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The economic value of teeth
Looks and height matter for economic outcomes, so why not teeth?
Healthy teeth are a vital and visible component of general well-being, but there is little systematic evidence to demonstrate any impact on the labor market. In this paper, we examine the effect of oral health on labor market outcomes by exploiting variation in access to fluoridated water during childhood. The politics surrounding the adoption of water fluoridation by local water districts suggests exposure to fluoride during childhood is exogenous to other factors affecting earnings. We find that children who grew up in communities with fluoridated water earn approximately 3% more as adults than children who did not. The effect is larger for women than men, and is almost exclusively concentrated amongst those from families of low socioeconomic status. Of the channels explored, we find that occupational sorting explains 14-23% of the effect, suggesting consumer and employer discrimination are the likely driving factors.
That is by Sherry Glied and Matthew Neidell; here is the paper on-line, note their findings are preliminary not final. Teeth seem to matter less for rich people because they have later chances to cover up -- using money of course -- for bad childhood teeth. The poor apparently remain stuck with their teeth problems. You might think that childhood exposure to fluoride is just proxying for quality of county and thus county human capital in some way, but the fluoride/earnings correlation seems to hold up even when variables are used to adjust for county quality. Can you dissent from a paper that writes:
...the anecdotes described above suggest that people who lack teeth may have trouble finding jobs.
I thank a loyal MR reader for the pointer.
Addendum: Here is Caplan (and Blinder) on the economics of teeth.
Posted by Tyler Cowen on October 31, 2007 at 07:34 AM in Medicine | Permalink
Comments
Anecdotes? Suggest? I'd say it's an utter given. People who lack teeth are instantly and automatically marked as being homeless or having been homeless and therefore members of the lowest class economically. That's because welfare will pay for having bad teeth pulled (that's life=threatening) but not having them fixed.
In a lot of jobs, possibly the majority, appearance counts for far more than one would imagine, even without the rat's nest of presumptions that goes along with 'homeless - mental problems, drugs, alcohol, bad habits - Their Own Fault - probably filthy - ' and BTW, the peculiar deep reddish-brown tan that goes with living outdoors day in and day out is another marker, though not as bad a one.
If I were in the business of getting jobs for people who had hit rock bottom and had the budget to do it, getting their teeth fixed or getting them dentures would be very, very high on the list. (Getting them a place to live would be #1).
Posted by: Pat Mathews at Oct 31, 2007 9:51:38 AM
Without having read the study, it seems like if anything they are giving a lowball estimate since their shock is macro and for most jobs teeth are positional rather than absolute. To the extent that fluoridation leads to across-the-board increases in teeth quality for the local labor market, it conceals this positional aspect.
Posted by: Gabriel Rossman at Oct 31, 2007 10:24:03 AM
Policy recommendation for Americans with bad teeth: put on a British accent and avoid labor market discrimination.
Posted by: Leo at Oct 31, 2007 12:35:19 PM
[We find that children who grew up in communities with fluoridated water earn approximately 3% more as adults than children who did not]
I recall Deirdre McCloskey on the distinction between statistical and practical significance.
Posted by: dsquared at Oct 31, 2007 3:21:40 PM
dsquared -
so you think earning 3% more or less does not make a difference in practice?!
Posted by: oomph at Oct 31, 2007 3:58:08 PM
I had worked at my factory for quite a while before I realized that some people didn't just have dirty teeth all the time. I know what tooth decay looks like now. I've seen a lot of $10/hr material handlers with snaggle teeth.
Then again, my unstraightened, unwhitened, uncapped teeth are just as much of a class marker to the better off.
Posted by: Noumenon at Nov 1, 2007 8:59:00 AM
When you actually look at the regressions, you will see that they had a tough time to show anything of significance - most of the regressions ended up insignificant (to their credit, they at least reported the unsuccessful ones). Obviously, there is an observable link between quality of teeth and socio-economic status - but a causal one? Isn't it simply because wealthier people care more about their teeth?
Posted by: pinus at Nov 1, 2007 3:02:34 PM
How isn't this just another proxy for looks?
1. Bad teeth are less attractive than good teeth. (personal opinion, but I suspect generalizable)
2. Lack of fluoridation increases probability of bad teeth. (known fact)
3. Lack of fluoridation increases probability of being less attractive than you could be. (1 + 2)
4. Attractive people get paid more on average. (we know from other studies)
5. Lack of fluoridation increases probability of being paid less. (3 + 4)
The study seems to be an interesting way to start quantifying what's meant by attractive.
Posted by: Jannia at Nov 1, 2007 5:41:52 PM
The problem is not that people missing some of their teeth do not receive jobs, they just may not receive high paying jobs that most people want. Some companies do hire according to looks as well as their education level because they want someone who will make the company look good. If they are filling a marketing postion they will most likely pick the good looking applicant that does not have complete knowlegde of what is going on, over the applicant who knows excatly what they are doing but does not "look the part". which is sad and not good for the company in the long run.
