van Doorslaer E, Wagstaff A, Bleichrodt H, et al. Income-related inequalities in health: Some international comparisons.  Journal Of Health Economics 1997;16(1):93-112.

What is the relationship among countries of so-called health inequalities (the term used to denote the relationship of socioeconomic status with health, ie. poorer people have poorer health, however poor is measured) and income inequality?  This sophisticated study makes direct comparisons between income and health differences in different countries by using individual self-reported health (use of self-reporting avoids  medicalization) in each country.  Health inequalities are computed by country with statistical tests used to establish confidence intervals.  A strong relationship with income  inequality is found suggesting that high income inequality generates a high degree of health inequality.  The US and the UK  look particularly bad in comparison to the other 7 European countries, a finding that is statistically significant.  It prompts the observation that a high degree of health care spending (per capita) are positively associated with health inequality.  [That the US is the biggest per capita spender on health care, yet has the worst health indicators should be troubling.] 

Abstract

This paper presents evidence on income-related inequalities in self-assessed health in nine industrialized countries. Health interview survey data were used to construct concentration curves of self-assessed health, measured as a latent variable. Inequalities in health favoured the higher income groups and were statistically significant in all countries. Inequalities were particularly high in the United States and the United Kingdom. Amongst other European countries, Sweden, Finland and the former East Germany had the lowest inequality. Across countries, a strong association was found between inequalities in health and inequalities in income.

Keywords

health inequality.  international comparisons, income distribution, self-assessed health