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Affordable Care Act, Economic Inequality, Government Programs, Government Spending, Health Care Reform, Health Disparities, Health Insurance, Health Reform, Healthcare, Inequality, Mental Health Care, Obama, Obamacare, Politics, Poverty, Public Health, Public Policy, Racial Disparities, Social Justice

Visualizing The Public Health Consequences of Income Inequality

economic inequality health

Rising and persistent economic inequality is one of the greatest challenges facing America. Economic inequality has reached unprecedented levels in our country (surpassing Depression-era levels) and the gap between the super-rich and the rest of us continues to grow. Since the economic recovery began in 2009, the richest 1% have benefited from an astounding 95% of the economic gains, while the remaining 99% shared just 5% of gains.  The median household income, adjusted for inflation, is decreasing.  At her Senate confirmation hearing, Janet Yellen, the nominee to replace Ben Bernanke as chair of the Federal Reserve after he steps down from his current term, discussed the rising trend of economic inequality and the threat it poses to the economy, saying, “This is a very serious problem, it’s not a new problem, it’s a problem that really goes back to the 1980s, in which we have seen a huge rise in income inequality… For many, many years the middle and those below the middle [have been] actually losing absolutely. And frankly a disproportionate share of the gains, it’s not that we haven’t had pretty strong productivity growth for much of this time in the country, but a disproportionate share of those gains have gone to the top ten percent and even the top one percent. So this is an extremely difficult and to my mind very worrisome problem.”

Income inequality is more than just an economic problem. The public health consequences of income inequality are well documented: low-income Americans are more likely to be uninsured or underinsured, have higher rates of chronic disease and poor health-related quality of life, and have a shorter life-expectancy than higher-income individuals. Increasing evidence from scientific studies conducted in countries around the world indicates that economic inequality is a significant determinant of health outcomes ranging from life expectancy and premature death to infant mortality and obesity. A recent study released by the Harvard University School of Public Health found that income inequality is associated with depression, particularly among women. Even modest increases in income inequality are associated with more than double the cumulative risk of death over a 12-year period. These effects are not limited to the poorest Americans: high levels of economic inequality affect the health of everyone, not just the poor. Further, economic inequality is also associated with higher health care spending, particularly in the later years of life.

Yesterday I posted an article discussing a new study from the Commonwealth Foundation, which found that low-income Americans have worse health outcomes, higher rates of being uninsured/underinsured, and are more likely to receive poor-quality health care in every state across the country. Today, I am going to post a series of charts and graphs  to help visualize the massive income-related disparities in health outcomes and access to health care in the United States. A large body of evidence indicates that socioeconomic determinants are even stronger predictors of population health than individual health behaviors, giving us all the more reason to address the growing problem of economic inequality in America.

The first series of charts shows how economic inequality is related to a variety of health and social indicators, comparing the U.S. to our peer nations. The second series focuses only within the U.S., comparing several health indicators across different income brackets.

Economic Inequality & Health: A Worldwide Perspective

Health and Social Problems are Worse in More Unequal Countries – and the U.S. is High on Both Measures

Screen Shot 2013-11-30 at 9.13.58 AM

Infant Deaths are Higher in More Unequal Countries

 

Screen Shot 2013-11-30 at 9.14.20 AM

Teen Birth Rates are Higher in More Unequal Countries

Screen Shot 2013-11-30 at 9.14.32 AM

The Prevalence of Obesity is Higher in More Unequal Countries

Screen Shot 2013-11-30 at 9.14.43 AM

Social Mobility is Lower in More Unequal Countries

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Health and Income Inequality in the United States

Life Expectancy Increases With Income

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Health Status Improves with Higher Income

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The Prevalence of Stroke Decreases as Income Increases

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The Prevalence of Heart Disease Decreases As Income Increases

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The Prevalence of Diabetes Decreases As Income Increases 

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Conclusions

So, what can we learn from these graphs? Well, first, that socioeconomic disparities in health are worse in the United States than in any of our peer nations. And second, that socioeconomic disparities in health are present across the income gradient, but the greatest disparities exist among the poorest Americans.

We can also see that we have a lot of work to do to reduce the prevalence of socioeconomic disparities in health. One of the goals of Healthy People 2020 is to reduce health disparities of all kinds, including socioeconomic disparities, and the Affordable Care Act includes several provisions aimed at tracking and reducing health disparities as well as increasing accessibility and affordability of health care. Over the years, efforts to eliminate disparities and achieve health equity have focused primarily on diseases or illnesses and on health care services. However, the absence of disease does not automatically equate to good health.

Within and across countries, individuals at the highest levels of socioeconomic status experience the best health outcomes, indicating that the major opportunity for improving the health of the population in the U.S. and other countries lies in improving health outcomes of those living at the lower end of the socioeconomic spectrum. This requires a long-term commitment and sustained funding to better understand the biological mechanisms and societal pathways through which disparities emerge and are maintained. Reducing the cost and increasing the accessibility of health care will improve health outcomes among lower-income individuals, but access to health care is not enough to eliminate the pervasive health disparities that impact low-income Americans. Building awareness of the negative impact of socioeconomic disparities in health is another crucial step to reducing health disparities. According to the American Public Health Association (APHA):

“Most Americans are not aware of the direct impact of health disparities on all citizens, not just a few select groups. In economic terms, all Americans pay for disparities through higher taxes, greater healthcare costs, and increased insurance premiums.”

Further, the APHA also cites the need for a coordinated national strategy aimed at reducing health disparities:

“Currently, many public health professionals work to reduce disparities either through research, clinical practice or public policy.Yet, in most cases, these programs operate independently for only a brief period of time. Reducing health disparities requires a long-term coordinated approach to research and intervention at the community level. Developing this strategy will require leadership and commitment from multiple sectors including government, private industry, academics and local community groups.”

Public health initiatives can have a significant impact, but addressing the fundamental cause of socioeconomic disparities in health – that is, economic inequality – is the only way to develop a long-term plan to reduce health disparities.

“We’re the richest economy in the history of the world. For the majority of Americans not to get the benefits of this extraordinarily prosperous economy, you know, there’s something fundamentally wrong.” -Former Labor Secretary Robert Reich

Be Well, my friends.

-C

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