Editorial

As microsimulations are mainly concerned with distributional outcomes, I take the opportunity of this issue to list a couple of books which make a very good case for why distributional outcomes – economic inequality in this case – matter. These are The Spirit Level: Why Equality is Better for Everyone, by epidemiologists Richard Wilkinson and Kate Pickett, and The price of inequality: How Today’s Divided Society Endangers Our Future, by Joseph Stiglitz. My choice is obviously arbitrary: inequality is a hot topic and there are many (good) books around, from the inevitable Capital in the XXI century by Thomas Piketty, to the recent Inequality by Tony Atkinson, including Stiglitz’s own sequel The Great Divide, where he expands the diagnosis offered in The price of inequality and suggests policy responses.¹ The two books I have selected are not new, but they somehow marked the debate (even if to a lesser extent than Piketty’s book). While both books have chapters on possible remedies, they focus more on the causes and the effects than on the possible solutions. The Spirit Level offers a comprehensive analysis of the negative impact of inequality on each of eleven different health and social problems: physical health, mental health, drug abuse, education, imprisonment, obesity, social mobility, trust and community life, violence, teenage pregnancies, and child well-being. The book sparkled a lively debate in the UK when it was first published in 2009, as critics argued that it offered little more than simple correlations. However, those simple correlations are disturbing enough at the very least, and are often backed by a significant amount of scientific research, duly cited by the authors. Either way, the book contributed, at least in the UK, to make inequality a political hot topic. The second book, as one would expect from a Nobel laureate like Stiglitz, has the immense quality of embedding the argumentation in solid economic theory. This guarantees that the book remains truly enjoyable, despite the inevitable ageing of the data. It is a must read for everyone interested in understanding the mechanisms and forces that are behind the increase in inequality in the recent decades.

Neither of these books employs microsimulations. However, with its comprehensive approach to modelling individual life trajectories, microsimulation modelling seems very well positioned to play a bigger role in the debate about the causes and consequences of economic inequality. The International Journal of Microsimulation will sustain this challenge.

More immediately related to microsimulation modelling, Associate Editor Deborah Schofield suggests the paper by Kypridemos et al. (2016). This paper is interesting from numerous perspectives, not least of which, it was written by a PhD candidate, it is an application of microsimulation that highlights the value of disaggregated data, and it is published in one of the world’s leading medical journals – the British Journal of Medicine. The paper reports on IMPACTNCD, a discrete time dynamic stochastic microsimulation model which simulates the life course of synthetic individuals under different counterfactual scenarios, up to 2030. During the simulation, CVD incidence and CVD and non-CVD mortality are recorded and then estimated the potential impact of universal screening for primary prevention of CVD on disease burden and socioeconomic health inequalities in England. The authors compared universal CVD screening with an alternative approach targeting only deprived areas, a feasible population-wide intervention, and a combination of both. The authors concluded that the most equitable strategy would be the combination of the population-wide intervention and concentrated screening, followed by concentrated screening alone and the population-wide intervention. Universal screening had the least apparent impact on socioeconomic inequalities in health.