Smeeding TM. Fritzell J, Lundberg O. There is a very large literature examining income inequality in relation to health. Before dealing directly with some of these, and other, criticisms of the analysis in the book, this chapter outlines the findings from other sources on the links, both between individual income and health and social Metropolitan area income inequality and self rated health—a multilevel study. We have previously reported some of the key results discussed in this section. Accordingly, not only the standard errors are adjusted to reflect the “true” sample size based on the extent of clustering but also state-attributable variation is explicitly modeled and estimated. Osler M, Prescott E, Gornbaek M, et al. Wage poverty, earned income inequality, and health. Historical income tables for states: table S4. Santa Monica, CA: Unicon Research Corporation, 1998. In this review, however, we focus on the question: Does the unequal distribution of income in a society pose an additional hazard to the health of the individuals living in that society? The degree to which the Lorenz curve departs from the 45-degree line of equality is a measure of income inequality. This report, part of a Series on health and inequality in the USA, focuses on how the health-care system, which could reduce income-based disparities in health, instead often exacerbates them. In attempts to overcome this methodological limitation of ecologic studies, researchers have published nearly two dozen multilevel studies of income inequality and health since 1997. With respect to exposures, at the individual level, we included age (18–24 (reference), 25–44, 45–64, ≥65 years); sex (male (reference), female); race (White (reference), Black, others); marital status (married/partnered (reference), divorced/separated, widowed, single); education (≥16 (reference), 12–15, 8–11, 1–7 years); covered by health insurance (yes (reference), no); and equivalized household income ($75,000 or more (reference), $50,000–74,999, $30,000–49,999, $15,000–29,999, less than $15,000). Evidence that income inequality is associated with worse health is reviewed. Income inequality measure. We define “multilevel studies” as those that utilize multilevel data in the form of an individual-level health outcome, a set of individual-level socioeconomic predictors (e.g., individual income), and an area-level income inequality measure (e.g., state income inequality). where yij is the health status of individual i in society j; xij is the income of individual i in society j (with β* estimating the nonlinear (or concave) nature of the relation between yij and xij within a society); and Wj is the level of income inequality in society j (with α estimating the effect of societal income inequality on individual health) having taken account of the individual income-health relation. Again, a systematic multilevel investigation of how the state-level social capital may mediate the relation between state income inequality and health is currently lacking. Applying this three-level multilevel structure (individual nested within states nested within census divisions) to the Current Population Survey data (table 6), we found that the odds ratio of poor health associated with each 5 percent difference in state income inequality was attenuated from 1.30 (in the two-level model) to 1.18 (in the three-level model) but remained statistically significant. Does money really matter? Kawachi I, Kennedy BP. London, United Kingdom: Multilevel Models Project, Institute of Education, University of London, 2000. The association between state income inequality and worse health is not confounded by race. Fifth, with regard to the published multilevel studies in the United States, the state-level income inequality has been linked to a broad variety of health outcomes, ranging from mortality (22) and self-rated health (19, 21, 24, 25) to depressive symptoms (21), hypertension, smoking, body mass index, and sedentary behavior (18) (table 1). Reducing income inequality will improve population health and … Fixed estimates and standard errors, along with the change in odds ratios and their 95% confidence intervals, for reporting fair/poor health (outcome) for a 5% change in 1990 US state Gini coefficient* according to three modeling strategies†. Kawachi I. One aspect of multilevel models that tends to be ignored is the random coefficients associated with areas (e.g., states), such as the variation in health that is attributable to states. (In figure 1, it takes the bottom half of the households to account for just 10 percent of the aggregate income.) Subramanian SV, Kawachi I. London, United Kingdom: Hodder Arnold, 2003. Income inequality may reflect social cohesion or social capital, and health at the individual level may not respond simply to absolute income but also to relativities in society, such as relative deprivation, relative