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PubMed1989

When violence has a benevolent face: the paradox of hunger in the world's wealthiest democracy.

During the last two decades, Americans initially discovered that millions of fellow-citizens were going hungry, then acted to virtually eliminate the problem, and, in the 1980s, learned that hunger has reappeared in epidemic proportions. Hunger, particularly in a wealthy democracy, is most appropriately seen as a form of institutionalized violence, the product of ideologies that fail to distribute national abundance in a manner that achieves the possible goal of preventing hunger. The return of hunger to the United States is associated with economic and tax policies that have reallocated income distribution from poor and middle-income groups to the wealthy, and with a concomitant reluctance to utilize the federal government to protect needy citizens from undernutrition associated with growing economic deprivation.

Adolescent↗

PubMed2006

For whom is income inequality most harmful? A multi-level analysis of income inequality and mortality in Norway.

This study investigates the degree to which contextual income inequality in economic regions in Norway affected mortality during the 1990s, above the effects of mean regional income and individual-level confounders. A further objective is to explore whether income inequality effects on mortality differed between socioeconomic groups. Data were constructed by linkages of administrative registers encompassing all Norwegian inhabitants. The outcome variable was all-cause mortality during 6 years (i.e., died 1994-1999 or alive end of 1999). Men and women aged 25-66 in 1993 were analysed. Regions' mean income and income inequality (in terms of gini coefficients) were calculated from consumption-units-adjusted family disposable income. Individual-level variables included sex, age, marital status, individual income, education, and being a recipient of health-related welfare benefits. Multilevel logistic regression models were fitted for 2,197,231 individuals nested within 88 regions. After adjusting for regional mean income and individual-level variables, the odds ratio (OR) for mortality 1994-1999 was 1.028 (95% CI 1.023-1.033) on the gini variable multiplied by 100. Analyses of cross-level interactions indicated some, albeit modest, income inequality effects on mortality in the upper income and educational categories. Among those with low individual income, low education, and among recipients of health-related welfare benefits, mortality effects of higher regional income inequality were significantly stronger than among those more advantageously placed in the social structure. The results of this study differ from previous studies which have suggested that contextual income inequality has a minor impact on population health in egalitarian countries. The results indicate that in Norway, neither a comparatively egalitarian income distribution nor generous and comprehensive welfare institutions hindered the emergence of regional-level income inequality effects on mortality, and these effects were particularly marked among socioeconomically disadvantaged groups. Explanations for the results are discussed.

Adult↗

PubMed2004

[Inequalities in health. Adult mortality in communities of Metropolitan Santiago].

BACKGROUND: In the last decade, Chile achieved a significant reduction in poverty, however income distribution still shows inequalities. The richest 10% of the population perceived 46% of total income. AIM: To study the relationship between territorial socioeconomic segregation and adult mortality in the Metropolitan area of Santiago de Chile. MATERIAL AND METHODS: Data from the 34 districts of Metropolitan Santiago were analyzed. Adjusted community mortality rates, during 2000, among adults aged 20 years or more, including specific rates per sex and age group, were analyzed. RESULTS: There was a negative correlation between income and mortality, specially among men (rS -0.42 p<0.005). The highest correlation coefficient was observed among subjects aged 45-64 years old (rS -0.42 p<0.005). There was a high degree of inequality in mortality among males aged 20-44 years old (Gini 0.54) and in the age group 45-64 years old in both sexes (Gini 0.50). Mortality rates decreased along with increasing incomes in both sexes. 20/20 ratio shows the higher values for mortality of men aged 20-44 years (20/20 ratio 1.7 95% CI 1.4-2.0), followed by mortality of men aged 45-64 years. CONCLUSIONS: There is a relationship between economic segregation (expressed by income) and mortality. The higher mortality rates are observed in districts of Metropolitan Santiago with the lower income.

Adult↗

PubMed1997

[Income, health, and health services utilization in Germany 1992].

