Much research has investigated the association of income inequality with average life expectancy, usually finding negative correlations that are not very robust. A smaller body of work has investigated socioeconomic disparities in life expectancy, which have widened in many countries since 1980. These two lines of work should be seen as complementary because changes in average life expectancy are unlikely to affect all socioeconomic groups equally. Although most theories imply long and variable lags between changes in income inequality and changes in health, empirical evidence is confined largely to short-term effects. Rising income inequality can affect individuals in two ways. Direct effects change individuals' own income. Indirect effects change other people's income, which can then change a society's politics, customs, and ideals, altering the behavior even of those whose own income remains unchanged. Indirect effects can thus change both average health and the slope of the relationship between individual income and health.


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Literature Cited

  1. Acheson D. 1.  1998. Independent Inquiry into Inequalities in Health: Report London: Station. Off https://www.gov.uk/government/publications/independent-inquiry-into-inequalities-in-health-report
  2. Antonovsky A. 2.  1967. Social class, life expectancy and overall mortality. Milbank Mem. Fund. Q. 45:231–73 [Google Scholar]
  3. Backlund E, Sorlie PD, Johnson NJ. 3.  1996. The shape of the relationship between income and mortality in the United States: evidence from the National Longitudinal Mortality Study. Ann. Epidemiol. 6:112–20 [Google Scholar]
  4. Bartels LM. 4.  2008. Unequal Democracy: The Political Economy of the New Gilded Age Princeton, NJ: Princeton Univ. Press
  5. Beckfield J. 5.  2004. Does income inequality harm health? New cross-national evidence. J. Health Soc. Behav. 45:3231–48 [Google Scholar]
  6. Blomgren J, Hiilamo H, Kangas O, Niemelä M. 6.  2012. Growing inequalities and their impacts in Finland GINI Country Rep., Amsterdam. http://www.gini-research.org/system/uploads/609/original/CR-Finland-v2.pdf
  7. Clarkwest A. 7.  2008. Neo-materialist theory and the temporal relationship between income inequality and longevity change. Soc. Sci. Med. 66:91871–81 [Google Scholar]
  8. Cutler DM, Huang W, Lleras-Muney A. 8.  2015. When does education matter? The protective effect of education for cohorts graduating in bad times. Soc. Sci. Med. 127:63–73 [Google Scholar]
  9. Cutler DM, Lange F, Meara E, Richards-Shubik S, Ruhm CJ. 9.  2011. Rising educational gradients in mortality: the role of behavioral risk factors. J. Health Econ. 30:61174–87 [Google Scholar]
  10. Davey Smith G. 10.  1997. Down at heart: the meaning and implications of social inequalities in cardiovascular disease. J. R. Coll. Phys. Lond. 31:4414–24 [Google Scholar]
  11. Deaton A. 11.  2003. Health, inequality, and economic development. J. Econ. Lit. 41:1113–58 [Google Scholar]
  12. Deboosere P, Gadeyne S, Van Oyen H. 12.  2009. The 1991–2004 evolution in life expectancy by educational level in Belgium based on linked census and population register data. Eur. J. Popul. 25:2175–96 [Google Scholar]
  13. Frémeaux N, Piketty T. 13.  2013. Growing inequalities and their impacts in France GINI Country Rep., Amsterdam. http://gini-research.org/system/uploads/455/original/France.pdf
  14. Gilens M. 14.  2012. Affluence and Influence Princeton, NJ: Princeton Univ. Press
  15. Glied S, Lleras-Muney A. 15.  2008. Technological innovation and inequality in health. Demography 45:3741–61 [Google Scholar]
  16. 16. House of Commons Health Comm 2009. Health Inequalities London: Station. Off http://www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/286/28602.htm
  17. Houweling TA, Kunst AE, Huisman M, Mackenbach JP. 17.  2007. Using relative and absolute measures for monitoring health inequalities: experiences from cross-national analyses on maternal and child health. Int. J. Equity Health 6:15 [Google Scholar]
  18. Kawachi I, Kennedy BP, Lochner K, Prothrow-Stith D. 18.  1997. Social capital, income inequality, and mortality. Am. J. Public Health 87:91491–98 [Google Scholar]
