nation: Denmark

Cross-posted at Reports from the Economic Front.

The Supreme Court has ruled favorably on the legality of the Affordable Care Act.  Actually, despite its name, the Act has more to do with extending and attempting to improve private health insurance coverage than it does with improving care or reducing its cost.

Unfortunately for us, the effort to improve our health care system has remained within bounds set by the needs of private health care providers and insurers.  As President Obama made clear from the start of his push for health care reform, there would be no consideration of a universal system.

Critics of such a universal system are always quick to argue that only market forces driven by the private pursuit of profit can ensure an efficient health care system.  Of course, in determining whether this is true, we need to recognize that efficiency is a complex term and that our health care system, like all systems, produces multiple outcomes.  The most obvious ones are private profit as well as the quality and cost of the relevant health care.

In terms of private profit there can be no doubt that our health care system functions well.  However, the story is quite different if we evaluate it in terms of quality and cost.  The fact that we continue to embrace a private health care system makes clear which measures of efficiency are considered most important and by whom.

The following map shows the countries, colored green, that have adopted a universal health care system.

mf-healthcaremap-p-thumb-615x314-91612.jpg

As Max Fisher explains:

What’s astonishing is how cleanly the green and grey separate the developed nations from the developing, almost categorically. Nearly the entire developed world is colored, from Europe to the Asian powerhouses to South America’s southern cone to the Anglophone states of Australia, New Zealand, and Canada. The only developed outliers are a few still-troubled Balkan states, the Soviet-style autocracy of Belarus, and the U.S. of A., the richest nation in the world.

The handful of developing countries that provide universal access to health care include oil-rich Saudi Arabia and Oman, Latin success story Costa Rica, Kyrgyzstan, and, famously, Cuba, among a few others. A number of countries have attempted universal health care but failed, such as South Africa, which maintains a notoriously inefficient and troubled public plan to complement the private plans popular among middle- and upper-class citizens…

That brings us to another way that America is a big outlier on health care. The grey countries on this map tend to spend significantly less per capita on health care than do the green countries — except for the U.S., where the government spends way more on health care per person than do most countries with free, universal health care. This is also true of health care costs as a share of national GDP — in other words, how much of a country’s money goes into health care.

The OECD just published a major study on the health care systems of its 34 member nations.  It found that:

 Health spending accounted for 17.6% of GDP in the United States in 2010, down slightly from 2009 (17.7%) and by far the highest share in the OECD, and a full eight percentage points higher than the OECD average of 9.5%. Following the United States were the Netherlands (at 12.0% of GDP), and France and Germany (both at 11.6% of GDP).

The United States spent 8,233 USD on health per capita in 2010, two-and-a-half times more than the OECD average of 3,268 USD (adjusted for purchasing power parity). Following the United States were Norway and Switzerland which spent over 5,250 USD per capita. Americans spent more than twice as much as relatively rich European countries such as France, Sweden and the United Kingdom.

combined1.jpg
What does all of this mean in terms of health outcomes?  According to the OECD report:

Most OECD countries have enjoyed large gains in life expectancy over the past decades. In the United States, life expectancy at birth increased by almost 9 years between 1960 and 2010, but this is less than the increase of over 15 years in Japan and over 11 years on average in OECD countries. As a result, while life expectancy in the United States used to be 1½ year above the OECD average in 1960, it is now, at 78.7 years in 2010, more than one year below the average of 79.8 years. Japan, Switzerland, Italy and Spain are the OECD countries with the highest life expectancy, exceeding 82 years.

One possible explanation for this lagging performance, highlighted in an earlier OECD report, is that the U.S. ranked 26th in terms of the number of practicing physicians relative to its population, 29th in terms of the number of doctor consultations per capita, 29th in terms of the number of hospital beds per capita, and 29th in terms of the average length of hospital stay.  At the same time, the “U.S. health system does do a lot of interventions… it has a lot of expensive diagnostic equipment, which it uses a lot. And it does a lot of elective surgery — the sort of activities where it is not always clear cut about whether a particular intervention is necessary or not.”

Private health care providers and insurers are clear about how they measure health care efficiency.  And as long as we rely on them to set the terms of the debate we will continue to suffer the consequences.

In a previous post I discussed how the U.S. became more religious in the 1950s, in part in response to its the Cold War enemies (atheist communists).  In fact, the U.S. is among the most religious countries in the world.  Using data from the International Social Survey Programme, Sociologist Tom Smith paints wildly different religious portraits of 28 nations (full text).

