Income in inequality and mortality in England

This paper starts out from the striking tendency for life expectancy to be highest in those developed countries where income is distributed most equally, rather than in those which are richest. It goes on to discuss the shape of the relationship between income and health which this implies within nations. After reproducing evidence from the Health and Lifestyles Survey of a cross-sectional relationship in Britain which is consistent with the international picture, the paper then reports on a test of the causality of that relationship.

Journal of Public Health, 2003

Journal of Urban Health-bulletin of The New York Academy of Medicine, 2005

The relationship between income inequality and mortality has come into question as of late from many within-country studies. This article examines the relationship between income inequality and working-age mortality for metropolitan areas (MAs) in Australia, Canada, Great Britain, Sweden, and the United States to provide a fuller understanding of national contexts that produce associations between inequality and mortality. An ecological cross-sectional analysis of income inequality (as measured by median share of income) and working-age (25–64) mortality by using census and vital statistics data for 528 MAs (population >50,000) from five countries in 1990–1991 was used. When data from all countries were pooled, there was a significant relationship between income inequality and mortality in the 528 MAs studied. A hypothetical increase in the share of income to the poorest half of households of 1% was associated with a decline in working-age mortality of over 21 deaths per 100,000. Within each country, however, a significant relationship between inequality and mortality was evident only for MAs in the United States and Great Britain. These two countries had the highest average levels of income inequality and the largest populations of the five countries studied. Although a strong ecological association was found between income inequality and mortality across the 528 MAs, an association between income inequality and mortality was evident only in within-country analyses for the two most unequal countries: the United States and Great Britain. The absence of an effect of metropolitan-scale income inequality on mortality in the more egalitarian countries of Canada. Australia, and Sweden is suggestive of national-scale policies in these countries that buffer hypothetical effects of income inequality as a determinant of population health in industrialized economies.

2011

Sociology of Health & Illness, 2000

The tendency for more egalitarian societies to have lower mortality rates has been identified in international data and subsequently confirmed in analyses of areas within countries, particularly within the USA. However, recent reports using data on OECD countries from the Luxembourg Income Study (LIS) suggest this relation no longer exists. We investigated whether the shift in relative poverty from elderly people (with high death rates) to young families (low death rates) may have affected the associations. Using age-and sex-specific mortality among 14 OECD countries in relation to income inequality, median income and absolute and relative poverty, we found that wider income distribution is related to higher premature mortality, and higher age-specific mortality rates below, but not above, age 65 years. Absolute income levels showed no consistent relation to mortality. The changing age distribution of relative poverty may have affected the way income inequality impacts on mortality measured across all ages.

Journal of Epidemiology & Community Health, 2002

Study objective: Several studies have reported an association between income inequality and increased mortality, but few have used net income data, controlled for individual income, or evaluated sensitivity to the choice of inequality measure. The study tested the hypotheses that people in regions of Britain with the greatest income inequality would report worse health than those in other regions, after adjusting for individual socioeconomic circumstances. Design: Cross sectional survey. Setting: England, Wales, and Scotland. Participants: 8366 people living in private households Main results: Regional income inequality, measured using the Gini index, was associated with worse self rated health, especially among those with the lowest incomes (adjusted OR 1.55, 95% CI 1.24 to 1.92) (p<0.001). This association was not robust to the choice of income inequality measure, being maximal for the Gini coefficient and weakest when using indices that are more sensitive to income differences among those at the top or bottom of the income distribution. Conclusions: The study found limited evidence of an association between income inequality and worse self rated health in Britain, which was greatest among those with the lowest individual income levels. As regions with the highest income inequality were also the most urban, these findings may be attributable to characteristics of cities rather than income inequality. The variation in this association with the choice of income inequality measure also highlights the difficulty of studying income distributions using summary measures of income inequality.

Health statistics quarterly / Office for National Statistics, 2005

This article examines the magnitude of inequalities in health by area deprivation using two composite indices of health expectancy, one based on a subjective assessment of general health status (healthy life expectancy) and the second on reported limiting longstanding illness (disability-free life expectancy). Trends in healthy life expectancy by deprivation for the period 1994-1999 were also examined. Results show that males and females living in the most deprived wards spend twice as many years in poor health, both in absolute (years of life) and relative (proportion of life) terms, than those living in the least deprived wards. There was no change in the healthy life expectancy gap between the most and least deprived areas over the study period.

Global health action, 2013

A lively public and academic debate has highlighted the potential health risks of living in regions characterized by inequality. Research provides an ambiguous picture, however, with positive association between income equality and health mainly being found on higher levels of geographical division, such as nations, but rarely at local level. We examined the association between income inequality (using the Gini coefficient) and all-cause mortality in Swedish municipalities in the 65-74 age group. A multi-level analysis was applied and controlled for by variables including individual income and average income level in the municipality. The analyses were based on individual register data on all residents born between 1932 and 1941, outcomes were measured for the year 2006. Lower individual income and lower average income in the municipality of residence were associated with significantly increased mortality. We found an association between income inequality and mortality with excessiv...

Social Science & Medicine, 2002

A new literature has recently emerged which suggests that among the developed economies, at least in terms of health status, the distribution of income may be more important than its absolute level. In this literature, the effect of income inequality, in particular, relative inequality on health status is tested by examining the relationship between aggregate mortality and a single measure of inequality (such as the Atkinson Index). In this paper we look at whether a single measure of income inequality, even augmented by a measure of representative income can at the aggregate level, distinguish between the effects of relative as opposed to absolute income. An alternative approach that uses disaggregated income to distinguish between the effects of changes in relative and absolute income levels is applied to data from the 1990 US Census and mortality figures from the National Centre for Health Statistics. Our results indicate that the rate of mortality is sensitive to absolute, but not relative poverty and therefore suggest that to improve the health of the poor the focus must be on raising their absolute standard of living. The results also indicate that government supported programs may have important health enhancing effects and may therefore represent a key policy tool to improve the health of those at the bottom of the income distribution.

The European Journal of Public Health, 1997

The aim was to identify the age-, sex-and cause-specific premature mortality rates contributing to the association between life expectancy and income distribution in developed countries. Income distribution was calculated for the 13 OECD countries and years for which the Luxembourg Income Study held data. The potential years of life lost (1-65 years) by sex and cause, as well as the age-and sex-specific all-cause mortality rates and standardized mortality ratios for children 1-19 years were calculated from data supplied by the WHO. On finding evidence suggesting that reported income distribution is strongly affected by low response rates in some income surveys, we used 2 measures of income distribution: that among households where the 'head of household' was aged less than 65 years (weighted by response rates) and that among households with children (among whom response rates are thought to be higher). Partial correlations and regressions controlling for the year were used to analyse the relationship between mortality and income distribution. Both measures of income distribution showed broadly similar results. A more egalitarian distribution of income was related to lower all-cause mortality rates In both sexes in most age groups. All 6 major categories of cause of death contributed to this relationship. The causes of premature mortality contributing most were road accidents, chronic liver disease and cirrhosis, infections, ischaemic heart disease among women and other injuries among men. Income distribution was associated not only with larger absolute changes in mortality from these causes, but also with larger proportionate changes. Suicides and stomach cancer tended to be more common in more egalitarian countries.