Eat the rich? First, measure the pie: new Stone Centre fellow Louis Fréget on wealth, health, and inequality

Louis Fréget, a health economist whose research looks at maternal health, birth outcomes, and income inequality, has joined the Stone Centre at UCL as a postdoctoral fellow, working on CORE Econ.

‍

Louis studied with CORE as an undergraduate at Sciences Po, ran a general-audience economics blog during his PhD, and is now writing a blog series on wealth inequality for CORE. We spoke to him about his research, what drew him to CORE, and why measuring wealth is harder than it looks.

‍

Tell us about your academic background. How did you become interested in economics?

‍

I've been interested in politics and public policy for as long as I can remember. And when I was preparing for the entrance exam to Sciences Po, a French university focused on social sciences, my best friend's mother, who was an economist, offered to help me prepare. Through our conversations, I discovered economics and realised how much I liked it. At university, I did a bachelor's degree that combined economics with subjects like political science and sociology, and I grew to like economics more. But I was also increasingly drawn to public health debates, such as those around vaccines, and I took a class in health sociology that I found fascinating. For a while, I hesitated over whether to do a master's and PhD in economics or in epidemiology and public health. Health economics turned out to be a nice way to combine the two, and it meant I could still work on the social questions economists care about, like income inequality. I've always been fascinated by health inequalities, like why people who are poorer tend to have worse health than those who are wealthier, and what we can do to close that gap.

‍

What does your research focus on?

‍

I did my PhD at the University of Copenhagen, where I focused on health inequalities. My main areas of research are maternal health and birth outcomes. I'm particularly interested in inequalities early in life, like how parents' income or social policies affect a baby's health at birth and the mother's health. But I'm also interested in the other direction, looking at how maternal health affects income inequality and other outcomes that economists care about. For example, I have a paper from my PhD on the impact of postpartum depression on income inequality: what happens when a mother is depressed after giving birth. We show that postpartum depression can make it harder for mothers to return to work, reducing their earnings relative to fathers. So postpartum depression is a meaningful contributor to the child penalty. What we call the child penalty is the fact that after mothers give birth to their first child, the earnings gap between mothers and fathers starts to appear and widen.

‍

For more information on the child penalty, see this research summary.

‍

I've also looked at how policies around childbirth, like labour induction, affect the health of mothers and babies, and what happens when care is disrupted during pregnancy, for example when the healthcare provider you've been seeing closes down. More recently, I have worked on digital health policy. For instance, I looked at the effect of storytelling-based prevention videos on health behaviours.

‍

What drew you to CORE?

First of all, I studied with CORE during my first years as an undergraduate, and I really liked it. It was very concrete. Then, during my PhD, I started a blog where I wrote popular science content on economics and evidence-based policy. I wanted to reach a wider audience than my economist peers. I built up a small readership. It wasn't much, but you don't need a big audience to feel you're not talking alone. Between Twitter and my blog posts, it was so nice to be able to talk about economics with all those people, many of them non-economists.

‍

How did the blog find its readers?

‍

What really gathered a following was gentle debunking. People were saying things about the economy and about economists, and I would show, in very respectful terms, that it might not be true: "Here's what economists actually think. Here's what econ research is really about."  For example, I wrote a blog post about Jean-Marc Jancovici, a French engineer and environmental activist who was incredibly popular in France at the time. Jancovici claimed he had found the "best macroeconomic model in the world"! He argues that energy consumption is the main driver of economic growth (even explaining the 2008 crisis) and that economists have completely missed this. I went through the research to show that economists have actually been studying this question for decades, and that the relationship between energy and economic growth is much more complicated than he suggests.

‍

Once I had built up that following, I could talk to people about all sorts of things related to economics. I wrote a lot about inequality and evidence-based policy, like how do you make sure that policies actually help the people they're supposed to help? And that was really rewarding. A few people told me that they used to have a very negative view of economists, but that reading my blog had changed their minds. They hadn't realised that economics could be so closely connected to issues they cared about, or that economists put so much effort into testing their theories against real-world evidence. I even had someone write to me saying he'd enrolled in a master's programme in applied economics partly because of my blog posts. That was really cool!

‍

But towards the end of my PhD, I had a lot of work, so I didn't have time to maintain the blog, and I lost that part of my life. I focused on academic work and getting papers out. When I saw the job posting, I thought it would be a great way to get back to blogging and writing for a general audience, so that was very exciting.

‍

You mentioned studying with CORE as an undergraduate. Was that your first introduction to economics?

‍

Yes. My introductory economics class at Sciences Po used CORE's The Economy. It was taught by Yann Algan, who was an early contributor to the CORE project. It was my first exposure to formal, university-level economics. After that, I did the more standard intermediate macro and micro courses, and I missed the CORE approach. Its strength was that it started from real-world problems. "We're going to tell you about the environment. We're going to tell you about inequality." It didn't start from models, as most economics teaching still does, which is a strange way to approach the issues. People don't usually come to economics because they want to study theory and then, three or four lectures later, apply it to the real world. They want to start with a real issue and then build a model to explain it. That's what I liked most. I also thought the models were a bit more realistic than those you are usually taught as an undergrad.

‍

You've been working on a blog series about wealth inequality for CORE. What will you discuss in it?

