People: Spotlight

Julia Lynch
Research Associate

PARC Associate Julia Lynch, Professor of Political Science and co-Director of the Penn Lauder Institute, dives deep into her career path, research, and the complexities of population health, health inequalities, and COVID-19.

Tell us about your career path and what motivates you to do what you do?

As a youngest child, I’ve always been interested in questions about who gets access to good things in life -- which also happen to be at the heart of political science as a discipline: “Who gets what, when, and how?”, in the famous words of political scientist Harold Lasswell. I was a political science undergrad major, a political science MA and PhD student, and immediately after my PhD took a job at Penn in the political science department.  And yet somehow I’ve ended up doing a ton of interdisciplinary work, and now really think of myself as a public health person with interests in demography as much as a political scientist. There were a few key moments that pushed me down this interdisciplinary path in the study of inequality: Right before I started my PhD program I worked with Gøsta Esping-Andersen at the European University Institute in Florence when I was there on a fellowship, and he exposed me to the interdisciplinary world of social policy research. Then a couple of years after I finished my PhD, I took two years off from teaching at Penn to do a Robert Wood Johnson Health Policy postdoc, hanging out with economists and sociologists who were also interested in health policy. When I came back to Penn, I hooked up with the RWJF Health and Society Scholars Program, through my mentees in that program ended up getting drawn more and more into public health. Finally, I had a Mellon New Directions fellowship right after I was promoted to Associate Professor that allowed me to do additional training in public health, bioethics, and demography, and that’s how I ended up as this very strange creature who studies the politics of health inequalities from within a political science department.

What questions are at the core of your research?

I’m interested in what social epidemiologists might call the “political determinants” of population health and health inequalities.  I look at how the choices that politicians make about how to address a variety of problems -- economic growth, trade, child care, environmental regulation, medical care – differentially affect health for different members of the community. We know that health care and individual choices about behavior can have an immediate impact on a person’s health, but the things that have the biggest influences on health at a population level are often far “upstream,” and determined by decisions that have their roots in the world of political and ideological competition.

Can you tell us more about the conflict of aging demographics and the ever-present/impending health crises in your book Ageing and Health: The Politics of Better Policies?

This book was a response to a request from the European Observatory on Health Systems and Policies to provide an evidence-based guide to policy makers for how to deal with the joint challenges of population aging and rising health care costs. The idea was that since older people are generally the largest consumers of health care in rich countries, aging populations would likely exacerbate the problem of rising healthcare costs. The economists who worked on the project found, however, that there wasn’t a lot of evidence that population ageing would necessarily lead to increased health spending on purely economic grounds.  And where I came in, as a political scientist and co-leader of the project, was to point out that the politics of ageing societies don’t necessarily point in that direction, either. 

 

What are some myths about the effects of ageing on economics and health systems? How are these myths debunked in your new book?

We talk about two myths: The myth of the “poor elderly” and the myth of the “greedy geezer.”  In the first view, the elderly are seen as vulnerable and under-protected, and so giving them adequate social protections and health services is seen as needed, but also likely to lead to “breaking the bank” in aging societies.  The second myth, which paradoxically people often believe at the same time, is that the elderly have an outsized voice in politics and policy because of their large numbers and habitual voting, and therefore have demanded and received too large a slice of the economic pie to be really sustainable as populations age.  We show that both of these common narratives are untrue.  In countries where the elderly are already well protected, it is generally not because of their electoral power; and in countries where they are not, spending more to upgrade their well-being would not break the bank.  We show that an important cause of insecurity among both elderly and young populations is inequalities WITHIN age groups – and we argue that policies that promote health equity across all age groups are also likely to be money-saving as populations age.

What role does COVID-19 play in this political and global conversations surrounding health care and ageing populations?

COVID-19 has really shone a spotlight on the complex intersections between age, socioeconomic status, and vulnerability. Older people are on average more susceptible than the young are to really bad outcomes if they become infected with the virus. But age alone doesn’t tell anything like the whole story. For example, if you look across the rich democracies, most of the deaths in the very early phase of the pandemic were among the frail elderly in nursing homes. But it wasn’t just any nursing homes where people were dying in large numbers – it was in nursing homes where workers were themselves poorly paid, and hence worked multiple shifts across many different care settings; and where these care workers were poorly protected from disease in their own communities. So it was the joint vulnerability of older nursing home residents and the workers who cared for them that led to the loss of life.  

So we know you’ve written a book about policy responses to the pandemic in the United States, but I’m curious if you could touch on your research that looks into public health, policy and inequality in Europe. What are some differences between European governments’ responses to the pandemic versus the US?

Where to begin?!? While there has been some policy innovation in response to the pandemic, the fact is that most governments in both North America and Europe have leaned heavily on the policy tools that they are used to using, and have built their pandemic responses on top of already-existing social policies.  What this means is that countries with robust welfare states and a history of forceful intervention in the economy and society to protect the vulnerable have generally confronted the pandemic with more vigor; whereas countries accustomed to a more laissez-faire approach have done less.  There are exceptions, of course. For example, policy makers in Sweden have acted less forcefully to contain the virus than their counterparts in Norway or Denmark have, despite fairly similar social welfare approaches generally; and Portugal has done remarkably well despite having more limited state capacity than some of its bigger neighbors. But overall, if a country had a history of working to create a relatively equitable society through a variety of mechanisms before the pandemic, it has done better at protecting its people during the pandemic.   

Demography is never destiny. Politicians have choices about how to deal with the challenges posed by demographic developments, be they slow-moving like population aging or fast-moving like a pandemic. And as citizens, we can hold our politicians and governments to account, even though it may sometimes seem difficult.

What are the policy implications of your research? And, what solutions would you point to help address the major problems at the core of your work?

Different projects I’ve worked on have obviously had different policy implications and lessons.  But I guess you could say that one overarching theme is that demography is never destiny.  Politicians have choices about how to deal with the challenges posed by demographic developments, be they slow-moving like population aging or fast-moving like a pandemic.  And as citizens, we can hold our politicians and governments to account, even though it may sometimes seem difficult.

Tell us about an accomplishment or milestone that is important to you.

I’ve now been in this business for long enough to see my former students – both PhDs and undergraduates – end up in really interesting places.  I recently learned that two of my former undergrads had both landed at the Innovation Center at the Centers for Medicare and Medicaid Services in the US government, and were working together on the same team.  That was a moment when I thought wow, I’m really having an impact!

What obstacles have you run into and overcome in terms of the perception and/or implementation of your research?

A lot of my research doesn’t take the form of testing interventions that can immediately be put to use.  Instead, it provides background information and context that is nevertheless really important for making good policy.  It can be hard to communicate to busy policy makers and journalists why they should nevertheless pay attention. That’s one of the reasons why I’m so pleased when my students land in policy positions – I know they’ve absorbed the context, and are ready to make good policy decisions.

Tell us something about yourself most people would not know.

I worked throughout grad school as a semi-professional French horn player.