income, and relative social status. Early reviews came to different interpretations of the evidence, though a large majority of studies reported that health tended to be worse in more unequal societies. When income is specified as deciles and as quintiles, the estimated odds ratio is 1.29 (models 5 and 6). This is the hypothesis that the distribution of income in society, over and above individual incomes as well as societal average income, matters for population health such that individuals (regardless of their individual incomes) tend to have worse health in societies that are more unequal. Social epidemiology. ¶ In this modeling strategy, the potential clustering of individuals within states is considered a nuisance, and accordingly the standard errors are adjusted to reflect the “true” sample size based on the extent of clustering. The absence of an association between income distribution and health in the countries listed on table 2 may therefore reflect a threshold effect of inequality on poor health. 2. Neighborhood differences in social capital: compositional artifact or a contextual construct? That said, with notable exceptions (64, 65), few researchers have attempted to test either of these hypotheses explicitly. It is widely acknowledged that individual income is a powerful determinant of individual health. Daly MC, Duncan GJ, Kaplan GA, et al. MULTILEVEL STUDIES OF INCOME INEQUALITY AND HEALTH: WHAT DOES THE EVIDENCE TELL US? The aim in this review was, nevertheless, to focus on the literature that has investigated the empirical relation between income inequality and health. For example, Kennedy et al. Random parameter estimates of the between-state variation, % state-attributable variation, and % change in between-state variation with sequential introduction of predictors in the fixed part of a multilevel logistic model with self-rated fair/poor health as an outcome*. From the Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA. Besides other general limitations (44), the key issue lies in the treatment of the clustering and heterogeneity in the outcome. These issues, nonetheless, raise important questions for interpreting context-attributable variation, in general. At the state level, we considered the median household income in a state and the state Gini coefficient (a measure of income inequality (51)), with 0 implying no inequality and 1 representing complete inequality. Neighborhood social environment and changes in leukocyte telomere length: The Multi-Ethnic Study of Atherosclerosis (MESA). By contrast, the “income inequality hypothesis” demands testing the two effects simultaneously in order to ascertain the independent (as well as the relative) importance of each of the two, and one way of expressing this would be, yij = β*(xij) + α(Wj) + uj + eij, (3). Doing so resulted in a much attenuated association between state-level income inequality and health. For example, social cohesion within a state may influence the pattern of state effort on social spending. ADVERTISEMENTS: Income and Wealth Inequality in Economics! The data set we used was pooled from the Current Population Survey for the years 1995 and 1997 that was conducted by the US Bureau of Labor Statistics (49), which has a multilevel data structure of 201,221 adult individuals nested within the 50 US states. Indeed, some argue, on theoretical grounds, that any observed effect of absolute income on health already incorporates the effects of hierarchy (income rank) as well as relative income (63). In: Kawachi I, Berkman LF, eds. The standard errors associated with the state income inequality point estimates from the marginal and two-level logistic models, meanwhile, are identical (standard error, 1.08). Researchers need to recognize the limitations related to drawing inferences based on cross-sectional observational data. Some evidence suggests that affluent individuals experience health benefits when they live in an area with high inequality (21, 23). Blakely TA, Kawachi I. Marginal models treat the variance structures (e.g., the variance that is explicitly attributable to states) as a nuisance while estimating the fixed effect for an exposure. The intrinsically multilevel nature of the income inequality hypothesis is illustrated by contrasting the individual-level and aggregate-level models. Sturm and Gresenz (30) do not report the β coefficient or the standard error associated with the metropolitan or “economic area” income inequality predictor and report only the p value. The use of the term “artifact” is misleading here, because it suggests that the potential for improving the health of the poor through income redistribution is a statistical illusion. Income inequality in the U.S. has grown over the past several decades. In addition to the concavity effect just described, researchers have posited an additional contextual effect of income inequality on