Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Data from the National Health Interview Survey and elsewhere showed a trend toward worsening self-reported health among American men and women in middle age and older during the 1970s. This evidence--combined with significant declines in age-specific mortality observed since the 1960s--led some researchers to suggest that, on average, the health of the older population is declining. We examine recent trends in self-reported health and find that the health declines observed during the 1970s generally reversed during the 1980s. This shift would appear to belie the notion that lower adult mortality necessarily implies worse health. We argue further that the reversals observed during the 1980s also call into question whether trends in self-reported health during the 1970s reflected actual health declines. We suggest that changes in the social and economic forces influencing the options available for responding to health problems, combined with earlier diagnosis of pre-existing conditions, provide a more plausible explanation for these trends--an explanation that is consistent with data from both the 1970s and 1980s.