Inequality of opportunity in health: evidence from a UK cohort study

Abstract

SUMMARYThis paper proposes an empirical implementation of the concept of inequality of opportunity in health and applies this to data from the UK National Child Development Study. Drawing on the distinction between circumstance and effort variables in John Roemer's work on equality of opportunity, circumstances are proxied by parental socioeconomic status and childhood health; effort is proxied by health-related lifestyles and educational attainment. Stochastic dominance tests are used to detect inequality of opportunity in the conditional distributions of selfassessed health in adulthood. Two alternative approaches are used to measure inequality of opportunity. Econometric models are estimated to illuminate and quantify the triangular relationship between circumstances, effort and health. The results indicate the existence of a considerable and persistent inequality of opportunity in health. Circumstances affect health in adulthood both directly and through effort factors such as educational attainment. This indicates that, while the influence of some unjust circumstances can only be tackled during childhood, the implementation of complementary educational policies may be of paramount importance.

Social health inequalities among older Europeans: the contribution of social and family background

“…It is thus an important question for the understanding of social health inequalities to know the share of the latter that may be attributable to the direct effect of social background and to the transmission of health status across generations, due to the unequal distribution of family background across wealth groups. Pioneered by Bourdieu [18], the theory of social reproduction across generations has been well-studied and confirmed in numerous empirical research studies in economics and sociology [17,[19][20][21]. More recently, the PISA follow-up survey focussing on education achievement and social background of young Europeans aged between 16 and 35 has shown that there is a substantial reproduction effect by the transmission of cultural capital in the family.…”

Equality of Opportunity: Policy and Measurement Paradigms

“…We note that lower percentage in these studies are always associated with one (or two) circumstances, thus, causality issue on partial circumstances matters and it confirms the idea that the share of inequality of opportunity can only be defined as a lower bound estimate of the ‘true’ inequality of opportunity. The Gini opportunity index advanced by Le Franc et al (2008) capture on average around 15% of income inequality of opportunity for nine developed countries while in the health context it counts for 21–26% in UK as verified by Rosa Dias (2009). According to health analysis, striking results are obtained by Jusot et al (2010) who observe around 45% of inequality of opportunity in France using CV and variance.…”

“…48 48 See Fleurbaey and Shokkaert (2009), Rosa Dias (2009), Trannoy et al (2009) for an overview about the measurement of inequality of opportunity in health. …”

Nudging, intervening or rewarding

“…Inspired by the philosophical concept of equality of opportunity developed by Dworkin (1981a,b), Roemer (1998), andFleurbaey (2008), a number of recent publications in health economics have focused on drawing the line between legitimate and illegitimate 3 causes of health inequalities (Fleurbaey and Schokkaert 2009;Dias 2009;Trannoy et al 2010;Dias 2010;Jusot et al 2013). The 1 For a review of policies aiming at changing health-related behaviours, see for example Cawley (2011).…”