Data from the 1992 wave of the Socioeconomic Panel were used to analyse the relation between incomes, need for and utilisation of health care in East- and West Germany employing methods coming from the economic measurement of income distributions. "Self assessed health" and "restricted activities of daily living" were employed as need indicators. Utilisation was measured by the number of "visits to physicians" and "days in hospital". Data was available for 6435 individuals (west) and 3928 individuals (east). Income was defined as equivalent net household income with an equivalence scale derived from the german social assistance program. Compared to the concentration of income all variables in the scope of this study were only marginally concentrated (i.e. equally distributed). A slight concentration of need amongst the lower income was overcompensated by utilisation. Thus a very small impact of the German health care system favouring lower income individuals was measured. The study shows methodological problems when combining data from regions with strongly different income levels instead of analysing them separately. A combined analysis tends to underestimate concentration.

Activities of Daily Living↗

PubMed1982

Distribution of family income: improved estimates.

This article describes the results of research to improve estimates of the distribution of family income. In this research, a microdata file was constructed for 1972 using several data sources. The data obtained from these sources were combined and adjusted to produce more precise estimates. Current Population Survey estimates were then evaluated using these improved estimates. Using the improved estimates increased 1972 mean income for all units by 11 percent. The income share of the top 5 percent of the distribution increased substantially. Property income increased and wage and salary income decreased in relative importance. The mean income of family units headed by persons aged 65 or older increased by about 40 percent, by far the largest rise for any group examined; the increase was far lower for low-income family units in that age group. A simple update of mean incomes to 1979 showed no substantial changes from the 1972 pattern of adjustments.

Adolescent↗

PubMed1992

Access to ambulatory care among noninstitutionalized, activity-limited persons 65 and over.

This study examined the impact of income and insurance type on ambulatory care contact use by persons 65 and over who expressed a limitation in their activity. This large group (39% of noninstitutionalized older persons in 1984) had significantly more health problems and ambulatory care contacts than persons not activity-limited. The only previous study on equity in use of physician services among elderly in poorer than average health found relatively little inequality of use due to income and insurance. This study came to the opposite conclusion. Activity-limited persons without Medicare private supplementary insurance, as well as those with supplementary insurance in the bottom and middle of the income distribution, had 15-32% fewer ambulatory care contacts than activity-limited persons with higher income and private supplementary insurance. Particularly striking were the declines in consumption among middle income persons relative to the reference group, indicating that the issue of equity in consumption of health services among older disabled persons affects a much broader group than only the poor and near-poor.

Activities of Daily Living↗

PubMed1999

Economic transition and changing relation between income inequality and mortality in Taiwan: regression analysis.

OBJECTIVE: To examine the changing relation between income inequality and mortality through different stages of economic development in Taiwan. DESIGN: Regression analysis of mortality on income inequality for three index years: 1976, 1985, and 1995. SETTING: 21 counties and cities in Taiwan. MAIN OUTCOME MEASURES: All age mortality and age specific mortality in children under age 5. RESULTS: When median household disposable income was controlled for, the association between income inequality and mortality became stronger in 1995 than in 1976. Especially, the association between income inequality and mortality in children aged under 5, with adjustment for differences in median household disposable income, changed from non-significant in 1976 to highly significant in 1995. In 1995, the level of household income after adjustment for income distribution no longer had a bearing on mortality in children under 5. CONCLUSION: The health of the population is affected more by relative income than by absolute income after a country has changed from a developing to a developed economy.

Adolescent↗

PubMed2006

Inequality and mortality: long-run evidence from a panel of countries.

We investigate whether changes in economic inequality affect mortality in rich countries. To answer this question we use a new source of data on income inequality: tax data on the share of pretax income going to the richest 10% of the population in Australia, Canada, France, Germany, Ireland, the Netherlands, New Zealand, Spain, Sweden, Switzerland, the UK, and the US between 1903 and 2003. Although this measure is not a good proxy for inequality within the bottom half of the income distribution, it is a good proxy for changes in the top half of the distribution and for the Gini coefficient. In the absence of country and year fixed effects, the income share of the top decile is negatively related to life expectancy and positively related to infant mortality. However, in our preferred fixed-effects specification these relationships are weak, statistically insignificant, and likely to change their sign. Nor do our data suggest that changes in the income share of the richest 10% affect homicide or suicide rates.

