Pain and inequality

by kathy on May 6, 2008

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)

{ 42 comments }

1

Barry 05.07.08 at 12:39 am

“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.”

In addition, he’d be allowed to do his job. For the standard white collar worker, anytime after age 50 is the Age of Obsolescence. He’d be eased out the door (if lucky; kicked out if not), and then find out that the closest thing that he’d ever get to a white collar job is greeter at Wal-Mart.

2

sara 05.07.08 at 12:39 am

Another likely cause of the disparity is that doctors and emergency rooms won’t dispense sufficient pain medication to the poor, because they think that poor people who want pain medication are drug addicts and dealers. The doctors are also caught between the patients and bureaucratic regulations.

It’s likely that Rush Limbaugh had no problem getting all the OxyContin he wanted.

3

Stuart 05.07.08 at 12:48 am

So is your plan to leave any predicted future problems with social security for future generations to fix? Or do you prefer an alternate solution like increasing the rate at which people pay in, raising the caps, reducing the payout?

4

Clover88 05.07.08 at 1:36 am

Would a policy with different retirement ages for different occupations be workable? My husband is a blue-collar worker who installs floors. As he has entered his 50s (he has done this work since age 18) he finds it more and more difficult to live pain-free.

5

greensmile 05.07.08 at 2:04 am

oh

you are talking about physical pain. Is any cause-effect relation really implied in this correlation? Seems like the most subjective thing in the world to me. How many Buddhists did they interview?

RE:

So please, let’s not hear anything more about raising the Social Security retirement age.

Its your blog post so you get to editorialize. I happen to agree strongly with this position. There are plenty of reasons why that is a valid request: the stats say the increases in longevity for Americans have ceased. Maybe we could roll back the retirement age to the 55 number it was when I was in high school and getting career counseling. I’d really like to retire. I am almost sixty, with over 40 years of writing code for a living. They might keep me until I slump glassy-eyed onto my keyboard…but the arthritis and carpal tunnel are nipping at me.

6

Barry 05.07.08 at 2:36 am

“So is your plan to leave any predicted future problems with social security for future generations to fix? Or do you prefer an alternate solution like increasing the rate at which people pay in, raising the caps, reducing the payout?”

Posted by Stuart

The predicted problems for Social Security are minor, even given prediction models which make pessimistic assumptions. Anybody who’s worried about fixing Social Security is misinformed.

7

noen 05.07.08 at 6:50 am

maybe they’ll think twice about raising the Social Security retirement age.

I like your idealism, it’s hopelessly naive but I like it.

Greensmile, you may qualify for SSDI. Check into it.

8

Mikhail 05.07.08 at 9:27 am

I think the study is quite useless, actually. Since there is no causality in the results, no intelligent conclusions can be drawn from this.

It could be that lower pain in people with higher economic status is a result of that status, but it’s more likely that it is their lower sensitivity that results in their higher achievement. Less sensitivity to any kind of pain – ability to do more, to persevere, to get further…

Also, such self-report surveys have a huge deviation spread – different people’s idea of a lot of pain or little pain can be dramatically different, so the different bins on the pain scale get constantly cross-contaminated in the data.

9

Tim Worstall 05.07.08 at 10:48 am

“So please, let’s not hear anything more about raising the Social Security retirement age.”

I’m with Brad Delong on this one. Social Security is a social insurance policy not an assurance one. The insurance is against outliving your savings. The age at which you can collect should thus be the average life span of the previous cohort.

10

John Quiggin 05.07.08 at 12:07 pm

“it’s more likely that it is their lower sensitivity that results in their higher achievement.”

I know the value of Sitzfleisch as well as anyone, but I never thought I’d see anyone seriously impute the high incomes of professionals and managers to their tolerance for pain, presumably manifested in superior padding in the appropriate spot.

11

John Quiggin 05.07.08 at 12:10 pm

On a more serious note, there’s lots more along similar lines in Michael Marmot’s The Status Syndrome, discussed at CT here and here.

