Individual health and the visibility of village economic inequality: Longitudinal evidence from native Amazonians in Bolivia

Mounting evidence suggests that income inequality is associated with worse individual health. But does the visibility of inequality matter? Using data from a horticultural-foraging society of native Amazonians in Bolivia (Tsimane’), we examined whether village inequality in resources and behaviors with greater cultural visibility is more likely to bear a negative association with health than village inequality in less conspicuous resources. We draw on a nine-year annual panel (2002–2010) from 13 Tsimane’ villages for our main analysis, and an additional survey to gauge the cultural visibility of resources. We measured inequality using the Gini coefficient. We tested the robustness of our results using a shorter two-year annual panel (2008–2009) in another 40 Tsimane’ villages and an additional measure of inequality (coefficient of variation, CV). Behaviors with low cultural visibility (e.g., household farm area planted with staples) were less likely to be associated with individual health, compared to more conspicuous behaviors (e.g., expenditures in durable goods, consumption of domesticated animals). We find some evidence that property rights and access to resources matter, with inequality of privately-owned resources showing a larger effect on health. More inequality was associated with improved perceived health – maybe due to improved health prospects from increasing wealth – and worse anthropometric indicators. For example, a unit increase in the Gini coefficient of expenditures in durable goods was associated with 0.24 fewer episodes of stress and a six percentage-point lower probability of reporting illness. A one-point increase in the CV of village inequality in meat consumption was associated with a 4 and 3 percentage-point lower probability of reporting illness and being in bed due to illness, and a 0.05 SD decrease in age-sex standardized arm-muscle area. In small-scale, rural societies at the periphery of market economies, nominal economic inequality in resources bore an association with individual health, but did not necessarily harm perceived health. Economic inequalities in small-scale societies apparently matter, but a thick cultural tapestry of reciprocity norms and kinship ties makes their effects less predictable than in industrial societies.     

Effects of gender inequality and wealth inequality on within-sex mating competition under hypergyny

Resources are often central to the formation and persistence of human consortships, and to the evolutionary fitness consequences of those consortships. As a result, the distribution of resources within a society should influence the number and quality of mating opportunities an individual of given status/wealth experiences. In particular, in a wide variety of societies, both contemporary and historic, women have been shown to prefer mates of higher rather than lower status and wealth, a pattern known as ‘hypergyny’. Such status-dependent within-sex competition is influenced not only by the preferences individuals express but also by the distribution of resources within and between sexes. Empirical studies show that economic inequality within a sex can amplify mating competition, and that inequalities between women and men also influence behaviours related to mating competition, but the links between resource distribution and mating competition have attracted limited systematic attention. We present simulation models of hypergynous preferences and the effects on mating competition among men and among women within a heterosexual mating market. Our modelling shows that the lower mating success of poorer men and richer women (when compared with richer men and poorer women) is worsened when resource gender gaps are relatively small or when women out-earn men on average. Likewise, high economic inequality, especially among men, amplifies the competition experienced by these groups. We consider the political implications in terms of sex- and status-dependent attitudes to gender equity, wealth inequality, and hypergynous mating norms.     

Socio-economic determinants of health and physical fitness in southern Ethiopia

The dependence of health and physical fitness on the socio-economic factors of rural families in southern Ethiopia is investigated, with particular emphasis on the role of inequality. This paper contributes to our knowledge of the effect of inequality on health in several ways: it compares the results of objective and subjective health measures, it distinguishes between wealth inequality and nutrition inequality, and it evaluates the impact of nutrition inequality both at the village level and at the household level. The subjective health measures are the number of days respondents were ill during the last month, their ability to walk distances, their ability to carry heavy loads, and their ability to work in the field. The objective health measure is having Body Mass Index (BMI) lower than 18.5. Males are healthier than females. Height has a positive and significant effect on health and fitness and the same is true for per-capita wealth measured at the village level. Availability of satisfactory health facilities has a negative effect on morbidity. Per-capita wealth inequality is positively associated with morbidity and with a low BMI. Within-household nutrition inequality has a complex effect on health and physical fitness: the effect is negative, but only for household members whose nutritional status is above the household mean. The results indicate a clear positive effect of economic well-being on health and physical fitness. The role of inequality is less clear, and certainly deserves further analyses at both the theoretical and empirical levels.     

Health and social cohesion: why care about income inequality?

