic violence as better-off women. But low-income women are also likely to face deficits in social and cultural capital, and it is very difficult to determine where one factor ends and another begins. (To Goldfarb’s credit, he notes that Medicaid “has a surprisingly modest impact on babies’ health.”)
I raise this issue because Goldfarb neglects to address the so-called “Hispanic paradox,” which Nicholas Eberstadt, a political economist at the American Enterprise Institute, summarized as follows in testimony to the Senate HELP Committee last fall:
Consider the situation for the Hispanic population in America today. By a number of measures, it would appear to be the most socio-economically disadvantaged major ethnic group in America today. Nearly 40 percent of Hispanic American adults, for example, have no high school degree (2009); over 30 percent of all have no health insurance (2010); and nearly 30 percent of Hispanic adults did not report even a single visit to get health care over the previous year (2010). Even so: the age-standardized mortality level for Hispanic Americans is estimated to be fully 25 percent lower than the average for the nation as a whole!
Thus the striking paradox of health in modern America is this: minority groups reporting higher incidences of poverty and income inequality, lower educational attainment, less health insurance coverage, and greater likelihood of no treatment by medical professionals than our Anglo majority also report significantly lower mortality (and thus longer life expectancy) than our Anglos—indeed, significantly better mortality levels than for America as a whole. And this paradox is not new: as Figures 3 and 4 attest, for males and females alike, mortality rates for our Asian and Hispanic minorities have been superior to those of non-Hispanic Whites for many decades—in fact, for as long as such numbers have been compiled. Non-Hispanic Blacks or African-Americans are the only ethnic minority whose health profile appears to be poorer nowadays than our Anglos.
Some believe that there could be a very simple explanation for the “ethnic health advantage” — Laura Blue and her co-author Andrew Fenelon attribute it to smoking, which they claim accounts for as much roughly 75 percent of the difference in life expectancy between Hispanics and non-Hispanic whites. But smoking is not best understood a wealth gap phenomenon.
So why would Goldfarb highlight the wealth gap in his article? The key strategy for improving infant health he identifies is the use of home visits during which trained personnel teach poor women how to care for their children. What is striking about this strategy is that it replicates the transmission of knowledge from one generation to the next that is a commonplace not just in affluent households, but in poor immigrant households where family bonds tend to be stronger. There is an interesting and important gap that is driving differences in health outcomes in the United States. But I don’t think it’s the wealth gap. Rather, the wealth gap and the longevity gap might both be driven by this more problematic inequality of social capital.