1. School of Economics Health and Wealth on the Roller- Coaster: Ireland 2003-2011 David Madden University College Dublin

2. Broad Outline Analysis of developments in income and health “poverty” over the 2003-2011 period Analysis of poverty in both dimensions and also correlation between the two Also analysis from time-series and cross-section perspective Income poverty falls up to 2009, then increases Health poverty unchanged Evidence that health inequality decreased Health/income correlation amongst poor has declined More detail available in full version of paper (ungated version at http://www.ucd.ie/t4cms/WP13_05.pdf ) http://www.ucd.ie/t4cms/WP13_05.pdf

3. Context (1) Are recessions good for your health? Ruhm (2000) said “yes”, but Ruhm (2013) said “maybe” Chang/Stuckler (2013), Great Recession led to excess suicides Not consistent with Walsh and Walsh (2011) for Ireland, also challenged by Denny (2013) Deaton (2011), Walsh (2011) – difficulties in relating movements in SWB to economic cycle Different dimensions of health may respond differently to economic cycle We look at micro-based data, self-assessed health (SAH) Also issue of income-health correlation within a given cross-section

4. Context (2) Measuring welfare/poverty across multiple dimensions Intersection or union approach? Alkire-Foster attempt to overcome this Multi-dimensional indices Gives single index, but black box? Weights? Dashboard approach – provide information on 2 (at most 3) indices and summary of their correlation This talk focuses on measurement – we do not look at explanatory factors

5. Data 9 waves of Survey of Income and Living Conditions (SILC) Nationally representative sample with information on sources of income, deprivation, health Income measure: equivalised disposable income (i.e. including social transfers and with taxes/pension contributions deducted) Health: “in general, how good would you say your health is?” Very bad, bad, fair, good or very good Good predictor of subsequent morbidities/mortality Analysis confined to over 16s (under 16s not asked health question) Sample size c.10,000 p.a.

6. P α Measures, Income, 2003-2011, Fixed Poverty Line (2003=100)

7. P α Measures, Income, 2003-2011, Relative Poverty Line (2003=100)

8. Health Dominance: 2003-2011 200320042005200620072008200920102011 2003FF 2004 2005F 2006SS 2007SSFFFF 2008FFFFFFF 2009SSSF 2010SS 2011SSSS

9. Health Poverty, 2003-2011

10. Health Poverty, 2003-2011 (with confidence intervals)

11. The story so far... Income poverty falls up to 2009 and then increases Health poverty broadly unchanged over period Some evidence of marginal reduction in overall health inequality from 2009 What if we look at them together?

12. Poverty Incidence by SAH, 2003-2011

13. Bi-Dimensional Poverty Indices -Fixed Income Poverty Line

14. Measure of Correlation – All Ages

15. Measure of Correlation – Under 65s

16. Measure of Correlation – 25-49

17. Measure of Correlation – 50-64

18. Summary No evidence that recent recession has been accompanied by meaningful deterioration in health (self-assessed) Health inequality seems to have slightly diminished Correlation between health and income within the poor (for each cross-section) has declined Note these are only two dimensions of welfare (albeit important ones) Other health measures? Also, early days – health effects of recession could operate with a lag

19. Poverty Dominance Income 200320042005200620072008200920102011 2003 2004WF 2005FWFWS 2006F* WFS 2007F* WFS F 2008FF*WF F 2009FF* WF FF 2010WF F 2011

20. Sequential Stochastic Dominance 200320042005200620072008200920102011 2003 2004 2005WF 2006WF 2007WF 2008FWF 2009FWF 2010WF 2011

21. Bi-Dimensional Poverty Indices - Relative Income Poverty Line