The impact of income inequality on individual and societal health: absolute income, relative income and statistical artefacts

The relative income hypothesis, that relative income has a direct effect on individual health, has become an important part of the literature on health inequalities. This paper presents a four-quadrant diagram, which shows the effect of income, relative income and aggregation bias on individual and societal health. The model predicts that increased income inequality reduces average health regardless of whether relative income affects individual health. If relative income does have a direct effect then societal health will decrease further.     

The effects of race, household income, and parental education on nutrient intakes of 9- and 10-year-old girls NHLBI growth and health study

Nutrient intakes of 2149 black and white, 9- and 10-year-old girls varied by race, household income, and parental education. Of the three variables, higher education was most consistently associated with more desirable levels of nutrient intakes, that is, lower percentage of dietary fat and higher levels of vitamin C, calcium, and potassium. Higher income was related to higher intakes of vitamin C, but lower intakes of calcium and iron. Higher income was associated with lower percentage of dietary fat. After adjustment for income and education, race was associated with intakes of calcium, vitamin C, and to a lesser extent, percentages of kilocalories from total fat and polyunsaturated fat, and potassium. Black girls had a significantly lower intake of calcium (720 versus 889 mg) and a higher intake of vitamin C (91 versus 83 mg).Proportions of the cohort with inadequate or excessive intakes of micronutrients and macronutrients were also estimated. A high proportion of girls exceeded the recommended intake level of 30% of kilocalories from total fat (90% of black girls; 84% of white girls) and 10% of kilocalories from saturated fat (92 and 93%, respectively). Low intakes of calcium (40% of black girls and 20% of white girls) and zinc (36 and 38%, respectively) commonly were found for girls of both races.     

Income, relative income, and self-reported health in Britain 1979-2000

We test the relative income hypothesis that an individual's health depends on the distribution of income in a reference group, as well as on the income of the individual. We use data on 231 208 individuals in Great Britain from 19 rounds of the General Household Survey between 1979 and 2000. Results are insensitive to the measure of self-assessed health used but the sign and significance of the effect of relative income depend on the reference group (national or regional) and the measure of relative income (Gini coefficient, absolute or proportional difference from the reference group mean, Yitzhaki absolute and proportional relative deprivation and affluence). Only one model (relative deprivation measured as income proportional to regional mean income) performs better than the model without relative income and has a positive estimated effect of absolute income on health. In this model the increase in the probability of good health from a ceteris paribus reduction in relative deprivation from the upper quartile to zero is 0.010, whereas an increase in income from the lower to the upper quartile increases the probability by 0.056. While our results provide only very weak support for the relative deprivation hypothesis, the inevitable correlation of measures of individual income and relative deprivation measured by comparing income and incomes in a reference group makes identification of the separate effects of income and relative deprivation problematic.     

收入相关健康不平等实证研究

本文应用自报健康资料测算了上海市4区（县）的健康集中指数，考察收入相关健康不平等。研究不仅从实证角度阐述了收入相关健康不平等的测算方法，而且研究结果表明在样本地区存在收入相关健康不平等，并提示改善低收入人群的经济状况特别是收入状况对改善健康的重要性。     

收入分配差距对我国卫生保健公平性的影响

本文概述了我国城乡、不同行业和地区之间居民收入差距及其原因，主要从卫生筹资、卫生服务利用两个方面分析了收入差距对卫生保健公平性的影响，并就如何改进卫生服务公平性提出了政策措施。     

The effects of income on health: Evidence from lottery wins in Singapore

We estimate the causal effects of household income on self-reported health status by exploiting random variations in the amount of lottery prizes won. We find that a S$10,000 (US$7,245) increase in income via lottery wins improves individuals’ health by a standard deviation of 0.18. As possible mechanisms, we find that lottery wins increase household consumption spending and improve overall life satisfaction, but do not change healthcare spending, labor supply, and risky health behavior. Previous studies, which focused on the health effects of lottery prizes in Western European countries with strong social safety nets, do not find positive effects other than those on mental health. By contrast, the current study contributes to the literature by providing new evidence of the positive health effect of income via lottery wins in a country without strong social safety nets.     

经济收入和医疗保健制度对卫生服务公平性的影响

文章应用“利用/需要比“(Le Grand法)对南通和淄博两市职工家庭卫生服务利用的公平性进行分析发现,家庭经济收入对卫生服务公平性影响不大,不同医疗保健制度人群间存在不公平性,自费医疗限制了卫生服务利用,且与宏观经济状况和卫生服务体系改革有密切的关系.建议完善卫生服务体制改革,关注城市自费人群的卫生服务利用,提高卫生服务公平性.     