  19. Kenworthy L. 19.  2015. Is income inequality harmful? Unpubl. Manuscr. http://lanekenworthy.net/thegoodsociety/
  20. King NB, Harper S, Young ME. 20.  2012. Use of relative and absolute effect measures in reporting health inequalities: structured review. BMJ 345:e5774 [Google Scholar]
  21. Kitagawa EM, Hauser PM. 21.  1973. Differential Mortality in the United States: A Study in Socioeconomic Epidemiology Cambridge, MA: Harvard Univ. Press
  22. Kondo N, Sembajwe G, Kawachi I, van Dam RM, Subramanian SV, Yamagata Z. 22.  2009. Income inequality, mortality, and self rated health: meta-analysis of multilevel studies. BMJ 339:b4471 [Google Scholar]
  23. Krieger N, Chen JT, Kosheleva A, Waterman PD. 23.  2011. Shrinking, widening, reversing, and stagnating trends in US socioeconomic inequities in cancer mortality for the total, black, and white populations: 1960–2006. Cancer Causes Control 23:2297–319 [Google Scholar]
  24. Krieger N, Rehkopf DH, Chen JT, Waterman PD, Marcelli E, Kennedy M. 24.  2008. The fall and rise of US inequities in premature mortality: 1960–2002. PLOS Med. 5:2e46 [Google Scholar]
  25. Leigh A, Jencks C. 25.  2007. Inequality and mortality: long-run evidence from a panel of countries. J. Health Econ. 26:11–24 [Google Scholar]
  26. Leigh A, Jencks C, Smeeding TM. 26.  2009. Health and economic inequality. The Oxford Handbook of Economic Inequality W Salverda, B Nolan, TM Smeeding 384–405 Oxford Univ. Press
  27. Leinsalu M, Stirbu I, Vågerö D, Kalėdienė R, Kovács K. 27.  et al. 2009. Educational inequalities in mortality in four Eastern European countries: divergence in trends during the post-communist transition from 1990 to 2000. Int. J. Epidemiol. 38:2512–25 [Google Scholar]
  28. Leinsalu M, Vågerö D, Kunst AE. 28.  2003. Estonia 1989–2000: enormous increase in mortality differences by education. Int. J. Epidemiol. 32:61081–87 [Google Scholar]
  29. 29. LIS 2015. Inequality and poverty key figures LIS Cross-Natl. Data Cent., Luxembourg. http://www.lisdatacenter.org/data-access/key-figures/
  30. Lynch J, Davey Smith G, Harper S, Hillemeier M. 30.  2004. Is income inequality a determinant of population health? Part 2. US national and regional trends in income inequality and age- and cause-specific mortality. Milbank Q. 82:2355–400 [Google Scholar]
  31. Lynch J, Davey Smith G, Harper S, Hillemeier M, Ross N. 31.  et al. 2004. Is income inequality a determinant of population health? Part 1. A systematic review. Milbank Q. 82:15–99 [Google Scholar]
  32. Lynch J, Davey Smith G, Hillemeier M, Shaw M, Raghunathan T, Kaplan G. 32.  2001. Income inequality, the psychosocial environment, and health: comparisons of wealthy nations. Lancet 358:194–200 [Google Scholar]
  33. Lynch JW, Davey Smith G, Kaplan GA, House JS. 33.  2000. Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. BMJ 320:1200–204 [Google Scholar]
  34. Ma J, Xu J, Anderson RN, Jemal A. 34.  2012. Widening educational disparities in premature death rates in twenty-six states in the United States, 1993–2007. PLOS ONE 7:7e41560 [Google Scholar]
  35. Mackenbach JP. 35.  2002. Income inequality and population health. BMJ 324:1–2 [Google Scholar]
  36. Mackenbach JP, Bos V, Andersen O, Cardano M, Costa G. 36.  et al. 2003. Widening socioeconomic inequalities in mortality in six Western European countries. Int. J. Epidemiol. 32:5830–37 [Google Scholar]
  37. Mackenbach JP, Kulhánová I, Bopp M, Deboosere P, Eikemo TA. 37.  et al. 2015. Variations in the relation between education and cause-specific mortality in 19 European populations: a test of the “fundamental causes” theory of social inequalities in health. Soc. Sci. Med. 127:51–62 [Google Scholar]
  38. Mackenbach JP, Kulhánová I, Menvielle G, Bopp M, Borrell C. 38.  et al. 2015. Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries. J. Epidemiol. Community Health 69:3207–17 [Google Scholar]
  39. Mackenbach JP, Kunst AE. 39.  1997. Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc. Sci. Med. 44:6757–71 [Google Scholar]
