Cure health inequality by reducing income inequality

Cure health inequality by reducing income inequality

by | Aug 30, 2017 | Opinion

The relationship between health and social context includes a range of factors influencing overall well-being. Social status, class, lifestyle, education, and environment primarily shape these factors. Age, gender, race, and ethnicity are structural variables of equal importance to health outcomes. Health is being facilitated or inhibited by the socioeconomic, cultural, and political backgrounds, in which one is born and raised. The people that view these data points and makes correlations between socioeconomic status and backgrounds to health issues have an interesting career because they constantly have to adapt to the understanding of new societal groups and focus on why a certain group would make a certain decision, for example.

In the last few decades, we have seen growing income inequality between the poor and rich. Since the 1980’s, the United States of America has seen a shift in wealth from the middle class towards the wealthiest people and transnational companies. The top one-tenth of 1 percent owns as much as the bottom 90 percent. Firebaugh and Beck argued economic growth would automatically benefit the masses, which in hindsight seems questionable.

As health outcomes and life expectations closely liaise to within-country income inequality, policies should aim at finding appropriate actions to address this phenomenon. Meaning, getting basic family urgent care, in terms of medical needs cannot be compromised. Currently, in some countries, those who earn more are able to find medical treatments to treat their injuries or illnesses, whilst those who don’t have as much money are having to cope with their illness or find other treatments. For example, those who suffer from digestive problems would have to pay a significant amount to get their illness looked at, so people on lower incomes will find supplements to help them instead. The bio complete 3 supplement can deliver prominent improvements for people’s digestive systems, so people are able to treat these problems. However, not all problems can be treated with supplements. This is why changes have to be made.

Wilkinson and Pickett found health issues to be strongly correlated to income inequality within a country. To support this finding, they used two different measurement tools. The first index, applied to Western countries, was a ratio of the 20 percent top incomes in relation to the 20 percent of the bottom earners. For different states within the USA they used a second index, the Gini-index, which adopts a different methodology. Where ‘Gini = 0′ represents perfect equality (same income for everyone) and ‘Gini = 1′ is total inequality (if all income goes to one person). The outcome of these results showed that the widening income gap led to an increase of different health issues related to mental disorders, life expectancy, infant mortality, obesity and teenage births. Societal problems that correlated to income inequality included: lower levels of trust, less educational performance, more homicides, higher imprisonment rates and a lack of social mobility. Some authors found Wilkinson and Pickett’s dismissal of poverty in relation to health outcomes incorrect as they did not measure it. On the other hand, research by Beckfield and Bambra confirmed the correlation between life expectancy and health stating that the lagging welfare state in the USA led to an average loss of 3.77 quality life years in comparison to other OECD countries. The USA has an income gap of 8:1 (the average biggest earners have 8 times the wage of those at the other end of the spectrum) leading to a life expectancy of 78.7 years, which is in contrast with Japan reaching an average of 83.0 years with an income gap of 4:1. The same age dependent relation has been found in Scandinavian countries having similar income gaps as Japan.

Goda and Torres Garcia looked at the rise of global inequality and confirmed previous results by stating that within-country inequality is responsible for 70 percent of the global inequality, suggesting 30% is due to in-between country inequality.

Taking national and local figures into account for the UK, the Office for National Statistics observed a life expectancy for new-born baby boys to be 83.3 years in the Kensington and Chelsea area. Meanwhile, the life expectancy for the same cohort in Blackpool is merely 74.7 years. Nationwide, the female life expectancy is 86.6 years in Purbeck and the lowest in Glasgow City with an expectancy of 78.5 years. The authors conclude that inequality has increased over the last two decades despite improvements in these local areas.

Medical technology has improved greatly over the past two decades, with many illnesses that were fatal twenty years ago proving simple to treat now. Simple technological breakthroughs such as RFID labeling and instant messaging have meant that medical practices can be streamlined, saving time and money which can then be invested back into treating patients. With all these improvements in technology, why is there still little improvement in life expectancy in some areas? The answer lies again with income inequality, with areas that suffer from low income also suffering from lower government funding. This directly impacts the access local hospitals have to new technology, meaning they have fewer new technologies to utilise for their patients.

We may assume a strong relation between income inequality and health outcomes on a global scale as Dorling in recent research concludes there are overarching arguments. Dorling (2007) confirmed a strong relation between income inequality and negative health outcomes on a global scale after an observational study performed in 126 countries.

The academic world has provided alternatives to deal with the widening gap between poor and rich. Reformed minimum wages, living wages, basic income or a global ‘fair tax’ and redistribution are only a few austerity counter-proposals to ensure overall well-being by reaching or transcending the poverty line. Minimum wages have proven insufficient and a basic income is still globally debated. An international fair tax may even prove more challenging as this requires global political support.

