UNNATURAL CAUSES is inequality making us sick? HEALTH EQUITY research topics and resources to learn more
Small Logo More films on equity and social justice »


Our top 10 resources
Childhood / Early Life
Chronic Stress
Food Security
Jobs & Work
Housing / Neighborhoods
Income & Wealth
Race / Racism
Social Inclusion
Policy & Change

Explore by episode:
Explore by type:
Keyword search:

Buy the DVD



Contact Us

Site Map


Sign up for our e-Newsletter
Bookmark and Share

Income & Wealth

Background: Perhaps the biggest predictor of one's health is one's wealth. It's not just the poor who are suffering; every step down the class pyramid corresponds to worse health. Study after study has shown that those at the top of the class pyramid live on average longer, healthier lives than the rest of us. The middle classes fare worse than those on the top, and the poor get sick more often and die sooner.

The greater the inequality in a society, the steeper the gradient. Currently, the United States has the greatest inequality among rich countries - and the worst health inequities. People in the middle are twice as likely to die prematurely (before age 65) as those on top; people at the bottom are three times as likely.

The life expectancy of American men in the highest income group is 8 years longer than for men in the lowest income group, two and a half years longer than for the second highest income group. Wealthy women live almost 7 years longer than poor women. Children in low-income families are seven times as likely to be in poor or fair health as those in high-income families. Poorer adults are three times as likely to have a chronic disease that limits their activity; twice as likely to have diabetes, and are nearly 50% as likely to die of heart disease.

Wealth doesn't just bring more material comfort, it also provides financial security and access to resources that promote opportunities for better health. Higher income affects health at every age, from the beginning of life to adulthood and old age. For adults, wealth is tied to neighborhood quality, work conditions, food security, access to medical care, and the availability of buffers against stress.

For children, the impact of advantages or disadvantages is even greater, because the effect on health is cumulative. The greater proportion of life one spends at the upper end of the class spectrum, the more benefits accrue. Children from affluent families are more likely to grow up in a house owned by their parents and to live in a neighborhood with healthy food options, safe places to play, good schools, libraries and other quality public services all of which help set them on the path to a successful, healthy life.

Children from less affluent families not only lack these advantages, they are more likely to experience conditions that limit their health and ultimately their life chances: injuries, inadequate or delayed health care, physical inactivity, poor nutrition, insecure or substandard housing, and exposure to toxins, high lead levels and violence. The influence of wealth on health begins even before a child is born, shaping the quality of prenatal care an expectant woman receives, her level of stress during pregnancy and her likelihood of delivering a premature or low birth weight baby.

Wealth is an important determinant of health because it has such a profound effect on other conditions. Yet at every socioeconomic level, African Americans, Native Americans and other people of color fare worse than their white counterparts. Racism as a stress factor independent of class partially explains this, but racism for example, in the form of residential segregation or job discrimination also directly affects wealth.

Today, the wealth gap in America is growing. The average CEO makes more than 250 times the average workers salary, and the top 1% of American households holds more wealth than the bottom 90% combined. In the last 25 years, the income of top earners has increased 81%, while wages for those on the low end of the pay scale have stagnated or declined.

Our health has followed suit. In 1980, the U.S. ranked 14th in the world for life expectancy. In 2007 we ranked 29th. One out of every five American children lives in poverty. Many of the countries that rank higher than we do have policies that protect workers, support families, and provide a safety net for their citizens. These policies typically address income and wealth inequality in one of two ways: (1) they reduce the overall gap so that everyone has sufficient resources to prosper and maintain control over their lives or (2) they loosen the connection between health and wealth by making certain resources available to everyone, not dependent on a family's individual assets.

Examples of policies to reduce the gap include a guaranteed living wage, earned income tax credits, family supports, guaranteed paid vacation and sick leave, secure pensions, and severance pay and job training for unemployed workers. Examples of policies to loosen the wealth-health relationship include universal preschool, better land use and zoning policies, school financing reform, universal health insurance, and stronger environmental protections and better enforcement.

