Politics of Poverty

Is inequality killing us?

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New report shows that shorter lives and poorer health will ultimately harm the US economy

What do high Gini coefficients and diabetes, regressive taxation and cardiovascular disease, and low minimum wages and respiratory ailments have to do with each other? More than most people—even physicians and economists—may think.

It’s not news that economic inequality in the United States has sharply increased during the last 30 years. It’s also not news that super-sized soft drinks, the easy availability of assault weapons, and the lack of health insurance for 49 million people are tragically cutting many American lives short.

What could be big news is that inequality in the United States may be a factor contributing to Americans’ poorer health, especially compared to Western Europeans, Japanese, Canadians, and Australians.  According to a massive new report by the National Research Council and the Institute of Medicine, “U.S. Health in International Perspective: Shorter Lives, Poorer Health,” the United States ranks dead last among 17 rich countries in life expectancy and at or near the bottom in nine key health indicators, ranging from infant mortality, obesity, and heart disease to homicides, chronic lung diseases, and sexually transmitted diseases (STDs).

Table courtesy the paper’s authors.

These international health rankings look remarkably similar to inequality rankings by the Organization for Economic Cooperation and Development (OECD). Denmark, Norway, and Sweden hover near the top with the best health outcomes and the least social inequality; France, Germany, the Netherlands, and Canada are in the middle of both rankings. The US and Portugal are at the bottom.

Among the 17 countries studied, the United States now has the greatest disparity in wealth between the richest 1 percent of households, whose $16.4 million average net worth is 288 times that of the median household. The US also has the lowest male life expectancy and the lowest probability of its citizens surviving to age 50. Likewise, average incomes of the top 1 percent are more than 70 times higher than those of the poorest fifth of Americans—much greater than in Western Europe or Japan. And finally, the US has the dubious distinction of having the highest rates of infant mortality, STDs, and deaths from car crashes and gun violence.

Table courtesy the paper’s authors.

Even fatal illnesses that our state-of-the-art medicine might be controlling, such as heart and lung diseases, are more likely to kill Americans than they are to kill citizens of all but one other country in the study. And the gaps have been widening, as America has been slipping farther behind other developed countries in health outcomes during the last 30 years.

Some might chalk this up to the fact that, prior to Obamacare, the US has had the highest proportion of people without health insurance. Others, pointing to the fact that the poor tend to be less healthy, would be right to note that the US has the highest poverty rate of the countries studied.

Yet, neither lack of health insurance nor poverty fully accounts for America’s miserable health ratings. Even well-to-do, white, college-educated Americans with health insurance fare less well than their counterparts in almost every other rich country.

While the report devotes only a paragraph to the role of high economic inequality, other researchers—notably Richard Wilkinson and Kate Pickett, authors of The Spirit Level: Why More Equal Societies Almost Always Do Better—argue that highly unequal income distribution harms all members of society. They posit that social stress, status anxiety, social competition, and lack of trust born of inequality lead to poorer health.

“Shorter lives and poorer health will ultimately harm the nation’s economy as health care costs rise and the workforce remains less healthy than that of other high-income countries,” concludes the authors of the National Research Council and the Institute of Medicine report.

Moral arguments against excessive inequality have recently been supplemented by macroeconomic evidence that inequality hinders economic growth and contributes to greater economic volatility. Now, we may add that inequality is medically harmful. This, in turn, brings the argument full circle.

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