Throughout the world, wealth and income are becoming more concentrated. Growing evidence suggests that the distribution of income-in addition to the absolute standard of living enjoyed by the poor-is a key determinant of population health. A large gap between rich people and poor people leads to higher mortality through the breakdown of social cohesion. The recent surge in income inequality in many countries has been accompanied by a marked increase in the residential concentration of poverty and affluence. Residential segregation diminishes the opportunities for social cohesion. Income inequality has spillover effects on society at large, including increased rates of crime and violence, impeded productivity and economic growth, and the impaired functioning of representative democracy. The extent of inequality in society is often a consequence of explicit policies and public choice. Reducing income inequality offers the prospect of greater social cohesiveness and better population health.     

Fertility decline and the changing dynamics of wealth,status and inequality

In the course of demographic transitions (DTs), two large-scale trends become apparent: (i) the broadly positive association between wealth, status and fertility tends to reverse, and (ii) wealth inequalities increase and then temporarily decrease. We argue that these two broad patterns are linked, through a diversification of reproductive strategies that subsequently converge as populations consume more, become less self-sufficient and increasingly depend on education as a route to socio-economic status. We examine these links using data from 22 mid-transition communities in rural Poland. We identify changing relationships between fertility and multiple measures of wealth, status and inequality. Wealth and status generally have opposing effects on fertility, but these associations vary by community. Where farming remains a viable livelihood, reproductive strategies typical of both pre- and post-DT populations coexist. Fertility is lower and less variable in communities with lower wealth inequality, and macro-level patterns in inequality are generally reproduced at the community level. Our results provide a detailed insight into the changing dynamics of wealth, status and inequality that accompany DTs at the community level where peoples'' social and economic interactions typically take place. We find no evidence to suggest that women with the most educational capital gain wealth advantages from reducing fertility, nor that higher educational capital delays the onset of childbearing in this population. Rather, these patterns reflect changing reproductive preferences during a period of profound economic and social change, with implications for our understanding of reproductive and socio-economic inequalities in transitioning populations.     

Do Markets Worsen Economic Inequalities? Kuznets in the Bush

Integration into a market economy or economic development can erode the quality of life of indigenous people by, for example, increasing income inequalities. The Kuznets hypothesis predicts that the link between income inequality and income (a proxy for economic development) resembles an inverted U. We test the hypothesis using a survey of 511 households from 59 villages of Tsimane' Amerindians, a horticultural-foraging society in the tropical rain forest of Bolivia. We measure village inequalities of three economic outcomes: income, imputed annual value of rice production, and wealth. We used three indices of inequality: the coefficient of variation, the standard deviation of the logarithm, and the Gini coefficient. Explanatory variables include either income and income squared, wealth and wealth squared, or imputed annual rice production and production squared. We used village-to-town distance as a control. We find little evidence that integration to the market increases inequalities of economic outcomes, with two exceptions: Wealth bore the predicted inverted U-shaped relation with wealth inequalities, and imputed rice production bore a U-shaped relation to inequality, but only when (a) using adult equivalents to express household size and (b) the Gini coefficient and the coefficient of variation to measure inequality; in no case were results robust to different econometric specifications. We advance several explanations for why economic development might not accentuate economic inequalities among relatively autarkic rural economies.     

Body mass,wealth, and inequality in the 19th century: Joining the debate surrounding equality and health

We explore relationships among BMI variation, wealth, and inequality in the 19th century US. There was an inverse relationship between BMI and average state-level wealth and a small, inverse relationship with wealth inequality. After controlling for wealth and inequality, farmers had greater BMI values than workers in other occupations, and blacks had greater BMI values because of nutritional deprivation in utero.     

How strategy environment and wealth shape altruistic behaviour: cooperation rules affecting wealth distribution in dynamic networks

Societies rely on individual contributions to sustain public goods that benefit the entire community. Several mechanisms, that specify how individuals change their decisions based on past experiences, have been proposed to explain how altruists are not outcompeted by selfish counterparts. A key aspect of such strategy updates involves a comparison of an individual''s latest payoff with that of a random neighbour. In reality, both the economic and social milieu often shapes cooperative behaviour. We propose a new decision heuristic, where the propensity of an individual to cooperate depends on the local strategy environment in which she is embedded as well as her wealth relative to that of her neighbours. Our decision-making model allows cooperation to be sustained and also explains the results of recent experiments on social dilemmas in dynamic networks. Final cooperation levels depend only on the extent to which the strategy environment influences altruistic behaviour but are largely unaffected by network restructuring. However, the extent of wealth inequality in the community is affected by a subtle interplay between the environmental influence on a person''s decision to contribute and the likelihood of reshaping social ties, with wealth-inequality levels rising with increasing likelihood of network restructuring in some situations.     

