Reply #1: I have a major section in my recent masters paper [View All]

[ashling]

which covers this - and uses charts from Wilkinson & Pickett (no relation) - I have been encouraged by several professors to develop it into a book ASAP. Here is part of it

Health
One measure of the health of a society is the health of members of that society, for they represent the human capital of the society.

Inequalities in health associated with socioeconomic status are large and they are growing. Most theories that explain these inequalities use indicators of socioeconomic status associated with the individual such as income, educational attainment, or occupation. A new hypothesis focuses on the distribution of income within a society as a predictor of health. Numerous ecological studies have provided support for this hypothesis showing that unequal distributions of income are associated with mortality in populations and life expectancy both between and within nations. These ecological
studies indicate that inequalities in income may have extraindividual or contextual effects that structure the social environment in ways that affect the health of a population. (Kennedy 1998)
“Within the United States, a strong, significant relationship has been observed between income inequality and mortality across the 50 states” (Kaplan et al. 1996; Kawachi and Kennedy 1997; Kawachi et al. 1997).

Obviously there is a wide variety of factors which have an impact on health. This fact has left some ambiguity in the research on the effect of inequality on health. In 1996 the editor of BMJ: British Medical Journal wrote, “The big idea is that what matters in determining mortality and health in a society is less the overall wealth of that society and more how evenly wealth is distributed. The more equally wealth is distributed the better the health of that society.” (BMJ 2009)

A recent editorial in that publication notes that since then there have been more than 200 peer reviewed studies published. “Income inequality has been variously associated with lower lif expectancy, higher rates of infant child mortality, shorter height, poor self reported health, low birth weight, AIDS, depression, mental illness, and obesity.”

Kennedy and Kawachi have studied the effects of income distribution and inequality of self rated health. The following key messages come from their work:
• Income inequalities are associated with fair or poor health
• Effects of income distribution on health were not limited to those in the lowest income groups
• Effects of income inequality are as strong as other individual risk factors

Their analysis leads to the inescapable conclusion that, “social and economic policies that affect income distribution may have important consequences for population health. (Kennedy 1998, 921) A recent (11/15/09) follow up epidemiological study of women who gave birth in 1988 and who had been contacted in 1991 concluded that “high income inequality confers an increased risk of poor mental and physical health, particularly among the poorest women. Both income inequality and household income are important for health in this population.” (Kahn, et al. 2000, 1311)

Women with young children in the lowest fifth of distribution of household income were at substantially higher risk of depression and poor health; the risk being further increased if women also lived in states with high income inequality. Household income and income inequality operated jointiy to influence maternal mental and physical health, suggesting a more integrated understanding of the two may help to focus research on the mechanisms at work. (Kahn, Wise, Kennedy, & Kawachi, 2000, p. 1315; see fig 10 & 11)





Mental Health & General Well Being
Positive mental health or ‘wellbeing’ influences a wide range of health outcomes. Healthier lifestyles, better physical health, improved recovery, fewer limitations in daily living, higher educational attainment, greater productivity, employment and earnings, better relationships, greater social cohesion and engagement and improved quality of life are all significantly affected by mental health. (Friedli 2009, 1) It is obvious, then, that positive mental health better equips individuals, and therefor communities and society in general, to function.

Traditionally, the relation between economic conditions and mental health indicated economic growth as a positive and poverty as a negative. An analysis done by University of York professor Kate Pickett (no relation), however suggests that higher national levels of income inequality are linked to a higher prevalence of mental illness and as countries get richer rates of mental illness increase. (Pickett et al 2006 see Fig 13)

Extreme socioeconomic inequality is extremely corrosive to positive mental health. A 2009 report by published by the World Health Organization on mental health, resilience, and socioeconomic inequality makes this very clear:
Mental health is a fundamental element of the resilience, health assets, capabilities and positive adaptation that enable people both to cope with adversity and to reach their full potential and humanity. Mental health is also the key to un-derstanding the impact of inequalities on health and other outcomes. It is abundantly clear that the chronic stress of struggling with material disadvantage is intensified to a very considerable degree by doing so in more unequal societies…. For this reason, levels of mental distress among communities need to be understood less in terms of individual pathology and more as a response to relative deprivation and social in-justice, which erode the emotional, spiritual and intellectual resources essential to psychological wellbeing. (Friedli 2009, III)

Communities with higher levels of “social capital, indicated by norms of trust, reciprocity, and participation, have advantages for the mental health of individuals, and these characteristics have also been seen as indicators of the mental health or wellbeing of a community.” (Friedli 2009, 25)