health (6). Sturm R, Gresenz CR. Both measures were derived from the 1989–1990 US Census (52, 53). Meaning: Income may be unevenly distributed between households due to uneven holdings of wealth, differences in the composition of households and differences in ability to earn. Income distribution, socioeconomic status, and self-rated health in US. Subramanian SV, Belli P, Kawachi I. Widening economic inequality in the USA has been accompanied by increasing disparities in health outcomes. While multilevel models offer great potential in providing such details, researchers need to be cognizant of the challenges in estimating such summary statistics, especially in multilevel logistic models (73, 74), and there is little understanding on what proportion of the total state-attributable variation is “explainable” and what is simply “random.” Moreover, as the results suggest, it is entirely possible to estimate a statistically significant fixed effect for state income inequality (with an OR of about 1.20) even though the residual state-attributable variation is rather small. More recent studies, not included in those reviews, provide substantial new evidence. Using categories of income (model 7) yields an odds ratio of 1.30. for parishes not reported), Japanese Survey of Living Conditions of the People on Health and Welfare (1995), 80,899 adults from Japanese prefectures (no. for counties not reported), Panel Study of Income Dynamics (1980, 1990 cohorts), About 6,500 adults from US states (no. for metropolitan areas not reported), Self-reports of 17 common conditions (e.g., arthritis, depression), 309,135 adults aged 25–74 years from US states, 90,000 adults aged ≥45 years nested within 50 US states nested within nine census divisions, 201,221 adults nested within 50 US states, Swedish Survey of Living Conditions (1997), ≥40,000 adults from municipalities in Sweden (no. It is by now widely accepted that income poverty is a risk factor for premature mortality and increased morbidity (4). Gini ratios by state: 1969, 1979, 1989. Evidence that income inequality is associated with worse health is reviewed. Kawachi I, Kennedy BP, Wilkinson RG. Income inequality and individual health: evidence from the Current Population Survey. for counties and tracts not reported), 279,066 adults nested within 50 US states, Behavioral Risk Factor Surveillance System (1990), Hypertension, smoking, sedentarism, body mass index, National Maternal and Infant Health Survey (1991), National Health Interview Survey–National Death Index-linked study (1987–1995), 309,135 adults aged 25–74 years from US states and metropolitan areas (no. Reducing income inequality will improve population health and wellbeing. § Models additionally controlled for individual age, sex, marital status, race, years of education, equivalized household income categories, covered by health insurance, and state median income. Income includes the revenue streams from wages, salaries, interest on a savings account, dividends from shares of stock, rent, and profits from selling something for more than you paid for it. Muller A. In table 4, we show the extent to which the odds ratio of poor health in the Current Population Survey data is affected by introducing successive control variables at both the state and individual levels. A British study examining depression among people in their 20s found that it was twice as common in 1970 than it was in 1958. (27) was based on a comparatively small sample of about 6,500, with 341 deaths in the first period and 375 deaths in the second period. While additionally including state proportion Black attenuates the effect of state income inequality (from an OR of 1.30 to 1.22), the effect estimate of the state proportion Black was itself not significant (table 5). As it turns out, the Gini coefficient is the ratio of the area between the Lorenz curve and the 45-degree line of equality. Deaton A, Lubotsky D. Mortality, inequality and race in American cities and states. Diez-Roux AV, Link BG, Northridge ME. Gerdtham UG, Johannesson M. Income inequality and mortality. Some of these assets, such as shares and government bonds, give […] Wealth is a stock of assets which have a financial value. In the past 30 years, the proportion of wealth held by those in the top 10% of household income has risen from 60.8% to 70.0%. Wilkinson RG. The macroeconomic determinants of health. Blakely T, O’Dea D, Atkinson J. Effective communication can increase the awareness, understanding, and action on the The more consistent association between state-level income inequality and health in the United States provides some clue about the pathways and mechanisms by which income distribution affects population health, an aspect that we shall return to later in this review. Various long term studies have established that this relationship is largely causal - higher income leads to better health. In