A few MA covid graphs

This is a low-stakes post.

Massachusetts has been releasing county-level coronavirus case counts, which I paired with data from the US Census to look for patterns. I actually didn’t end up finding anything particularly interesting, but some of the graphs are nice, so I thought I’d share.

On case growth

A few days ago, it looked like the growth of covid cases in Massachusetts might be flattening. But as of yesterday, it seems like that’s not quite the case across the board. Here are the total case counts per 1,000 residents of each county county since March 15:

Dukes and Nantucket counties omitted.

And here are cases per 1,000 residents on April 7, with the geometric growth rate of cases over the last week indicated by color:

Growth rate calculated as (x_1/x_0)^(1/7)-1

Berkshire, Barnstable, and Franklin counties have the lowest case growth rates, ranging from 6.2% to 7.3% on average per day over the last week. These counties have some common characteristics:

  • They’re geographically remote;
  • They are the only MA counties to have experienced population decline over the last decade;
  • They have the highest non-Hispanic white populations per capita and the least foreign residents;
  • They have the greatest proportion of residents over 65 (at least 22% in each case!);
  • Franklin and Berkshire counties have the lowest population densities, at 102 and 141 people per square mile, respectively.

To me, the above is consistent with the idea that economic activity is a vector for the spread of coronavirus (not literally, but it gets people in contact which causes person-person transmission).

Plymouth, Hampden, and Bristol are the counties with the fastest-growing case counts, each of them averaging an increase of over 11% daily over the last week. These counties don’t have much in common, so I’m having trouble putting together a potential unifying narrative.

Race and population density as correlates

It’s starting to look like black Americans might be more susceptible to coronavirus than other racial and ethnic groups. At first glance, that appears to show up in county-level data. But upon closer examination, that doesn’t appear to be the case — first because population density and the percentage of black residents are collinear, and population per square mile has a higher correlation coefficient; and second because Suffolk county (Boston) is influencing the linear relationship in both cases. Adjusted R-squared drops heavily if we exclude Suffolk county from the data set. (Race and population density were the best predictors I found of cases per 1,000 residents.)

This isn’t to say race and its many correlates aren’t good predictors. I think it speaks more to the (severe) limits of the data set I’m working with. If I have time, I may try to build a city-level data set. If anyone knows of one (or something better), link me!

Cigarette Daydreams

Last week, U-Haul announced that beginning February 1 of this year it would no longer hire nicotine users in the 21 states that permit employers to take that information into account when hiring. To be clear, this covers use outside of the workplace, and it could affect former smokers who use nicotine patches or similar delivery systems.

If you didn’t hear about this, you have my envy and my respect, as it probably indicates that you’re employed and/or don’t spend hours on Twitter, where the topic was briefly trending.

From what I can tell, the reaction has mostly been cynicism about U-Haul wanting to cut healthcare expenses. I think that’s probably true; smokers can indeed be charged higher premiums than non-smokers under the Affordable Care Act, and presumably U-Haul will cover at least some of this.

But since I spent a small chunk of last year’s blog posts talking about selection effects and signalling (most notably here, here, and here), I feel obliged to point out that selecting against smokers is also an effective way to screen for other undesirable qualities in employees. As smoking rates have plunged, smoking has become an increasingly good proxy for a bunch of socioeconomic factors.

(Pardon the use of 2013 data in the following charts; I happened to have this version of the BRFSS on my laptop, and went with it for convenience. I don’t think there’s a good reason the general idea should have changed much in the interceding years.)

For example, smokers, and to a lesser extent, former smokers, miss more days due to their physical or mental health than non-smokers:

Smokers miss more days
The examples given in the BRFSS codebook of “usual activities” are work, self-care, or recreation.

They’re also more likely to have less education and to have lower incomes:

Educational attainment by smoking status

Income bracket by smoking status

Notably, U-Haul is pitching this as a step in “fostering a culture of wellness”:

“We are deeply invested in the well-being of our Team Members,” said U-Haul Chief of Staff Jessica Lopez in a press release. “Nicotine products are addictive and pose a variety of serious health risks. This policy is a responsible step in fostering a culture of wellness at U-Haul, with the goal of helping our Team Members on their health journey.”

So here we have a company policy that is ostensibly for the benefit of employees’ health, but the actual consequences of which will be to save money for the employer and disproportionately preclude the candidacies of many low-SES applicants. Mind you, this is for a job at U-Haul during a period of supposedly record-low unemployment.

I think what bugs me most about this is a feeling (which could be wrong but is at least widespread) that there are diminishing opportunities—especially for low-SES Americans—to participate in the productive side of the economy, which by all indication is something that gives people a sense of meaning and self-respect.

I also can’t shake the feeling that a more powerful or organized constituency would be able to generate some public sympathy in a similar situation. If U-Haul made it policy to deny employment to obese people, presumably to similar effect, there would have been a cascade of outraged NYT opinion pieces and an ACLU lawsuit.

Still more hilarious is the contrast with growing corporate, public, and governmental acceptance (or even endorsement) of marijuana use. A new, publicly announced prohibition on employee use of marijuana would come across as horribly retrograde and likely receive more negative attention.

Smokers, alas, are nearly universally reviled, out of the graces of the upper classes and on the wrong side of demographics.

