Does Income Inequality Kill People?

In a 2015 review now cited more than a thousand times, Kate Pickett and Richard Wilkinson do not equivocate. The relationship between income inequality and poor health meets criteria for causality. The causal path involves violence and other problems with social structures. So reducing inequality will improve public health and wellbeing.

Predicting COVID-19 Deaths

In the COVID-19 pandemic, this observation has proven to have profound importance. Researchers pour over statistics on COVID deaths to understand why the rates vary so much from place to place. Three factors stand out: inequality, population density, and nursing home residents per capita. But income inequality rises to the top.

Youyang Gu, whom Bloomberg describes as a COVID-19 data superstar, wrote in June that “income inequality is the single best predictor of total COVID deaths in the U.S.”

The Economist recently followed up with a survey of global research and concluded that Gu has a solid observation:

“Our survey of the dozens of papers investigating the determinants of the toll from covid-19 finds that inequality has consistently high explanatory power. A recent study by Frank Elgar of McGill University and colleagues, looking at 84 countries, finds that a 1% increase in the Gini coefficient is associated with a 0.67% increase in the mortality rate from covid-19. Another, by Annabel Tan, Jessica Hinman and Hoda Abdel Magid of Stanford University, looks at American counties. They find that the association between income inequality and covid-19 cases and deaths varied over 2020 but was generally positive; higher inequality tends to lead to more suffering.”

Health, Work, and Social Capital

The Economist tells us three factors might explain this relationship. First is pre-existing health. People with chronic diseases – like obesity – are more likely to die when infected. As Pickett and Wilkinson describe quite clearly, poor health and income inequality go hand in hand. One part of this is the relationship is the link between obesity and inequality. George Bray spoke memorably about this in the 2013 Blackburn Lecture. Pickett and Wilkinson wrote about it in the Journal of Epidemiology and Community Health.

The second factor is the workplace. Where frontline workers have more equal status, they can expect better working conditions. They enjoy conditions that don’t expose them to infection. Frontline workers in Sweden, for example, have not faced a higher risk of deaths from COVID. But in the U.S., Britain, and Canada they have had less protection. Thus, they’ve faced more risks. Yet some U.S. employers complain that “people don’t want to work.” They simply don’t understand that low-wage work might not be worth risking the loss of life.

The third factor is social capital. With high inequality comes a loss of trust – in neighbors, experts, and government. Thus, it may be less likely that people will follow advice to control the risks of this pandemic.

Lifting People Up

Is it possible cajoling people about nutrition and health is not so helpful? Perhaps some of that effort should go into lifting people up – reducing inequality. Because if Pickett and Wilkinson are correct, less inequality might mean better health for us all. It’s worth considering on this Labor Day.

Click here for more from The Economist. Click here, here, and here for more from Pickett and Wilkinson.

Power House Mechanic, photograph by Lewis Hine / Wikimedia Commons

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September 6, 2021