Pretax incomes for the poorest 50% of Americans have stayed mostly unchanged for the past 40 years, widening income gaps in the country. We leave the question of why inequality matters for the economy to others. What is of concern to us is whether income inequality matters to our health, and, to the extent that it does, how the health profession should respond.
In 1992, Richard Wilkinson, then a professor at the University of Sussex, published a paper in The British Medical Journal called “Income distribution and life expectancy.” The paper concerned 12 European countries and concluded that “the relation between income distribution and life expectancy is sufficiently strong to produce significant associations.” The paper’s thesis launched two decades of intense scientific discussion about the influence of national income inequality on health (and death), including several systematic reviews and books. This work, which continues to the present day, shows that income inequality is a foundational driver of physical and mental health. By way of example, a 2018 systematic review considers the relationship between income inequality and depression, and it concludes that across studies there is “greater risk of depression in populations with higher income inequality relative to populations with lower inequality.”
Why might income inequality affect the health of the public?
Countries or regions where there are wide gaps in income tend to be characterized by weaker social ties and less investment in the social and physical resources that create health. Countries with more income inequality are less likely to have healthy air, water, and food, safe places to work and play, and affordable quality housing—all of which are necessary for health.
For these reasons, income inequality should be a core focus of public health. It is true that discussing subjects like taxation policies, the minimum wage, and universal income guarantees broadens the scope of what we are used to discussing in the context of health. However, broadening the conversation in this way has long been a first step toward creating a healthier world. After all, at one time, few imagined that cigarettes had anything to do with health, and even doctors promoted smoking. It took a widening of our collective imagination to see tackling smoking and the tobacco industry as central to promoting health. In the same way, by discussing income inequality, we start to see the truth of what the data are telling us: money—who has it and who does not—is at the heart of health in our society. Until we address this, we will continue to see health gaps between those at the top of the economic ladder and those at the bottom.
Featured image: Pixabay