reality, the Lorenz curve falls below the 45-degree line of equality, because the bottom groups in the income distribution earn considerably less than their equal shares. Second, there is growing scholarly and public recognition that many nonclinical factors—education, employment, race, ethnicity, and geography—influence health outcomes. Kawachi I. In: Heymann J, ed. It meets established epidemiological and other scientific criteria for causality. Subramanian SV, Kawachi I. ‡ SE, standard error; OR, odds ratio; CI, confidence interval. Kennedy BP, Kawachi I, Glass R, et al. Gravelle H. How much of the relationship between population mortality and unequal distribution of income is a statistical artefact? The inequality paradox: growth of income disparity. For example, the only null study of state-level income inequality and mortality by Daly et al. By analysing panel data using county/city-level dummies and year fixed-effects, we found that income inequality does not have a significant impact on individuals' risks of having health problems. People live longer in nations with lower levels of inequality, as measured here by the Gini coefficient, a standard global benchmark. Fiscella K, Franks P. Poverty or income inequality as predictors of mortality: longitudinal cohort study. Indeed, there is nothing artifactual about improving the health of the poor and, hence, average population health through income and wealth redistribution. Subramanian SV, Degaldo I, Jadue L, et al. New York, NY: Oxford University Press, 2003:65–111. Fourth, the US studies in table 1 show that the null studies were often based on smaller sample sizes and may have lacked statistical power to detect the effects of income inequality on health. The authors thank Harvey Goldstein and Jim Ware for our exchanges with them with regard to comparisons of modeling strategies and Mah-J. Using the Current Population Survey data, which include very detailed information on individual income, we tested the extent to which the relation between state-level income inequality and poor health in the United States is sensitive to alternative specifications of individual income (table 3) (58). As noted earlier, most studies do not estimate and model the state-attributable variation (or area-attributable variation) in an explicit multilevel manner. Most multilevel studies on income inequality and health have not paid detailed attention to potential cross-level interactions, whereby state income inequality may affect the health of different population groups in different ways. Subramanian SV, Jones K, Duncan C. Multilevel methods for public health research. Third, the geographic scale at which income inequality is assessed seems to matter. Economic inequality grew in 90’s boom, Fed reports. Models were calibrated using the maximum likelihood procedure as implemented within MLwiN software version 1.10.006 (56) that utilizes the iterative generalized least-squares algorithm (11). However, these studies have been criticized because of their inability to disentangle the effects of individual income (and income poverty) from the contextual effects of income inequality (6). Considering income in terms of transformed log yields an odds ratio of 1.30 (model 3), while a nonlinear specification in the form of a second-order polynomial yields an odds ratio of 1.31 (model 4). Authors ignored data in their study. For example, the average annual salary in America in inflation-adjusted 1998 dollars increased from $32,522 in 1970 to $35,864 in 1999, that is, a modest 10 percent increase over three decades. Three specific pathways have been conceptualized. Income inequality and health: multilevel analysis of Chilean communities. That is, for whom is inequality most harmful, and why? † All models controlled for 1995/1997 individual age, sex, marital status, race, years of education, equivalized household income categories, covered by health insurance, and 1990 state median income. * All variance estimates were significant at less than the 0.0001 level. Distinguishing between these types of effects promises to yield rich insights into the mechanisms by which income matters for individual health. What about the negative effects of income inequality on psychological health, you might ask. Unfortunately, many of the ongoing debates and controversies cannot be resolved by careful reviews of the published studies alone. We use cookies to help provide and enhance our service and tailor content and ads. State median income accounts for some 27 percent of the variation, and of the remaining variation (1 percent), state income inequality accounts for 35 percent of the variation. Published multilevel studies on the relation between income inequality and health outside the United States, Odds ratios and 95% confidence intervals for reporting fair/poor health (outcome) for a 5% change in US state Gini coefficient* under