Who Killed Home Ec?

That’s the title of an article in Huff Post which pens some interesting history on the discipline. Go figure the first women admitted- Ellen Swallow Richards— to MIT is credited with generally credited with its development back in 1876.

Far from regressive the aim of the coursework is described here:

At the Women’s Laboratory, Richards turned her scientific attention to the study of how to make home life more efficient. According to the Chemical Heritage Foundation, “Richards was very concerned to apply scientific principles to domestic topics — good nutrition, pure foods, proper clothing, physical fitness, sanitation, and efficient practices that would allow women more time for pursuits other than cooking and cleaning.”

The categories under the umbrella of home economics today have expanded to seven: Cooking · Child Development · Education and Community Awareness · Home Management and Design · Sewing and Textiles · Budgeting and Economics · Health and Hygiene .

An enhanced understanding of these directly effect community engagement from health to housing, governance to safety. Such a shame to have lost fifty years of home focused education to a stigma.

A public of Two

When I was young 50th wedding anniversaries were common. The local golf course was the venue for gatherings and cake, and for testimonials from friends and relatives. Stories about the young couple’s meeting and courtship, and then marriage and the crazy baby years, were spun out over the white table clothed tables. Maybe there were even stories of difficult times and persistence. In today’s world an announcement about an anniversary surpassing the 30 year mark is commented upon, oddly with: WOW! Congratulations!!

This most basic public of two, (as the property they share is available to them both and actions of one effect the health, wealth and well-being of the other) continues to be threatened by a considerable risk of dissolution. “About 90% of people in Western cultures marry by age 50. In the United States, about 50% of married couples divorce, the sixth-highest divorce rate in the world. Subsequent marriages have an even higher divorce rate: 60% of second marriages end in divorce and 73% of all third marriages end in divorce.”

You would think the benefits of a longer life would be an incentive for all those folks to stick together. The CDC reports: “Previous studies have found that married persons have lower mortality rates than unmarried persons, attributable to either selectivity in entering marriage (i.e., healthier people are more likely to marry) or health-protective effects of marriage, or a combination of the two (1,2). ” Even in the COVID numbers we find “strong and stable families seem to be more resistant to the pandemic.”

Things only get worse as people age and live alone which leads to a crisis of loneliness. In Minnesota the total number of housing units is 2,477,753. With the total population at 5,639,632 the average number per household ends up at 2.49. So everytime you can think of a household made up of more than two people, there is someone living alone. The estimates I saw came in at 20-23% of the population. That’s a lot of singles.

So what gives when the advantages of coupling are out there for all to see. I’m starting a list:

  • With both parties in the work force, the short term transactional nature of business sub-plants the long term ambitions of a social contract.
  • Fear of being duped -don’t take it.
  • The transactional measure of giving ‘enough’ should be replaced by the social measure of giving their best effort.
  • Lack of celebrations that recognize couples in front of an audience.
  • No standards for friends and family to support or constructively comment.
  • Avoid failing at marriage by not getting married.

The data proves that marriage is good for us. So why folks don’t invest a little more work at staying together is odd to me.

Internalize and Trade

Health care providers incorporate a variety of incentive methods to encourage healthy behavior.  Many HMO’s will pay $25/mo toward a gym membership fee if their member goes to workout twelve times in a month. In effect they are internalizing the externalities of poor future health by inducing members to live a healthier lifestyle. The numbers must indicate that $25 is both enough to change behavior and in doing so avoid future medical procedures.

This transaction all occurs within the same group, those covered by an HMO’s policy. The trade of cash towards a gym fee benefits the same people who will then incur fewer medical costs in the future.  But what about a hybrid trade that included beneficiaries outside the group?

Obesity in the US has been on the rise for a number of years. It is becoming a leading public health crisis as rates of obesity among Americans are running above 40% in all age groups. The CDC outlines a number of health effects that stem from carrying around excessive weight.

One remedy is weight-loss (bariatric) surgery.  There are several procedures that help you lose weight which lowers your risk of medical problems associated with obesity. The cost of weight loss surgeries can range from $14,000 to $23,000 and are being covered more frequently by health insurance.

Since there are also downsides to surgery in general, what if the HMO tried an incentive program to get the member to a healthy weight? Say the cost was determined to be $20,000 for the surgery, and the member was considered to be 80 pounds overweight. Say the sum of the surgery could be divided up over a five year time span where the member received a portion for every 20 pounds lost, the HMO retained a portion and, a single mom in a third world country received food subsidies for a year.

A recent contest found that the most compelling argument that resulted in the highest philanthropic donations was a scenario structured in a similar fashion. I describe this structure in the post Philosophy and Philanthropy. Perhaps a late middle aged mom has served her family diligently, and in the process lost site of her own needs. Perhaps she has gained a bunch of weight that she can’t seem to shake, at least not for herself. But if you gave her the option to feed a single mom with five kids, maybe she would see her way to bringing her own weight in line.

It’s all about the Group

Amy Finkelstein’s video for MRU about the economics of mammograms just popped into my email. She and her colleagues are wondering about the efficacy of the present policy for screening for breast cancer. The blurb following the video explains.

One in eight women will be diagnosed with breast cancer. The current recommendation is that women should receive annual mammograms starting at age 40. But who is actually following this recommendation, and does that affect the test’s efficacy? MIT’s Amy Finkelstein and two of her coauthors, Tamar Oostrom and Abigail Ostriker, explore this question in this video. This video is based on the following paper: Screening and Selection: The Case of Mammograms Liran Einav, Amy Finkelstein, Tamar Oostrom, Abigail Ostriker, and Heidi Williams https://economics.mit.edu/files/20062

Past studies suggested dividing women into two groups in order to tackle a public health response to cancer: those under age 40 and those over age 40. Once over forty years of age, women are considered at a higher risk and thus were encouraged to have mammograms on a regular basis. The Susan G Komen organization provides data on how screening has saved lives. “From 1989-2017 (most recent data available), breast cancer mortality decreased by 40 percent due to improved breast cancer treatment and early detection [60]. Since 1989, about 375,900 breast cancer deaths in U.S. women have been avoided [60].”

It wasn’t long, however, that the drawbacks of misdiagnosis became apparent. False positive tests were causing patients unnecessary mental and physical costs. The fear and treatment associated with a false positive took time, energy and resources away from women who were in fact not likely to acquire the disease.

Amy and her MIT colleagues found that grouping by age was not specific enough. They observed that women who comply, and get screened, share habits that actually make them less likely to be prone for a positive test. Based on information from the medical community, women who disregarded screenings were more likely to eventually experience breast cancer.

By regrouping the women in consideration of their norms and lifestyles, the MIT professors are acknowledging that the public health of women in regards to breast cancer is multidimensional. They do not propose a new public policy but rather further insight into how the topic should be considered. Tamar Oostrom voices in the video: “our paper brings an additional dimension” to the issue.

When you think of the nature of people who would follow the recommendations and comply with regular testing, they are probably folks who can afford to be tested, both in the sense of the medical services expense and in the time it takes out of their lives. They probably have access to transportation to be tested. They have the willpower and ability to prepare and eat a healthy diet and exercise. It’s interesting to note that many if not all of these activities are tied into access to other public goods.

This video confirms a couple of things. Putting public resources towards a problem reaches a point of no additional returns, and can cause additional costs to the targeted group. Secondly, solving for the optimal amount of screening involves an understanding of how to distinguish groups and there access to other public goods markets.