Inequality's Death Toll: A New Calculation

What has the potential to save more lives, the insurance reforms in the House health care bill or the higher taxes on the rich the bill imposes to pay for those reforms? This rather odd question, suggests a new study on inequality and health, really does merit asking.

Over the past year, Americans have been heatedly debating how best to help people who get sick. But why do people get sick in the first place? Why do some developed nations seem to have much healthier populations than others? Why do people in Japan live much longer, on average, than people in the United States?

Epidemiologists — the scientists who study the health of populations — have been busily exploring these questions for decades now, and they’ve fixed upon a reality that has stimulated an enormous scholarly debate within the public health community. Equal societies, the researchers have found, consistently exhibit better health than unequal societies.

Why should this be so? Last week, in the British medical journal BMJ, an editorial [1] by epidemiologists Kate Pickett and Richard Wilkinson neatly identified the two competing explanations.

The first explanation suggests “that more unequal societies have worse health simply because they have more poor people.” If poor people had more money, they would likely spend more on “things that benefit health” — better food, for instance, or warmer housing.

But the problems inequality creates, other epidemiologists contend, go far beyond poverty. Income gaps, these scientists argue, corrode social bonds and create a chronic stress that wears away at the health of all people who live in deeply unequal societies, not just the poor.

This second explanation has just gained significant new support — from a new “meta-analysis [2],” also published last week in BMJ, of previously conducted inequality and health studies.

The new paper’s authors, epidemiologists from Japan’s University of Yamanashi and the Harvard School of Public Health, subjected these studies to a series of complex statistical analyses. Their goal: to offer “quantitative evaluations on the association between income inequality and health.”

Their principal finding: Individuals “living in regions with high income inequality have an excess risk for premature mortality independent of their socioeconomic status, age, and sex.”

In other words, if you’re a middle-income person in an unequal society, you’re going to have shorter life than a similarly situated middle-income person in a more equal society.

How powerful an impact does inequality have on health? In the world’s top 30 industrial nations, the Japanese and American research team concludes, “upwards of 1.5 million deaths” — nearly 10 percent of total mortality in the age 15-to-60 age group — could be prevented by reducing income inequality.

The impact of inequality on the United States turns out to be even more stunning, not surprisingly since no developed nation sports wider gaps in income and wealth. Of the deaths the new BMJ study ties to inequality, almost 900,000 came in the United States.

That total, University of Washington epidemiologist Stephen Bezruchka pointed out last week, amounts to a sizeable share of America's annual death toll.

“We can say,” he calculates, “that one in four deaths can be attributed to our high rates of income inequality.”

Such numbers have, of course, enormous political implications. An unequal society, as last week’s BMJ [1] editorial [1] noted, amounts to a “broken society.” Political leaders, the editorial continued, ought now endeavor to repair that break — “by undoing the widening of inequalities that has taken place since the 1970s.”

Sam Pizzigati edits Too Much [3], the online weekly on excess and inequality.