Psychosocial and material pathways in the relation between income and health: a response to Lynch et al

Much of the debate on health inequalities has centred on the damage done by poverty. However, evidence suggests that health is also related to inequality. Firstly, as the Whitehall studies of British civil servants show, there is a gradient in health among those who are not poor, indicating that the higher the socioeconomic position, the lower the morbidity and mortality.1–4 Whole population samples show that this gradient runs right across societies and that its magnitude varies between societies and over time. 5 6 Although absolute mortality has been falling in Britain, inequalities in mortality have increased. 7 8 Secondly, despite the health gradient within societies, there is little relation between average income (gross domestic product per capita) and life expectancy in rich countries. This suggests that absolute material standards are not, in themselves, the key. Thirdly, there is a strong relation between mortality and income inequalities. People living in countries with greater income inequality have a shorter life expectancy.9–11 Furthermore, a similar relation has been found for geographical areas within countries.12–15 #### Summary points Economic and social circumstances affect health through the physiological effects of their emotional and social meanings and the direct effects of material circumstances Material conditions do not adequately explain health inequalities in rich countries The relation between smaller inequalities in income and better population health reflects increased psychosocial wellbeing In rich countries wellbeing is more closely related to relative income than absolute income Social dominance, inequality, autonomy, and the quality of social relations have an impact on psychosocial wellbeing and are among the most powerful explanations for the pattern of population health in rich countries These observations support our argument that there are psychosocial pathways associated with relative disadvantage which act in addition to the direct effects of absolute material …

[1]  M. Turshen.  Development as Freedom , 2001 .

[2]  W. Galston.  Bowling Alone: The Collapse and Revival of American Community , 2001 .

[3]  I. Kawachi,et al.  State income inequality, household income, and maternal mental and physical health: cross sectional national survey , 2000, BMJ : British Medical Journal.

[4]  M. Bobák,et al.  International comparators and poverty and health in Europe , 2000, BMJ : British Medical Journal.

[5]  George Davey Smith,et al.  Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions , 2000, BMJ : British Medical Journal.

[6]  D. Grobbee,et al.  Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study , 2000, Journal of epidemiology and community health.

[7]  Alistair Woodward,et al.  National infant mortality rates in relation to gross national product and distribution of income , 1999, The Lancet.

[8]  David R. Williams.  Race, Socioeconomic Status, and Health The Added Effects of Racism and Discrimination , 1999, Annals of the New York Academy of Sciences.

[9]  R. Wilkinson.  Health, Hierarchy, and Social Anxiety , 1999, Annals of the New York Academy of Sciences.

[10]  T. Chiang.  Economic transition and changing relation between income inequality and mortality in Taiwan: regression analysis , 1999, BMJ.

[11]  J. Lynch,et al.  Relation between income inequality and mortality: empirical demonstration. , 1999, BMJ.

[12]  E. Kramarow,et al.  Health, United States, 1999; with health and aging chartbook , 1999 .

[13]  Harry Hemingway,et al.  Evidence based cardiology: psychosocial factors in the aetiology and prognosis of coronary heart disease. Systematic review of prospective cohort studies. , 1999, BMJ.

[14]  I. Kawachi,et al.  Income distribution, socioeconomic status, and self rated health in the United States: multilevel analysis , 1998, BMJ.

[15]  M McKee,et al.  Economic change, crime, and mortality crisis in Russia: regional analysis , 1998, BMJ.

[16]  R. Cohen,et al.  Income inequality and mortality in metropolitan areas of the United States. , 1998, American journal of public health.

[17]  B. McEwen.  Protective and damaging effects of stress mediators. , 1998, The New England journal of medicine.

[18]  I. Kawachi,et al.  Social capital, income inequality, and mortality. , 1997, American journal of public health.

[19]  P McDonough,et al.  Income dynamics and adult mortality in the United States, 1972 through 1989. , 1997, American journal of public health.

[20]  M. Marmot,et al.  Contribution of job control and other risk factors to social variations in coronary heart disease incidence , 1997, The Lancet.

[21]  S A Stansfeld,et al.  Low job control and risk of coronary heart disease in whitehall ii (prospective cohort) study , 1997, BMJ.

[22]  Ichiro Kawachi,et al.  Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States , 1996, BMJ.

[23]  M. Marmot,et al.  Childhood social circumstances and psychosocial and behavioural factors as determinants of plasma fibrinogen , 1996, The Lancet.

[24]  L. Berkman.  The role of social relations in health promotion. , 1995, Psychosomatic medicine.

[25]  C. Shively,et al.  Social status and coronary artery atherosclerosis in female monkeys. , 1994, Arteriosclerosis and thrombosis : a journal of vascular biology.

[26]  R. Putnam,et al.  Making Democracy Work: Civic Traditions in Modern Italy. , 1994 .

[27]  Ching-Chi Hsieh,et al.  Poverty, Income Inequality, and Violent Crime: A Meta-Analysis of Recent Aggregate Data Studies , 1993 .

[28]  D. Baker,et al.  Income distribution and life expectancy. , 1992, BMJ.

[29]  Gower Street,et al.  Health inequalities among British civil servants: the Whitehall II study , 1991, The Lancet.

[30]  J. House,et al.  Social relationships and health. , 1988, Science.

[31]  E. Pamuk,et al.  Social class inequality in mortality from 1921 to 1972 in England and Wales. , 1985, Population studies.

[32]  M. Marmot,et al.  INEQUALITIES IN DEATH—SPECIFIC EXPLANATIONS OF A GENERAL PATTERN? , 1984, The Lancet.

[33]  Karl Marx,et al.  Wage Labour and Capital , 1849 .

[34]  E. Uslaner.  The Moral Foundations of Trust , 2002 .

[35]  F. Pratto,et al.  Social Dominance: An Intergroup Theory of Social Hierarchy and Oppression , 1999 .

[36]  I. Kawachi,et al.  Women's status and the health of women and men: a view from the States. , 1999, Social science & medicine.

[37]  Anders G. Olsson,et al.  Attenuated cortisol response to a standardized stress test in lithuanian versus swedish men: The livicordia study , 1998, International journal of behavioral medicine.

[38]  I. Kawachi,et al.  (Dis)respect and black mortality. , 1997, Ethnicity & disease.

[39]  M. Whitehead,et al.  Health Inequalities Decennial Supplement , 1997 .

[40]  R. Wilkinson.  Unhealthy Societies: The Afflictions of Inequality , 1996 .

[41]  R. Wilkinson.  The epidemiological transition: from material scarcity to social disadvantage? , 1994, Daedalus.

[42]  H. Colhoun,et al.  Health Survey for England 1994 , 1994 .

[43]  M. Lewis,et al.  The Culture of Inequality. , 1978 .