Status competition,inequality, and fertility: implications for the demographic transition

The role that social status plays in small-scale societies suggests that status may be important for understanding the evolution of human fertility decisions, and for understanding how such decisions play out in modern contexts. This paper explores whether modelling competition for status—in the sense of relative rank within a society—can help shed light on fertility decline and the demographic transition. We develop a model of how levels of inequality and status competition affect optimal investment by parents in the embodied capital (health, strength, and skills) and social status of offspring, focusing on feedbacks between individual decisions and socio-ecological conditions. We find that conditions similar to those in demographic transition societies yield increased investment in both embodied capital and social status, generating substantial decreases in fertility, particularly under conditions of high inequality and intense status competition. We suggest that a complete explanation for both fertility variation in small-scale societies and modern fertility decline will take into account the effects of status competition and inequality.     

Human capital, wealth, and nutrition in the Bolivian Amazon

We analyze anthropometric variables of a society of forager-horticulturalists in the Bolivian Amazon (Tsimane') in 2001-2002. Community variables (e.g., inequality, social capital) explain little of the variance in anthropometric indices of nutritional status, but individual-level variables (schooling, wealth) are positively correlated with nutritional status. Dietary quality (foods high in animal proteins), access to foraging technology, and traditional knowledge of medicinal plants are related to better anthropometric indices.     

The Role of Community and Individuals in the Formation of Social Capital

Because social capital shapes many desirable socioeconomic outcomes, we ask what incentives drive private investments in social capital. We estimate the association between private investments in social capital (outcome variable) and the following explanatory variables: (a) individual-level variables from an optimal investment model, (b) spillovers from group social capital, (c) village income inequality, and (d) market openness. We draw on information from Tsimane’, a native Amazonian society of foragers and farmers in Bolivia, and equate social capital with gifts, help given, and communal labor offered by the household. Age bore an inverted U-shaped and income bore a positive association with social capital, but geographic mobility, wealth, and schooling bore no significant association with social capital. We found strong group-level associations even after instrumenting social capital; the association probably stems from strong kinship ties which tend to blur the line between the group and the individual. Village measures of social capital were positively and significantly associated with private investments in social capital. We found some evidence that village income inequality and market openness were negatively associated with private investments in social capital.     

Entrepreneurs, chance, and the deterministic concentration of wealth

In many economies, wealth is strikingly concentrated. Entrepreneurs--individuals with ownership in for-profit enterprises--comprise a large portion of the wealthiest individuals, and their behavior may help explain patterns in the national distribution of wealth. Entrepreneurs are less diversified and more heavily invested in their own companies than is commonly assumed in economic models. We present an intentionally simplified individual-based model of wealth generation among entrepreneurs to assess the role of chance and determinism in the distribution of wealth. We demonstrate that chance alone, combined with the deterministic effects of compounding returns, can lead to unlimited concentration of wealth, such that the percentage of all wealth owned by a few entrepreneurs eventually approaches 100%. Specifically, concentration of wealth results when the rate of return on investment varies by entrepreneur and by time. This result is robust to inclusion of realities such as differing skill among entrepreneurs. The most likely overall growth rate of the economy decreases as businesses become less diverse, suggesting that high concentrations of wealth may adversely affect a country's economic growth. We show that a tax on large inherited fortunes, applied to a small portion of the most fortunate in the population, can efficiently arrest the concentration of wealth at intermediate levels.     

The biological wellbeing of the working-poor: The height of prisoners in Buenos Aires Province,Argentina, 1885–1939*

As a way to contribute to the debate on social inequality, poverty, and well-being in Argentina's long-term development, this article presents new evidence on the stature of prisoners in Buenos Aires province, the richest province in the Pampa region. The evidence shows very modest gains in the stature of prisoners for the period 1885–1939. This finding clearly indicates the persistence of early childhood malnutrition and poor health among families of the working-poor in the small towns of Buenos Aires province. Five decades of modest stature growth underscores the limitation of state policies of education, sanitation, and social reform in elevating the health and nutrition conditions of the working-poor. At the heart of the pampas, in the context of a successful food exporting economy, a working-class population cursed by the combination of low human capital and social vulnerability failed to attained a substantial improvement in their biological wellbeing.     

