Is income inequality a determinant of population health? Part 1. A systematic review

John Lynch, George Davey Smith, Sam Harper, Marianne Hillemeier, Nancy Ross, George A Kaplan, Michael Wolfson, John Lynch, George Davey Smith, Sam Harper, Marianne Hillemeier, Nancy Ross, George A Kaplan, Michael Wolfson

Abstract

This article reviews 98 aggregate and multilevel studies examining the associations between income inequality and health. Overall, there seems to be little support for the idea that income inequality is a major, generalizable determinant of population health differences within or between rich countries. Income inequality may, however, directly influence some health outcomes, such as homicide in some contexts. The strongest evidence for direct health effects is among states in the United States, but even that is somewhat mixed. Despite little support for a direct effect of income inequality on health per se, reducing income inequality by raising the incomes of the most disadvantaged will improve their health, help reduce health inequalities, and generally improve population health.

Figures

Figure 1
Figure 1
Household Income Inequality and Poverty, 1913–1996, and Age-Adjusted All-Cause Mortality, U.S., 1900–1998
Figure 2
Figure 2
Average Annual Income and Mortality Rate for 500,000 Canadian Men
Figure 3
Figure 3
GDP per Capita and Life Expectancy for 161 Countries, 2000
Figure 4
Figure 4
Income Inequality and Life Expectancy at Birth for Nine Countries (late 1970s–early 1980s)
Figure 5
Figure 5
Income Inequality (1989–1992) and Life Expectancy at Birth (1991–1993) in the Same Nine Countries Used in Figure 4
Figure 6
Figure 6
Income Inequality and Life Expectancy in the Full Sample of 16 Countries
Figure 7
Figure 7
Relative Risk of Dying and Population Distribution for U.S. Individuals by Household Income
Figure 8
Figure 8
Income and Mortality in a Pair of Hypothetical Societies
Figure 9
Figure 9
Scatter Plots of Hypothetical and Actual Mortality Rates for Infants and Working-Age Males by Income Inequality, U.S. States, 1990
Figure 10
Figure 10
Working-Age Mortality by Median Share of Income in 528 Metropolitan Areas in Five Countries, 1990–1991: United States, United Kingdom, Canada, Sweden, and Australia
Figure 11
Figure 11
Comparison of U.S. and Canadian Cities over Canadian Range of Income Inequality

Source: PubMed

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