COMPLEMENTS AND SUBSTITUTES IN THE PRODUCTION OF HEALTH

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Most morbidity and mortality is due to preventable illnesses. In 1975, The Centers for Disease Control (CDC) reported that 50% of premature deaths were behaviorally determined and as an unfortunate sign of our lack of progress in the effort to reverse this trend, McGinnis and Foege (1993) point out that this rate has not changed. Of the 2,148,000 deaths in the United States in 1990, almost 50% were preventable and directly attributable to behavioral causes. In very poor communities in the U.S., such as Central Harlem in New York City, the average life expectancy is considerably lower than the national average. In fact, in Harlem, the average African American man is more likely to die before reaching the age of 65 than the average man in Bangladesh, one of the poorest nations on Earth (McCord and Freeman 1990). Most of these deaths are preventable. At least one half of the excess deaths in Harlem are the result of causes linked to specific health-related behaviors. This problem is not just limited to Harlem. The United States faces serious health problems. According to data from 1993, 23% of the white population and 25% of the black population lived in areas where air quality was below Environmental Protection Agency (EPA) standards., the 1992 homicide rate for whites was 9.1 per 100,000 population and for blacks it was 67.5 per 100,000 population, and one quarter of the adult populations still smokes, while 33% of black males still smoke. Blacks, the poor, and those living in ventral cities all have lower childhood vaccination rates. These data indicate that there is still a long way to go to improve the health not only of Harlem, but of the United States, as well. The overall goal of this project is to investigate the impact of exogenous environmental factors and inherited health endowments on the participation in preventive health behaviors. A model incorporating key factors of social psychological health behavior models and of health economic models will be developed. It is hypothesized that poor environmental conditions and poor inherited health endowments decrease subjective survival probabilities, and therefore decrease the incentive to participate in healthy behaviors whose benefits accrue in time periods that exceed survival times. This model will be tested using data from two national health surveys and from one household survey conducted in Harlem, New York City.