12

Mikhail 05.07.08 at 1:02 pm

I’m not imputing anything. :) I’m just saying that the observed correlation is more likely to run this way than to say you can endure more pain because you have more money. I simply don’t see any mechanism by which that could possibly work…

13

Dave 05.07.08 at 1:32 pm

But mikhail, how does this account for the fact that social mobility has effectively stopped in the West? Have we now achieved some bizarre utopia, where your earning-potential is defined by your pain-threshold, which just happens to be coincidentally correlated to what your parents did for a living? Or should we consider other research, which indicates that poverty is itself experienced as a burden, perhaps in itself a source of pain?

http://www.boston.com/bostonglobe/ideas/articles/2008/03/30/the_sting_of_poverty/?page=full

14

Tracy W 05.07.08 at 1:39 pm

This study shows correlation, not causation. It strikes me that one of the main reasons for the difference in earnings between my father and my father-in-law is that my father is bursting with good health, while my father-in-law has a series of serious, painful health problems that have prevented him working. If you raised my father-in-law’s disability payments to the same level as my father’s income, I would be rather surprised if his pain suddenly disappeared.

15

Alison P 05.07.08 at 1:42 pm

You can endure more pain because you have more money… I simply don’t see any mechanism by which that could possibly work

There seem to me to be two obvious mechanisms. One is that a feeling of greater personal control is associated with reduced stress and lower pain perception. This is a very well known relationship, and explains why self-administration of morphine is used in British hospitals nowadays – the self-administered dosage is lower (I’ve experienced the difference first hand myself – when in control of the dose I barely needed any – it’s a very striking effect).

The second is that a person whose life lacks pleasure, and/or includes a lot of unhappiness and pain, is going to be operating close to a limit of what they can endure. They are susceptible to feeling additional pains particularly unendurable. Also they are likely to be susceptible to be tempted by quick short-term treats. I don’t blame them at all.

16

Maria 05.07.08 at 1:45 pm

So you would like people to retire at the same age, live longer, while at the same time birth rates have gone down. Do you anticipate any sort of problems?

17

Picador 05.07.08 at 2:26 pm

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.

I find it hard to believe that a professor of Economics at the University of Chicago would be so oblivious to the realities of poverty. Whenever I talk to Chicago-school economists about these issues, they are always quick to assure me that the apparent disconnect between their models and the actual lived experience of the poor can be accounted for by the fact that poor people attach a high utility value to being miserable.

18

Mikhail 05.07.08 at 3:01 pm

#15: “One is that a feeling of greater personal control is associated with reduced stress and lower pain perception. This is a very well known relationship…

I’m not aware of this relationship being anything more than a placebo effect. Sure, it occurs in some cases, but nobody would suggest that placebos can be used to treat anything… :)

The second argument of operating close to capacity is better, but I don’t buy it. For the following reason – prolonged exposure to any sensory stimulus (light, noise, pain, etc.) causes accommodation, i.e. reduction in sensitivity. So, while the magnitude of pain required to “max out”, whatever that means?, may be less, but it has nothing to do with sensitivity.

Also, it’s not clear to me which way this would go – if you’re close to your pain treshold limit and are exposed to more pain, are you likely to report higher pain levels because you “can’t take it anymore” or lower levels because marginally it’s not much? I’m sure there must be research on this, but I don’t know it.

19

Christopher Colaninno 05.07.08 at 4:20 pm

“Easy for you to say, Mr. Economics Professor! You can do your job until you’re 100, or until senility sets in, at least

Eugene Steuerle will likely drop dead at the age of 95 testifying before Congress about the need to extend the retirement age because people only spend such a small fraction of their life ‘working’.

http://www.urban.org/about/EugeneSteuerle.cfm

20

Dave 05.07.08 at 6:10 pm

mikhail, read the article link I posted @13, for a start…

21

Barry 05.07.08 at 7:12 pm

“I’m with Brad Delong on this one. Social Security is a social insurance policy not an assurance one. The insurance is against outliving your savings. The age at which you can collect should thus be the average life span of the previous cohort.”

Posted by Tim Worstall

Can we kill, cook and eat Tim? I’ll spring for a five gallon jug of cheap wine for the marinade.

I’m only saying this because it looks like right-wing professional propagandists (and the stupid, stupid followers so eager to screw themselves over) are the only true renewable resource that we have.

Of course, if being a right-wing professional propagandist stopped paying, we might find that their numbers declined sharply :)

Then again, there would still be their followers, so eager to throw themselves on the alter.

22

Brett Bellmore 05.07.08 at 7:53 pm

“but it’s more likely that it is their lower sensitivity that results in their higher achievement. Less sensitivity to any kind of pain – ability to do more, to persevere, to get further…”

I’ve done both stoop labor (And still ache in cold weather thanks to that!) and desk jobs, and this suggestion strikes me as ludicris outside of a few fields like professional sports, where people get paid highly for physical ‘labor’. I’m not being paid for my astounding physical endurance, I’m being paid for my highly specialized skills.