Minimum wages and living wages have the same aim; raising income for the least fortunate to reduce the impact of a growing income gap. A minimum wage is defined as a minimum market valued income, imposed by law and paid by employers. A living wage is a locally liaised and negotiated pay rate that a fulltime employee needs for a household of four to reach the poverty line. For the latter, societal context is important, as living in a metropolitan area is more expensive than living in the countryside. The Basic Income Earth Network defines basic income as “a periodic cash payment unconditionally delivered to all on an individual basis, without means, test or work requirement”.

A locally implemented living wage project in the UK, facilitated by the General and Municipal Boilermakers Union in 400 councils, has proven to be successful in reducing (health) inequalities as well as being beneficial for government tax income. Awareness within the community influenced policy in a way that living wages became accepted as a benchmark for society. In this regard, a living wage clearly will contribute to individual well-being and social cohesion – both factors improve health within communities.

Proposals for a Universal Basic Income (UBI) are slowly reaching the minds of global policymakers, but this process will take more time in achieving broader support. In developing a short-term response tackling inequality, a living wage appears to be a possible solution for developed countries yet remains a huge challenge for developing countries.

Emerging new technologies will demand economical strategies that are able to cope with less job certainty and keeping up with growing demands in healthcare.

A redistribution of capital, as proposed by Thomas Piketty in his book ‘Capital in the Twenty-First Century’, in combination with a UBI may prove to be the best strategy in the long-run to counter income-related health inequalities on a global scale. We must urge politicians to finally face transnational companies and the top one percent in order to obtain a globally acceptable taxation rate.

About the author:

Sam Brokken hails from Belgium and lives near the city of Leuven. He studied physiotherapy, sports physical therapy and manual therapy practicing these areas for years in private practices within local communities. He lectures in musculoskeletal disorders in relation to manual handling and ergonomics for healthcare service providers.
He is currently engaged in postgraduate work at the Robert Gordon University (Aberdeen – Scotland) within the MSc Public Health and Health Promotion course.

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“Reducing poverty and inequality through tax-benefit reform and the minimum wage: the UK as a case-study”

by | Aug 30, 2017 | Research

Inequality in the UK has been rising for some time as gaps between the lower and upper classes increase. But, there are movements such as levelling up the north east that are looking to reducing this inequality to ensure everyone gets good healthcare, education, job opportunities, etc. And now, the Institute for Social and Economic Research (ISER) at the University of Essex has released a paper titled “Reducing poverty and inequality through tax-benefit reform and the minimum wage: the UK as a case-study” as part of its EUROMOD working paper series.

The paper uses the EUROMOD microsimulation model to examine the impact on poverty and inequality of the proposals put forth in economist Anthony Atkinson’s most recent–and final–book Inequality: What Can Be Done? (2015). Atkinson, himself a co-author of the ISER study, passed away on January 1, during the final stages of preparation of the working paper.

The proposals considered include a “significantly more progressive income tax structure,” a “major increase in the minimum wage” (i.e. a “living wage”), and an increase in the amount of the nation’s universal child benefit, and two types of programs of social transfers: a strengthening of the UK’s social insurance system, and a “participation income”. A participation income–an idea developed and promoted by Atkinson–is similar to a basic income in that it guarantees all members of society a stable and secure livable income. It differs from a basic income, however, in that it is not fully unconditional: as its name suggests, a participation income is subject to a participation requirement. According to Atkinson, however, fulfilling this requirement should not require paid work or looking for paid work; it should also be able to be met through caregiving, community volunteer work, full-time education, or other unpaid but socially valuable activities.

In the simulation study, the authors note that “this participation condition cannot be imposed in our simulation exercise due to lack of data” and thus carry out the study “on the basis that everyone is entitled.” In other words, for the purposes of the working paper, they have chosen to simulate what is effectively an unconditional basic income.

The authors simulate a basic income at the level of £75 per week (or £3,902 per year), which replaces many means-tested programs.

One conclusion of the study is that, in comparison to strengthened social insurance (SI), the set of reforms introducing a participation income (PI) “produces a larger immediate impact on both inequality and poverty”. As the authors summarize, “[i]n achieving this greater impact the PI-focused package affects considerably more households, both positively and negatively: 43% of all households see a substantial gain and 21% a substantial loss, compared to 34% and 10% respectively with the SI-focused alternative.”

Other researchers have also recently used the EUROMOD microsimulation method to model the effects of basic income policies–including Malcolm Torry of the Citizen’s Income Trust (“A variety of indicators evaluated for two implementation methods for a Citizen’s Basic Income“) and, to more skeptical conclusions, the OECD (“Basic Income as a Policy Option: Can it add up?“).

 

The full working paper is free to download from ISER’s website:

Anthony B. Atkinson, Chrysa Leventi, Brian Nolan, Holly Sutherland and Iva Tasseva (June 2017) “Reducing poverty and inequality through tax-benefit reform and the minimum wage: the UK as a case-study,” EUROMOD Working Paper Series.

