Pain and inequality

By Kathy G.

The results of this new study on pain assessment by Princeton’s Alan Krueger and SUNY Stony Brook’s Arthur Stone are for the most part not particularly surprising. As it turns out, economic inequality impacts practically every dimension of human existence; even physical pain is unequally shared. For example, the Krueger/Stone study found that respondents with low socio-economic status experienced “significantly higher pain occurrences and severity.” For instance:

The average pain rating is twice as high for those in households with annual incomes below $30,000 as for those in households with incomes above $100,000.

And

Participants with less than a high school degree reported twice the average pain rating as did college graduates.

Occupational status seems to play an important role, given that

the average pain rating for blue collar workers is 1.00 during work and 0.84 during nonwork, and for white collar workers it is 0.61 during both work and non-work episodes.

And in an interview, Krueger said, “Those with higher incomes welcome pain almost by choice, usually through exercise,” he says. “At lower incomes, pain comes as the result of work.”

It’s a pretty decent study; though the response rate was low enough (37%) to be worrying, the sample was weighted to reflect the composition of the general population. It’s also an improvement on earlier surveys which had asked for retrospective estimates of pain over the past month. This survey, by contrast, asks about pain experienced in the last day, and such contemporaneous estimates tend to be more reliable.

The results aren’t exactly news; other studies have shown that pain and socioeconomic status tend to be inversely related. But Krueger said the relationship between pain and socioeconomic status was “stronger” than he expected.

What are the policy implications? Well, for one thing, the authors say:

The strong association between self-reported disability status and pain is notable given concerns by economists and some policymakers that able-bodied individuals may seek benefits from the Disability Insurance system.

So maybe, just maybe, all those people applying for disability aren’t just a bunch of perfectly able-bodied fakers and whiners after all?

Also, one expert says the results demonstrate “the need for pain preventing measures [in the workplace] such as better ergonomics.” Well maybe, but it’s hard to see how even the most high-quality ergonomic devices are going to make life much easier for people who make a living by scrubbing floors all day, or lifting heavy boxes. And sure, a health care system that provided universal access and did a better job at pain management would help things, too.

Given that pain is higher among blue collar workers than among white collar workers, and given that pain tends to increase with age, retirement has got to look to very different to blue collar workers who have done physical labor all their life, than it does to their more sedentary white collar counterparts. Conservatives and other Social Security crisis-mongerers love to scream about how if we don’t raise the retirement age the Social Security fund will go bankrupt. The more honest ones don’t claim Social Security is going to go under any time soon, but they do say that, given increased life expectancy, increasing the retirement age only makes sense.

In fact, I once heard a University of Chicago economics professor make that very argument. It was a lecture so I couldn’t interrupt, but it was exasperating to listen to. Easy for you to say, Mr. Economics Professor! You can do your job until you’re 100, or until senility sets in, at least.

But what about the people who scrub toilets for a living? Or health care workers who spend much of their work day manually lifting patients? Asking people to do highly physically demanding jobs like those until they’re 65 is already asking quite a lot. There’s a reason why the classic union steelworker contract had a “30 and out” pension provision. After 30 years on the job, a lot of those guys’ bodies had taken so much that they weren’t physically capable of doing physical labor anymore.

So please, let’s not hear anything more about raising the Social Security retirement age. If the Krueger and Stone report can help policymakers get it through their heads that folks who do physical labor experience significantly higher levels of pain, and that that pain increases as they age, maybe they’ll think twice about raising the Social Security retirement age. And that would be a very good thing indeed.

(H/T: Shakesville)