The Link between Inequality and Population Health in Low and Middle Income Countries: Policy Myth or Social Reality?

An influential policy idea states that reducing inequality is beneficial for improving health in the low and middle income countries (LMICs). Our study provides an empirical test of this idea: we utilized data collected by the Demographic and Health Surveys between 2000 and 2011 in as much as 52 LMICs, and we examined the relationship between household wealth inequality and two health outcomes: anemia status (of the children and their mothers) and the women'' experience of child mortality. Based on multi-level analyses, we found that higher levels of household wealth inequality related to worse health, but this effect was strongly reduced when we took into account the level of individuals'' wealth. However, even after accounting for the differences between individuals in terms of household wealth and other characteristics, in those LMICs with higher household wealth inequality more women experienced child mortality and more children were tested with anemia. This effect was partially mediated by the country''s level and coverage of the health services and infrastructure. Furthermore, we found higher inequality to be related to a larger health gap between the poor and the rich in only one of the three examined samples. We conclude that an effective way to improve the health in the LMICs is to increase the wealth among the poor, which in turn also would lead to lower overall inequality and potential investments in public health infrastructure and services.     

A comprehensive wealth index for cities in Germany

We apply a comprehensive wealth index for the 100 largest autonomous cities in Germany to measure their endowment with environmental, energy, social, human, and economic capital stocks. We find that (i) there is no inherent trade-off between economic and environmental capital stocks; (ii) clear regional differences exist between West and East Germany and between North and South Germany; and (iii) the comprehensive wealth index is strongly correlated with housing rents, which reflect individual willingness to pay for living in a certain city.     

Rich-poor gap in utilization of reproductive and child health services in India, 1992-2005

This paper examines the trends in utilization of five indicators of reproductive and child health services, namely, childhood immunization, medical assistance at delivery, antenatal care, contraceptive use and unmet need for contraception, by wealth index of the household in India and two disparate states, Uttar Pradesh and Maharashtra. The data from three rounds of the National Family and Health Survey conducted during 1992-2005 are analysed. The wealth index is computed using principal component derived weights from a set of consumer durables, land size, housing quality and water and sanitation facilities of the household, and classified into quintiles for all three rounds. Bivariate analyses, rich-poor ratio and concentration index are used to understand the trends in utilization of, and inequality in, reproductive and child health services. The results indicate huge disparities in utilization of these services, largely to the disadvantage of the poor. Utilization of basic childhood immunization among the poorest and the poor stagnated in India, as well as in both states, during 1998-2005 compared with 1992-1998. The use of maternal care services such as medical assistance at delivery and antenatal care remained at a low level among the poor over this period. However, contraceptive use increased relatively faster among the poor, even with higher unmet need. Of all these services, the inequality in medical assistance at delivery is consistently large, while that of contraceptive use is small. The state-level differences in service coverage by wealth quintiles over time are large.     

Two pathways, but how much do they diverge?

This document presents an argument on how low income differences are associated to the well being of the population. The health of the population was said to be related to either narrow differences in individual income or the greater effect of social disparity. The reality of the health benefits or the central policy implications could not be modified by the pathway. An experiment conducted on monkeys revealed that low status is a risk factor for poor health in a plausible psychosocial pathway. The income of the individual can be considered as one of the marker for social status and inequality in the society can be caused by material risk factors. Inequality effect of the small proportion of the population may be too great when explained using a curvature. Also, the income and health status in the developed countries is closely related and would still fall on the better part of the international curve. A less democratic society may develop an aggressive and less supportive social environment could cause deprivation and low social status. An increase in health inequalities was driven by a more socially antagonistic, delinquent and risky forms of behavior accompanied by deprivation throughout the society. The reduction of health inequalities associated between the pathways of income inequality and population health must not differ with the aim of improving health standards in the society. As a result, redistribution of health services could probably increase the health of those who are in need.     

