Sociological Images

The Institute of Medicine and the National Research Council released some damaging numbers this month: Americans ranks startlingly low in life expectancy, compared to 16 other similarly developed countries.  This is especially true for younger Americans. Indeed, among people 55 and under, we rank dead last.  Among those 50-80 years old, our life expectancy is 3rd or 2nd to last.

Sabrina Tavernise at the New York Times reports that the “major contributors” to low life expectancy among younger Americans are high rates of death from guns, car accidents, and drug overdoses.  We also have the highest rate of diabetes and the second-highest death rate from lung and heart disease.

Americans had “the lowest probability over all of surviving to the age of 50.”  The numbers for American men were slightly worse than those for women. Overall, life expectancy for men was 17 out of 17; women came in 16th.  Education and poverty made a difference too, as did the more generous social services provided by the other countries in the study.

What isn’t making a difference?  Apparently our incredible rate of health care spending.

Via Citings and Sightings.

I’m bringing this old post back up to the top because I found an additional example. I would like for knowledge of this practice to spread far and wide. Please share!

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A former editor at Cosmopolitan, Leah Hardy, recently wrote an exposé about the practice of photoshopping models to hide the health and aesthetic costs of extreme thinness. Below is an example featuring Cameron Diaz:

The story about Diaz, in The Telegraph, includes the following description of the image’s manipulation:

• Face: Cheeks appear filled out
• Bust: Levelled
• Thighs: Wider in the picture on the right
• Hip: The bony definition has been smoothed away
• Stomach: A fuller, more natural look
• Arms: A bit more bulk in the arms and shoulders

Another example was posted at The Daily What. Notice that her prominent ribcage has been photoshopped out of the photograph on the right, which ran in the October 2012 issue of  Numéro.

Hardy, the editor at Cosmo, explains that she frequently re-touched models who were “frighteningly thin.”  Others have reported similar practices:

Jane Druker, the editor of Healthy magazine — which is sold in health food stores — admitted retouching a cover girl who pitched up at a shoot looking “really thin and unwell”…

The editor of the top-selling health and fitness magazine in the U.S., Self, has admitted: “We retouch to make the models look bigger and healthier”…

And the editor of British Vogue, Alexandra Shulman, has quietly confessed to being appalled by some of the models on shoots for her own magazine, saying: “I have found myself saying to the photographers, ‘Can you not make them look too thin?’”

Robin Derrick, creative director of Vogue, has admitted: “I spent the first ten years of my career making girls look thinner — and the last ten making them look larger.”

Hardy described her position as a “dilemma” between offering healthy images and reproducing the mythology that extreme thinness is healthy:

At the time, when we pored over the raw images, creating the appearance of smooth flesh over protruding ribs, softening the look of collarbones that stuck out like coat hangers, adding curves to flat bottoms and cleavage to pigeon chests, we felt we were doing the right thing… We knew our readers would be repelled by these grotesquely skinny women, and we also felt they were bad role models and it would be irresponsible to show them as they really were.

But now, I wonder. Because for all our retouching, it was still clear to the reader that these women were very, very thin. But, hey, they still looked great!

They had 22-inch waists (those were never made bigger), but they also had breasts and great skin. They had teeny tiny ankles and thin thighs, but they still had luscious hair and full cheeks.

Thanks to retouching, our readers… never saw the horrible, hungry downside of skinny. That these underweight girls didn’t look glamorous in the flesh. Their skeletal bodies, dull, thinning hair, spots and dark circles under their eyes were magicked away by technology, leaving only the allure of coltish limbs and Bambi eyes.

Insightfully, Hardy describes this as a “vision of perfection that simply didn’t exist” and concludes, “[n]o wonder women yearn to be super-thin when they never see how ugly [super-]thin can be.”

