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Copyright 1996 Globe Newspaper Company
The Boston Globe

April 19, 1996, Friday, City Edition


LENGTH: 745 words

HEADLINE: Income inequality, mortality linked;
Gap found to hurt wide segment in US

BYLINE: By Alison Bass, Globe Staff

The widening income gap between rich and poor Americans is hurting more than the poorest of the poor, according to two studies. The surveys found that wide disparities are accompanied by health repercussions that affect middle-income people as well.

Both studies, to be published today in the British Medical Journal, found that states with the largest gaps in income between rich and poor had the highest overall death rates, as well as the highest rates of mortality from heart disease, stroke and homicide. States with smaller disparities in income had lower death rates, the researchers found.

"Many people no longer feel they can buy into the American dream," said Bruce Kennedy, director of public health practice at the Harvard School of Public Health and lead author of one of the studies. "And research shows that increased levels of stress and hopelessness lead to poorer health."

Kennedy believes there is good reason why large gaps in income affect the health of more than just the very poor. He said growing income inequality - a sharp trend in the United States since the early 1980s - results in a breakdown of social cohesion, increased competition for scarce resources and greater levels of stress and frustration, and then to poorer health.

Some economists and physicians said they are skeptical that stress from economic circumstances causes major health problems, particularly among middle-income Americans. And a correlation between income inequality and high mortality rates does not mean a cause-and-effect relationship, they said.

"I find it hard to believe that stress gives middle-income heads of households a higher rate of health problems," said John Liu, a health economist with the Heritage Foundation, a conservative think tank in Washington.

Kennedy argued that the finding "shows that trickle-down economic policies don't work. The notion that a rising tide raises all boats doesn't hold if there is a substantial discrepancy in how wealth is shared. A lot of people are drowning."

The two studies could not tease apart how disparities in income correlated with the health status of specific income sub-groups. However, Kennedy said, the effects on health were too large to have been confined to poor people; he added that both studies controlled for the known effects of poverty on health.

Both studies also controlled for, or took into account, other possible confounding factors such as smoking and drinking rates, household income and household size.

"This effect on health wasn't just happening to poor people; middle-class people were affected too," said George A. Kaplan, chief of the human population laboratory for the California Department of Health Services in Berkeley, Calif., and lead author of the other study. "When we accounted for income differences, there was still a strong relationship between income inequality and mortality rates."

Kaplan and his colleagues also found that states such as Mississippi, Louisiana, Alabama and Kentucky that had the largest discrepancies in income also had the highest mortality rates. In contrast, states such as New Hampshire, Vermont, Wisconsin and Utah that had the least income disparities had the lowest rates. Massachusetts ranked in the middle in income inequality and mortality rates.

"We found that the most unequal states had the poorest educational outcomes and the fewest number of social services," Kaplan said.

While arriving at the same conclusion, the two studies used different measures of income distribution. Kaplan's group measured how much of total household income goes to people in the bottom half of the population. It found that in states where the bottom half gets less of the pie, mortality rates were highest.

In the Harvard study, researchers used a measure known as the "Robin Hood index" to determine income distribution. It approximates the share of income that would have to be transferred from those above the mean to those below to achieve equal distribution of income. The higher the index, the less equal is the income distribution.

"The US Robin Hood index is one of the highest in the developed world; i.e. one of the most unequal," Kennedy said. "And that may explain why, despite the fact that we are the wealthiest nation in the world and we spend more on health than any other nation, we are among the highest in the developed countries in rates of infant mortality, homicide and other mortality measures."