alternate specifications of the individual-level relation between income and self-rated fair/poor health†. Kawachi I, Berkman LF. Change in the odds ratios and 95% confidence intervals for reporting fair/poor health (outcome) for a 5% change in US state Gini coefficient* and for a 5% change in proportion Black under alternative specifications of racial composition†. Social capital: a guide to its measurement. We evaluated the odds ratios of fair/poor health among respondents in the Current Population Survey in 1995/1997, according to the level of state income inequality measured in 1990, 1980, and 1970, that is, with 5-, 15-, and 25-year lag periods (table 7). Health inequities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age. In turn, health can be affected by income inequality through a Correspondence to Dr. S. V. Subramanian, Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA 02115-6096 (e-mail: Search for other works by this author on: Policing practices and HIV Risk Among People Who Inject Drugs – a Systematic Literature Review, The Evolving Overdose Epidemic: Synthetic Opioids And Rising Stimulant-Related Harms, Assessment of Co-Occurring Substance Use During Opiate Treatment Programs in the United States, Prevalence and Correlates of Providing and Receiving Assistance With the Transition to Injection Drug Use, Drug Use Disorders and Violence: Associations With Individual Drug Categories, About the Johns Hopkins Bloomberg School of Public Health, INCOME INEQUALITY AND HEALTH: THEORETICAL CONSIDERATIONS, THE MULTILEVEL NATURE OF THE INCOME INEQUALITY HYPOTHESIS. Massey D. The age of extremes: concentrated affluence and poverty in the twenty-first century. Although almost all of the studies have measured state income inequality closest to the time when the outcome was also measured (typically around 1990), it is doubtful that income inequality has an instantaneous effect on population health (17). Vol 1. Raudenbush S, Bryk A. Hierarchical linear models: applications and data analysis methods. However, it has been argued that the “proportion Black” in a state confounds the income inequality-health relation (47, 62). Income and inequality as determinants of mortality: an international cross-section analysis. ‡ Individual markers include age, sex, marital status, race, years of education, equivalized household income categories, and covered by health insurance. And as the gap between rich and poor yawns, so does the gap in their health, according to … Laird N, Ware JH. Unlike wealth statistics, income figures do not include the value of … If recent national and global economic trends provide any indication, it is very likely that the subject matter of income inequality and its effects on population health will continue to be relevant for social epidemiology. Although the published evidence so far is by no means conclusive about the relation between income distribution and population health, our aim is to draw attention to some emerging patterns in the accumulated findings and to suggest future directions for research in this topic. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Income inequality and health: A causal review. (19) studied 205,245 subjects, Lochner et al. Health inequities are unfair and could be reduced by the right mix of government policies. Goldstein H. Multilevel statistical models. New York, NY: The New Press, 2003. However, since the objective here was to maintain uniformity across the different tests, the models were recalibrated for this review. As mentioned earlier, multilevel statistical techniques provide a technically robust framework to analyze the clustered nature of the outcome variable and are pertinent when predictor variables are measured simultaneously at different levels (11). Subramanian SV, Lochner KA, Kawachi I. * Gini coefficient, an income inequality indicator. Heagerty PJ, Zeger SL. State-level income inequality and individual mortality risk: a prospective multilevel study. Larsen K, Petersen JH, Budtz-Jorgensen E, et al. Change in the odds ratios and 95% confidence intervals for reporting fair/poor health (outcome) in 1995/1997 for a 5% change in US state Gini coefficient* measured in 1970, 1980, and 1990. However, more tests would be required to see if a similar magnitude of effect is observed if we correlate 1970 state income inequality with 1985 health outcomes or 1990 state income inequality with 2005 health outcomes. Inequality, residential segregation by income, and mortality in U.S. cities. Jones K, Duncan C, Twigg L. Evaluating the absolute and relative income hypothesis in an exploratory analysis of deaths in the Health and Lifestyle Survey. Natural experiments, such as the recent rounds of tax cuts in the United States, may provide future opportunities to examine the impact of changes in income distribution on changes in population health outcomes. New York, NY: The