Developed Countries↗

PubMed2003

Income, education, and blood pressure in adults in Jamaica, a middle-income developing country.

BACKGROUND: At present, little is known about how socioeconomic status (SES) is related to blood pressure (BP) and hypertension in developing countries. This cross-sectional study examined associations between SES and BP in 2082 adults from a peri-urban area of Jamaica, a middle-income developing country. METHODS: Hypertension (systolic BP >/=140 mmHg, diastolic BP >/=90 mmHg or current hypertensive medication use) was estimated based on self-reported medication use and the mean of the second and third of three manual BP measurements. Income and education were self-reported. Linear or logistic regressions were used to estimate multivariate associations between BP or hypertension and SES. RESULTS: Hypertension prevalence was 20% in men and 28% in women. In both men and women, the income distributions of BP and hypertension were non-linear, indicating elevated levels in low as well as in high-income groups. In contrast to the negative relationships typical for industrialized countries, multivariate-adjusted BP and hypertension were highest in the wealthiest women. In men with some high school education, income was positively associated with BP, while there were negative associations in men with lesser education. Unlike women, mean BP were highest in poor men with limited education. Low SES men were also least likely to receive diagnosis and treatment. CONCLUSIONS: Socioeconomic status is related to BP and hypertension in Jamaica, although relationships are non-linear. Behavioural and environmental factors that explain elevated BP among both low and high SES adults in developing countries must be identified to develop effective prevention strategies.

Adult↗

PubMed2005

Income inequality and population health: a review and explanation of the evidence.

Whether or not the scale of a society's income inequality is a determinant of population health is still regarded as a controversial issue. We decided to review the evidence and see if we could find a consistent interpretation of both the positive and negative findings. We identified 168 analyses in 155 papers reporting research findings on the association between income distribution and population health, and classified them according to how far their findings supported the hypothesis that greater income differences are associated with lower standards of population health. Analyses in which all adjusted associations between greater income equality and higher standards of population health were statistically significant and positive were classified as "wholly supportive"; if none were significant and positive they were classified as "unsupportive"; and if some but not all were significant and supportive they were classified as "partially supportive". Of those classified as either wholly supportive or unsupportive, a large majority (70 per cent) suggest that health is less good in societies where income differences are bigger. There were substantial differences in the proportion of supportive findings according to whether inequality was measured in large or small areas. We suggest that the studies of income inequality are more supportive in large areas because in that context income inequality serves as a measure of the scale of social stratification, or how hierarchical a society is. We suggest three explanations for the unsupportive findings reported by a minority of studies. First, many studies measured inequality in areas too small to reflect the scale of social class differences in a society; second, a number of studies controlled for factors which, rather than being genuine confounders, are likely either to mediate between class and health or to be other reflections of the scale of social stratification; and third, the international relationship was temporarily lost (in all but the youngest age groups) during the decade from the mid-1980s when income differences were widening particularly rapidly in a number of countries. We finish by discussing possible objections to our interpretation of the findings.

Global Health↗

PubMed1997

Inequalities in income and long-term disability in Spain: analysis of recent hypotheses using cross sectional study based on individual data.

OBJECTIVE: To compare the relation between inequalities in long-term disability and income in the 17 regions of Spain. DESIGN: Data were taken from the survey on impairments, disabilities, and handicaps that was carried out in Spain in 1986. For each region the inequality in long-term disability associated with income was calculated as the odds ratio associated with reducing monthly household income by 10,000 pesetas (about Ponds 50) (estimate of effect of inequality of income) and the odds ratio for the inequality in long-term disability between those at the bottom and those at the top of the income hierarchy (relative index of inequality). MAIN OUTCOME MEASURE: Prevalence of long-term disability. RESULTS: Five of the eight regions where lowering income had a greater effect on long-term disability were among those with the lowest income per head, while six of the remaining nine regions where the effect was smaller were among those with the highest income per head. Three regions with the highest estimate of relative index of inequality had the highest estimate of effect, and another three regions with the lowest estimate of relative index of inequality had the lowest estimate of effect. In contrast, the relative position of the remaining 11 regions varied from one measure to another. CONCLUSIONS: These results support the theory that additional increments in material wellbeing have a negligible effect on health in countries with high socioeconomic development. However, inequality in income distribution did not determine inequality in health between those at the bottom and those at the top of the income hierarchy in many Spanish regions.