The relationship of household income to a range of health measures in three age cohorts from the West of Scotland

Background: The aim of this study was to determine the relationshipbetween household income and measures of health at differentpoints in the life course. Method: Analysis of second-wave datacollected in 1990–1991 in a longitudinal study of threeage cohorts (15, 35 and 55 years in 1987–1988) in theWest of Scotland was performed. The subjects were 851 18 yearolds, 801 39 year olds and 761 58 year olds on whom data onIncome and a range of health measures were available (92% ofthose interviewed in 1990–1991). Results: Blood pressurewas not significantly related to household income. Height, weight,waist:hip ratio, body mass index, pulse rate, long-standingillness and limiting long-standing illness showed linear associationswith household income and FEV₁/height², number of recent malaisesymptoms reported, number of checklist of 22 recent symptomsreported, GHQ scores and self-assessed health had curvillnearrelationships with household Income. There were interactionsbetween Income and sex for weight, waist:hip ratio, BMI andpulse rate and interactions between income and age for malaise,symptom checklist and self-assessed health. A threshold modelof the relationship between income and health was not supported.Conclusion: The relationship of income to health varies notonly according to the health measure chosen but by age and gender.     

Child health: evidence on the roles of family income and maternal mental health from a UK birth cohort

There is a growing literature showing an association between higher family income and better child health. This paper uses cohort data with rich information on mother's early life events, her health, child-health-related behaviours, and her child's health to examine this association for the UK and to identify some of the mechanisms through which income affects child health. The paper examines the cross-sectional association between income and health, finds the expected association, but concludes that the association with current income cannot be distinguished from one between permanent income and child health. It then focuses on the mechanisms by which income translates into better child health; these include parental behaviours that may affect child health and parental health, including maternal mental health. Controlling for these factors, there is almost no direct impact of income. A significant role is played by mother's own health, particularly her mental health. No clear role is played by child-health production behaviours of the mother. Examining the maternal mental health-child health link in more detail suggests a role for maternal anxiety and somaticism.     

The effects of state‐level earned income tax credits on suicides

This study examines the relationship between state‐level earned income tax credit (EITC) laws in the United States on suicides. Following findings in previous work showing that the EITC is associated with lower depression rates and reduced number of risky biomarkers, I estimated the effects of state EITC generosity on suicide rates. Using data for the years 1996 to 2016, a period with 74 state‐level EITC policy changes, I find that introducing a high state EITC rate reduces suicide rates for adults aged 25 or above by 3.91%. The results are consistent across four different measures of EITC generosity.     

The role of income differences in explaining social inequalities in self rated health in Sweden and Britain.

STUDY OBJECTIVE: To analyse to what extent differences in income, using two distinct measures-as distribution across quintiles and poverty-explain social inequalities in self rated health, for men and women, in Sweden and Britain. DESIGN: Series of cross sectional surveys, the Swedish Survey of Living Conditions (ULF) and the British General Household Survey (GHS), during the period 1992-95. PARTICIPANTS AND SETTING: Swedish and British men and women aged 25-64 years. Approximately 4000 Swedes and 12 500 Britons are interviewed each year in the cross sectional studies used. The sample contains 15 766 people in the Swedish dataset and 49 604 people in the British dataset. MAIN RESULTS: The magnitude of social inequalities in less than good self rated health was similar in Sweden and in Britain, but adjusting for income differences explained a greater part of these in Britain than in Sweden. In Britain the distribution across income quintiles explained 47% of the social inequalities in self rated health among women and 31% among men, while in Sweden it explained, for women 13% and for men 20%. Poverty explained 22% for British women and 8% for British men of the social inequalities in self rated health, while in Sweden poverty explained much less (men 2.5% and women 0%). CONCLUSIONS: The magnitude of social inequalities in self rated health was similar in Sweden and in Britain. However, the distribution of income across occupational social classes explains a larger part of these inequalities in Britain than in Sweden. One reason for this may be the differential exposure to low income and poverty in the two countries.     

常州和无锡市不同收入人群自评健康状况分析

目的 了解江苏省南部常州和无锡市不同收入人群的健康状况.方法 应用自测健康评定量表 (SRHMS1.0)调查2市居民共1350名.结果 2市不同收入人群的总体自测健康得分差异有统计学意义 (P<0.01);人均月收入低于1000元的群体得分最低,而月收入高于4000元的人群得分最高.不同收入人群在生理健康子量表、心理健康子量表、社会健康子量表上的得分差异均有统计学意义 (P<0.01);1000元以下的人群在各子量表的得分均为最低,而1000元～,2000元～,3000元～,4000元～各组的生理健康子量表得分差异无统计学意义;4000元～组的心理健康量表及社会健康量表得分最高.结论 2市居民的经济收入状况同其自测健康得分相关,低收入人群的健康状况较差;除了生理健康方面,收入最高的人群健康状况最好.     

