Health effects of income inequalities

Wilkinson summarizes his group’s research on the health effects of inequality in a TED talk at http://www.ted.com/talks/lang/en/richard_wilkinson.html.  Among developed countries, those with greatest inequality have worst average outcomes on many, many measures of health and other social measures (such as % of population in prison).  The same association holds among states within the USA.

Three things that are interesting to me are that:

1. On a descriptive level, Wilkinson doesn’t show us the data of health vs. income per capita with strata of socio-economic status separated. It is possible that more unequal societies (within the developed world) have lower average health status just because they have more poor people, for whom their health is lower because their absolute conditions are worse. Clarifying whether that is the case fits under the label of avoiding the ecological fallacy.   Even if it turns out that that is not the case, it is interesting that Wilkinson did not see the need to mention that issue.  He expects his audience to be convinced by what he presents  that it is relative inequality, not absolute conditions that needs changing if health is to improve.

2. On the causal level, Wilkinson explains the effects in psychosocial terms — the accumulated effects of stress that results from status inequalities. I would be interested to see how he addresses the claims of John Lynch and other social epidemiologists (http://www.sph.umich.edu/rwjhssp/lectures/lynch.mov) that 25+ years of research into psychosocial effects of relative inequality has distracted attention from the rick factors associated with absolute health inequalities, in particular, the eminently changeable four risk factors for the major killer in developed countries, namely, heart disease.

3. On the policy level, Wilkinson promotes progressive taxation policies.  I am interested to know what he thinks should be done in the area of health while waiting for such taxation policies to occur.  Would he join Lynch in promoting health interventions around the major risk factors for heart disease, or would he join others, such as Marmot, in emphasizing the psychosocial domain?  (In light of the controversy over Hanauer’s short TED talk, we might also wonder how much TED would have promoted his talk if he had presented and discussed the facts of who has promoted tax cuts for the rich and resisted any return to earlier rates.)

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