When asked whether they “know that God really exists and… have no doubt about it,” 61% of Americans say “yes.”  Of the 28 nations studied, only four were more likely to say “yes” to this question: Poland, Israel, Chile, and the Philippines. Here’s how we look compared to similar countries:

Here’s all 28 in rank order (borrowed from LiveScience).  Notice how wide the divergence is.  In Japan, the least religious country according to this measure, only 4% say they have no doubt God exists.  In The Philippines, 84% have no doubt.

% Have No Doubt God Exists:

  • Japan: 4.3 percent
  • East Germany: 7.8 percent
  • Sweden: 10.2
  • Czech Republic: 11.1
  • Denmark: 13.0
  • Norway: 14.8
  • France: 15.5
  • Great Britain: 16.8
  • The Netherlands: 21.2
  • Austria: 21.4
  • Latvia: 21.7
  • Hungary: 23.5
  • Slovenia: 23.6
  • Australia: 24.9
  • Switzerland: 25.0
  • New Zealand: 26.4
  • West Germany: 26.7
  • Russia: 30.5
  • Spain: 38.4
  • Slovakia: 39.2
  • Italy: 41.0
  • Ireland: 43.2
  • Northern Ireland: 45.6
  • Portugal: 50.9
  • Cyprus: 59.0
  • United States: 60.6
  • Poland: 62.0
  • Israel: 65.5
  • Chile: 79.4
  • The Philippines: 83.6

Americans are also particularly likely to believe in a “personal God,” one who is closely attentive to the lives of each and every person.

Quite interestingly, the U.S. is in the minority in that Americans tend to become increasingly religious as they age.  In most countries, people become less religious over time.  This graph (confusingly labeled), shows changes in DISbelief over the life course.  The U.S. is the only country among these in which disbelief declines:

Lifetime Change in Religiosity (from increase in disbelief to increase in belief):

  • The Netherlands: -14.0
  • Spain: -12.4
  • Australia: -12.0
  • France: -11.3
  • Norway: -11.0
  • Great Britain: -10.1
  • Switzerland: -8.2
  • Germany (East): -6.9
  • Denmark: -6.1
  • Czech Republic: -5.5
  • Sweden: -5.5
  • Germany (West): -5.4
  • New Zealand: -4.0
  • Italy: -2.7
  • Poland: -1.8
  • Japan: -1.5
  • Ireland: -0.9
  • Chile: +0.1
  • Cyprus: +0.2
  • Portugal: +0.6
  • The Philippines: +0.8
  • Hungary: +1.0
  • Northern Ireland: +1.0
  • United States: +1.4
  • Israel: +2.6
  • Slovakia: +5.6
  • Slovenia: +8.5
  • Latvia: +11.9
  • Russia: +16.0

Rates of atheism — a strong disbelief in God — also vary tremendously.  East Germany is the most atheist, with more than half of citizens claiming disbelief.  The country is a stark contrast to the atheist among them, Poland and the U.S. (only 3% atheist), Chile and Cyprus (2%), and The Phillipines (1%).

% Atheist:

  • East Germany: 52.1
  • Czech Republic: 39.9
  • France: 23.3
  • The Netherlands: 19.7
  • Sweden: 19.3
  • Latvia: 18.3
  • Great Britain: 18.0
  • Denmark: 17.9
  • Norway: 17.4
  • Australia: 15.9
  • Hungary: 15.2
  • Slovenia: 13.2
  • New Zealand: 12.6
  • Slovakia: 11.7
  • West Germany: 10.3
  • Spain: 9.7
  • Switzerland: 9.3
  • Austria: 9.2
  • Japan: 8.7
  • Russia: 6.8
  • Northern Ireland: 6.6
  • Israel: 6.0
  • Italy: 5.9
  • Portugal: 5.1
  • Ireland: 5.0
  • Poland: 3.3
  • United States: 3.0
  • Chile: 1.9
  • Cyprus: 1.9
  • The Philippines: 0.7

As a post-9/11 American watching another election cycle, I can’t help but notice how so much of our rhetoric revolves — sometimes overtly and sometimes not — around people who are the wrong religion.  Notably, Muslims.  And yet, the U.S. and many Muslim countries are alike in being strongly religious, at least in comparison to the many strongly secular countries.

This is odd because stands in contrast to recent data on American attitudes.  Within the U.S., people express much less tolerance for atheists than they do Muslims (homosexuals, African Americans, and immigrants). Weirdly, we think we have more in common with more secular nations like Great Britain than we do with countries like Pakistan or Saudi Arabia. In certain ways, the opposite might be true.

