A note on life expectancy and development

Dani Rodrik has an interesting post discussing how some North African countries have done surprising well in terms of the human development index, despite seeing much slower rates of GDP growth than the more famous East Asian models:

Which are the countries that have improved their human development indicators the most since 1970 relative to their peers? You’d be surprised, as I was, to find that the top 10 is dominated not by East Asian superstars, but by Moslem countries: Oman, Indonesia, Saudi Arabia, Tunisia, Morocco, and Algeria. This year’s Human Development Report is full of neat analysis and results, including this one.

Leaving aside the oil exporting countries, the North African cases are particularly interesting. As Francisco Rodriguez and Emma Samman, two of the report’s authors, note, Tunisia, Morocco, and Algeria have experienced remarkable gains in life expectancy and educational attainment, leaving many Asian superstars in the dust.

Rodriguez and Samman make the following claim:

Consider the following comparison. In 1970, a baby born in Tunisia could expect to live 54 years; one born in China, 62 years. Today, life expectancy in Tunisia has risen to 74 years, a year longer than that of China. So while China’s per capita income grew almost three times as fast as Tunisia’s, Tunisia’s life expectancy grew twice as fast as China’s. Since it also significantly outperformed China on the education front, Tunisia gives China a run for its money in the overall development story (as captured by the HDI).

I don’t wish to challenge this finding, partly because I am not an expert in this area.  Tunisia’s performance does look impressive, and we all know China’s health care and education systems have some gaping holes.  Instead I’d merely like to suggest we need to be very careful when considering the impact of economic development on life expectancy.  Life expectancy at birth is a sort of snapshot that reflects conditions over a very long period of time.

I believe that life expectancy at birth in China is now much higher than the official statistics show, as those data are measuring life expectancies for people born at various times over the past 100 years.  And I hope to convince you that the average person born in China today will live longer than the average person born in Denmark today.

One factor that has held back China is the poor health of its rural population.  Part of that reflects poor health care facilities and part reflects environmental risks.  But I also think a large part reflects poor health when young.  Chinese who are 50 years old were born during the Great Leap Forward, when between 20 and 40 million Chinese starved to death, and many more suffered malnutrition.  This link has data from an interesting study of Dutch people born during the 1944-45 famine in Holland.  It turns out those people had consistently worse health during their entire lives.

Admittedly, only a small share of the Chinese population was born during the GLF, but most older people were born during periods of political and economic turmoil.  Indeed until the land reform of 1979 sharply boosted food output, much of the countryside was chronically malnourished.  Old people dying today (which make up a large part of the data from which we estimate life expectancy at birth), lived most of their lives in a country as poor as India and Sub-Saharan Africa were during the same time period.  That’s much poorer than Tunisia.

The following list is the CIA estimate of life expectancy in 2009, which is the most recent I could find.  I excluded nations with fewer than 100,000 people.

1.  Macao  84.36

2.  Japan  82.12

3.  Singapore  81.98

4.  Hong Kong  81.86

5.  Australia   81.63

5.b  Shanghai in 2008   81.28

6.  Canada  81.23



40.  South Korea    78.72

46.  Denmark   78.30

50.  U.S.   78.11

72.  Tunisia  75.78

105.  China  73.47

What do you notice?  I see East Asian countries scoring really high, and the highest western countries being places with lots of East Asian immigrants.  I also see Korea and China lagging somewhat, with indications (from Shanghai) that the problem in China is in rural areas.  The other laggard (Korea) is also a country that suffered extreme poverty and war during the 1950s.  I believe that Shanghai was less affected by famines than the countryside, although it also has better health care, so it’s hard to know what explains the difference.  But I find the Korean case especially interesting; it suggests that the long cloud of history affects life expectancy for quite some time, at least when conditions were extremely bad in previous decades.

This data also suggests that environmental factors may be overrated.  Obviously air pollution is extremely bad in Hong Kong and Shanghai, yet both places have extremely high (and fast rising) life expectancy.  Undoubtedly there are industrial areas of China where local health suffers due to chemical spills, etc, but I’d guess the nationwide life expectancy is more affected by other factors, such as childhood nutrition, smoking, and current health facilities and access.

