Inequality of Wealth: Inequality of Health

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An imbalance between rich and poor is the oldest and most fatal ailment of all republics.

Plutarch

Absolute income has always remained the dominant indicator of personal health (as this research from a sample population of Swedish people studied over 15-17 years indicate). The money in your wallet will obviously have a say in the quality of healthcare you have access to and how regularly you can take those full-body check-ups that can be availed at special discounts on holidays. In recent times, a growing body of literature suggests how income distribution in a society can also be a determiner of health. The “relative income hypothesis,” as it is called, predicts that individuals lead better lives in more income equal societies.

A strong correlation was reported between life expectancy and income inequality in a rigorous examination of the Organization for Economic Cooperation and Development (OECD) countries. The USA also severely lags in health parameters despite being one of the wealthiest nations in the world. Researchers attribute it to the growing income inequality, where the wealthiest one per cent holds about 40–50% of the national wealth.

Hence, the distribution of wealth amongst a population, whether it is fair or not, is essential for health and mortality. This statement must be taken with a pinch of salt because in this scenario, being richer does not help you live to be 150 years old but being poorer takes years off your life. In other words, every step up the socio-economic ladder has only a diminishing effect in increasing health. Here, we see that it is not about the nation’s absolute income—a country could be poor or wealthy—but the proportion of its population living on the edge will become the largest variable in health economics.

The 1960s to the 2000s was when countries like India, China, and others implemented significant economic policies like liberalization, which accelerated their economic growth. This growth, catalyzed by opening the floodgates of trade barriers, benefitted only the big players. The poor enjoyed the fruits of this growth only through a trickle-down effect, where the continuous expansion of the economy is expected to trickle down its way to the bottom eventually. Ascertaining to this, in “The Determinants Of Mortality,” Cutler D. et al. found almost no relationship between economic growth and life expectancy during this period. Their paper suggests that “countries have made a remarkable improvement in health with little or no economic growth.” In fact, Cuba’s healthcare model is a remarkable statement of how a country achieved the best health care system in Latin America and the Caribbean through efficient employment of its scarce resources. Even so, for health and social parameters like teenage pregnancies, mental illness, homicide, and infant mortality, a direct correlation with income is evident. The numbers reveal that more unequal countries perform worse in these indicators. 

So why does a correlation like this exist? There could be three plausible reasons(Lynch and Kaplan 1997). Firstly, in societies with rising income disparities, the rich’s wants and the poor’s needs begin to diverge—the more significant this income gap, the worse this clash of interests. Ultimately, the elite’s whims will win because markets and governments have come to be centered on wealth over everything.

Another way to explain this correlation is the erosion of social capital or the lack of reliable networks among people. Higher inequality in an area increases the mistrust amongst its people and lowers their confidence in the public administration. These directly translate into lower voter turnout and reduced participation in government policies and decision making. Researchers suggest that such places are less likely to invest in policies to help society’s vulnerable sections. So in the absence of well-developed policies to help the poor, a vicious cycle of poverty perpetuates.

Thirdly, the psychosocial effects of income inequality can be detrimental too. Literature has routinely proved how relative deprivation affects the levels of frustration. Widening inequality implies a constant and critical comparison of an individual’s stature with well-off. Income inequality can act as a “social stressor,” affecting memory, mental health, blood pressure, and cardiovascular systems. Richard Wilkins, a social epidemiologist who is a pioneer researcher in this field, calls this  “status anxiety,” he explains: “based on massive and repeated questionnaires, we know that status anxiety … affects everyone, the super-rich and the dirt-poor, in the most unequal countries. It becomes an ironic unifying characteristic across an unequal landscape.”

As the mounting research reveals that the accumulation of wealth in a few hands is a health hazard in itself, we must strive for an economic democracy that will promise an egalitarian society. Let us not punish the poor for being poor and reward the rich for being rich.

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