As someone who is interested in public health policy and primary determinants of health, this question has perked my curiosity since college years. A recent NYTimes' Commentary by Thomas Edsall "The Hidden Prosperity of the Poor" highlighted the debate over the rising inequality in this country. I would like to summarize my own take of this complex topic.
- a number of studies (Kondo, Elgar, Zheng to name a few recent ones, see bib) have examined the association between income inequality and population health; results are mixed/inconsistent but there seems to be a negative impact of income inequality (as measured by gini coeff) on premature mortality, healthy life expectancy and self-rated health
- it is thought that income inequality results in poor health through loss of social capital, social cohesion, interpersonal trust, psychosocial stress.
- The effects of income inequality are more "apparent" in multilevel, cross-sectional datasets, over time and gender-specific (seen in men), and there is a threshold effect of income inequality on health.
- it is unclear whether public health expenditure could mediate the harmful effect of income inequality on health.
- the question is not laissez faire and the belief in the hidden prosperity of the poor and middle class but which policies in social security, welfare, labour market, immigration, tax reform are necessary to address poverty and income inequality!
"I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful"