Income inequality is a strong predictor of poor health because it is about being made to feel poor

In many ways, an even more accurate tag line for the phenomena in which stress-related disease among the poor usually has more to do with feeling poor than actually being poor is that it is about being made to feel poor. This point is made clearer when considering the second body of research in this area, championed by Richard Wilkinson of the University of Nottingham in England. Wilkinson took a top-down approach, looking at the “How are you doing?” ladder from the societal level.

Let’s consider how answers to “How are you doing?” can be distributed along the ladder. Suppose there is a business with ten employees. Each earns $5.50 anh o u r . T h u s t h eco m p an y i s p a y in g o u t a t o t a l o f$ 55/hour in salary, and the average income is $5.50/ h o u r . Wi t h t ha t d i s t r ib u t i o n, t h e w e a lt hi es t e m pl oyee i s makin g$ 5.50/hour, or 10 percent of the total income ( $5.50/$ 55). Meanwhile, in the next business, there are also ten employees. One earns $1/ h o u r, t h e n e x t$ 2/hour, the next $3, an d soo n . O n ce a g ain, t h eco m p an y p a ys a t o t a l o f$ 55/hour in salary, and the average salary is again $5.50/ h o u r . B u t n o wt h e w e a lt hi es t e m pl oyee, e a r nin g$ 10/ hour, takes home 18 percent of the total income ( $10/$ 55). Now, in the third company, nine of the employees earn $l / h o u r, an d t h e t e n t h e a r n s$ 46/hour. Again, the company pays a total of $55/ h o u r, an d t h e a v er a g es a l a ry i s$ 5.50/hour. And here, the wealthiest employee takes home 84 percent of the total income ( $46/$ 55). What we have here are businesses of increasingly unequal incomes. What Wilkinson and others have shown is that poverty is not only a predictor of poor health but, independent of absolute income, so is poverty amid plenty—the more income inequality there is in a society, the worse the health and mortality rates.

This has been shown repeatedly, and at multiple levels. For example, income inequality predicts higher infant mortality rates across a bunch of European countries. Income inequality predicts mortality rates across all ages (except the elderly) in the United States, whether you consider this at the level of states or cities. In a world of science often filled with wishy-washy data, the effect is extremely reliable—income inequality across American states is a really strong predictor of mortality rates among working men. When you compare the most egalitarian state, New Hampshire, with the least egalitarian, Louisiana, the latter has about a 60 percent higher mortality rate. Finally, Canada is both markedly more egalitarian and healthier than the United States—despite being a “poorer” country.

References

Sapolsky, Robert. (2004). Why Zebras Don’t Get Ulcers Chapter 17. The View from the Bottom (p. 524). New York, NY: Henry Holt and Company.

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