Cost of Illness↗

PubMed2005

Further examination of the cross-country association between income inequality and population health.

Several scholars have put forward the view that the estimates by Rodgers [(1979). Income and inequality as determinants of mortality: An international cross-section analysis. Population Studies, 33 (2), 343-351], Flegg [(1982). Inequality of income, illiteracy and medical care as determinants of infant mortality in underdeveloped countries. Population Studies, 36 (3), 441-458] and Waldmann [(1992). Income distribution and infant mortality. Quarterly Journal of Economics, 107 (4), 1283-1302] showing a negative cross-country association between income inequality and population health, cannot be replicated from recent data. In view of the importance of this matter, the present study further examines the issue from the most recent, and probably more accurate, data for the largest cross-country sample used in this line of research. The main conclusion is that the negative cross-country association between income inequality and good health, reported by Rodgers, Flegg, and Waldmann, is replicated very well. The different findings indicated by some scholars may have been due to their samples or the models being unusual. Therefore, the recent skepticism about the existence of such a negative association needs to be reconsidered. Several additional points are also noted. First, income inequality shows significance even after an index of ethnic heterogeneity is included. Second, ethnic heterogeneity itself has a negative association with population health. Third, income inequality retains significance in the presence of a measure of social capital. Fourth, however, the association between the measure of social capital and population health appears weak. Fifth, a simple analysis does not support the view that the positive association between income inequality and infant mortality in less developed countries (LDCs) may just be a reflection of the role of poverty. Finally, there is some support for the proposition that while income may be relatively more important for health in LDCs, the role of income inequality may be stronger in developed economies.

Cross-Cultural Comparison↗

PubMed2004

Geographical inequalities of mortality by income in two developed island countries: a cross-national comparison of Britain and Japan.

In this paper we examine the ecological relations between household income distribution and age-grouped mortality in Britain and Japan. Comparable datasets were prepared in terms of age intervals of mortality, household income intervals and geographical units for years around 1990. Then we conducted a series of regression analyses to associate absolute and relative income indices with age and sex-specific standardized mortality ratios (SMRs). The results are as follows: (1) In Britain mortality is lower where inequalities in income are lower, while in Japan there is no obvious relationship. It is, however, apparent that-just as in the case of the USA and Canada-Britain and Japan appear to merge and appear part of a greater pattern when considered as a series of city regions. Thus an overall global relationship between income inequality and mortality may exist. To assess such global relationship, further studies using cross-national regional datasets covering a wide rage of rich nations are desirable. (2) Income-mortality relations are consistent among different age-sex groups in Britain, but there are substantial differences in the relationships as revealed between different demographic groups in Japan. In particular, while absolute income levels are correlated negatively with mortality of working-age men in both countries, mortality of elderly people in Japan is higher where absolute income is higher. This indicates the different historical contexts to the health divides these two different geographical contexts, but further consideration of a more historically nuanced understanding of income-mortality relations is required.

Adult↗

PubMed1982

Distributions of households by size: differences and trends.

"This article deals with the distributions of households by size, that is, by number of persons, as they are observed in international comparisons, and for fewer countries, over time." The contribution of differentials in household size to inequality in income distribution among persons and households is discussed. Data are for both developed and developing countries.

Demography↗

PubMed2005

Income as mediator of the effect of occupation on the risk of myocardial infarction: does the income measurement matter?

