People living in areas with high income inequality have worse health outcomes than people living in areas where income is more evenly distributed, a New York Times Upshot column reports, based on a new study from the University of Wisconsin Population Health Institute.
But researchers investigating the social determinants of health have long noted that income inequality is just one of many socioeconomic status (SES) variables that contributes to disparities in health outcomes. Differences in education, outright poverty and—often overlooked—differences in social status also play a major role in determining who gets to live longer, healthier lives in any society.
Dr. Michael Marmot, the British dean of SES research, made that point during a visit to Modern Healthcare's offices in 2013. In an interview with reporter Andis Robeznieks, the author of the famous British civil servants study (known as the Whitehall study) noted that differences in health outcomes could be found at every level of the income scale.
“All the way, from top to bottom, the lower you were, the higher the mortality, the higher the morbidity and the shorter the length of life,” he said. “This means that if we want to reduce inequalities in health, we have to act not only on the poor health of the poor, but on the whole of society to reduce inequalities in health.”
Since publication of his original research in 1991, U.S. researchers have echoed that finding by noting it would take far more than income redistribution to reduce the differences in health outcomes between social groups, races or social classes. “Not only do those in poverty have poorer health than those in more favored circumstances, but those at the highest level enjoy better health than do those just below,” wrote (PDF) a University of California, San Francisco-led group in 1994.
Another group, also out of UCSF, wrote in the Journal of the American Medical Association (PDF) in 2005 that a wide range of variables could be shown to contribute to negative health outcomes: disparities in education, housing, race or ethnicity, childhood experiences and, of course, income.
The Times Upshot column concludes with the observation that the Affordable Care Act serves as a major form of income distribution, since most of its benefits flow to those largely in the lower portion of the income distribution. That should help reduce barriers to healthcare access, which disproportionately affect racial and ethnic minorities in the U.S.
But will better access to healthcare services reduce disparities in population health outcomes? Hopefully, it will. But if Dr. Marmot's Whitehall study and subsequent research is correct, it will take a broader assault on all the factors that contribute to unequal socioeconomic status to achieve more equal health outcomes.
