Tag: death rates

Prosperity and World Population Growth

Readers of Matt Ridley’s The Rational Optimist and Ronald Bailey’s columns in the Reason magazine will not be surprised to hear that the rate of population growth is slowing—dramatically—throughout the world. Jeff Wise’s article in the Slate magazine, “About that Overpopulation Problem,” revisits that familiar territory and makes some interesting points. Ultimately, however, Wise fails to appreciate the real reasons for the fall in population growth rate.

First, the good news. As Wise notes, “[The] rate of global population growth has slowed. And it’s expected to keep slowing. Indeed, according to experts’ best estimates, the total population of Earth will stop growing within the lifespan of people alive today. And then it will fall… the long-dreaded resource shortage may turn out not to be a problem at all.”

“For hundreds of thousands of years,” Wise’s article continues, “in order for humanity to survive things like epidemics and wars and famine, birthrates had to be very high. Eventually, thanks to technology, death rates started to fall in Europe and in North America, and the population size soared. In time, though, birthrates fell as well, and the population leveled out.”

Why might that be? “The reason,” Wise avers, “for the implacability of demographic transition can be expressed in one word: education. One of the first things that countries do when they start to develop is educate their young people, including girls. That dramatically improves the size and quality of the workforce. But it also introduces an opportunity cost for having babies.”

True enough, better education is a by-product of development, but where does development come from?

For that we have to look to Ronald Bailey. As he writes, “In 2002, Seth Norton, a business economics professor at Wheaton College in Illinois, published a remarkably interesting study on the inverse relationship between prosperity and fertility. Norton compared fertility rates of over 100 countries with their index rankings for economic freedom and another index for the rule of law. ‘Fertility rate is highest for those countries that have little economic freedom and little respect for the rule of law,’ wrote Norton. ‘The relationship is a powerful one. Fertility rates are more than twice as high in countries with low levels of economic freedom and the rule of law compared to countries with high levels of those measures.’”

And, “Economic freedom and the rule of law produce prosperity which dramatically lowers child mortality which, in turn, reduces the incentive to bear more children. In addition, along with increased prosperity comes more education for women, opening up more productive opportunities for them in the cash economy. This increases the opportunity costs for staying at home to rear children. Educating children to meet the productive challenges of growing economies also becomes more expensive and time consuming.”

So, education is a proximate cause of population growth slowdown. The ultimate cause, however, rests with economic freedom and resulting prosperity.

Study: Competition Saves Lives in Britain’s NHS

This interesting NBER study just came across the transom:

The effect of competition on the quality of health care remains a contested issue.  Most empirical estimates rely on inference from non experimental data. In contrast, this paper exploits a pro-competitive policy reform to provide estimates of the impact of competition on hospital outcomes. The English government introduced a policy in 2006 to promote competition between hospitals. Patients were given choice of location for hospital care and provided information on the quality and timeliness of care. Prices, previously negotiated between buyer and seller, were set centrally under a DRG type system…

Our results constitute some of the first evidence on the impacts of a market-based reform in the health care sector. We find strong evidence that under a regulated price regime that hospitals engage in quality competition and that the 2006 NHS reforms were successful. Within two years of implementation the NHS reforms resulted in significant improvements in mortality and reductions in length-of-stay without changes in total expenditure or increases in expenditure per patient. Our back of the envelope estimates suggest that the immediate net benefit of this policy is around £227 million. While this is small compared to the annual cost of the NHS of £100 billion, we have only calculated the value from decreases in death rates. Allowing for improvements in other less well measured aspects of quality will increase the benefit, as will any further falls in market concentration which may occur as the policy continues in operation. If the UK were to pursue policies that lead to deconcentration of hospital markets, the gains could be substantially larger.

These results suggest that competition is an important mechanism for enhancing the quality of care patients receive. Monopoly power is directly harmful to patients, in the worst way possible - it substantially increases their risk of death. The adoption of pro-market policies in European countries, as well as policies directed at increasing or maintaining competition such as antitrust enforcement, appear to have an important role to play in the functioning of the health sector and assuring patients’ well being.

The study is, “Death by Market Power: Reform, Competition and Patient Outcomes in the National Health Service,” by Martin Gaynor (Carnegie-Mellon University), Rodrigo Moreno-Serra (Imperial College Business School), and Carol Propper (University of Bristol).

More to Be Thankful For

In a new study, Glen Whitman and Raymond Raad demonstrate that America leads the world in medical innovations that ease and extend our lives. And in Tuesday’s Wall Street Journal, Melinda Beck details some of the health care advances that we should give thanks for this Thanksgiving Day:

• Fewer Americans died in traffic fatalities in 2008 than in any year since 1961, and fewer were injured than in any year since 1988, when the National Highway Traffic Safety Administration began collecting injury data. One possible reason: Seat-belt use hit a record high of 84% nationally.

Life expectancy in the U.S. reached an all-time high of 77.9 years in 2007, the latest year for which statistics are available, continuing a long upward trend. (That’s 75.3 years for men and 80.4 years for women.)

Death rates dropped significantly for eight of the 15 leading causes of death in the U.S., including cancer, heart disease, stroke, hypertension, accidents, diabetes, homicides and pneumonia, from 2006 to 2007. (Of the top 15, only deaths from chronic lower respiratory disease increased significantly.) The overall age-adjusted death rate dropped to a new low of 760.3 deaths per 100,000 people—half of what it was 60 years ago….

• Around the world, 27% fewer children died before their fifth birthday in 2007 than in 1990, due to greater use of insecticide-treated mosquito nets, better rehydration for diarrhea, and better access to clean water, sanitation and vaccines.…

• Twenty-seven countries reported a reduction of up to 50% in the number of malaria cases between 1990 and 2006.

Read it all. (I should note that Beck attributes more of this good news to government action than I would, and she counts the mere existence of smoking bans as a “health care advance,” despite the lack of evidence that they actually have any health effects. But that’s an argument we can save for next week. Today and tomorrow let’s just celebrate the good news.)

I wrote a couple of years ago about the good news of falling cancer death rates and falling heart disease death rates.

In his book The Improving State of the World, Indur Goklany examined, as the subtitle put it, Why We’re Living Longer, Healthier, More Comfortable Lives on a Cleaner Planet.

The Improving State of New York City, circa 1800-2007

Two figures that say it all.

200910_blog_goklany1Death Rates (deaths per 1,000 population), New York City, c. 1800-2007. Source: NYC Department of Health & Mental Hygiene. Summary of Vital Statistics (2008). H/T to William Briggs for making me aware of this figure.

200910_blog_goklany2Infant Mortality Rate (deaths per 1,000 live births), New York City, 1898-2007. In 1898 IMR was estimated to be 140.9 Because of incomplete reporting of early neonatal deaths, this is almost certainly an underestimate. In 2007 IMR was 5.4 deaths per 1,000 live births. Source: NYC Department of Health & Mental Hygiene. Summary of Vital Statistics (2008)