The Hidden Cost of Public Health

Starting on January first of next year, the City of Philadelphia plans to impose a “soda tax” of 1.5 cents per ounce. The new law—already set to be challenged in court—has proved highly controversial, even within the political left where its revenue-raising potential is pitted against concerns over its regressive nature. The political right seems fairly uniformly unenthused.

But that’s boring. What’s really interesting is that Philadelphia’s government is avoiding calling the tax a public health measure, instead choosing to focus on the additional revenue it might generate, despite soda taxes’ endemic appeal to the public health profession.

Public health officials often laud soda taxes as a means of reducing demand for sugary drinks that are linked to obesity, diabetes, tooth decay and other maladies. The underlying economics are relatively straightforward—raise the price of soda and people will consume less of it. The hope is that doing so will reduce the incidence of the aforementioned conditions and curb associated healthcare spending.

But despite the wide approval of public health professionals, it’s far from clear that a soda tax is an appropriate solution in this scenario. Not only is there reason to doubt it’s efficacy, but in a sense, such a policy blurs the line between public and what we might call ‘private’ health in a way that marks a pernicious slide away from self-determination and seems to me unethical.

Using a tax to “correct” demand is one of the classic methods of solving collective action problems, which tend to involve public goods or open-access resources and often require regulatory oversight. President Bush’s cap and trade initiative in the 1980s, meant to reduce emissions of sulfur dioxide, is a successful example of such an endeavor.

The idea is that if a resource is shared (in this scenario, air quality), then it makes sense to have a centralized agency impose regulations to account for the “social cost” associated with its degradation. If something can be proven to affect others (without requiring an onerous amount of nuance), there’s a compelling case for using coercive public policy to address it.

That’s certainly the case when air quality is concerned. But there are key differences between air pollution and obesity; even though they both affect people’s health, one is far more likely to be incurred privately. We all breathe the same air; but your neighbor drinking a Double Gulp everyday doesn’t affect your waistline. Someone else being fat doesn’t harm you. Right?

Actually, depending on how an individual’s healthcare is paid for, that last part is up for debate.

Soda drinkers tend to be poorer, (the same is true for users of tobacco, which is subject to similar tax-based deterrence) and therefore more likely to have their healthcare publically subsidized. In a not-so-tangential sense, that means it’s very much in the interest of the taxpayer that those people be deterred from such actions. After all, any tax dollars not spent on healthcare can be spent on something else or not collected.

In my view this poses an ethical challenge—does public financing of healthcare erode beneficiaries’ sovereignty over their health-related decisions? And, if it does, what sort of precedents are we setting should America switch to a universal healthcare system, which would effectively render all health public?

It does seem to be the case that as more resources are poured into social safety nets, there is increased incentive for societies to attempt to engineer the results they want through coercive means. The resulting policies range from ethically dubious taxation to outright illiberalism.

Take, for example, the rather harsh methods by which the Danish government discourages immigration and asylum seekers: seizing assets worth more than $1,450; using policy to force assimilation (in one city mandating that pork be included on municipal menus); cutting benefits to refugees by up to 45%.

A similar situation is unfolding in Sweden, where the extensive social safety net has turned immigration into a tug-of-war between classical and contemporary liberal sentiments. The Economist writes:

The biggest battle is within the Nordic mind. Is it more progressive to open the door to refugees and risk overextending the welfare state, or to close the door and leave them to languish in danger zones?

Closer to home, Canada has recently received some scrutiny for its habit of turning away immigrants with sick children so as to not overburden its single-payer healthcare system.

Some of this might sound cruel or discriminatory. Some of it is. But these are rational responses from systems forced to ration scarce resources. In a sense, it’s the ethical response, given that governments are beholden to their taxpayers.

It’s a natural goal for public health experts, economists, and others whose jobs are to optimize society to try to promote a healthier nation. Our national health and wealth would clearly be improved if obesity, diabetes, etc. were eradicated. And yes, that could conceivably be achieved by any number of forceful policies—what about a Trump-style deportation of the obese?!

But we must consider the costs as well as the benefits of such policies. Are the potential gains worth ceding dominion of our personal decisions to rooms of “experts?” Is it possible for the conversion of health from a private to public good to coincide with our liberal values?

I don’t think so, at least not in the extreme. If health becoming a public resource means that the government must take an increasingly paternalistic and protectionist role in our society, it’s not worth whatever we might gain—or lose around the midsection. After all, if people can’t be trusted to decide what food to eat, what can we be trusted with? If a soda tax is okay, what about a tax on red meat, sedentarism, or motorcycles? Surely we’d be healthier if we did less of each.

I do believe there is an appropriate role for government to play in promoting the private health of the masses, but it’s significantly more parochial than the sort of collective action scheme fetishized by academics. To loosely paraphrase the Great Ron Swanson: people deserve the right to make their own peaceful choices, even if those choices aren’t optimal.

Side note: I would also argue that there’s some pretty heavy cognitive dissonance at play here as far as soda taxes go. The federal government hands out generous subsidies—collected from taxpayers—to corn producers that make junk food and soda cheaper to consumers. If more expensive soda is the remedy, why not remove those subsidies rather than tax consumers twice?