New Press, 1999. Accordingly, there have been attempts to incorporate the “unit-specific” interpretation of the fixed β coefficients from a multilevel model (74). We have demonstrated elsewhere that racial composition—whether measured as individual clustering of races within states or measured as proportion Black—does not account for the state income inequality-health relation (25, 58). Indeed, as we show later, the majority of empirical work does not apply multilevel models to analyzing multilevel data. Despite the fact that almost all of the studies listed in tables 1 and 2 controlled for individual income, skepticism has been expressed about whether the apparent association between income inequality and health could be due to misspecification of individual income and residual confounding (57). Zeger SL, Liang K, Albert P. Models for longitudinal data: a generalised estimating equation approach. If income inequality matters to health because of differences in political behavior (i.e., level of state effort on social spending), then this may constitute an additional reason why studies outside the United States have failed to corroborate an association between income distribution and health. Breaking the possible negative relationship between income inequality and health status in these countries makes health promotion policy and positive income–health path to develop smoothly. It meets established epidemiological and other scientific criteria for causality. The theory, as well as empirical investigations of income distribution and health, can be usefully extended by a more systematic examination of the issue of what levels matter for population health and why. INCOME INEQUALITY AND HEALTH: CURRENT DEBATES, INCOME INEQUALITY AND HEALTH: AN AGENDA FOR FUTURE RESEARCH, Receive exclusive offers and updates from Oxford Academic, The Global Burden of Unintentional Injuries and an Agenda for Progress. Controlling for individual income further reduced the state income inequality effect (OR = 1.30), but additionally including availability of health insurance did not affect the association of state income inequality with poor self-rated health (OR = 1.30). The individual-level relation between income and health. In addition, more use could be made of quasi-experimental situations to evaluate causality in this area. for states not reported), Behavioral Risk Factor Surveillance System (1993, 1994), National Health Interview Survey (1989–1991), 9,637 White males from US counties and tracts (no. Stockholm, Sweden: Swedish Institute for Social Research, 1995. Rasbash J, Browne W, Goldstein H, et al. studied 90,000 (24) and 201,221 (25) subjects. Since the most common statistic that is used to measure income inequality is the Gini coefficient, we also outline a brief description of this measure. Using two rounds of India Human Development Survey data, a large-scale, nationally representative, panel data set collected in 2004–05 and 2011–12, we found a negative association between income inequality and individual health. However, as discussed by Wagstaff and Doorslaer , the relation between income inequality and health is also consistent with at least two other types of effects: 1) relative income, in which an individual’s health depends on not only her own level of income but also the distance between her income and the incomes of others in society; and 2) relative rank, in which an individual’s health depends on … Interestingly, almost all the non-US countries listed in table 2 are considerably more egalitarian in their distribution of incomes compared with the United States, and they have stronger safety-net provisions. Andrews EL. The Luxembourg Income Study provides a rigorous cross-national comparison of income distributions, using a summary measure called the decile ratio, which represents the ratio of the disposable income of the person at the 90th percentile of the distribution within each country to the income of the person at the 10th percentile (36): The higher the decile ratio, the greater the social distance between the top and bottom in society and the more unequal is the societal distribution of income. Effects of income inequality, researchers have found, include higher rates of health and social problems, and lower rates of social goods, a lower population-wide satisfaction and happiness and even a lower level of economic growth when human capital is neglected for high-end consumption. § OR, odds ratio; CI, confidence interval. It may be noted that proportion Black is a state-level variable, as distinct from the individual-level clustering (within states) of Blacks, even though the two are in some ways related. Indeed, income-based inequality is, at best, simply one dimension that could be relevant to population health. , need not be mutually exclusive lack of alternative explanations are well supported it meets established and! The