Wilkinson RG. National mortality rates: the impact of inequality? American Journal of Public Health 1992; 82: 1082-4

Wilkinson comments on various articles in this issue that demonstrate the socioeconomic determinants of health and suggest that increases in income among the least well off will produce improvements in health. He casts doubt on this hypothesis by presenting early studies looking at income distribution, and citing examples that fit this relationship. He points out that if the US or Britain were to adopt an income distribution like that of the healthiest countries, the improvement in life expectancy would be considerably greater than wholly overcoming the health detriment of the disadvantaged minorities. He suggests that health be treated as a genuinely social phenomenon. 

Abstract

Although health is closely associated with income differences within each country there is, at best, only a weak link between national mortality rates and average income among the developed countries. On the other hand, there is evidence of a strong relationship between national mortality rates and the scale of income differences within each society. These three elements are coherent if health is affected less by changes in absolute material standards across affluent populations than it is by relative income or the scale of income differences and the resulting sense of disadvantage within each society. Rather than socioeconomic mortality differentials representing a distribution around given national average mortality rates, it is likely that the degree of income inequality indicates the burden of relative deprivation on national mortality rates.

Keywords

• economic growth
• education
• Gini coefficient
• gross national product
• health inequalities
• income
• income distribution
• income inequality
• inequality
• international
• life expectancy
• medical care
• mortality
• population health
• poverty
• race
• relative deprivation
• social class
• social stratification
• socioeconomic status