Pauvreté, Egalité, Mortalité: mortality (in)equality in France and the United States

Abstract

We develop a method for comparing levels and trends in inequality in mortality in the United States and France between 1990 and 2010 in a similar framework. The comparison shows that while income inequality has increased in both the United States and France, inequality in mortality in France remained remarkably low and stable. In the United States, inequality in mortality increased for older groups (especially women) while it decreased for children and young adults. These patterns highlight the fact that despite the strong cross-sectional relationship between income and health, there is no necessary connection between changes in income inequality and changes in health inequality.

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Notes

  1. 1.

    Between 1990 and 1999, a funding reform for public hospitals introduced global budgeting, and Act #91-748 aimed to balance health-care delivery across French regions and to introduce strategic planning for hospitals. The 1996 reform aimed to create “universal health insurance” giving the right to social security to anyone over the age of 18 regularly residing in French territory. Many changes occurred after 2000 as well, including the reorganization of the health insurance governance system starting in 2004.

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Acknowledgments

We thank the Center for Health and Wellbeing at Princeton University for supporting this research and CépiDc for providing the data used in the analysis. Josselin Thuilliez benefited from a research fellowship at Princeton University and a Fulbright fellowship (2016–2017). We are also thankful to Magali Barbieri, Pierre-Yves Geoffard, Jean-Paul Moatti, and two anonymous referees for useful comments.

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Appendix

Appendix

Fig. 6
figure6

Population size of poverty quantile in France and the United States, in millions. Notes: Poverty quantiles are constructed by ranking French départements and U.S. counties by their 2010 poverty rates and dividing them into 20 groups, each representing approximately 5% of the total population

Fig. 7
figure7

Schematic guideline for interpretation

Fig. 8
figure8

French male and female mortality rates by poverty percentile across age groups in 1990, 2000, and 2010. Notes: One-year mortality rates across département groups ranked by their poverty level are plotted by age group and gender across 3 different years

Fig. 9
figure9

U.S. male and female mortality rates by poverty percentile across age groups

Fig. 10
figure10figure10

France versus U.S. male mortality rates in 1990 and 2010, using alternative rankings. Notes: Education refers to High school dropout rate in the US and population without a baccalaureate degree in France. Rankings by median income and life expectancy are reversed such that higher ranks refer to lower median income and lower life expectancy, respectively

Fig. 11
figure11

French male mortality rates by educational levels (population without a baccalaureate degree) percentile across age groups. Notes: Fig. 7 (subpanel for males) is replicated, ranking départements by education instead of poverty. In the upper panel, départements are ranked by their education in 2012, while the ranking is reordered in each year in the lower panel

Fig. 12
figure12

U.S. mortality rates in 1990 and 2010, assuming the French 2010 mortality rate for homicides. Note: The dashed blue lines show the mortality rates across poverty percentiles for the United States in 1990 and 2010. The solid red line shows mortality rates for France in 2010. The dotted green line shows hypothetical U.S. mortality rates using the French mortality rate for selected causes of death. Overall homicide rates are reported in Table 7

Fig. 13
figure13

French poverty rates by share without a baccalaureate degree. Notes: This figure shows that the fraction without a baccalaureate across départements is highly correlated with the fraction of poor

Table 4 Characteristics of département/county groups by poverty rate in 2010
Table 5 Slopes of regression lines fitted through 3-year mortality rates across poverty percentiles in France
Table 6 ICD codes for causes of death
Table 7 Homicides and deaths of despair in 1990 and 2010, by country and gender

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Currie, J., Schwandt, H. & Thuilliez, J. Pauvreté, Egalité, Mortalité: mortality (in)equality in France and the United States. J Popul Econ 33, 197–231 (2020). https://doi.org/10.1007/s00148-019-00736-7

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Keywords

  • France
  • Income
  • Inequality
  • Mortality
  • Health inequality

JEL classification

  • I14
  • I18
  • I12