I claimed that I would try to convince you that Chinese born today might live longer than Danes born today.  That’s already true for Chinese living in places like Beijing, Shanghai and other wealthy coastal cities.  My claim is that today even children in the Chinese countryside generally do not suffer from malnutrition (with very localized exceptions) and by the time they are old enough where medical facilities become very important in longevity (say in 50 or 60 years), even interior China will be at least as rich as Shanghai is today.

Why do Asian countries lead the world in life expectancy?  Not because they spend a lot on health care, but rather some other factors (perhaps diet, culture, lifestyle, genetics, etc.)  Whatever the reason, I’d expect the East Asian/Western gap to become even more noticeable over time, as the older generation of Chinese and Koreans dies off, and all of East Asia converges to Japanese life expectancies.

One reason I indicated that I didn’t wish to challenge the Rodriquez and Sammon finding is that they look at changes in life expectancy–and Tunisia’s has risen faster than China’s.  Whether my argument is at all relevant to that claim is a surprisingly complex question that I’ll just hint at here.  It depends on both the change in current health care, environmental, and nutrition conditions, as well as the extent to which chronic health problems developed in earlier decades can be ameliorated by those improvements.  I’ll leave that to others.  And of course they also look at many other indicators of development, such as education.

Ed Dolan on China and Russia

Ed Dolan recently sent me an interesting theory on difference between Chinese and Russian corruption.  I suggested he post it, but his blog specializes in other topics.  So we decided I could post it here.  This is Ed Dolan’s idea:

Dynamic China, Stagnant Russia: Can Corruption Explain the Difference?

As a long-time Russia watcher, I endorse the widespread notion that corruption is one major explanation for that country’s relative stagnation. Even Russian president Medvedev agrees, saying that corruption is “systemic in nature” and has “deep historic roots.” (The Guardian). But what about China? China is pretty corrupt, too. Transparency International’s corruption perceptions index ranks Russia at a dismal 146 out of 180 countries surveyed, but China, at 79, is not exactly squeaky clean. Other attempts to measure corruption specifically and institutional quality generally seem to reach similar rankings. Yet China is far from stagnant. Why?

Is it simply that China, although corrupt, is less corrupt that Russia? Only as corrupt as Burkina Faso, instead of as corrupt as Kenya? No doubt the degree of corruption plays a role, but I wonder if part of the explanation also lies in differences in kind among the corruption encountered in one place or another.

By analogy, consider a distinction that Russians make between “white envy” and “black envy.” If your neighbor buys a new BMW, and your reaction is to want to work harder so that you can buy one too, that is white envy. If your reaction is to want to sneak over during the night and slash his tires, that is black envy.

By the same token, it seems to me there is “white corruption” and “black corruption.” In the white variant, a corrupt official might say, “I’ll pull strings to help your business grow if you will cut me in on a share of your future profit.” In the black variant, the official would say, “pay me off, or I’ll shut your business down,” or alternatively, “pay me off, and I’ll shut your competitor’s business down.”

I don’t mean to say that “white corruption” is actually good. It introduces distortions and raises costs relative to government based on honesty, transparency, and the rule of law.  But it certainly seems possible that comparatively speaking, white corruption is more pro-growth and black corruption is more pro-stagnation. The reason is partly that black corruption involves negative sanctions rather than positive incentives, and partly because it suggests more of a long-term, trust-based relationship. To borrow a term from Mancur Olson, the official practicing white corruption would be more of a stationary bandit, and the one practicing black corruption would be more of a roving bandit. The stationary bandit encourages the local farmers to take good care of their cows; the roving bandit slaughters the cows (maybe the farmers, too) and moves on after the feast.

I know from my own experience in Russia that black corruption is pretty widespread, although the white variant also exists. I have heard anecdotes about China that suggest that the white variant of corruption might be more common there. Does anyone with more experience of China than I have think that is true, and if so, if it could play a role in explaining how China can be corrupt, but dynamic?