  40. Mackenbach JP, Stirbu I, Roskam A-JR, Schaap MM, Menvielle G. 40.  et al. 2008. Socioeconomic inequalities in health in 22 European countries. N. Engl. J. Med. 358:232468–81 [Google Scholar]
  41. Marmot M. 41.  2004. The Status Syndrome: How Social Standing Affects Our Health and Longevity New York: Henry Holt
  42. Martikainen P, Makela P, Peltonen R, Myrskyla M. 42.  2014. Income differences in life expectancy: the changing contribution of harmful consumption of alcohol and smoking. Epidemiology 25:2182–90 [Google Scholar]
  43. Meara ER, Richards S, Cutler DM. 43.  2008. The gap gets bigger: changes in mortality and life expectancy, by education, 1981–2000. Health Aff. 27:2350–60 [Google Scholar]
  44. Mellor JM, Milyo J. 44.  2001. Reexamining the evidence of an ecological association between income inequality and health. J. Health Polit. Policy Law 26:3487–522 [Google Scholar]
  45. Miech R, Pampel F, Kim J, Rogers RG. 45.  2011. The enduring association between education and mortality: the role of widening and narrowing disparities. Am. Sociol. Rev. 76:6913–34 [Google Scholar]
  46. Mullainathan S, Shafir E. 46.  2013. Scarcity: Why Having Too Little Means So Much New York: Times Books, Henry Holt
  47. Olshansky SJ, Antonucci T, Berkman L, Binstock RH, Boersch-Supan A. 47.  et al. 2012. Differences in life expectancy due to race and educational differences are widening, and many may not catch up. Health Aff. 31:81803–13 [Google Scholar]
  48. Phelan JC, Link BG, Diez-Roux A, Kawachi I, Levin B. 48.  2004. “Fundamental causes” of social inequalities in mortality: a test of the theory. J. Health Soc. Behav. 45:3265–85 [Google Scholar]
  49. Phelan JC, Link BG, Tehranifar P. 49.  2010. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J. Health Soc. Behav. 51:1 Suppl.S28–40 [Google Scholar]
  50. Sanger-Katz M. 50.  2015. Income inequality: It's also bad for your health. New York Times March 30. http://www.nytimes.com/2015/03/31/upshot/income-inequality-its-also-bad-for-your-health.html
  51. Shkolnikov VM, Andreev EM, Jdanov DA, Jasilionis D, Kravdal Ø. 51.  et al. 2012. Increasing absolute mortality disparities by education in Finland, Norway and Sweden, 1971–2000. J. Epidemiol. Community Health 66:372–78 [Google Scholar]
  52. Shkolnikov VM, Leon DA, Adamets S, Andreev E, Deev A. 52.  1998. Educational level and adult mortality in Russia: an analysis of routine data 1979 to 1994. Soc. Sci. Med. 47:3357–69 [Google Scholar]
  53. Singh GK, Siahpush M. 53.  2002. Increasing inequalities in all-cause and cardiovascular mortality among US adults aged 25–64 years by area socioeconomic status, 1969–1998. Int. J. Epidemiol. 31:3600–13 [Google Scholar]
  54. Singh GK, Siahpush M. 54.  2006. Widening socioeconomic inequalities in US life expectancy, 1980–2000. Int. J. Epidemiol. 35:4969–79 [Google Scholar]
  55. Subramanian SV, Kawachi I. 55.  2004. Income inequality and health: What have we learned so far?. Epidemiol. Rev. 26:178–91 [Google Scholar]
  56. Tarkiainen L, Martikainen P, Laaksonen M. 56.  2013. The changing relationship between income and mortality in Finland, 1988–2007. J. Epidemiol. Community Health 67:121–27 [Google Scholar]
  57. Tarkiainen L, Martikainen P, Laaksonen M, Valkonen T. 57.  2012. Trends in life expectancy by income from 1988 to 2007: decomposition by age and cause of death. J. Epidemiol. Community Health 66:7573–78 [Google Scholar]
  58. Wagstaff A, van Doorslaer E. 58.  2000. Income inequality and health: What does the literature tell us?. Annu. Rev. Public Health 21:1543–67 [Google Scholar]
  59. Waldron H. 59.  2007. Trends in mortality differentials and life expectancy for male Social Security-covered workers, by socioeconomic status. Soc. Secur. Bull. 67:1–28 [Google Scholar]
  60. White C, van Galen F, Chow YH. 60.  2003. Trends in social class differences in mortality by cause, 1986 to 2000. Health Stat. Q. 1329:25–37 [Google Scholar]
  61. Wilkinson RG. 61.  1992. Income distribution and life expectancy. BMJ 304:165–68 [Google Scholar]
  62. Wilkinson RG. 62.  2010. The Spirit Level: Why Equality Is Better for Everyone London: Penguin

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