From quantified to qualculated age: the health pragmatics of biological age measurement

There is growing interest, within the social sciences, in understanding self-quantification and how it affects health practices in contemporary society. There is, however, less research on how ageing and health measurement relate, even though this relationship has become more pertinent with the growing availability of services and devices offering biological, personalised age measurements, from simple online questionnaires to telomere length quantification. Little is known about who uses these devices, why they use them and the socio-technical implications of such uses. To explore these issues, we conducted semi-structured interviews and focus groups with users of measurements of biological age (BA) in Denmark. We found that participants engage with the measurements with a degree of scepticism regarding their technical validity, reliability and sensitivity. Rather than seeking an exact biological quantification, participants use measurements as a pragmatic, rough indication of individual health. We develop a conceptual model to understand participants’ engagement with BA measurements, which suggests that, instead of a substitution of chronological age for BA, users gauge the difference between the two to qualify their present and future individual trajectory in a lay model of the relationship between functional capacity and age.     

农民收入水平及其卫生服务利用研究

为研究农民卫生服务公平性 ,按照收入水平由低到高分为 5组 ,比较 5个收入组农民卫生服务利用、就诊流向和医疗预防保健费用支出等指标。结果表明 ,各组农民住院率、未住院率和未就诊率没有显著性差异 ,低收入组两周就率高 (P<0 .0 5 ) ;就诊流向上 ,89.1%的门诊病人主要集中在村卫生室和乡卫生院 ,5 2 %的住院病人集中在县乡级医院。低收入者乡卫生院门诊就诊比例较高 ,县乡级医院住院利用较高 ,差异有显著性 (P<0 .0 5 ) ;各组年人均医疗预防保健支出没有显著差异 ,但最低收入组年人均医疗费用占收入的 19.6 % ,面临较重的疾病经济负担     

Financial security and public health: How basic income & cash transfers can promote health

ABSTRACT

Inadequate financial resources are a major driver for poor health. Financial insecurity contributes to health inequities in mutually reinforcing ways, with some effects lasting years. Fostering financial security to reduce the likelihood or magnitude of such pressures would have significant present and future health benefits. We review several models for bolstering financial security to determine which have the most significant health contributions based on current evidence and their theoretical potential. We hypothesise that basic income guarantees might have the greatest positive health impact for beneficiaries, though this is heavily contingent on programme design and how financing affects other social welfare programmes. Cash transfer programmes also contribute to financial security and promote health, with particularly strong evidence for the health benefits of conditional cash transfers, and may be more feasible programmes in some contexts.     

Individual vulnerability and the nurturing state: The case of self-reported health and relative income

This paper develops a method to model the effect of income on self-reported health at the individual level. The model is estimated using the meta-analytic data of 68 studies from 13 countries, and is used to test two hypotheses. The first hypothesis is that income affects health at the individual level. If this is the case, the incidence of poor health will differ across people from different income groups. The second hypothesis is that income differentials are associated with differential vulnerability to poor health. If so, the influence of income on health outcomes will differ across members of different income groups in different countries.     

Summer‐born struggle: The effect of school starting age on health,education, and work

Children starting school older consistently exhibit better educational outcomes. In this paper, we underscore child development as a mechanism driving this effect. Using unique administrative data on health examinations, we study the causal effect of school starting age (SSA) on a child's probability of being diagnosed with special educational needs in early grades. Results show that children with higher SSA are less likely to develop behavioral problems and speech impediments, whereas learning disabilities, ADHD, and dyslexia/dyscalculia remain unaffected. Importantly, these effects only arise after primary school entry and are not due to preexisting health conditions. We also find that teachers tend to over‐refer relatively young children to special needs services, but this over‐referring behavior is not driving the results, which are based on psychologists' diagnoses. The SSA effect persists throughout compulsory schooling, resulting in higher test scores and better quality vocational training contracts. However, SSA does not affect employment, earnings, or disability insurance benefits at labor market entry.     

健康教育对贫困山区已婚育龄妇女生殖健康的影响

目的:研究集中授课、生殖健康教育手册、妇科疾病普查普治及个别咨询相结合的健康教育模式对贫困山区已婚育龄妇女的生殖健康状况的影响。方法:首先采用问卷调查、妇科检查的方法对1114例已婚育龄妇女生殖健康状况进行评估,再采用上述综合的健康教育模式对其进行为期1年的干预。结果:干预后生殖健康知识得分(71·85±12·15)高于干预前(40·25±8·70),P<0·01;妇科疾病检出率(34·83%)低于干预前(44·37%),P<0·01;性生活满意率(39·23%)高于干预前(23·39%),P<0·01。结论:四结合的健康教育模式能提高贫困山区妇女生殖健康知识水平。     

我国与收入相关的健康不平等实证研究

利用第三次国家卫生服务总调查的自评健康和收入数据,计算我国及各样本县区的健康集中指数,用以衡量与收入相关的健康不平等程度.从国际比较来看,我国的健康不平等程度处在较高水平;从地区比较来看,各地区的健康不平等程度存在较大差异.同时还发现,收入不平等程度与健康不平等之间存在较为密切的关系,但单从收入不平等本身不能很好地解释健康不平等.