UPDATE:  A comment has brought up the point that it’s bad to police people’s bodies, no matter whether they’re thin or fat.  And this is an important point (made well here) and, while I agree that some of the language is harsh, that’s not what’s going on here.  The vast majority of the models who need reverse photoshopping aren’t women who just happen to have that body type.  They are part of an social institution that demands extreme thinness and they’re working hard on their bodies to be able to deliver it.  This isn’t, then, about shaming naturally thin women, it’s about (1) calling out an industry that requires women to be unhealthy and then hides the harmful consequences and (2) acknowledging that even people who are a part of that industry don’t necessarily have the power to change it.

As politicians negotiated regarding the fiscal cliff, they debated whether to cut social programs aimed at alleviating poverty and deprivation.  Most of us imagine that these programs help a minority of the population.  In fact, the Pew Research Center reports that more than half of the population has received government benefits from one of the six most well-known programs:

This isn’t the so-called 47% that Romney claimed would vote for a Democrat no matter what.  In fact, people who received one of these six benefits were only slightly more likely to vote Democratic:

In fact, receiving benefits is pretty well spread out among the population. Except for people over 65, there seems to be significant consistency in the receipt of at least one benefit:

Notably, these programs also go to help the poor, women (largely because they end up single with young children), and people in rural areas.

Interestingly, many of us who have benefited from targeted government programs (“targeted” because we all benefit from programs like, oh, transportation initiatives and environmental protection and [insert dozens more here]) don’t know that we do.  In a previous post, we showed that large proportions of people who’ve benefited from social programs don’t recognize that they have unless their thinking is sparked by asking them about specific programs.  (It’s kind of like responding “No I don’t do drugs” and then being asked specifically about marijuana and saying, “Oh yeah, well that one I guess!”).

Since it is indeed the majority of Americans who benefit from targeted programs, it shouldn’t be too hard for politicians to find it in their hearts to support these programs.  That 57% of conservatives and 52% of Republicans have used them suggests that the political right is more interested in purporting an ideology than serving its constituency.

Alternatively, they realize that a certain proportion of benefit recipients also believe that the government “does not have the responsibility to care for those who cannot care or themselves.” About a third of people who hold onto this principle have used benefits:

It seems that data like this might be very useful for what we really need: an educational campaign designed to help Americans understand what social programs do and who benefits from them.   Maybe then we could have sensible policy discussions.

Cross-posted at Family Inequality and The Atlantic.

The problem of income inequality often gets forgotten in conversations about biological clocks.

The dilemma that couples face as they consider having children at older ages is worth dwelling on, and I wouldn’t take that away from Judith Shulevitz’s essay in the New Republic, “How Older Parenthood Will Upend American Society,” which has sparked commentary from Katie Roiphe, Hanna Rosin, Ross Douthat, and Parade, among many others.

The story is an old one — about the health risks of older parenting and the implications of falling fertility rates for an aging population — even though some of the facts are new. But two points need more attention. First, the overall consequences of the trend toward older parenting are on balance positive, both for women’s equality and for children’s health. And second, social-class inequality is a pressing — and growing — problem in children’s health, and one that is too easily lost in the biological-clock debate.

Older mothers

First, we need to distinguish between the average age of birth parents on the one hand versus the number born at advanced parental ages on the other. As Shulevitz notes, the average age of a first-time mother in the U.S. is now 25. Health-wise, assuming she births the rest of her (small) brood before about age 35, that’s perfect.

Consider two measures of child well-being according to their mothers’ age at birth. First, infant mortality:

(Source: Centers for Disease Control)

Health prospects for children improve as women (and their partners) increase their education and incomes, and improve their health behaviors, into their 30s. Beyond that, the health risks start accumulating, weighing against the socioeconomic factors, and the danger increases.

Second, here is the rate of cognitive disability among children according to the age of their mothers at birth, showing a very similar pattern:

(Source: Calculations made for my working paper)

Again, the lowest risks are to those born when their parents are in their early 30s, a pattern that holds when I control for education, income, race/ethnicity, gender, and child’s age.

When mothers older than age 40 give birth, which accounted for 3 percent of births in 2011, the risks clearly are increased, and Shulevitz’s story is highly relevant. But, at least in terms of mortality and cognitive disability, an average parental age in the late 20s and early 30s is not only not a problem, it’s ideal.

