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Crawford Kilian

The gap between richest and poorest in a society tends to correlate with morbidity and mortality rates: the wider the income gap, the more people get sick and die earlier, at least at the bottom end of the scale.

The Whitehall Studies, for example, have been tracking British civil servants since the 1960s, and have found that senior civil servants have something a quarter the rate of fatal heart disease experienced by civil servants at the bottom of the pay scale...despite equal access to health care.

Other British and American studies have confirmed that "wealthier is healthier"—every socioeconomic class tends to be healthier than the one below it and sicker than the one above it.

This may also help to explain why the US, with by far the best medical system in the world, is about #27 in life expectancy—behind not only countries like Canada and Japan, but even behind Cuba. These countries all tend to have relatively narrow gaps between richest and poorest, though the gap in Canada has widened since the advent of free trade in the late 1980s.

The actual cause of reduced life expectancy is still under debate, with some scholars like Richard G. Wilkinson, in the UK, suggesting "psychosocial stress" that not only reduces immunity but triggers self-destructive behaviour like smoking, drinking, violence, etc. The jury is still out on that.

The income gap/mortality issue has been a very big one in the public-health field, but it hasn't really registered with the public itself. Some public-health scholars like Dennis Raphael, here in Canada, and Steven Bezruchka at the U of Washington in Seattle, are trying to alert the public to the issue. But it's going to be a long, slow process.

Todd Bass

Yes, I'm familiar with Wilkinson's work on income inequality / socioeconomic status and health. It's fascinating, though I think the Wilkinsonians overstate their case to a degree and don't yet fully understand the mechanism(s) involved. For absolute poverty also affects health status even in countries with universal health insurance such as the UK: http://news.bbc.co.uk/2/hi/health/1323362.stm

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