Academic journal article Canadian Journal of Public Health

Income Inequality and Health: Coastal Communities in British Columbia, Canada

Academic journal article Canadian Journal of Public Health

Income Inequality and Health: Coastal Communities in British Columbia, Canada

Article excerpt

Coastal Communities in British Columbia, Canada

ABSTRACT

Objective: An imbalance in the distribution of economic resources, i.e., income inequality, is a characteristic of a community that may influence the aggregate health of the population. In North America, income inequality seems to be strongly related to mortality rates among American communities such as states and metropolitan areas but largely irrelevant for health at similar levels of geopolitical aggregation in Canada. This article summarizes relevant international and North American evidence and then explores relationships between income inequality and mortality rates among coastal communities in the province of British Columbia, Canada.

Methods: Cross-sectional analysis was conducted among twenty-four coastal communities in British Columbia, utilizing four measures based on the 1996 Census to measure income inequality and crude, age-standardized and age- and gender-specific mortality rates averaged over the five-year period 1994-98 to measure health.

Results: The three valid measures of income inequality were positively and significantly related to the crude mortality rate but were not significantly related to the agestandardized mortality rate. Two of the inequality measures were related to mortality rates for males aged 0-44 and for males aged 45-64 before but not after controlling for mean household income.

Discussion: Health researchers have yet to report a meaningful relationship between income inequality and population health within Canada. At the risk of committing the ecological fallacy, these findings provisionally support a psycho-social interpretation of the individual-level relationship between income and health wherein members of these communities compare themselves to an encompassing community, e.g., all Canadians.

Within many, if not all, Western countries, income is related to various measures of health status, 1-6 a finding that certainly applies to the United States7,8 and Canada.9-14 The relationship between income and health appears to be curvilinear: the average difference in health status between those near the bottom of the income ladder and those a few steps up is more pronounced than among steps nearer the top.15-17 Such inequalities in income and health represent an individual-level approach to economic determinants of health. Alternatively, income inequality can be conceptualized as a characteristic of a community or society that is relevant for the aggregate health of the entire population. One simple measure of income inequality is the proportion of total household income dollars held by the poorest 50% of households. More complex measures tend to focus on the Lorenz curve, i.e., they order the population by wealth, calculate the proportion of total wealth held by each proportion of the (ranked) populace and then assess the area under the curve.

Income inequality as a characteristic of a community is thought to affect the aggregate health of the entire populace via health-relevant attributes of communities potentially caused by and/or dialectically interrelated with inequality. Hypothesized attributes include an ungenerous welfare state, characterized by minimal investment in education, health and social services, affordable housing, roads or environmental protection;20 high rates of crime;19 intense social class or ethnic competition and discrimination;" strong adherence to neoliberal doctrines;21 changing household compositions22 and low levels of social cohesion or social capital.18,23-26 Explanations that focus on such ecological correlates locate the relationship between income inequality and health primarily in the realm of social, economic and political relations. Conversely, inequality-health relationships among communities may be generated by an individual-level relationship between income and health. Given the purported curvilinear nature of the relationship between income and health, we would expect to find a significant ecological relationship between income inequality and health. …

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