Filter by Type

Income & Wealth: 0 items found

Image Thumbnail Disease and Social Policy in the American South: A Case Study of the Pellagra Epidemic (pdf) E-mail to a friend
LESSON PLAN, by Joan Brodsky Schur for California Newsreel, 2008

This lesson plan uses the series and the examination of primary source documents to guide students in understanding the social, economic, and political contexts of two epidemics in American history: pellagra and Type II diabetes. In six activities, students reflect on their own conceptions about the factors that influence health and longevity, learn about the socioeconomic conditions in the post-bellum South that led to the pellagra epidemic of the early 1900's, propose legislative solutions to the crisis, and finally use what have learned about pellagra to inform their understanding of the Type II diabetes epidemic among the Pima and Tohono O’odham Indians of southern Arizona today.

The lesson plan includes worksheets, links to primary sources, evaluation rubrics, and references to relevant standards.

In Word (doc) format

Image Thumbnail DiversityData E-mail to a friend
DATABASE of the Harvard School of Public Health and The Center for the Advancement of Health

DiversityData is an interactive website on socioeconomic indicators in U.S. metropolitan areas.

Image Thumbnail Economic Mobility Project E-mail to a friend

Pew's Economic Mobility Project (EMP) focuses public attention on economic mobility - the ability to move up or down the income ladder within a lifetime, or from one generation to the next. By forging a broad and nonpartisan agreement on the facts, figures and trends in mobility, the project is generating an active policy debate about how best to improve economic opportunity in the United States and to ensure that the American Dream is kept alive for generations that follow.

Image Thumbnail Economic Policy Institute E-mail to a friend

EPI is a nonprofit, nonpartisan think tank that seeks to broaden the public debate about strategies to achieve a prosperous and fair economy. It conducts original research on economic issues, makes policy recommendations based on its findings, and disseminates its work to the appropriate audiences. EPI's research focuses on four main economic areas: Living standards/labor markets; Government and the economy; Globalization and trade; and Education.

Image Thumbnail Embodying Inequality: Epidemiologic Perspectives E-mail to a friend
BOOK edited by Nancy Krieger

To advance the epidemiological analysis of social inequalities in health, and of the ways in which population distributions of disease, disability, and death reflect embodied expressions of social inequality, this volume draws on articles published in the International Journal of Health Services between 1990 and 2000. Framed by ecosocial theory, it employs constructs of "embodiment"; "pathways of embodiment"; "cumulative interplay of exposure, susceptibility, and resistance across the lifecourse"; and "accountability and agency" to address the question: who and what drives current and changing patterns of social inequalities in health? The book is aimed at health professionals, policymakers, and advocates concerned with social disparities in health, including class inequalities (including occupational health), racial/ethnic inequalities, gender inequalities and women's health, and disparities involving sexuality (including lesbian, gay, bisexual, and transgender health) and disability.

Image Thumbnail Enough to Make You Sick?: Something is Killing America's Urban Poor E-mail to a friend
NEWS ARTICLE by Helen Epstein, New York Times, 2003

A newspaper article that looks at the epidemic of premature "aging" and death in the poor. Epstein explores the question, "Is there something deadly in the American experience of urban poverty itself?"

Image Thumbnail European Portal for Action on Health Equity E-mail to a friend
EU Consortium for Action on the Socio-economic Determinants of Health

This Portal is a tool to promote health equity amongst different socio-economic groups in the European Union. Here, you can find information on policies and interventions to promote health equity within and between the countries of Europe, via the socio-economic determinants of health.

The information presented is the result of the collaboration of a wide range of health and social actors in the EU, that have come together in the context of a pan-European initiative that aims to stimulate action for greater health equity.

Image Thumbnail Falling Behind: Life Expectancy in US Counties from 2000 to 2007 in an International Context E-mail to a friend
SCHOLARLY ARTICLE , Population Health Metrics 2011 9:16

This study uses mortality data from 2000 to 2007 to assess disparities in life expectancy across US counties. Life expectancy rates for counties are compared to the life expectancies across nations in 2000 and 2007.