‍

Wealth inequality is such a big topic right now, and so is wealth taxation. People are saying "eat the rich" and that we need to do something about it. The series is in two parts. First, we look at what wealth is. If you want to tax wealth — if you want to eat the rich — you need to know what there is to eat in the first place. What's the size of the pie? The second part looks at the big questions for wealth taxation, such as what you would tax and whether rich people would flee if you taxed them. I have not been working on that second part just yet, so I can only talk about the first.

‍

We talk about wealth all the time, but we don't always mean the same thing by it. Even among economists, there are debates about what should count as wealth and how we should measure it. And these debates often get mixed up with political questions about whether inequality is good or bad, or what we should do about it. So we wanted to take a step back and look at how wealth is actually measured, what assumptions go into the numbers, and why those choices matter, before getting into the political debate.

‍

Take a look at the CORE Econ blog.

‍

Is that the biggest issue with the existing literature on wealth inequality?

‍

I'm talking less about the academic literature and more about the political discourse around it. As Wendy Carlin, director of CORE Econ, pointed out to me, there can be some lack of clarity about what exactly counts as wealth... even at conferences on wealth taxation!

‍

It's also about how people engage with the academic debate. It's very polarised. When people hear an economist talking about inequality, they often want to know whether they're left-wing or right-wing before they've even heard the arguments. But I think that if we want to be well-informed citizens, we need to do more than just side with people who already agree with us or repeat slogans we find appealing. We need to understand what the arguments actually are, why economists disagree, and what the possible consequences of the policies we're advocating for might be. And that's really what we're trying to do with this series: give our readers the tools to make up their own minds.

‍

So the problem is more about how research is communicated than about the study of wealth itself?

‍

Precisely. There are two things. First, it's a very dense literature, so it's useful to take a step back and synthesise what's out there and what exactly the debate is. And some of the questions are interesting. How do you measure wealth when some people try to hide it? Or how do you figure out what the very rich own when they don't respond to surveys? Economists have come up with some ingenious methods to tackle these problems. One of them even involves using records of people who've died to estimate the wealth of people who are still alive. So, in a way, economists are summoning the dead to measure the wealth of the living!

‍

Second, as I said, we felt it was good to have a non-partisan approach before getting into the questions people discuss in the media, for good reason — whether inequality is good or bad, or whether wealth inequality has really been increasing. Sometimes it's good to talk about political issues without injecting the moral questions too quickly.

‍

How does this align with your interest in health? Do you see a connection between wealth inequality and health outcomes?

‍

There's definitely a relationship. We know there's an income gradient in health: in general, people with higher incomes tend to be healthier. Most of my work has been on income rather than wealth, but they're closely related. There are several mechanisms that help explain this gradient. The first is whether people can afford healthcare. This is obviously a big issue in the US, but it also matters in Europe, even in countries like France or Denmark, where healthcare is heavily subsidised. You still have to pay for things like prescription medicines, dental care, or glasses, and those costs can really add up, especially for people on lower incomes. But there are other mechanisms that go beyond whether people can afford healthcare. One is health behaviour, things like smoking or drinking. These behaviours are often linked to people's social backgrounds and the environments they live or work in. If you have a very stressful job, for example, or work in a profession where heavy drinking is the norm, that can influence your behaviour. Then there's exposure to health risks. Some jobs expose people to dangerous substances, physically demanding conditions, or high levels of stress. Some people live in areas with more pollution. That's a bit different from behaviour, because it's often something people have very little control over. And finally, there's whether people seek medical help when they need it. If you're better informed about healthcare, or you come from a social background where you feel comfortable going to the doctor and asking questions, you might seek help earlier. You might get a cancer diagnosed at an earlier stage, for example, and that can make a huge difference to your health outcomes.

‍

So all these things are linked to income and social class, but they're not just about how much money you have. All of this is about income, though. Income is what flows into the bathtub, and wealth is the bathtub — your house, your savings, your investments, and so on. But if you want to know more about that distinction, you'll have to read the blog series we've got coming up!

‍

Anyway, I'd expect a similar relationship between wealth and health, although that's not something I've studied directly. Wealth could also matter for health in ways that income doesn't. For example, wealth can act as a financial buffer. If you lose your job or face an unexpected expense, having savings to fall back on can make a big difference. And even if you never experience such a shock, simply knowing that you have that safety net might reduce chronic stress!

‍

Are there any exceptions to that picture?

‍

There's actually a pretty surprising exception when it comes to health at birth. A study looking at California and Sweden found that birth weight doesn't just keep increasing with parental income. It increases at first, but then starts to fall again among the richest families. So the relationship isn't quite what you'd expect. And you see a similar pattern for other birth outcomes. But interestingly, this doesn't hold for mortality: mothers and babies in the richest families are still less likely to pass away around birth. In my PhD, I found a similar pattern for birth weight in Denmark. One explanation is simply that mothers with higher incomes tend to have children a bit later in life, which is sometimes associated slower foetal growth or complications, though usually without serious consequences.

‍

Louis, thank you so much for talking to us. Welcome to the team — we're looking forward to reading the wealth inequality series. Visit Louis' website to learn more about him and follow CORE Econ to see his upcoming blog.

‍