Secular Trends in Physiological Capital: Implications for Equity in Health Care

Robert Fogel, University of Chicago and National Bureau of Economic Research (NBER)

Over the past three centuries physiological capital has accumulated rapidly in OECD countries. Enhanced physiological capital is tied to long-term reduction in environmental hazards and to the conquest of chronic malnutrition. As physiological capital has become more equally distributed, socioeconomic disparities in the burden of disease have decreased. Implications for health care policy are: (1) enhanced physiological capital has done more to reduce inequities in health status than has wider access to health care; (2) so far, more advanced medical treatment has mainly contributed by retarding depreciation in individuals’ physiological capital; (3) prenatal and early childhood care and environmental issues are key for interventions aimed at enhancing physiological capital and at affecting its rate of depreciation; (4) lifestyle change is the most important issue affecting health equity in rich countries; and (5) greater access to clinical care should be promoted through aggressive outreach, since expanded insurance coverage alone is inadequate.