Reviewed by Caroline Pearce.

Photo: “The Poverty Trap…” CC BY-NC-ND 2.0 Neil Moralee (taken in Taunton, England)

 

Ville-Veikko Pulkka, “A free lunch with robots – can a basic income stabilise the digital economy?”

Ville-Veikko Pulkka, “A free lunch with robots – can a basic income stabilise the digital economy?”

by | Aug 29, 2017 | Research

Ville-Veikko Pulkka, a public policy researcher and doctoral candidate at the University of Helsinki, has published his paper “A free lunch with robots – can a basic income stabilise the digital economy?” in European Review of Labour and Research.

Pulkka was previously employed as part of the research team at Kela, the Finnish Social Insurance Institution, responsible for the design and preparation of the nation’s two-year experiment replacing conditional unemployment benefits with an unconditional basic income.

The Finnish experiment has been the topic of most of his previous published work and presentations related to basic income (including presentations at conferences in Switzerland, Poland, Finland, and Ireland).

Pulkka’s research at the University of Helsinki, including his doctoral dissertation, centers on the implications of the digital economy for labor and public policy.

“A free lunch with robots,” his latest publication on basic income, moves away from focus on the Finnish experiment to explore the latter topic in more general terms:  

The discussion on the possible implications of the digital economy for labour continues unabated. An essential dimension of the discussion is the widely shared view that a basic income could guarantee sufficient purchasing power for unemployed, underemployed and precarious workers should technological unemployment and labour market insecurity increase. A budget-neutral basic income has serious limitations as an economic stabilisation grant, but if financing proposals are revised, these limitations can be tackled. Even though guaranteeing sufficient purchasing power for unemployed, underemployed and precarious workers does not necessarily require an unconditional universal benefit, it seems clear that traditional activation based on strict means-testing and obligations will not be a strategy flexible enough to guarantee sufficient consumer demand in fluctuating labour markets. An economically sustainable solution might be to reduce means-testing gradually and to study carefully the effects.

The full article is available behind a paywall here.

Reviewed by Russell Ingram.

Photo CC BY-NC 2.0 Helen Taylor

Basic Income: Tradeoffs and Bottom Lines

by | Aug 21, 2017 | Research

This paper represents a massive undertaking by both University of Melbourne Australia faculty and an independent agency called the the Brotherhood of St. Laurence dedicated to social Justice.  It looks at a collection of BI pilot projects, as well as other projects which can be considered close approximations of a BI, from around the world.  Government projects which have been run in the past as well as private and government projects currently being implemented.

The paper provides a number of graphs and and analyses aimed at comparing and contrasting the examined projects while underlining the incredible number of variables affecting both the design and the outcome of any such project that must be attended to.  But the main focus of this paper is to determine how a BI can ensure equity of income, improved efficiency of governance and an end to the stigma of social supports.

While considering the concept of a BI to be attractive for a host of reasons, not the least of which are equity and the automation of the workplace, the paper is decidedly cautious and suggests careful consideration of “… broader issues and the intersecting domains and policies” which one can only assume refers to the social and economic ramifications of such a project. A very bureaucratic summation of some extremely crucial social concerns.

Book Review: Basic Income as a ‘realistic revolution of the welfare state’

Book Review: Basic Income as a ‘realistic revolution of the welfare state’

by | Aug 21, 2017 | Opinion

Why do so many leading economists pronounce themselves in favor of a Basic Income? Because of its positive economic effects on the distribution side, for example. Basic Income stabilizes the overall domestic consumption and provides a kind of regulation for the ratio between expenditures and savings. Furthermore, the Basic Income helps up to a certain degree to equalize the “unnecessary” distortions arising from the free play of market forces within the context of automation, digitalization, delocalization and further developments in society. And finally, Basic Income constitutes a lean and just system to provide every single individual with the minimal share of the wealth of nations that he/she is entitled to.

The economist and former head of the Hamburg World Economic Institute Thomas Straubhaar does not put the emphasis on the macroeconomic aspects. In 2006, he was one of the originators of the liberal Basic Income proposal “Solidary Citizens’ income” promoted by Dieter Althaus, member of the center-right party CDU and Thuringia’s prime minister at the time. Straubhaar’s new publication “Radikal gerecht” (radically just) shows some interesting development, while maintaining the core of the arguments in favor of a Basic Income from a liberal perspective.