Image Thumbnail Family Income Impacts Children's Health E-mail to a friend
NEWS ARTICLE by Steven Reinberg, U.S. News & World Report, onREPORT by the RWJF Commission to Build a Healthier America, October 2008

Reinburg's article provides an overview of the Commission's 2008 report, America's Health Starts With Healthy Children: How Do States Compare?, which examines the health of children from different socioeconomic backgrounds in each state to document how healthy our nation's children are now and how healthy they could be if we as a nation were realizing our full health potential.

Image Thumbnail Foreclosed: State of the Dream 2008 E-mail to a friend
REPORT, United for a Fair Economy, January 2008

In this year's report for Martin Luther King, Jr. Day, United for a Fair Economy found that the subprime lending crisis is causing the greatest loss of wealth to people of color in modern US history. They also estimate the difference in losses due to racial bias. The report details how and why the damage occurred, and offers solutions for what can be done.

Image Thumbnail Forum #1: Healthy Communities (pdf) E-mail to a friend

Dolores Acevedo-Garcia, Meizhu Lui, Makani Themba-Nixon, and Jack Shonkoff answer questions from Web site visitors about neighborhoods, community organizations, labor, family, and early childhood.

Image Thumbnail Forum #3: Myths About Health Inequities (pdf) E-mail to a friend

William Dow, Tony Iton, Dennis Raphael, and David Williams answers questions from Web site visitors on diet, universal health care, the economic costs of poor health, the "healthy immigrant effect," and the difference between health disparities and health inequities.

Image Thumbnail Free lunch isn't cool, so some students go hungry E-mail to a friend
NEWS ARTICLE - New York Times, March 1, 2008

Lunchtime “is the best time to impress your peers,” said Lewis Geist, a senior at Balboa and its student body president. Being seen with a subsidized meal, he said, “lowers your status.”
San Francisco school officials are looking at ways to encourage more poor students to accept government-financed meals, including the possibility of introducing cashless cafeterias where all students are offered the same food choices and use debit cards or punch in codes on a keypad so that all students check out at the cashier in the same manner...

Image Thumbnail From Womb to Tomb E-mail to a friend
RADIO SHOW TRANSCRIPT, Stephen Bezruchka, Alternative Radio, April 2005

Bezruchka explains that an increasing stratification between the rich and the poor plays a major role in the United States' decline in health and life expectancy rankings over the last five decades. Life spans and infant mortality rates depend very much on the hierarchal structure of a society. And new research shows that half of what influences our health as adults is largely determined before the age of five. What can we learn from other countries whose citizens live longer and healthier lives?

The above link opens a pdf of the transcript. Audio of this and other radio pieces by Bezruchka are available at Alternative Radio. Other articles and presentations by Bezruchka are available in the Population Health Forum's Resource Library.

Image Thumbnail Gap in Life Expectancy Widens for the Nation E-mail to a friend
NEWS ARTICLES by Robert Pear, New York Times, March 23, 2008

New government research has found “large and growing” disparities in life expectancy for richer and poorer Americans, paralleling the growth of income inequality in the last two decades.

Image Thumbnail Getting Ahead or Losing Ground: Economic Mobility in America E-mail to a friend
REPORT by the Economic Mobility Project, Feb 2008

While the American Dream remains a unifying tenet for an increasingly diverse society, it may be showing signs of wear. Growing income inequality and slower economic growth suggest that now is an important moment to review the facts about opportunity and mobility in America and to attempt to answer the basic question: Is the American Dream alive and well?

This volume, authored by a team of scholars at the Brookings Institution, is one in a series of major research products that aims to further enlighten the public dialogue on economic opportunity.

Image Thumbnail Getting Under the Skin: Using Knowledge about Health Inequities to Spur Action E-mail to a friend
RESEARCH-IN-ACTION BRIEF, Charles Hamilton Houston Institute for Race and Justice, Harvard Law School, 2009

"This brief has two purposes. The first is to translate knowledge from the so-called “social determinants of health” arena into a useable form. The second purpose is to explore how to best use this knowledge to lobby for, and create policy and programming changes on the ground in, communities of concentrated disadvantage."

