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Abstract
The demographic, economic, and public policy implications of a rapidly aging population, such as the United States today, are pressing and widespread. Through a combination of medical advancements, behavioral changes, and social influences, life expectancy has increased significantly since the start of the twentieth century. Whether these additional years of life are spent in good health is an important question that affects the solvency of public health care programs and quality of life. As populations age and become more diverse, sex and racial disparities in healthy life also become increasingly important. As the baby boom generation ages to retirement, the solvency of the Social Security program has become an increasingly contentious political, social, and economic issue. In parallel with declines in smoking prevalence has come increases in obesity that may halt the steady gains in life expectancy. Considering these possibilities of future mortality are vitally important to assessing the solvency of public pension programs.
Specifically, in Chapter 2, a statistical foundation of Sullivan’s method, the most widely used method to estimate healthy life, is established, several important properties are proven, and new methodology is developed to estimate healthy life expectancy in birth cohorts. In Chapter 3, I use the newly developed methodology discussed in Chapter 2 to assess racial and sex disparities in healthy life by birth cohort. Finally, in Chapter 4, I assess the possible impact of both smoking and obesity on the fiscal viability of Social Security through changes in mortality.
This work yields several important results that contribute to our collective understanding of the demography of aging. First, a statistical foundation of Sullivan’s method is established and expanded to examine healthy life in birth cohorts. Second, among the oldest old, few racial or sex disparities exist over age and time in mild disability. Yet, racial and sex disparities in this age group persist over age and time in severe disability. The results imply persistent race and sex inequality over age and time. Third, historical declines in smoking are associated with rapid declines in future mortality over age and time. Yet, increases in historical obesity are associated with much slower declines and sometimes stagnation in future mortality. These differences in mortality translate into substantial differences in Social Security finances. By 2030, I find that the trust fund balance may be approximately 0.5 trillion nominal dollars greater for Social Security projections using mortality informed by both smoking and obesity compared to projections using mortality informed by smoking alone.