Examining the effect of household wealth and migration status on safe delivery care in urban India, 1992-2006

Background

Although the urban health issue has been of long-standing interest to public health researchers, majority of the studies have looked upon the urban poor and migrants as distinct subgroups. Another concern is, whether being poor and at the same time migrant leads to a double disadvantage in the utilization of maternal health services? This study aims to examine the trends and factors that affect safe delivery care utilization among the migrants and the poor in urban India.

Methodology/Principal Findings

Using data from the National Family Health Survey, 1992–93 and 2005–06, this study grouped the household wealth and migration status into four distinct categories poor-migrant, poor-non migrant, non poor-migrant, non poor-non migrant. Both chi-square test and binary logistic regression were performed to examine the influence of household wealth and migration status on safe delivery care utilization among women who had experienced a birth in the four years preceding the survey. Results suggest a decline in safe delivery care among poor-migrant women during 1992–2006. The present study identifies two distinct groups in terms of safe delivery care utilization in urban India – one for poor-migrant and one for non poor-non migrants. While poor-migrant women were most vulnerable, non poor-non migrant women were the highest users of safe delivery care.

Conclusion

This study reiterates the inequality that underlies the utilization of maternal healthcare services not only by the urban poor but also by poor-migrant women, who deserve special attention. The ongoing programmatic efforts under the National Urban Health Mission should start focusing on the poorest of the poor groups such as poor-migrant women. Importantly, there should be continuous evaluation to examine the progress among target groups within urban areas.     

The HIV-poverty thesis re-examined: poverty, wealth or inequality as a social determinant of HIV infection in sub-Saharan Africa?

Although health is generally believed to improve with higher wealth, research on HIV in sub-Saharan Africa has shown otherwise. Whereas researchers and advocates have frequently advanced poverty as a social determinant that can help to explain sub-Saharan Africa's disproportionate burden of HIV infection, recent evidence from population surveys suggests that HIV infection is higher among wealthier individuals. Furthermore, wealthier countries in Africa have experienced the fastest growing epidemics. Some researchers have theorized that inequality in wealth may be more important than absolute wealth in explaining why some countries have higher rates of infection and rapidly increasing epidemics. Studies taking a longitudinal approach have further suggested a dynamic process whereby wealth initially increases risk for HIV acquisition and later becomes protective. Prior studies, conducted exclusively at either the individual or the country level, have neither attempted to disentangle the effects of absolute and relative wealth on HIV infection nor to look simultaneously at different levels of analysis within countries at different stages in their epidemics. The current study used micro-, meso- and macro-level data from Demographic and Health Surveys (DHS) across 170 regions within sixteen countries in sub-Saharan Africa to test the hypothesis that socioeconomic inequality, adjusted for absolute wealth, is associated with greater risk of HIV infection. These analyses reveal that inequality trumps wealth: living in a region with greater inequality in wealth was significantly associated with increased individual risk of HIV infection, net of absolute wealth. The findings also reveal a paradox that supports a dynamic interpretation of epidemic trends: in wealthier regions/countries, individuals with less wealth were more likely to be infected with HIV, whereas in poorer regions/countries, individuals with more wealth were more likely to be infected with HIV. These findings add additional nuance to existing literature on the relationship between HIV and socioeconomic status.     

Modeling the Origin and Possible Control of the Wealth Inequality Surge

The rapid increase of wealth inequality in the past few decades is a most disturbing social and economic issue of our time. In order to control, and even reverse that surge, its origin and underlying mechanisms should be revealed. One of the challenges in studying these mechanisms is to incorporate realistic individual dynamics in the population level in a self-consistent manner. Our theoretical approach meets the challenge by using interacting multi-agent master-equations to model the dynamics of wealth inequality. The model is solved using stochastic multi-agent iterated maps. Taking into account growth rate, return on capital, private savings and economic mobility, we were able to capture the historical dynamics of wealth inequality in the United States during the course of the 20th century. We show that the fraction of capital income in the national income and the fraction of private savings are the critical factors that govern the wealth inequality dynamics. In addition, we found that economic mobility plays a crucial role in wealth accumulation. Notably, we found that the major decrease in private savings since the 1980s could be associated primarily with the recent surge in wealth inequality and if nothing changes in this respect we predict further increase in wealth inequality in the future. However, the 2007–08 financial crisis brought an opportunity to restrain the wealth inequality surge by increasing private savings. If this trend continues, it may lead to prevention, and even reversing, of the ongoing inequality surge.