The welfare state lowers mortality
With a substantial reduction in poverty and inequality, one would expect the welfare state to reduce mortality. Empirical evidence suggests that this assumption is indeed correct. Even without a very in-depth analysis the correlation between welfare state spending and mortality is easily visible. Gains in life expectancy across the world were largest during the Keynesian consensus and have dropped off since the rise of neoliberalism in the early 1980s for those in the lower reaches of the socio-economic strata. According to Ezzati, Friedman, Kulkarni and Murray (2008), "there was a steady increase in mortality inequality across the US... between 1983 and 1999, resulting from stagnation or increase in mortality among the worst-off segment of the population." According to Conley and Springer (2001), increases in welfare state spending along with increases in GDP per capita correlated strongly with decreases in infant morality.

Empirical evidence that goes beyond exposing casual correlations further supports the notion that the welfare state reduces mortality. Pampel and Pallai (1983) examined infant mortality in developed countries between 1950 and 1975. They found that the mothers' educational attainment played the most important role in reducing infant mortality. Gross national income, along with overall social expenditure and less inequality also reduced infant mortality. Inequality and the number of physicians per capita were not as great a factor for developed countries as for developing countries, though both remained important variables. To explain this phenomenon the authors suggest that regarding the number of physicians, developed countries "appear to have a reached a saturation point" (p. 537). Regarding inequality, all developed nations seem to have reached a level of affluence where even the poor receive the most rudimentary levels of care. The U.S. stands out, with relatively high female educational attainment, high per capita income and, unlike what one would expect, high infant mortality. The authors assert that America's higher rate of teenage pregnancies, heterogeneous population and lackluster access to hospital beds is partially to blame. The findings by Pampel and Pallai do, however, suggest that the welfare state reduces infant mortality. It is, after all, the welfare state that educates the vast majority of women and men in all developed countries and reduces the effects of inequality by providing universal health care.[1]

More recent evidence on the relationship between of infant mortality and welfare state spending, underlines the important role of the welfare state in reducing morality. According to Conoley and Springer (2001), welfare state spending considerably reduces the infant morality rate (IMR) and incidence of children born with an excessively low birth weight (LBW). The authors found that,

Each additional 1% in per capita health care spending... is associated with a reduction in the LBW rate by 0.129% and the IMR by 0.184%... Over a five-year period, an increase of 1% in per capita of health spending (per year on average) may yield a decrease in the LBW rate of 0.182%. The cumulative effects of state spending on infant mortality are even more impressive. The same increase in spending is associated with a 0.348% reduction in the infant death rate. (p. 799) Cultural differences and biology cannot, according to Conoley and Springer, explain such a correlation.

                Sen (1998) reported similar findings in his Innocenti Lecture of UNICEF. Sen finds that in the UK, between 1900 and 1960, increases in life expectancy correlated poorly with increases in per capita income but strongly with expansions of the welfare state. While Sen stresses the existence of a significant positive correlation between higher per capita income and higher life expectancy, he finds that per capita income effects life expectancy through "the incomes specifically of the poor, and... public expenditure, specifically on public health. In fact, once these two variables are included in the statistical relation, the connection between GNP per head and life expectancy altogether vanishes" (pp. 8-9). While evidence on the exact impact of public health spending in particular is somewhat ambiguous, according to the literature review conducted by Conoley and Springer, their study, that of Pampel and Pallai as well as the evidence presented by Sen, unambiguously suggests that the welfare state in all its faculties reduces mortality - be it through public health expenditure, poverty relief or education.

[1] Even in the U.S. hospitals are required to provide the most rudimentary of care to patients, including assistance during childbirth, even if patients are uninsured or unable to pay.

 References:

  1. Conley, D. & Springer, K. W. (2001). Welfare state and infant mortality. The American Journal of Sociology, 107(3), 768-807. Retrieved April 14, 2008 from JSTOR: http://www.jstor.org/stable/3081151
  2. Ezzati, M., Friedman, A. B., Kulkarni, S. C., & Murray, C. J. L. (2008). The reversal of fortunes: Trends in county mortality and cross-county mortality disparities in the United States. PLoS Medicine, 5(4), e66. Retrieved April 29, 2008 from the PLoS Medicine journal web-site: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050066&ct=1
  3. Pampel, F. C. & Pillai, V. K. (1986). Patterns and determinants of infant mortality in developed nations: 1950-1975. Demography, 23(4), 525-542. Retrieved April 29, 2008 from JSTOR: http://www.jstor.org/stable/2061349
  4. Sen, A. (January 1998). Mortality as an indicator of economic success and failure. The Economic Journal, 108(446), 1-25. Retrieved March 29, 2008 from JSTOR: http://links.jstor.org/sici?sici=0013-0133%28199801%29108%3A446%3C1%3AMAAIOE%3E2.0.CO%3B2-7
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