Low Income Differentials mean Good Health
Keith Rankin, 12 April 2000
Recent research has shown that, in all except the very poorest countries, it is not the richest which have the best health outcomes. Rather longevity is highest in those societies which have the smallest income differences between rich and poor.
In his 1996 book Unhealthy Societies, British economic historian Richard Wilkinson has shown through painstaking research that the predominant determinant of a nation's life expectancy is its income distribution.
People who are relatively disadvantaged within their societies have a significantly increased chance of dying prematurely of, for example, heart disease. Relative poverty amidst affluence is more of a problem than is a generally low per capita income.
After relative equality, the second way for a society to have a long average life expectancy is through social cohesion, including shared adversity. Thus people who lived through World War 2 had much higher life expectancies than their parents.
"Psychosocial causes" - ie stress - arising from inequality and other sources of social incohesion account for 60% of deaths, whereas physical factors relating to diet, smoking and exercise together only account for 40% of deaths in developed nations.
It is the low-status subservient jobs, and casual job situations which yield low and irregular incomes that lead to the greatest stress; ie not high-powered managerial positions. Stress levels are highest in people at the bottom of their pecking orders at work and elsewhere. The argument suggests that people facing poverty traps - ie unable to use their own initiative to improve their situations - are more susceptible to premature death than are people who are simply poor and live in communities in which material poverty is normal.
The political campaign against inequality is actually much more important than most of us realise. Income distribution is a political outcome that can be targeted by policymakers. An egalitarian income distribution is an economic fundamental, because public health is a central goal that economic policy serves.
The Health Costs of Inequality, Keith Rankin's Thursday Column, 2 March 2000
© 2000 Keith Rankin
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