Image Thumbnail Growing Unequal: Income Distribution and Poverty in the OECD (United States) PDF E-mail to a friend
Charts & Data, OECD, 2008

"Growing Unequal?" brings together a range of analyses on the distribution of economic resources in OECD countries. The evidence on income distribution and poverty covers, for the first time, all 30 OECD countries in the mid-2000s, while information on trends extending back to the mid-1980s is provided for around two-thirds of the countries.  

The United States is the country with the highest inequality level and poverty rate across the OECD, Mexico and Turkey excepted. Since 2000, income inequality has increased rapidly, continuing a long-term trend that goes back to the 1970s.

Image Thumbnail Growing Wealth Divide Is Bad for Health E-mail to a friend
VIDEO EXCERPT, Unnatural Causes - Episode 7

In Michigan, as in other parts of the country, there's a growing chasm between the "haves" and the "have nots." As unemployed workers struggle to make ends meet and suffer declining health as a result, the wealthiest Americans are enjoying the spoils of our "winner-take-all" society.

Image Thumbnail Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease E-mail to a friend
BOOK edited by Richard Hofrichter

This public health reader draws on the growing body of recent literature to offer a comprehensive collection of articles written by a panel of expert contributors who represent a broad range of fields—sociology, epidemiology, public health, ecology, politics, organizing, and advocacy. Each article explores a particular aspect of health inequalities and demonstrates how the sources of health inequalities are rooted in injustices associated with racism, social class, and sex discrimination. This important book examines the political implications of various perspectives used to explain health inequities and explores alternative strategies for eliminating them. 

See especially: "The Politics of Health Inequities," by Richard Hofrichter, available free online.

Image Thumbnail Health Education Resources for ESL Educators E-mail to a friend

KQED has developed lesson plans for use with ESL/ ESOL student, using clips from UNNATURAL CAUSES and other media to broaden students' understanding of factors affecting health.

Lessons using the series:
Stress: The Bigger Picture (Not Just a Paycheck / When the Bough Breaks)
This Place Matters: The Impact of Neighborhood on Health (Place Matters and online video)
Living in the United States: Is It Good for Our Health? (Becoming American / In Sickness and In Wealth)
Food Pyramids: What We Eat and Who We Are (Becoming American)

Other lesson plans explore health literacy, the social contexts of drug and alcohol addiction, stress management, and cultural differences in medical practice.

Image Thumbnail Health Equity and Social Justice Resources E-mail to a friend

From the National Association of County and City Health Officials (NACCHO)

Image Thumbnail Health in America E-mail to a friend
VIDEO EXCERPT, Unnatural Causes - Episode 1

The U.S. is one of the richest countries in the world, yet we rank 29th for life expectancy. We spent more than twice what other countries spend per capita on health care. Why aren't we healthier?

Image Thumbnail Health in Black and White, An Interview with David Williams E-mail to a friend
INTERVIEW by Madeline Drexler, The American Prospect, April 27, 2007

Medical care itself is hardly the major determinant of health -- social context matters. Sociologist David Williams, one of the world's leading scholars on racial disparities in health and now the Norman Professor of Public Health at Harvard, talks about racial and socioeconomic disparities in health.

Image Thumbnail Health in Times of Global Economic Crisis E-mail to a friend
CONFERENCE VIDEOS, Oslo, Norway, 1-2 April 2009

Held by the World Health Organization in the European Region, this conference aimed to
- review the situation in the WHO European Region by identifying the main risks for health and health systems and the main opportunities for action;
- discuss policy options for responding to the negative impacts of the economic crisis on health systems and health outcomes in low-, middle- and high-income Member States in the Region;
- identify health- and health systems-related measures that could be used in the short and medium terms to counter the economic downturn and, in the longer term, to help address (some) structural issues confronting our societies.

« Prev   1 | 2 | 3 | 4 | 5 | 6 | 7    Next »