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[PAHO/WHO Equity list & Knowledge network]

 

Income inequality and health: A causal review

Kate E. Pickett, Richard G. Wilkinson

 

Social Science & Medicine, 128(2015), 316-326

Published: March 2015

 

Abstract / Resumen:

There is a very large literature examining income inequality in relation to health. Early reviews came to different interpretations of the evidence, though a large majority of studies reported that health tended to be worse in more unequal societies. More recent studies, not included in those reviews, provide substantial new evidence. Our purpose in this paper is to assess whether or not wider income differences play a causal role leading to worse health. We conducted a literature review within an epidemiological causal framework and inferred the likelihood of a causal relationship between income inequality and health (including violence) by considering the evidence as a whole. The body of evidence strongly

suggests that income inequality affects population health and wellbeing. The major causal criteria of temporality, biological plausibility, consistency and lack of alternative explanations are well supported. Of the small minority of studies which find no association, most can be explained by income inequality being measured at an inappropriate scale, the inclusion of mediating variables as controls, the use of subjective rather than objective measures of health, or follow up periods which are too short. The evidence that large income differences have damaging health and social consequences is strong and in most countries inequality is increasing. Narrowing the gap will improve the health and wellbeing of populations.

 

Key Points: Evidence that income inequality is associated with worse health is reviewed. It meets established epidemiological and other scientific criteria for causality. The causal processes may extend to violence and other problems with social gradients. Reducing income inequality will improve population health and wellbeing.

 

Keywords / Palabras clave:

Income Distribution; Review; Population Health; Causality

 

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