Mortality, lifestyle and socio-economic status

This paper uses the British Health and Lifestyle Survey (1984-1985) data and the longitudinal follow-up of May 2003 to investigate the de- terminants of premature mortality risk in Great Britain and the con- tribution of lifestyle choices to socio-economic inequality in health. A behavioural model, which relates premature mortality to a set of observ- able and unobservable factors, is considered. We focus on unobservable individual heterogeneity and endogeneity a®ecting the mortality equa- tion. A maximum simulated likelihood (MSL) approach for a multivari- ate probit (MVP) is used to estimate a recursive system of equations for mortality, morbidity and lifestyles. In order to detect inequality in the distribution of health within the population and to calculate the con- tribution of socio-economic factors, we compute the Gini coe±cient for overall health inequality. A decomposition analysis for predicted mor- tality shows that, after allowing for endogeneity, lifestyles contribute strongly to inequality in mortality, reducing the direct role of socio- economic status. This contradicts the view, which is widely held in epidemiology, that lifestyles make a relatively minor contribution to ob- served socio-economic gradients in health.