Unequal health

But the second figure above hints at another problem — inequality in the health of parents and children. On that purple chart, a college graduate in her early 40s has the same risk as a non-graduate in her late 20s. And the social-class gap increases with age. Why is the rate of cognitive disabilities so much higher for the children of older mothers who did not finish college? It’s not because of their biological clocks or genetic mutations, but because of the health of the women giving birth.

For healthy, wealthy older women, the issue of aging eggs and genetic mutations from fathers’ run-down sperm factories are more pressing than it is for the majority of parents, who have not graduated college.

If you look at the distribution of women having babies by age and education, it’s clear that the older-parent phenomenon is disproportionately about more-educated women. (I calculated these from the American Community Survey, because age-by-education is not available in the CDC numbers, so they are a little different.)

Most of the less-educated mothers are giving birth in their 20s, and a bigger share of the high-age births are to women who’ve graduated college — most of them married and financially better off. But women without college degrees still make up more than half of those having babies after age 35, and the risks their children face have more to do with high blood pressure, obesity, diabetes, and other health conditions than with genetic or epigenetic mutations. Preterm births, low birth-weight, and birth complications are major causes of developmental disabilities, and they occur most often among mothers with their own health problems.

Most distressing, the effects of educational (and income) inequality on children’s health have been increasing. Here are the relative odds of infant mortality by maternal education, from 1986 to 2001, from a study in Pediatrics. (This compares the odds to college graduates within each year, so anything over 1.0 means the group has a higher risk than college graduates.)

This inequality is absent from Shulevitz’s essay and most of the commentary about it. She writes, of the social pressure mothers like her feel as they age, “Once again, technology has given us the chance to lead our lives in the proper sequence: education, then work, then financial stability, then children” — with no consideration of the 66 percent of people who have reached their early 30s with less than a four-year college degree. For the vast majority of that group, the sequence Shulevitz describes is not relevant.

In fact, if Shulevitz had considered economic inequality, she might not have been quite as worried about advancing parental age. When she worries that a 35-year-old mother has a life expectancy of just 46 more years — years to be a mother to her child — the table she consulted applies to the whole population. She should breathe a little bit easier: Among 40-year-old white college graduates women are expected to live an average extra five years compared with those who have a high school education only.

When it comes to parents’ age versus social class, the challenges are not either/or. We should be concerned about both. But addressing the health problems of parents — especially mothers — with less than a college degree and below-average incomes is the more pressing issue — both for potential lives saved or improved and for social equality.

Cross-posted at Reports from the Economic Front.

One of the subthemes of current discussions about how best to reduce our national debt is that we must rein in out-of-control spending on federal safety net programs.   The reality is quite different.

The chart below shows spending trends in terms of GDP for the ten major needs-tested benefit programs that make-up our federal social safety net. The programs, in the order listed on the chart, are:

• The refundable portion of the health insurance tax credit enacted in the 2010 health care reform law
• Medicaid and the Children’s Health Insurance Program (CHIP)
• The Supplemental Nutrition Assistance Program (SNAP)
• Financial assistance for post-secondary students (Pell Grants)
• Compensatory Education Grants to school districts
• Assisted Housing
• The Earned Income Tax Credit (EITC)
• The Additional Child Tax Credit (ACTC)
• Supplemental Security Income (SSI)
• Family Support Payments

As Jared Bernstein explains:

…for all the popular wisdom that programs to help low-income people are swallowing the economy, the truth is that like so much else that plagues our fiscal future, it’s all about health care spending.  The figure shows that as a share of GDP, prior to the Great Recession, non-health care spending was cruising along at around 1.5% for decades.  It was Medicaid/CHIP (Medicaid expansion for kids) that did most of the growing.

The takeaway from this: we need a new health care system (think single payer).