How about raising the default retirement age, with adjustments for medical conditions?

23

Tim Worstall 05.07.08 at 8:30 pm

Er, Barry, but that is Brad Delong’s view. I’ve not misrepresented it, not even made it more extreme. Argue with him, not me.

24

Barry 05.07.08 at 9:14 pm

“Er, Barry, but that is Brad Delong’s view. I’ve not misrepresented it, not even made it more extreme. Argue with him, not me.”

Posted by Tim Worstall

I’m sorry, Tim – did he twist your arm to make you come post that crap here? Or is he holding your family hostage?

Sheesh.

25

cynical again 05.08.08 at 5:36 am

Brad Delong is a right-winger now?

26

Petering Time 05.08.08 at 6:04 am

Nice link to that study, Kath G. An interesting read.
As to the comment thread. All I can say is – thank Hughie I don’t live in the USA.

27

Tim Worstall 05.08.08 at 10:25 am

“I’m sorry, Tim – did he twist your arm to make you come post that crap here? Or is he holding your family hostage?”

Barry, perhaps you might turn your efforts to refuting the argument rather than throwing epithets?

28

magistra 05.08.08 at 10:38 am

Has anyone yet done what seems the obvious kind of study? Compare pain experiences of people in jobs with similar physical demands but very different kinds of status/pay? There are an awful lot of jobs which involve mostly sitting at a desk all day, ranging from the relatively menial to the very highly paid. Why not start with looking at those and try and reduce some variables? (Or try comparing those in higher status manual jobs e.g. chefs in top restaurants as opposed to those in cheap cafes)?

29

Mikhail 05.08.08 at 4:18 pm

As far as I know, the answer is no – that study was not done. As weren’t a lot of others to be able to talk about this meaningfully. In my opinion neither the study in the post, nor the article in the comments shed any light on whether these claims are true…

30

nihil obstet 05.08.08 at 8:59 pm

Two factors always seem to be left out of retirement discussions:
1) Increasing productivity. With increased productivity, fewer workers can support more non-workers.
2) Role of wages. This is actually just another facet of increasing productivity. From 1972 to 2001, nearly 50% of productivity gains went to the top 10% of wage earners, with most concentrated in the top 1%. Since Social Security funding is based on wages upto a cap, increasing the wages of those whose earnings are under the cap will increase the funding of Social Security. In short, make the productivity gains available for retirement.

31

psychology grad student 05.08.08 at 11:14 pm

“For the following reason – prolonged exposure to any sensory stimulus (light, noise, pain, etc.) causes accommodation, i.e. reduction in sensitivity.”

Mikhail, this is simply not true; for example a quick search on google scholar for “adaptation to noise psychology” you can see a host of articles that show that people do not adapt to chronic noise, for example, and that it has long term effects on stress and health. So one of (many) mechanisms I can think of are that the living situations of the poor contribute to their increased experience of chronic pain.

32

Steve Sailer 05.09.08 at 12:38 am

Clearly, we should favor policies that lead to greater mechanization of pain-producing jobs like scrubbing floors, lifting boxes, and picking crops by driving up wages for unskilled labor, making mechanization more profitable. Instead, we’ve imported million of unskilled illegal immigrants, making stoop labor more affordable to employers and reducing the incentives to mechanize.

33

Noni Mausa 05.09.08 at 2:05 am

Raising my retirement age won’t help at all, except in playing the blame game.

I got early retirement as a result of a workplace trauma, and returned to school for that wonderful cure-all, retraining. Today, out of school and my savings mostly spent on the schooling, I can find no work either in my original career nor the new one, both sedentary, both things I am good at. After all, who wants to hire someone within shouting distance of 60?

Make me work till 65! C’mon you cowards, throw me in that briar patch!

Noni

34

Dan Hill 05.09.08 at 2:29 am

I’m a white collar professional and I expect to keep working in some form as long as my mind holds out (and I’m not relying in the slightest on the government taking care of my retirement or even semi-retirement.

Conversely my dad is one of the hardest working people I’ve ever known but he was a skilled but blue collar worker meaning he did physical labour all his working life. His body was shot by the time he was 60. Fortunately his employer moved him into a mentoring role until he turned 65, but he needed to retire.

