Decline in Inequality? In the US?

There is finally some evidence that inequality in the US is declining! No, it's not income inequality, but instead inequality in the distribution of happiness. Betsey Stevenson and Justin Wolfers from the Wharton School discovered that while Americans on average have not gotten happier since the 1970s, the dispersion in happiness has declined steadily. Their NBER working paper is available here.

Here is the abstract:
This paper examines how the level and dispersion of self-reported happiness has evolved over the period 1972-2006. While there has been no increase in aggregate happiness, inequality in happiness has fallen substantially since the 1970s. There have been large changes in the level of happiness across groups: Two-thirds of the black-white happiness gap has been eroded, and the gender happiness gap has disappeared entirely. Paralleling changes in the income distribution, differences in happiness by education have widened substantially. We develop an integrated approach to measuring inequality and decomposing changes in the distribution of happiness, finding a pervasive decline in within-group inequality during the 1970s and 1980s that was experienced by even narrowly-defined demographic groups. Around one-third of this decline has subsequently been unwound. Juxtaposing these changes with large rises in income inequality suggests an important role for non-pecuniary factors in shaping the well-being distribution.

The Politics Behind Treating Combat Veterans for Brain Injuries

Traumatic Brain Injury (TBI) has emerged to the top of the list of medical conditions that have long-term consequences on US veterans.
In another in-depth look on US veterans' health, The New York Times reported a story titled "War Veterans' Concussions Are Often Overlooked." The story documents the types of long-term health costs of the war in Iraq for American soldiers once they return home. The Pentagon estimates that as many as 300,000 combat veterans have suffered at least one concussion. Of those, tens of thousands are left with long term problems such as persistent memory loss, headaches, mood swings, dizziness, hearing problems and light sensitivity. Medically, the Army classifies these as Traumatic Brain Injury (TBI). Because of high rates of under-diagnosis, the Congress ordered the Army to follow only the Veterans' Affairs new set of diagnostic tools that tend to give veterans more disability pay. The Department of Defense invested $300 million into TBI research through the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. The very diagnosis and treatment of TBI has become an economic and public policy issue, with significant distributive effects for veterans.

Very little is known scientifically about mild traumatic brain injuries and their long-term effects, and research on the effects of combat have emerged only recently. The same New York Times article reported on Charles W. Hodge's research at the Walter Reed Army Institute. Published in the New England Journal of Medicine, and available here, the research quantified the prevalence of TBI symptoms in soldiers returning from Iraq and Afghanistan. Importantly, only 23-40 percent of those with symptoms sought any kind of mental health care. The study was also the first to find that TBI, especially when patients lose consciousness as a result of a bomb blast for example, are associated with prevalence of the post-traumatic stress disorder (PTSD), suggesting a specific neurophysiologal mechanism behind PTSD in combat veterans. Here is their abstract:

Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care.

Would you trust your doctors' prognosis?

Our study of doctors' prognoses showed that most doctors over-estimate their patients' chances of survival. This opens up the question of how we could improve the accuracy of prognosis and limit some of the costs patients' families and health care systems suffer when doctors make wrong prognoses. See: Alexander, M. and Christakis, N.A. "Bias and Asymmetric Loss in Expert Forecasts: A Study of Physician Prognostic Behavior with Respect to Patient Survival," Journal of Health Economics 27 (2008): 4: 1095-1108. Here is the abstract:

We study the behavioral processes undergirding physician forecasts, evaluating accuracy and systematic biases in estimates of patient survival and characterizing physicians’ loss functions when it comes to prediction. Similar to other forecasting experts, physicians face different costs depending on whether their best forecasts prove to be an overestimate or an underestimate of the true probabilities of an event. We provide the first empirical characterization of physicians’ loss functions. We find that even the physicians’ subjective belief distributions over outcomes are not well calibrated, with the loss characterized by asymmetry in favor of over-predicting patients’ survival. We show that the physicians’ bias is further increased by (1) reduction of the belief distributions to point forecasts, (2) communication of the forecast to the patient, and (3) physicians’ own past experience and reputation.