Posted by: Leigh at Nov 4, 2007 3:52:11 PM
Interesting. Agreed that the appearance of good oral health influences general well but general well being may influence good oral health more. As a dentist with a patient population of over 3000 patients in New York (and 50 percent of those are foreign born and without fluoridated water systems) I would like to make a few points. "Bad" (by bad we will limit this discussion to increased incidence of decay) teeth are due to a combination of heredity, fluoridated environment and refined sugars. If we examine human skulls prior to fluoridation and refined sugar we would find most teeth without decay or edentulous mouths only due to periodontal disease. My patients born in Africa without fluoridation (about 500 in number) have remarkably good teeth but their children born in the US with fluoridated water seem to have increased incidence of decay (enough refined sugar trumps fluoridation). Secondly lower socioeconomic groups are less healthy (orally and systemically) likely because they are less responsible about health care and oral care (not due to lack of fluoridation). Medicaid does cover dental care and the replacement of missing teeth if so desired therefore the dental areas compromised could be restored, rendering the appearance of "oral health and general well being" and you would think the better able to gain employment in the labor marked. You would think, wouldn't you? One final point is that children that get to much fluoride have a condition known as fluorosis (increasingly more common) which renders the teeth more susceptible to decay and poor esthetics. How can we even begin to factor this into the equation?
Posted by: Marc (dentist) at Nov 4, 2007 5:49:13 PM
The author is missing one glaring fact - that most fluoridated U.S. states have the highest rate of tooth loss making the total argument moot.
See: http://tinyurl.com/3x7nuq
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In a statement released August 9, 2007, over 600 (now 1,200) professionals urge Congress to stop water fluoridation until Congressional hearings are conducted. They cite new scientific evidence that fluoridation, long promoted to fight tooth decay, is ineffective and has serious health risks. (http://www.fluorideaction.org/statement.august.2007.html)
Signers include a Nobel Prize winner, three members of the prestigious 2006 National Research Council (NRC) panel that reported on fluoride’s toxicology, two officers in the Union representing professionals at EPA headquarters, the President of the International Society of Doctors for the Environment, and hundreds of medical, dental, academic, scientific and environmental professionals, worldwide.
Signer Dr. Arvid Carlsson, winner of the 2000 Nobel Prize for Medicine, says, “Fluoridation is against all principles of modern pharmacology. It's really obsolete.”
An Online Action Petition to Congress in support of the Professionals' Statement is available on FAN's web site, www.fluorideaction.org.
“The NRC report dramatically changed scientific understanding of fluoride's health risks," says Paul Connett, PhD, Executive Director, Fluoride Action Network. "Government officials who continue to promote fluoridation must testify under oath as to why they are ignoring the powerful evidence of harm in the NRC report,” he added.
An Assistant NY State Attorney General calls the report “the most up-to-date expert authority on the health effects of fluoride exposure.”
The Professionals’ Statement also references:
-- The new American Dental Association policy recommending infant formula NOT be prepared with fluoridated water.
-- The CDC’s concession that the predominant benefit of fluoride is topical not systemic.
-- CDC data showing that dental fluorosis, caused by fluoride over-exposure, now impacts one third of American children.
-- Major research indicating little difference in decay rates between fluoridated and non-fluoridated communities.
-- A Harvard study indicating a possible link between fluoridation and bone cancer.
-- The silicofluoride chemicals used for fluoridation are contaminated industrial waste and have never been FDA- approved for human ingestion.
The Environmental Working Group (EWG), a DC watchdog, revealed that a Harvard professor concealed the fluoridation/bone cancer connection for three years. EWG President Ken Cook states, “It is time for the US to recognize that fluoridation has serious risks that far outweigh any minor benefits, and unlike many other environmental issues, it's as easy to end as turning off a valve at the water plant.”
Further, researchers reporting in the Oct 6 2007 British Medical Journal indicate that fluoridation, touted as a safe cavity preventive, never was proven safe or effective and may be unethical. (1)
Partially, as a result of the professionals' statement, at least one city, Cobleskill NY, stopped 54 years of water fluoridation. See: http://www.fluoridealert.org/news/2998.html
Many communities rejected or stopped fluoridation over the years. See: http://www.fluoridealert.org/communities.htm
On October 2, Juneau Alaska voters rejected fluoridation despite the American Dental Association's $150,000 political campaign to return fluoride into the water supply after the legislative body voted it out.
SOURCE: Fluoride Action Network http://www.FluorideAction.Net
References:
(1) “Adding fluoride to water supplies,” British Medical Journal, KK Cheng, Iain Chalmers, Trevor A. Sheldon, October 6, 2007
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