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  1. 1. Centre for Behaviour and Health Early Life Conditions, the distribution of well-being in Ireland, and ageing UCD Geary Institute
  2. 2. Introduction <ul><li>Understanding the health and well-being of the Irish population is a key task for social and bio-medical scientists who wish to inform policy </li></ul><ul><li>These attributes are formed by early influences as well as contemporaneous factors. The conditions experienced in Ireland in the 1930s and 1940s may be as important in explaining the health of the ageing population as the current state of the health services </li></ul><ul><li>Ignoring those who emigrated could misrepresents historical patterns </li></ul><ul><li>Health and well-being are multi-dimensional constructs, and unpicking the causal mechanisms involved requires a variety of different approaches </li></ul><ul><li>Innovative new techniques such as the day reconstruction method are required if the real underlying differences in health and well-being are to be understood </li></ul>
  3. 3. We are living longer… <ul><li>Life expectancy at birth (men) was 57.4 years in 1926, 75.07 in 2002, and 79.9 in 2006 (CSO, Eurostat) </li></ul><ul><li>Recent growth has been largely driven by declines in mortality in higher age groups </li></ul><ul><li>Dramatic increase since 2002 has come after the period of fastest economic growth </li></ul>
  4. 4. Life Expectancy At Birth and Age 65 (1926-2002) Source: Saorstát and CSO Lifetables
  5. 5. EU convergence is only recent Source: Eurostat
  6. 6. … but the experience has not been unambiguously positive Source: OECD
  7. 7. Valuing changes in life expectancy could significantly raise growth levels over the Celtic Tiger period <ul><li>Reductions in mortality are not taken into account when evaluating welfare (e.g. GDP Per Capita), but well being depends on both quantity and quality of life </li></ul><ul><li>Incorporating changes in life expectancy could dramatically alter trends in well being over time </li></ul><ul><li>According to Robert Fogel (2005), doing so could double estimates of US income per head since 1900 </li></ul><ul><li>Murphy & Topel (2006) argue that gains since 1970 added $3.2 trillion to national wealth </li></ul><ul><li>Becker et al (2005) reverse the findings on convergence between developed and developing countries by taking account of changes in life expectancy. Since 1960, full income growth rates for rich countries was 2.8%, while those of poor countries were 4.1% </li></ul>
  8. 8. The causal mechanisms are hard to isolate… <ul><li>Cutler et al (2005) describe three periods in mortality declines </li></ul><ul><li>First up to end of 19 th century depended on increased nutrition (Robert Fogel) </li></ul><ul><li>Second from early to mid 20 th century relied on the introduction of public health schemes in water, housing, and sewage </li></ul><ul><li>Third, from mid century on has been much more complicated, relying much more on personal behaviour and education than exogenous government initiatives </li></ul><ul><li>Roots of recent improvements are much more difficult to isolate due to the “intricate interplay of advances in income, salubrity, nutrition, education, sanitation and medicine, with the mix varying over age, period, cohort, place and disease” (Oeppen & Vaupel, 2002) </li></ul>
  9. 9. … and require an interdisciplinary approach <ul><li>Literature involves demographers, psychologists, sociologists, evolutionary biologists, epidemiologists, and economists </li></ul><ul><li>Main contribution of economists has been to untangle causal mechanisms (Cutler et al, 2008) </li></ul><ul><li>Projects underway at the Geary Institute: </li></ul><ul><ul><li>Ageing (SHARE) </li></ul></ul><ul><ul><li>Early Life Conditions </li></ul></ul><ul><ul><li>Irish Abroad </li></ul></ul><ul><ul><li>Day Reconstruction Study </li></ul></ul>
  10. 10. Inequalities in health persist despite the rise in incomes <ul><li>Several welfare measures have decoupled from income in developed countries since the 1930s (Soares, 2007) </li></ul><ul><li>Within countries clear relationship between health and SES (O’Shea 1991,2003, Banks et al 2005) </li></ul><ul><li>Holds even within well-off cohorts (Whitehall I & II) </li></ul><ul><li>Gradient has not dissipated with rising incomes </li></ul><ul><li>Holds even when controlling for risky behaviour (Marmot et al, 1991, Woodward et al, 1990) </li></ul><ul><li>Robust to introduction of public health schemes such as NHS and Medicade (Cutler et al, 2005) </li></ul>
  11. 11. Research into alternative explanations is required <ul><li>Smith (1999) “A t least for industrial countries, the old standby arguments – the less well-to-do have access to less or lower quality medical care or a stronger pattern of deleterious personal behaviours- have been rejected as insufficient .” </li></ul><ul><li>Research in the Geary Institute into these alternatives is ongoing: </li></ul><ul><ul><li>Psychosocial Stress (DRM) </li></ul></ul><ul><ul><li>Early Life Conditions </li></ul></ul>
  12. 12. The importance of early life conditions <ul><li>Dramatic decline in infant mortality from 1940s on </li></ul><ul><li>Taking infant mortality as a proxy, early life conditions improved by 50% between 1940 and 1960 </li></ul><ul><li>According to Cutler et al (2005), this decline may be the crucial factor in enabling people to live longer today </li></ul><ul><li>The cohort who are exhibiting increased longevity today are those who experienced improvements in early life conditions </li></ul><ul><li>Reductions in deaths from cardiovascular illness have accounted for 70% of the decline in mortality since 1960 (Cutler et al 2005) </li></ul>