Thanks to Claude Fischer for the graphs.  Fischer, a sociologist at UC Berkeley, is the author of Made in America: A Social History of American Culture and Character.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Cross-posted at Family Inequality.

In 1994, Sara McLanahan and Gary Sandefur published, Growing Up With A Single Parent: What Hurts, What Helps. The growth of children living with only their mothers was — then as now — a matter of concern not only for children’s well-being, but for intergenerational mobility. One of their empirical conclusions was this:

For children living with a single parent and no stepparent, income is the single most important factor in accounting for their lower well-being as compared with children living with both parents. It accounts for as much as half of their disadvantage. Low parental involvement, supervision, and aspirations and greater residential mobility account for the rest.

The biggest problem, in other words, is economic. The other factors —  involvement, supervision, aspirations, mobility — are related to social class and the time poverty that economically-poor parents experience.

Examples

Here are some bivariate illustrations — that is, head-to-head comparisons of the difference between children of poor and non-poor versus single and married parents.

These are the “skill group” rankings by teachers of children by socioeconomic status (or SES, a composite of parents’ education, occupational prestige and income) versus race/ethnicity, gender and family structure. SES shows the widest spread in reading teachers’ group placement of first graders.

Source: Condron (2007)

Similarly, the poor/nonpoor difference is greater than the two-parent/single-parent difference in kindergarten entry scores:

Source: Early Childhood Longitudinal Study (2009)

Those are just two examples from early-childhood assessments. More importantly, here is the breakdown seen in a longitudinal study of children growing up. When women grow up to be mothers, their poverty level in childhood is more important than their family structure for predicting whether they will be in poverty themselves. The poverty difference is large, the family structure difference is not:

Source: Musik & Mare (2006)

This study included a more sophisticated set of multivariate analyses than this simple graph, but the author’s conclusion fits it:

Net of the correlation between poverty and family structure within a generation, the intergenerational transmission of poverty is significantly stronger than the intergenerational transmission of family structure, and neither childhood poverty nor family structure affects the other in adulthood.

That is, childhood poverty matters more.

Fewer single parents, or less poverty?

But if single parenthood and poverty are so closely related, some people say, we should spend hundreds of millions of dollars promoting marriage to help children avoid poverty (and other problems). That’s what the government has done, with money from the welfare budget. Even if it worked, which it apparently doesn’t, it’s only one approach. What about reducing poverty? And, more specifically, reducing the relative likelihood of poverty in single-parent families versus those with married parents. That is, address the poverty gap between the two groups, rather than the size of the two groups. This has the added advantage of not singling out one group — single mothers — for social stigmatization (of the kind I mentioned here). And, because it defines the problem as economic rather than moral, may make it easier to build public support for helping the poor.

Consider a recent paper by David Brady and Rebekah Burroway, which will be published in Demography. They analyzed the relative poverty of single mothers versus the total population — that is, what percentage had incomes below half the median (per person, after accounting for taxes and government transfers). Such a relative poverty measure is really a measure of inequality, but specifically inequality at the low end. (Regardless of how rich the rich are, it’s theoretically possible to have no one below half the median income). Here is my graph showing that result, with only the countries that have reliable sample sizes in the survey:

The Nordic countries have the lowest overall poverty rates. But in absolute terms their advantage is much bigger for single mothers. (The red line shows equal poverty rates for single mothers and the total population.) The US and UK have the largest difference in poverty rates between single mothers and overall poverty. That is, we have the largest poverty penalty for single motherhood. If the relative poverty rates for single mothers were lower in the US, we might spend more time and money addressing poverty and less trying to change family structures.

How does the U.S. compare to other developed countries on measures of social justice? According to the New York Times, not very well.  The visual below compares countries’ poverty rates, poverty prevention measures, income inequality, spending on pre-primary education, and citizen health.  The “overall” rating is on the far left and the U.S. ranks 27th out of 31.


Via Feministing.  See also how the U.S. ranks on measures of equality and prosperity(33 out of 33, for what it’s worth). Thanks to Dolores R. for the link!

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Tara B. drew my attention to a New York Times article on economic mobility in the U.S. and Europe. This chart compares intergenerational mobility in the U.S. and Denmark, showing where men raised in each quintile of the population (based on income) end up as adults (lighter bars = Denmark, dark bars = U.S.):

For both countries, there is more movement in the middle of the income distribution than at the extremes. However, there are important differences. As we see, in the U.S. men whose dads were in the bottom fifth in terms of income are much more likely to remain in the bottom earnings tier than men in Denmark are, with over 42% experiencing no mobility. We also see that they are less likely to move to the highest levels of the income ladder than are their Danish equivalents. However, this is partially due to differences in the overall distribution in income; because there is more income inequality in the U.S., an individual would have to gain much more income to make it from the lowest to the highest quintile than would someone living in Denmark, where the income distribution is more compact.

The full article from which this data is drawn, “American Exceptionalism in a New Light: A Comparison of Intergenerational Earnings Mobility in the Nordic Countries, the United Kingdom and the United States,” is available for free here.

Dmitriy T.M. sent in a New York Times slideshow of the contents of “MREs” from different countries.   MREs stands for “Meals Ready to Eat”; they are combat rations for soldiers. The rations are each some combination of comfort food, nutrition, and necessity.  And the different contents across countries reveal some interesting similarities and differences.

All MREs include some sort of meat, but the type and form of the meat vary, from meatballs to paté.  Meanwhile, almost all of the MREs include candy; it’s probably cheap, in the big scheme of things, to throw a few skittles, m&ms, or squares of chocolate, but what a treat it must be.  Likewise, the fruit-flavored beverages and tea must be a taste of home.  As for practicality, countries vary in whether they provide moist towelettes, toothpicks, tooth brushes.   Most offer matches; the U.S. includes toilet paper.

That said, the content of rations are also strikingly consistent.  I’ve love to see a flow chart tracing the development of MREs.  Were the logics for these rations developed in isolation?  Or were some countries influential over others?

These are my uneducated observations.  Feel free to offer more informed thoughts in the comments.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.

Cross-posted at Family Inequality.

I have criticized sloppy statistical work by some international feminist organizations, so I’m glad to have a chance to point out a useful new report and website.

The Progress of the World’s Women is from the United Nations Entity for Gender Equality and the Empowerment of Women. The full-blown site has an executive summary, a long report, and a statistics index page with a download of the complete spreadsheet. I selected a few of the interesting graphics.

Skewed sex ratios (which I’ve written about here and here) are in the news, with the publication of Unnatural Selection, by Mara Hvistendahl. The report shows some of the countries with the most skewed sex ratios, reflecting the practice of parents aborting female fetuses (Vietnam and Taiwan should  be in there, too). With the exception of Korea, they’ve all gotten more skewed since the 1990s, when ultrasounds became more widely available, allowing parents to find out the sex of the fetus early in the pregnancy.

The most egregious inequality between women of the world is probably in maternal mortality. This chart shows, for example, that the chance of a woman dying during pregnancy or birth is about 100- 39-times higher in Africa than Europe. The chart also shows how many of those deaths are from unsafe abortions.

Finally, I made this one myself, showing women as a percentage of parliament in most of the world’s rich countries (the spreadsheet has the whole list). The USA, with 90 women out of 535 members of Congress, comes in at 17%.

The report focuses on law and justice issues, including rape and violence against women, as well as reparations, property rights, and judicial reform. They boil down their conclusions to: “Ten proven approaches to make justice systems work for women“:

1. Support women’s legal organizations

2. Support one-stop shops and specialized services to reduce attrition in the justice chain [that refers to rape cases, for example, not making their way from charge to conviction -pnc]

3. Implement gender-sensitive law reform

4. Use quotas to boost the number of women legislators

5. Put women on the front line of law enforcement

6. Train judges and monitor decisions

7. Increase women’s access to courts and truth commissions in conflict and post-conflict contexts.

8. Implement gender-responsive reparations programmes

9. Invest in women’s access to justice

10. Put gender equality at the heart of the Millennium Development Goals

Does American prosperity translate into long retirements?  Not compared to other developed countries in the world.  Flowing Data borrowed OECD numbers on life expectancy and age of retirement to calculate the average number of years in retirement for men and women across many different countries.  The portion of each bar with the line is the average number of years working, while the non-lined portion represents years in retirement.

Largely because of life expectancy, women enjoy more years than men in all states except Turkey, but the number of years varies quite tremendously, from an average of zero years for men in Mexico, to an average of 26 years for women in Austria and Italy.  The United States is way down on this list, not doing so well relatively after all.

Lisa Wade, PhD is an Associate Professor at Tulane University. She is the author of American Hookup, a book about college sexual culture; a textbook about gender; and a forthcoming introductory text: Terrible Magnificent Sociology. You can follow her on Twitter and Instagram.