Income Inequality: When Wealth Determines Health: Earnings Influential as Lifelong Social Determinant of Health

By Krisberg, Kim | The Nation's Health, October 2016 | Go to article overview

Income Inequality: When Wealth Determines Health: Earnings Influential as Lifelong Social Determinant of Health


Krisberg, Kim, The Nation's Health


WHEN IT COMES TO HEALTH, there are many factors that influence how long and how well people will live, from the quality of their education to the cleanliness of their environment. But of all social determinants of health, research shows there is one that is perhaps the most influential: income.

Public health workers have long been witness to the inextricable links between poor health and poverty. Science consistently shows that low incomes are a significant risk factor in disease incidence and severity as well as life expectancy.

For example, in a study published in April in the Journal of the American Medical Association that examined more than 1 billion U.S. tax records from 1999 through 2014, researchers found that higher income was linked with longer life, with differences in life expectancy across income groups increasing over time.

In particular, the study found that the gap in life expectancy between the richest 1 percent and poorest 1 percent was more than 14 years for men and more than a decade for women. Inequality in life expectancy increased as well, with men and women in the top 5 percent of income distribution gaining about three years of life expectancy, while those in the bottom 5 percent gained virtually no additional years of life.

However, the effect of income on health is much more nuanced than the divide between the richest and poorest Americans.

"Research also shows that at all levels of income, our health is affected by economic conditions, so even middle-class and upper-middle-class people are in worse health than richer people," said APHA member Steven Woolf, MD, MPH, director of the Virginia Commonwealth University Center on Society and Health. "We're all in this together--it's not a problem restricted to the very poor."

While higher incomes and wealth are linked to better health within the U.S., their protective nature does not perform as well in a global context. Woolf coauthored a 2013 report from the National Academies of Sciences, Engineering and Medicine that compared Americans' health to counterparts in 16 other high-income nations, finding that Americans typically die sooner and incur higher rates of disease and injury than many of their peers. In fact, the report found that even rich Americans are less healthy than their global counterparts.

Woolf noted that the reasons for such global difference are not entirely clear. But he said one contributor may be the growing gap between the high- and low-income people in the U.S. --otherwise known as income inequality. For instance, the "2015 County Health Rankings" report, which included income inequality measures for the first time, found that the unhealthiest counties also had greater income inequality.

"Unfortunately, I think the public health community is often marginalized in these discussions (about income) because we're not often at the table where these discussions are happening," Woolf told The Nation's Health. "We have to get better at understanding the audience we're talking to and raising awareness of health issues in a frame that makes sense to other sectors."

One of the more obvious ways to address income inequality is by raising the minimum wage, an issue currently at the forefront of national debate and finding success in states and localities across the country. In 2015 alone, 14 cities, counties and states passed a $15 minimum wage. The federal minimum wage still sits at $7.25. And as policy efforts on the minimum wage move forward, so too has the public health science. For instance, in a study published in June in APHA's American Journal of Public Health, researchers found that if New York City's minimum wage had been $15 between 2008 and 2012, 2,800 to 5,500 premature deaths could have been averted, with the majority of such prevented deaths realized in low-income communities.

U.S. income inequality has been increasing for decades, and there are large wage gaps by gender, race and ethnicity, according to the Pew Research Center. …

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