  13. 13. Irish Infant Mortality Source: CSO
  14. 14. Ageing in Ireland <ul><li>An ageing population and declining mortality means an increasing focus on the welfare of the older age groups </li></ul><ul><li>By 2021 the proportion of total population aged over 65 will have grown by 59 per cent, and by 2061 a further 142 per cent (Green Paper on Pensions, 2007) </li></ul><ul><li>SHARE (2007) survey provides a comprehensive overview of this cohort in Ireland, and across Europe </li></ul><ul><li>But current health is partly determined by early life conditions, which we need to document in order to understand contemporary distributions in health </li></ul><ul><li>SHARE Life </li></ul>
  15. 15. Health declines with age… Source: SHARE Ireland, 2007
  16. 16. And exhibits a clear social gradient Source: SHARE Ireland, 2007
  17. 17. There are also gradients in cognitive function
  18. 18. And life satisfaction
  19. 19. Irish Abroad <ul><li>Millions of Irish people emigrated since the famine </li></ul><ul><li>To evaluate the successes and failures of the Irish state, we need to take account of these people </li></ul><ul><li>What conditions did these people experience that caused them to want to leave Ireland? </li></ul><ul><li>Were they typical of the population as a whole? </li></ul><ul><li>Major project underway at the Geary Institute to catalogue the experience of first and subsequent generations of Irish abroad </li></ul>
  20. 20. A Selection Effect? <ul><li>There is evidence that Irish migrants to the US were at an increased risk of heart disease (Kelleher et al, 2004) </li></ul><ul><li>Similarly for Irish migrants to the UK, their children and their grandchildren (Harding & Balarajan, 2001) </li></ul><ul><li>But need to disentangle the effects of what happened in the UK from what happened before they left </li></ul><ul><li>Was there a selection effect? </li></ul><ul><li>Use UK Census data from 1991 and 2001 </li></ul><ul><li>The fact that they are less well educated (a proxy for early life conditions), suggests some support for a selection effect </li></ul>
  21. 21. Irish Migration 1926-2002 Source: CSO
  22. 22. Health of Irish in the UK Source: UK Census 2001
  23. 23. Education in the UK and Ireland by age
  24. 24. Education in the UK and Ireland by age (2)
  25. 25. The Foetal Origins Hypothesis <ul><li>David Barker, chronic heart disease </li></ul><ul><li>When a foetus is exposed to a shock such as under nutrition, resources are diverted to the brain in order to ensure survival </li></ul><ul><li>Organs undergoing critical periods of development may be structurally weakened, predisposing the individual to chronic conditions in later life </li></ul><ul><li>Intrauterine environment as a “weather forecast” Baston and Martin (2000) </li></ul><ul><li>If socio economic groups experience different conditions in utero , they will experience different health in adulthood </li></ul>
  26. 26. Irish Infant Mortality
  27. 27. Health Inequalities in Ireland <ul><li>Ireland exhibits a significant health gradient in both adult and foetal health, but no attempt to link the two </li></ul><ul><li>Women in the unemployed socio-economic group are more than twice as likely to give birth to low birth weight babies as women in higher professional groups (Barry et al, 2001) </li></ul><ul><li>In 1991 unskilled workers were almost three times more likely to die from circulatory diseases than those in the higher professional category (O’Shea, 1997). </li></ul><ul><li>Persisted despite Celtic Tiger: circulatory diseases mortality is 120% higher in the lowest occupational classes (Battel-Kirk and Purdy, 2007) </li></ul>
  28. 28. Evidence <ul><li>Problems surrounding measurement, confounding factors, time horizon </li></ul><ul><li>Black, Devereux and Salvanes (2006) Norwegian twin study. A 10% increase in birth weight =>.57 cm increase in height, 1% increase in the probability of high school completion, 1% increase in income </li></ul><ul><li>Natural Experiments: 1918 Influenza outbreak (Almond, 2006), Chinese Famine (Chen & Zhou, 2007) </li></ul>
  29. 29. Ireland 1947 – Death Rate
  30. 30. Ireland 1947 – Infant Mortality
  31. 31. Ireland 1947 – Temperature
  32. 32. Contemporary Evidence
  33. 33. A Test of the Foetal Origins Hypothesis <ul><li>1947 represented an exogenous shock to foetal health, any confounding factor would have to vary with the weather </li></ul><ul><li>Height is a good predictor or premature mortality (Steckel, 2008). CHD </li></ul><ul><li>Compare the height of people born during the harsh winter to surrounding cohorts. Interested in people from lower socio economic groups (proxy with parental education) </li></ul><ul><li>Use recent Irish surveys </li></ul>
  34. 34. Estimation <ul><li>By how much do particular birth cohorts deviate from trend </li></ul>
  35. 35. Height of 1947 Cohort
  36. 36. Conclusions <ul><li>There are a variety of projects underway in the Geary Institute aimed at describing trends in welfare over the course of the Irish state </li></ul><ul><li>Evidence suggests that early life conditions are important for understanding current health and inequality. The effects of the decisions taken in the 1940s and 1950s are still being felt today </li></ul><ul><li>Some of those who left Ireland during this period suffered most from these policies </li></ul><ul><li>Evaluating daily patterns in stress and well being can shed light on other causal mechanisms </li></ul><ul><li>These factors must be taken into consideration by policy makers. Early life intervention (PFL) </li></ul>
  37. 37. Websites <ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul>