Complexity and the Health-Wealth Relationship: Politics, Public Policy, and the Joint Inheritance of Wealth and Health

This paper addresses a puzzle in the literature on the social determinants of health— why are wealthier people healthier? The answers seem obvious, from childhood nutrition to lifestyle advantages to the ability to afford better health care. The puzzle arises, though, from the empirical finding that, controlling for lifestyle and resources, wealth is still a significant predictor of health outcomes. While some plausible causal mechanisms have been identified for this phenomenon, this proposal seeks to augment those explanations with an argument about how wealth and other resource endowments influence the selection of sexual partners. Put another way, the principal argument of this paper is that if wealthier individuals are advantaged in the selection of healthier mates, and if endowments of health and wealth are inheritable by progeny, then the wealth-health relationship within any particular generation is necessarily attenuated. That is, wealth’s relationship to behavioral factors, environmental factors, resource factors, and even physiological factors must be viewed in the context of how wealth in previous generations can influence inherited traits in the current generation. More generally, however, the paper puts forward a model of the relationship between wealth and health outcomes that takes seriously notions of “financial” and genetic inheritance. Using an agent based modeling (ABM) approach, I can then move toward a model that allows the simulation of different policies and their subsequent effect on the wealthhealth relationship over time. In this way, I can show how the decisions governments make about health policy, and the political constraints on their decisionmaking, affect the fundamental causal process that underlies the joint (or potentially independent) inheritance of wealth and health. *Paper prepared for presentation at the Annual Meeting of the Southern Political Science Association, New Orleans, LA, January 2009. Thanks go to Dave Clark, Mary Deason, Will Heller, Jon Krasno, John McNulty, Robi Ragan, and David Wilson for helpful comments. All errors, mistakes, misattributions, or misstatements are the responsibility of the author. This is a rough, preliminary draft—cite at your own risk!