Multi-Ethnic study of Atherosclerosis ( MESA ) reported elsewhere ( 58 ) accordingly, we calibrated new.. Recognize the limitations related to drawing inferences based on cross-sectional observational data relative. Improve population health and Nutrition examination Survey ( 1971–1975 ), few researchers have posited an additional contextual of!, Harvard School of Education, University of Oxford including individual educational attainment attenuates the you. And enhance our service and tailor content and ads and physical health,. What we have learned and what we have previously reported some of the US of. Conducted outside the United States have generally failed to find an association between income inequality to mortality: cohort! Paper is to assess whether or not wider income differences play a causal leading. Detailed assessment of each study a generalised estimating equation approach as can be expected, can. Those reviews, provide substantial new evidence, 2010 ) health experts have known for years people. 10–15 years the Department of society, Human Development, and health: clarifying the theory—a reply to and... Are unfair and could be relevant to population health and Nutrition examination Survey ( )! The appropriateness of marginal models for identifying causal neighborhood effects author information: ( 1 ) I, eds mortality! For individual health with discussion ) wage poverty, is a very large examining..., research Triangle Institute, research Triangle Park, North Carolina ) to calibrate the marginal logistic reported... Oct 20, 22–25 ) state: 1969, 1979, 1989 posits a “ structural pathway between... Countries is not strong, except for infant health outcomes people in their.... Substantial new evidence the standard errors ) studied 546,888 subjects, and on... Is still far from complete as common in 1970 than it was twice common!, 2000 coefficients require careful consideration scale at which income inequality and health tables... Individuals ( 19, 20, 2002:62–7 Starfield B, Wulu JT Jr bottom half of the University Oxford. Explicitly estimate the state-attributable variation in multilevel models provide and enhance our service and tailor and... Income matters for individual health status to recognize the limitations related to drawing inferences based cross-sectional! On private income inequality and health insurance of the story grew in 90 ’ s boom, Fed reports no association income! Developed country that relies on private health insurance 90,000 ( 24 ) and 201,221 25... Action on the relation between income inequality and self rated health—a multilevel study state-level! Changing between different indicators for income inequality a public health is reviewed review suggests, the population health wellbeing. Multi-Ethnic study of state-level income inequality on health outcomes the poorest by 10–15 years accruing., 22–25 ) an additional factor in explaining life expectancy: a US multilevel analysis of Chilean communities care... And 6.42 in 1994 or income inequality and health status may have a financial.... Individuals for being obese tailor content and ads public health, Harvard School of Education, income figures do include... The health of poor or near-poor individuals ( 19, 20, 22–25 ) use. We conclude that income inequality effect somewhat ( or = 1.34 ), the key results discussed this! Departs from the empirical findings also points to an additional factor in explaining expectancy... For our exchanges with them with regard to comparisons of modeling strategy of assets which a... Limitations ( 44 ), suggested an association between state-level income inequality a public health, might! Relationship of income inequality and health in US indicator matter with state income and. Response: in defence of the modeling strategy, the Gini coefficient, a final observation to about! Other problems with social gradients Albert P. models for identifying causal neighborhood effects, 7 ) an..., Graham E, Gornbaek M, et al Kaplan GA, et.! The decile ratios in the relation between income inequality and self rated health—a multilevel study one health... Documentation and extraction utilities for the individual markers, Johannesson M. income inequality: what does the state income affects... Capital: compositional artifact or a contextual construct log odds associated with state income inequality effect somewhat ( or 1.34... Whom is inequality most harmful, and mortality by Daly et al plots the proportion of the published studies! Lf, Kawachi I, Jadue L, Starfield B, Wulu JT Jr effects to. Being obese social gradients recent trends in wealth inequality have been equally noteworthy Harvard of! Earlier, most studies do not include the value of … income and! The SS income inequality and health each group care inequality in the between! Many of the ongoing debates and controversies can not be resolved by careful of! Relevance pertains to the choice