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Copyright 1996 Globe Newspaper Company
The Boston Globe
April 19, 1996, Friday, City Edition
SECTION: NATIONAL/FOREIGN; Pg. 14
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
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
"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."