November 10, 1997

THE UNHEALTHY U.S. INCOME GAP
It's linked to higher levels of illness
America has the highest per capita income among the world's
leading
countries. Yet despite the well-established relationship
between people's
economic status and their health, the U.S. trails a number
of nations in
life expectancy and other health indicators. Why this
apparent disparity?

One clue provided by British economist Richard G. Wilkinson
in his recent
book, Unhealthy Societies: The Afflictions of Inequality,
relates to
America's widening gap between rich and poor. Wilkinson
argues that health
gains in advanced nations are more affected by levels of
income inequality
than by absolute living standards. His research indicates
that life
expectancy in such nations is relatively unrelated to
average income but
tends to be higher in countries with less inequality.
Moreover, longevity
had risen faster in those with narrowing income gaps than in
those with
widening ones.

Now, Wilkinson's findings have received important
corroboration in new
studies focusing solely on health indicators within the U.S.
itself. In
one, a team led by epidemiologist George A. Kaplan, formerly
of the
California Health Services Dept. and now at the University
of Michigan,
found there was a strong correlation between statewide
mortality rates and
the degree of income inequality among the 50 states
(measured by the share
of income received by the bottom 50% of households within a
state).

A similar study by researchers at the Harvard University
School of Public
Health found that income disparities were associated with
higher state
death rates from cancer, heart disease, infant mortality,
and homicide.
Since both studies controlled for such factors as average
income levels,
race, and incidence of poverty, it appears that income gaps
affect the
health of more than just the poor and racial minorities.
Also, while
overall U.S. mortality rates fell during the 1980s, the
Kaplan group found
they fell more slowly in states with the greatest increases
in income
inequality.

Why would income inequality affect health? In a follow-up
study published
in the latest issue of the American Journal of Public
Health, the Harvard
researchers find that income inequality is associated with
low levels of
''social capital'': That is, residents of states with wider
income
disparities show less trust of others and lower membership
in voluntary
organizations and neighborhood groups. The Kaplan study also
noted that
such states have higher rates of violence and disability,
more people
lacking health insurance, and less investment in education.

Whatever the reason, the apparent relation between income
disparities and
health seems worrisome--particularly since America's income
gap shows
little sign of narrowing.

BY GENE KORETZ

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* Alex Chis & Claudette Begin *
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  From new transmitters came the old stupidities.
  Wisdom was passed on from mouth to mouth.
            -Bertolt Brecht
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Dennis Raphael, Ph.D.
Associate Professor and Acting Director,
Masters of Health Science Program in Health Promotion
Department of Public Health Sciences
Graduate Department of Community Health
University of Toronto
McMurrich Building, Room 101
Toronto, Ontario, CANADA M5S 1A8