Objectives. We evaluated use of the Index of Concentration at the Extremes (ICE) for public health monitoring.Methods. We used New York City data centered around 2010 to assess cross-sectional associations at the census tract and community district levels, for (1) diverse ICE measures plus the US poverty rate, with (2) infant mortality, premature mortality (before age 65 years), and diabetes mortality.Results. Point estimates for rate ratios were consistently greatest for the novel ICE P ublic health monitoring data need to be informative about not only health outcomes, but also their societal distribution and determinants, so that the data can be useful for policies, programs, and advocacy focused on improving population health and advancing health equity.1-3 Both the global and US literature increasingly recognize the importance of assessing progress and setbacks in reducing health inequities (i.e., unfair, unnecessary, and preventable health differences between the groups at issue). [1][2][3][4][5][6][7][8][9][10][11] Adding to the urgency of using measures that illuminate inequitable health gaps is growing concern about 21st-century rising concentrations of income and wealth [12][13][14][15][16][17][18][19] and their implications for public health and health inequities. 12,20,21 Most public health monitoring systems, however, do not employ metrics that convey societal distributions of concentrations of privilege and deprivation.1,2 Instead, the typical practice is to present health data in relation to characteristics measured at the individual or household level, such as income, educational level, and also, chiefly in the United States, race/ethnicity. Health outcomes are then compared across groups defined in relation to the chosen characteristics, which may be modeled either continuously or categorically. 1-3,22-24Some analyses additionally employ variants of these measures aggregated to the neighborhood level (e.g., percentage of persons or households below poverty, percentage of persons with less than a highschool education, percentage of persons who are Black). [22][23][24] In either case, although gaps in health outcomes can be quantified by comparing groups with less versus more resources, distributional information on the extent to which the population is divided into the groups at issue is not part of the metric. The excess risk of societal groups that get the proverbial short end of the stick becomes the focus, and these groups effectively become characterized as the "problem"; by contrast, the societal groups holding the stick's other, longer end simply stand as a referent group, and the problematic economic, political, and social relationships that produce health inequities are hidden from view. 11,12,25,26 A troubling feature of our era, however, is not a property of individuals or households but instead pertains to increasing spatial social polarization, part and parcel of growing concentrations of extreme income and wealth. [12][13][14][15][16][17][18][19][20][21]26,27

While numerous studies have examined how health affects retirement behavior, few have analyzed the impact of retirement on subsequent health outcomes. This study estimates the effects of retirement on health status as measured by indicators of physical and functional limitations, illness conditions, and depression. The empirics are based on seven longitudinal waves of the Health and Retirement Study, spanning 1992 through 2005. To account for biases due to unobserved selection and endogeneity, panel data methodologies are used. These are augmented by counterfactual and specification checks to gauge the robustness and plausibility of the estimates. Results indicate that complete retirement leads to a 5-16 percent increase in difficulties associated with mobility and daily activities, a 5-6 percent increase in illness conditions, and 6-9 percent decline in mental health, over an average post-retirement period of six years. Models indicate that the effects tend to operate through lifestyle changes including declines in physical activity and social interactions. The adverse health effects are mitigated if the individual is married and has social support, continues to engage in physical activity post-retirement, or continues to work part-time upon retirement. Some evidence also suggests that the adverse effects of retirement on health may be larger in the event of involuntary retirement. With an aging population choosing to retire at earlier ages, both Social Security and Medicare face considerable shortfalls. Eliminating the embedded incentives in public and private pension plans, which discourage work beyond some point, and enacting policies that prolong the retirement age may be desirable, ceteris paribus. Retiring at a later age may lessen or postpone poor health outcomes for older adults, raise well-being, and reduce the utilization of health care services, particularly acute care.

While numerous studies have examined how health affects retirement behavior, few have analyzed the impact of retirement on subsequent health outcomes. This study estimates the effects of retirement on health status as measured by indicators of physical and functional limitations, illness conditions, and depression. The empirics are based on seven longitudinal waves of the Health and Retirement Study, spanning 1992 through 2005. To account for biases due to unobserved selection and endogeneity, panel data methodologies are used. These are augmented by counterfactual and specification checks to gauge the robustness and plausibility of the estimates. Results indicate that complete retirement leads to a 5-16 percent increase in difficulties associated with mobility and daily activities, a 5-6 percent increase in illness conditions, and 6-9 percent decline in mental health, over an average post-retirement period of six years. Models indicate that the effects tend to operate through lifestyle changes including declines in physical activity and social interactions. The adverse health effects are mitigated if the individual is married and has social support, continues to engage in physical activity post-retirement, or continues to work part-time upon retirement. Some evidence also suggests that the adverse effects of retirement on health may be larger in the event of involuntary retirement. With an aging population choosing to retire at earlier ages, both Social Security and Medicare face considerable shortfalls. Eliminating the embedded incentives in public and private pension plans, which discourage work beyond some point, and enacting policies that prolong the retirement age may be desirable, ceteris paribus. Retiring at a later age may lessen or postpone poor health outcomes for older adults, raise well-being, and reduce the utilization of health care services, particularly acute care.

No abstract