The principles remain the same: Basic Income is paid unconditionally, to each individual, in addition to existing income and an amount that allows for a dignified living of each person. According to Straubhaar, Basic Income is a liberal concept because it promotes free choice of the individual (including the poor) and abolishes social bureaucracy. And it is a just cause because people with a high income pay more net taxes than those with a low income. While the citizen’s income of 2006 was calculated at €600 per adult per month (Bürgergeld), Straubhaar now speaks of €1,000 per person. He does not insist on this sum, saying that a) the basic needs of the individuals have to be re-evaluated periodically by the responsible office, for instance the federal statistical office, and b) in addition the amount is and will be a function of the political debate. A higher Basic Income requires higher taxes, which is the expression of the political will respectively of the political majorities. “It is obvious that the amount of the Basic Income and the tax rate are the levers of the policy makers and of the population to steer this new social system”, he writes on page 17.

Straubhaar presents the Basic Income as a kind of radical reform of the tax system. He calls it a negative income tax, however. A core element of this tax reform would be a flat rate tax on all kinds of income, not only wages, but also capital revenues and revenues from automats and robots. Here, Straubhaar reacts in a raw form to the fact that in the future, products from fully automated factories are going to have a price as well. Hence these have to be taxed like any other income. This is a major difference to most other models (and specifically the solidary citizen’s income of 2006) which deal mostly or exclusively with revenue taxes, and it is very welcome to see such an adaptation from the liberal side and in a systemic (even if at this moment still rather crude) form.

Concerning the financing, Straubhaar argues that the €960 billion cost of a Basic Income of €1,000 per person per month (80 million x €12’000) is somewhat higher than the actual expenses for the social state in Germany of €880 billion. The actual gross value-added amounts to €2.73 trillion (2015), which means that a flat rate of tax of 40% on this (at the moment it is transformed into income) would provide €1.1 trillion. The rest of the state’s expense would be covered by indirect taxes. At the same time, the contributions for the classical social insurance that actually are deducted from the gross salaries would largely be abolished.

Straubhaar admits this calculation to be very rough and not able to reflect all the possible and dynamic effects of the introduction of a Basic Income scheme, and insists on the flexible elements such an introduction will imply (estimation of cost of living, political process etc.). As with other authors, financing is not the core of this motivation. He sees the Basic Income as the best and most viable solution to adapt the classical system of social insurance of the 19th century to the 21th century. It creates a sort of a “blind” social policy, contrary to the targeted schemes whose advantage all too often is only to maintain a class of social bureaucrats who decide on sums and subjects. Furthermore, it is a core contribution to big issues of our times, namely an ageing population, digitalization/automation, individualization, and so on. Economically, it is not only viable, but it makes sense within the context of globalization and full automation. And he insists on paid labor continuing to be the main source of income but in new, more flexible and open forms, as activities and careers keep changing, as we witness already today. In this context, the existing organizations like trade unions or entrepreneurs’ federations will maintain their significance. The work motivation, which some economists see threatened by a Basic Income, will not decrease, but on the contrary increase thanks to the increased degree of freedom.

Straubhaar’s book is an important step for the liberal promotors of the Basic Income scheme in Germany. He aligns in practice with the other wings (Netzwerk Grundeinkommen, Goetz Werner) by speaking now of a sum of €1,000 per person per month (without being categoric about it). He urges it as a core element for the rebuilding of the social state, an adaptation to the 21th century and a blind social policy with arguments that are widely acknowledged by intelligent people. However, it is not certain that his fellow liberal economist colleagues in Germany are willing to follow his arguments. Many of them are still anchored in the concept of a 19th century social state. On the promotor’s side, some might be tempted to criticize Straubhaar’s concept of a negative income tax. Furthermore, several questions about the additional tasks of the social state remain.

There is one point that cannot be conceived in the way Straubhaar does. On page 98, he writes that every German citizen is part of the Basic Income scheme from birth until death, and those living abroad would have a right to their full claim, independent of their new country of residence. This is a flashback to the 19th century concepts of citizenship and nationality. Today, we speak of resident population and debate the introduction of a Basic Income in the whole world. Thus, if a German citizen would live in France, he would get the French Basic Income without the German Basic Income. But this is a tiny remark and does not impair the substantial progress of “Radikal gerecht”.

Finally, although Straubhaar labels Basic Income as radically just, he does not close the loop from a moral perspective to a legal standpoint, by omitting the step from basic income to basic right. As Thomas Paine wrote in 1796, the whole earth was originally in the possession of the whole human race. Now, on the base of an immensely increased wealth of nations and individuals, Basic Income represents the entitlement of every individual to a minimal (or basic) share of this wealth.

 

More information at:

(in German)

Thomas Straubhaar, Radikal gerecht [Radically just], Edition Körber-Stiftung, 2017

Written by: Albert Jörimann

Albert Jörimann, was president of BIEN-Switzerland from 2008 until 2013. His main research subject is financing questions of basic income.

 

Works cited:

Das Solidarische Bürgergeld. Analyse einer Reformidee.» Konrad Adenauer Stiftung, Edited by Michael Burchard, Lucius & Lucius, Stuttgart 2007.