July 20, 2018 | ° F

Princeton professor talks wealth, healthcare disparity

Photo by Yangeng Lin |

Angus Deaton, professor of economics and international affairs at Princeton University, discusses inequalities in health care at the Institute for Health, Health Care Policy and Aging Research on Paterson Street in New Brunswick.

Health care in first-world and developing nations have been growing apart for centuries, said Angus Deaton, a professor of economics and international affairs at Princeton University. It is time for society to close that gap.

Deaton discussed health care inequality yesterday at the Institute for Health, Health Care Policy and Aging Research on Paterson Street in New Brunswick.

Deaton is among the world’s foremost development economists, said Carol Boyer, associate director of the institute. His current research includes health and economic development.

The disparity between the rich and the poor and their overall levels of health has persisted for centuries, Deaton said. Changing this situation requires a different way of analyzing the issues than policy makers currently use and expect.

Researchers traditionally use life expectancy to determine health levels, he said. But apart from interruptions caused by diseases such as AIDS, the disparity is closing, while other standards remain the same.

“I would argue that life expectancy isn’t the right measure,” he said. “There’s a lot more inequality in the world than you get just by looking at life expectancy.”

“The Great Divergence,” an event that occurred in the West in the 16th century, is a source for health inequality in the world. Life expectancy and the standard of living both increased dramatically in the West while remaining the same in the East.

This global inequality never closed, he said, resulting in the Western world having a significantly more organized and developed healthcare systems.

Gross domestic product per capita and life expectancy are strongly correlated.

Even within a single first-world country, the amount of wealth a group has determines its members’ health, Deaton said. The largest disparities come from the higher tax brackets. 

Income and wealth inequalities lead to further inequalities, he said. Political inequalities are common, though they should not be. 

In the past, this disparity was not as negative. While initially, cures and treatments were expensive, allowing only the rich to take advantage of them, they would eventually spread throughout the population. 

Smallpox was a fatal disease in medieval Britain, Deaton said. The wife of an ambassador brought the vaccination back to the British Isles. While at first only those among the upper classes received the vaccination, it later spread throughout the empire. It dramatically reduced the mortality rate, especially among children.

The British Empire integrated a number of cures and treatments from across the globe. They brought remedies from across the globe to fight their diseases, helping to lead to The Great Divergence. 

This is different from what happens today, Deaton said. In modern times, cures and vaccinations spread outwards from a single starting point, due to the way diseases are researched.

This does not change that many children still die in third-world countries through accidental geography of birth. These children often die of curable diseases near modern hospitals. 

The issue is the result of how poor countries receive aid, Deaton said.

Any individual or group needs a lot of information before they can affect positive changes, said Stephen Crystal, the director of the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management and Outcomes.

The problems are not simple, and solving them requires bringing ideas from multiple disciplines into one strategy, said Crystal, a distinguished research professor. People need to figure out smarter solutions than those that exist currently. 

Creating strategies to fix the disparity must be done carefully. People must think about unintended consequences before they act on any plans.

Financial aid is exacerbating the problem of wealth and health disparity in third-world countries, Deaton said. Often the funds exceed government expenditure, resulting in the donations paying for all the government’s costs. 

According to globalissues.org, governments typically give financial aid for specific purposes with donors deciding what that aid will be spent on. This disenfranchises the host government from taking care of its own people.

That problem is more about the government’s capacity than its funding, Deaton said. Specifically, the government does not have the capacity to adequately deal with its issues. The governments in question are unable to take the necessary steps to revamp their healthcare systems. 

The people who need the money must decide what it can be spent on, he said, rather than the affluent. 

“Citizens must be responsible for their own healthcare system,” he said.

Nikhilesh De

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