AIM: To investigate whether the effect of occupational grade on the risk of myocardial infarction (MI) is mediated by income with different aspects of income taken into account. METHODS: Data were used from three prospective population studies conducted in Copenhagen. A total of 16 665 employees, 43% women, aged 20-75 years, with an initial examination between 1974 and 1992 were followed up until 1999 for incident (hospital admission or fatal) MI. Register based information on job categories and income was used. RESULTS: During follow up, 855 subjects were diagnosed with a MI: 708 men and 147 women (in total 47% fatal). The hazards by household and individual income showed a graded effect with a hazard ratio (HR) of 1.43 (95% CI 1.12 to 1.83) for the lowest household income group compared with the highest, whereas equivalent income showed an inverse "J shape" effect with a HR of 1.55 (95% CI 1.25 to 1.82) for the third income group compared with the highest. HR for unskilled workers as compared with executive managers was reduced from 1.55 (95% CI 1.24 to 1.93) to 1.42 (95% CI 1.12 to 1.81) after adjustment for household income. CONCLUSIONS: Occupation and income are not mutually exclusive, but at least partly explained by or mediated through the other on the risk of MI. The mediating effect of income is independent of the choice of an income indicator. Income is not a big contributor to inequality in MI; probably because of the rather even income distribution in Denmark.

Adult↗

PubMed2004

Population health and income inequality: new evidence from Israeli time-series analysis.

BACKGROUND AND OBJECTIVES: The relationship between population health and inequality in income distribution has attracted much attention during the last two decades. The purpose of this paper is to examine that relationship using Israeli time-series data, and considering three types of income: economic, pre-tax, and disposable. METHODS: Israeli time series (1979-2000) on life expectancy of men and women at birth and at ages 5 and 65, as well as infant mortality, were related to Gini coefficients measuring inequality in economic, pre-tax (after transfers) and disposable (after taxes) incomes, controlling for gross domestic product (GDP) per capita. This design allows for the estimation of the effects on population health of changes in income inequalities over time as well as of contemporaneous reduction in inequality due to transfers and taxes. RESULTS: None of the three income inequality measures by itself had an effect over time on population health. However, larger contemporaneous reductions in inequality, mainly through the transfers system, were associated with better population health, in particular with lower infant mortality. CONCLUSIONS: A significant part of the temporal improvement in the health of the Israeli population has been due to the increasing effort to reduce inequality in economic income by increasing transfer payments. The results are generally inconsistent with the argument of adverse psychosocial effects of inequality on health, and are consistent with inequality being related to other harmful public goods affecting health and with Rodgers' argument.

Aged↗

PubMed2004

Eating, drinking and being depressed: the social, cultural and psychological context of alcohol consumption and nutrition in a Brazilian community.

Much has been written about the socioeconomic distribution of nutritional status, both in more economically developed, and in developing nations. In general, persons of lower socioeconomic status suffer adverse consequences of poor nutritional status, although these consequences can vary depending on the level of development, i.e. in more developed countries the problem tends to be one of over-nutrition and obesity, while in developing countries the problem tends to be one of under-nutrition and nutritional deficiencies. In this paper, we explore the socioeconomic distribution of dietary intake in a Brazilian city, in an area that in some ways is neither prototypically developed or underdeveloped. The analysis presented here was stimulated by the surprising observation of no socioeconomic differences in total caloric intake in the context of extreme differences in income distribution. Further examination showed that socioeconomic differences in total caloric intake appeared after controlling for alcohol intake. A complete analysis of the data suggests that lower income leads to lower cultural consonance, which in turn leads to higher depression, higher alcohol intake, and higher total caloric intake. In this model, alcohol ingestion can be seen as both a psychological and nutritional adaptive strategy to economic, social and cultural marginality in a highly stratified society.

Adult↗

PubMed2001

Economic growth, income equality, and population health among the Asian Tigers.

The "Tiger" economies of Southeast Asia provide examples of developing nations where economic growth and increasing income equality are compatible and, when occurring together, are associated with superior health trends over time. The degree of income inequality in the Asian Tigers declined during the period of rapid economic growth. Traditionally, economists have viewed economic growth and relative parity in income distribution as incompatible, or trade-offs. This poses a public policy dilemma, since a reasonable propensity to increase a nation's overall economic well-being would mean forsaking measures that increase income parity. The Asian Tigers, however, have shown that this need not be viewed as a trade-off. Economic growth and a simultaneous increase in income equality are possible and, with respect to health outcomes, desirable. The authors propose a variety of mechanisms through which income inequality can enhance economic growth, and discuss policies in education, agricultural land reform, and housing that influence the simultaneous attainment of income equality and economic growth.

Asia, Southeastern↗