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As the debate over health care reform continues, costs have become a critical measure in the many plans and proposals to come before us. Knowing costs is important because it allows comparisons across such disparate health conditions as AIDS, Alzheimer's disease, heart disease, and cancer. This book presents the results of a major study estimating the large and largely overlooked costs of occupational injury and illness--costs as large as those for cancer and over four times the costs of AIDS.The incidence and mortality of occupational injury and illness were assessed by reviewing data from national surveys and applied an attributable-risk-proportion method. Costs were assessed using the human capital method that decomposes costs into direct categories such as medical costs and insurance administration expenses, as well as indirect categories such as lost earnings and lost fringe benefits. The total is estimated to be $155 billion and is likely to be low as it does not include costs associated with pain and suffering or of home care provided by family members.Invaluable as an aid in the analysis of policy issues, "Costs of Occupational Injury" "and Illness" will serve as a resource and reference for economists, policy analysts, public health researchers, insurance administrators, labor unions and labor lawyers, benefits managers, and environmental scientists, among others.J. Paul Leigh is Professor in the School of Medicine, Department of Epidemiology and Preventive Medicine, University of California, Davis. Stephen Markowitz, M.D., is Professor in the Department of Community Health and Social Medicine, City University of New York Medical School. Marianne Fahs is Director of the Health Policy Research Center, Milano Graduate School of Management and Urban Policy, New School University. Philip Landrigan, M.D., is Wise Professor and Chair of the Department of Community Medicine, Mount Sinai Medical Center, New York.

A number of health policies have implications for, and in turn can be influenced by, the distribution of income. However, current discussions define the distribution in current, not lifetime, income. This study describes a method of estimating gender and race differences in the distribution of lifetime incomes that account for mortality differences. When cohort lifetime incomes of living and deceased persons are compared, black men are found to be much worse off, whereas white women are found to be better off than existing estimates using annual income suggest. The mortality and lifetime income advantage of white women, however, is offset if, as some argue, white women have higher morbidity rates than white men of the same age. The authors use the concept of lifetime income to draw implications for health policy debates on cigarette and beer taxes, occupational safety and health, Medicaid versus Medicare spending, educational health promotion programs, and general investments in education.

Existing econometric studies of the efficacy of motorcycle helmet laws assume that such laws are exogenously determined and may therefore yield biased results. To correct for possible selectivity bias, we specify and estimate a self-selection model in which the choice of having a helmet law is endogenous. Our results indicate selectivity bias exists and that if laws were randomly assigned, fatality rates for states with helmet laws would on average be less than 1% lower than for states without laws.

In the health production literature, schooling has distinguished itself as "the most important correlate of good health," according to Fuchs [11]. Economists have been so persuasive in their demonstration of the importance of schooling that medical researchers are increasingly drawing attention to lack of schooling as a "risk factor" in a variety of diseases [24]. While there is little doubt among health economists about the empirical strength of the relation between schooling and health, there is considerable controversy surrounding explanations for the empirical association. Grossman [15; 16] maintains that schooling directly enhances health, for example, by increasing knowledge pertaining to healthy habits. Fuchs [11; 12], on the other hand, maintains that schooling serves as an empirical proxy for some unobserved "third" variable which also happens to be associated with health. The "third" variable most frequently mentioned is time preference. Fuchs rejects the Grossman idea that education plays a direct role in promoting health. The debate has relevance for policy. If schooling promotes health, it could be argued that expenditures on schooling could be compared to, for example, expenditures on medical care as an alternative for increasing average life-spans. But, if Fuchs is right, any expenditure comparisons would be futile.

Economists have long realized that schooling and good health are strongly positively correlated. Some conclude that schooling has a direct positive effect on the production of good health while others argue that some unobserved variable such as rate of time discount positively affects both health and schooling. This study investigates the validity of alternative explanations for the observed schooling-health correlation. Models are estimated using four different measures of overall health: disability, functional limitations, and systolic and diastolic blood pressures. The results uniformly indicate that the direct effect of schooling on health is more important than the effect of unobservables.