35

John Thacker 05.09.08 at 7:11 am

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

No, but it certainly doesn’t explain why the rates of people applying for disability has increased (not just in the US, but in Western Europe) as the percentage of people in backbreaking blue collar and farm jobs has decreased.

You’ve demonstrated that being poor is painful, and that blue collar jobs are hard on one’s body. I’m not sure what that has to do with the general retirement age, though. Why does it make sense to have everyone’s retirement age stay the same even as a smaller percentage of people are doing blue collar work? It seems like an argument rather for the Social Security age being lower for blue collar workers, or for the poor getting a better deal from Social Security, or something along those lines.

36

John Thacker 05.09.08 at 7:22 am

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.

A strong association between self-reported disability status and self-reported pain? I certainly believe the general result that being poor results in having more pain, and that blue collar jobs are rougher, but surely this result isn’t all that surprising is it? Did you expect a large number of people to respond to the survey with “Sure, I’m on disability, but I feel great and am in no pain! By the way, don’t tell anybody.” I’m not saying that people are lying, but if they were lying about needing disability isn’t there a decent chance that they would lie about pain?

It seems to me that one of few things less likely than “all those people applying for disability [being] just a bunch of perfectly able-bodied fakers and whiners” would be “all those people applying for disability who are perfectly able-bodied fakers and whiners being willing to admit to such on a survey.”

37

Mikhail 05.09.08 at 7:31 am

psychology grad student:

We really shouldn’t get so far off-topic, but you clearly are reading the wrong books. :)

There is a reason why we can’t see anything walking into a dark room from the street, but we start to after a while. There is a reason why people living close to a waterfall, let’s say, can have a normal conversation standing close to it whereas we wouldn’t be able to hear each other. It’s called accommodation – reduction in sensitivity.

Also, it has absolutely nothing to do with long-term effects! I was merely pointing out that the original study doesn’t allow for a meaningful explanation of the effects, even if they are not spurrious. Loss of sensitivity doesn’t mean the stimulus stops affecting you – it just means you stop noticing it! Sure, looking at the sun will blind you and living in high noise environment will do other damage, but that is beside the point. The question was not whether pain is good or bad :), but rather can we meaningfully measure these differences through a self-report study…

38

well 05.09.08 at 7:32 pm

why has everyone failed to notice that when SS was set up in the 1930s benefits kicked in right around life expectancy? if we followed that rationale (not saying we necesssarily should) the SS age should be raised to 78-80, right?

i read in these comments about all the people whose loved ones “need” to retire at 65 (and get full SS) cause their bodies are shot. well, that ethic didn’t seem to matter when the system was established. should it now? are our jobs harder physically (even manual labor jobs)? i’m not so sure…

39

Hoo 05.09.08 at 9:26 pm

Why not implement something similar to “30 and out” for Social Security, rather than having a fixed retirement age? It seems like this would neatly solve the problem that different jobs really need different retirement ages:

– Physically strenuous jobs tend not to require as much education beyond high school (ignoring on-the-job training). So folks in those sorts of jobs enter the workforce younger, and thus are able to retire younger.

– White collar workers will usually have some amount of post-high school education, delaying their entry into the workforce, so that they are older when they reach the retirement threshold.

40

rmjiv 05.09.08 at 11:41 pm

Why not dispense with the concept of retirement age entirely and replace it with a definition of disabled that factors in age and profession?

If you *can* work in your profession, I see no reason why the government should pay for your retirement. If you’re too old or infirm to work anymore, than you’re disabled and you should get SSDI benefits.

41

Will Franklin 05.11.08 at 8:03 pm

Social Security is in crisis. And we don’t have to raise the retirement age any further if we’d just privatize it now.

42

dpirate 05.12.08 at 2:38 am

The causation mechanism is both cultural and learned. The poor guy is not only the recipient of more pain due to the relative safety level of his occupation (cuts, bruises, backache etc), but he is subject to pressure by his employer and peers to ‘walk it off’. In the highrt-income scenario, this pressure is real only recreationally (sports or exercise). He becomes inured. That’s all it is.

Yes, physical labor ruins the body (and the mind, depending), but where retirement is concerned it would be more useful to have hard data of disability claims than subjective ideas of pain tolerance.

BTW, lets not privatise SS, unless the aim is to have old folks dying in the street.

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