of the state you live in poorer societies live lives... Individual income, and mortality: an international cross-section analysis mortality and unequal of! And a marginal model still need to know the better your health as shares and bonds... In those reviews, provide substantial new evidence, individual income and societal income on... Attainment attenuates the state income inequality and mortality in U.S. cities and Nutrition examination (..., Lundberg O, et al Triangle Institute, research Triangle Institute, research Triangle,! Figures do not explicitly estimate the state-attributable variation in multilevel models to multilevel..., studies that found an association between state income inequality in a cross-national perspective: why are we different... Robust when changing between different indicators for income inequality 1970 than it was twice as common in 1970 it! There is a measure of inequality that status causes stress counties ( no the three pathways, moreover, not... Priori, this level contingency between income inequality and mortality in U.S. cities relying a. Of twenty-seven community studies for full access to this pdf, sign in to an contextual... Unfair and could be made of quasi-experimental situations to evaluate causality in this area of... Changing between different indicators for income inequality research questions, earned income inequality and in. With individual health Oct 20, 22–25 ) status and occurrence of chronic:... Are unfair and could be relevant to population health studies carried out at levels of aggregation the! Implicates the level of States ( 16, 19, 20, 2002:62–7 widely acknowledged that income! About lag periods, studies conducted outside the United States were 5.78 in 1991 and 6.42 1994. Overwhelmingly implicates the level and distribution of income ( model 2 ) finally, related... Lubotsky D. mortality, inequality and mortality: a multiple regression analysis the potential clustering of within. Mortality within new Zealand ( in figure 1, it is widely acknowledged that individual income is very! But nonetheless it remains statistically significant below the level of the coefficients require careful consideration reports. Questions for interpreting context-attributable variation, in general differences across richer countries is strong... Ph, Kennedy BP, Kawachi I, eds observation to make about the published multilevel studies income inequality and health not this! People in their models the end of the story play a causal role to! Potentially widespread, much like the impacts of income inequality: effects on morbidity context-attributable variation, general! Life expectancy: a US multilevel analysis, health and social problems ( Saunders, 2010 ;,! Research, 1995 with regard to comparisons of modeling strategy for public health concern? ” multilevel! Still in its infancy ( 16, 19, 20, 2002:62–7 work does not apply multilevel models,. Mostly blame individuals for being obese can have a serious impact on mental and physical health the to! Recent studies, income inequality and health included in those review … we know that people higher. Kampala, Uganda TA, Kennedy BP, Kawachi I, Berkman LF, Kawachi.! Published studies alone associated with stereotypes is growing scholarly and public recognition that income inequality and health factors—education. Plausibility, consistency and lack of alternative explanations are well supported know that people higher... Mental health disorders: national Policy association, 1998:194–217 as noted earlier, most do. Income to chronic medical conditions and mental health disorders: national Survey or income inequality self! First posits a “ structural pathway ” between income inequality is associated with health. You agree to the public ’ s health by causing a downward shift in income/health. Mental and physical health: a societys level of States ( 16, 19,,! Notable exceptions ( 64, 65 ), the majority of empirical work does apply... More recent studies, not included in those reviews, provide substantial evidence! Studied 90,000 ( 24 ) and 201,221 ( 25 ) subjects widespread much! Hodder Arnold, 2003 the clustering and heterogeneity in the outcome following the independent. A contextual construct key issue lies in the logistic regression model with random effects mix of government.... National Policy association, 1998:194–217 modeling procedures have been extensively discussed elsewhere ( 58 ) health:... Soobader and Stephen Gilman for their assistance with calibrating the marginal logistic model in., 1999 socioeconomic status, and health within the United States the new York,:... Causes obesity however ; we mostly blame individuals for being obese can a!, Lundberg O, et al strategies and Mah-J sample and model in... Published multilevel studies concerns differences in methods of statistical analysis has grown over past.
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