Regardless, the recent explosion in the ratio of Medicare/CHIP spending to GDP is largely due to the severity of the Great Recession, not the generosity of the programs. The recession increased poverty and thus eligibility for the programs, thereby pushing up the numerator, while simultaneously lowering GDP, the denominator.   Moreover, spending on all non-health care safety net programs is on course to dramatically decline as a share of GDP. Even Medicare/Chip spending is projected to stabilize as a share of GDP.

These programs are essential given the poor performance of the economy, and in most cases poorly-funded. Cutting their budgets will not only deny people access to health care, housing, education, and food, it will also further weaken the economy, in both the short and long run.

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Martin Hart-Landsberg is a professor of Economics and Director of the Political Economy Program at Lewis and Clark College.  You can follow him at Reports from the Economic Front.

For the last week of December, we’re re-posting some of our favorite posts from 2012. Cross-posted at The Huffington Post.

If you live in the U.S. you are absolutely bombarded with the idea that being overweight is bad for your health.  This repetition leaves one with the idea that being overweight is the same thing as being unhealthy, something that is simply not true.  In fact, people of all weights can be either healthy or unhealthy; overweight people (defined by BMI) may actually have a lower risk of premature death than “normal” weight people.  Being fat is simply not the same thing as being unhealthy.

The Health At Every Size (HAES) movement attempts to interrupt the conflation of health and thinness by arguing that, instead of using one’s girth as an indicator of one’s health, we should be focusing on eating/exercising habits and more direct health measures (like blood pressure and cholesterol).

A recent study offered the HAES movement some interesting ammunition in this battle. The study recruited almost 12,000 people of varying BMIs and followed them for 170 months as they adopted healthier habits.  Their conclusion? “ Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index.”

Take a look.  The “hazard ratio” refers to the risk of dying early, with 1 being the baseline.  The “habits” along the bottom count how many healthy habits a person reported.  The shaded bars represent people of different BMIs from “healthy weight” (18.5-24.9) to “overweight” (25-29.9), to “obese” (over 30).

The three bars on the far left show the relative risk of premature death for people with zero healthy habits. It suggests that being overweight increases that risk, and being obese much more so.  The three bars on the far right show the relative risk for people with four healthy habits; the differential risk among them is essentially zero; for people with healthy habits, then, being fatter is not correlated with an increased relative risk of premature death.  For everyone else in between, we more-or-less see the expected reduction in mortality risk given those two poles.

This data doesn’t refute the idea that fat matters.  In fact, it shows clearly that thinness is protective if people are doing absolutely nothing to enhance their health.  It also suggests, though, that healthy habits can make all the difference.  Overweight and obese people can have the same mortality risk as “normal” weight people; therefore, we should reject the idea that fat people are “killing themselves” with their extra pounds.  It’s simply not true.

h/t to BigFatBlog.

For the last week of December, we’re re-posting some of our favorite posts from 2012.

In Mother-Blame in the Prozac Nation, sociologist Linda Blum describes the lives of women with disabled children.  While mothers are held to an essentially impossibly high standard of motherhood in the contemporary U.S. and elsewhere, mothers of disabled children find themselves even more overwhelmed.

The daily care of their child is often more intensive but, in addition to that added responsibility, mothers were actively involved in getting their children needed services and resources.  The need for mothers to be proactive about this was exacerbated by the fact that they had to negotiate different social institutions, each with an interest in claiming certain service spheres, but also limited budgets.  ”While each system claims authoritative expertise,” Blum writes, ” either system can reject responsibility, paradoxically, when costs are at issue.”  Because they often had to argue with service providers and find ways to beat a system that often tried to keep them at bay, they had to become experts in their child’s disability, of course, but also public policy, learning styles, the medical system, psychology/psychiatry, pharmaceutics, manipulation of jargon and law, and more.

Mothers often felt that they were their child’s only advocate, with his or her health and future dependent on making just one more phone call, getting one more meeting with an expert, or trying one more school. Accordingly, they were simultaneously exhausted and filled with guilt.  I wondered, when I came across this Post Secret confession, if this mother was experiencing some of the same things:

Lisa Wade is a professor of sociology at Occidental College. You can follow her on Twitter and Facebook.