This isn’t my area  of expertise, but his argument makes sense.   I was reminded of Ed’s email when I recently ran across the paper “Spite and Development” by Fehr, Hoff, and Kshetramade:

In a wide variety of settings, spiteful preferences would constitute an obstacle to cooperation, trade, and thus economic development. This paper shows that spiteful preferences – the desire to reduce another’s material payoff for the mere purpose of increasing one’s relative payoff – are surprisingly widespread in experiments conducted in one of the least developed regions in India (Uttar Pradesh). In a one-shot trust game, the authors find that a large majority of subjects punish cooperative behavior although such punishment clearly increases inequality and decreases the payoffs of both subjects. In experiments to study coordination and to measure social preferences, the findings reveal empirical patterns suggesting that the willingness to reduce another’s material payoff – either for the sake of achieving more equality or for the sake of being ahead – is stronger among individuals belonging to high castes than among those belonging to low castes. Because extreme social hierarchies are typically accompanied by a culture that stresses status-seeking, it is plausible that the observed social preference patterns are at least partly shaped by this culture. Thus, an exciting question for future research is the extent to which different institutions and cultures produce preferences that are conducive or detrimental to economic development.

Alex Tabarrok recently linked to another item that is relevant to Dolan’s argument:

In Russia, the ‘Ask the Audience’ lifeline isn’t one that the contestant would often use because the audience often gives wrong answers intentionally to trick the contestants.

Healthy, wealthy, and wise?

Will Wilkinson linked to this beautiful graph:

Please scroll waaay down for a bigger and more readable image.

This is what Will has to say about the graph:

Gapminder has made available a lovely map/chart illustrating the relationship between GDP per capita and life expectancy. It shows that one thing economic growth is good for is keeping people alive longer.

I’m not going to disagree with that, I think it does suggest a positive relationship.  But I wonder if the graph might be a bit misleading.  Perhaps what it is really showing is that there is a positive relationship between the cultural factors that produce economic growth, and life expectancy.

Why do I make that distinction?  Because it seems to me that part of what we are observing is the relationship between region and life expectancy.  Suppose I were right.  Then you’d expect to see little correlation between life expectancy and income within a region of similar cultural characteristics.  (By the way, I mention “culture” as a catch-all term.  It could be climate, or diet, or genetics, or any other factor correlated with location.)

Note the pattern in Africa.  Most of the countries are poor, but a few are not (look at the big graph because they are often small.)  Do you notice that even the richer African countries, like South Africa, Gabon and Equatorial Guinea also have fairly low life expectancies?

Now look at the Middle East.  Relatively rich Saudi Arabia has a similar life expectancy to poorer neighboring countries.  I don’t want to deny that income has some effect, Kuwait and UAE are higher than most of the others. Bu the effect may be less than you’d think.  Israel seems like a counterexample to my argument; it is much richer and has a much high life expectancy than average.  But it is also culturally different from its neighbors (i.e. European migrants) so that actually fits my cultural explanation.  On the other end is Yemen.  But maybe the regions are not fine-grained enough.  Note that Yemen is closer to Ethiopia than to other Middle Eastern countries like Syria.

Another interesting outlier is Cuba.  Why is the life expectancy so high?  Naive leftists will tell you it’s their “national health care.”  They need to read Robin Hanson.  Wasn’t Cuba one of the richest countries in Latin America in 1958?  If I am right, it has exactly the sort of life expectancy you’d expect if income did not affect life expectancy.  Castro’s nutty economic policies have made Cuban’s poor, but they can enjoy their poverty for just as many years as the more affluent Chileans.

I see no relationship in South Asia, although the sample size is too small.  There are positive relationships in Europe and the Americas, but not necessarily at more fine-grained geographical levels.  For instance, many of the former Soviet republics are in the 65-70 year band, at widely different incomes.  Canadians live longer than their richer North American neighbors.

Now I would never argue that economics doesn’t matter at all.  If you starve your people, then life expectancy will fall (see North Korea/South Korea).  And I concede that China is almost certainly depressed by its relative poverty (when compared to richer countries with similar East Asian cultures.)  I don’t know how much of that is related to the fact that many Chinese went through North Korean-style trauma when they were younger.  Say what you will about Castro, but he avoided the worst excesses of communism.

But I also would guess that a glance at this chart overplays the influence of money, in and of itself.  It may be that much of the relationship is due to some third factor that causes both wealth and health, say education.  That could explain the relatively low longevity levels in some oil-rich countries.