Why inequality matters to your health

SINGAPORE - Rising inequality within and across nations does not just have an impact on incomes and economic opportunities. It can also affect public health.

It is generally accepted that poor people are more likely to fall ill and die early. When sick, they find it harder to get access to medical treatment. And when they do get care, they are more likely to die or to take longer to recover than the well-to-do.

A report produced by the World Health Organisation this year underlined the point. It noted that a woman born in some countries (Japan and Sweden) can expect to live for more than 80 years whereas a woman born in many African states can expect to live fewer than 50 years.

The high cost of health care can also force people into poverty in developed countries. Interview-based studies done in the United States by my research team have shown that many families slip into poverty in the wake of a health crisis. With the high cost of health care in the US, many families are an illness away from bankruptcy.

What is less well known, however, is that public health also tends to decline as inequality rises. That is, a society or community with higher income inequality is also less healthy as measured by mortality rates and self-reported health.

It isn't just the health of the poor who are adversely affected by rising inequality. The entire community feels the negative impact.

Why this should be so remains unclear. A recent review of 60 studies published in the International Journal for Equity in Health has shown that societies with high income inequality also have other social problems.

High inequality is associated with low levels of trust within communities and public institutions. It has also been linked to declining levels of public participation in community organisations, and low social cohesion. Other studies have noted a link between the incidence of crime in a community and the size of the income gap.

Benign social conditions, on the other hand, appear to be related to good health. In a recent article published in the Journal of Health Psychology, researchers analysed 39 studies conducted across multiple countries. They concluded that social ties, community participation, sense of community, reciprocity (willingness to help others, altruism and giving), social support and trust in a community are positively related to health.

Understanding how income inequality affects public health can help societies design policies that improve access to health-care resources and treatment as well as address the social determinants of health.

Looking at health care through the lens of income inequality allows policymakers and academics to ask questions about the different experiences of families when a member becomes ill.

What is the experience of a lower-middle-income family when a member is chronically ill? Can the family afford health care costs without becoming bankrupt? What are the health prospects for such a patient, compared with those for an upper-middle-income patient?

These are vital questions to consider when evaluating the quality of a health care system.

They are also relatively new issues for Singapore to contend with, given the dearth of studies looking at the impact of income on health outcomes.

But it is also an area of study worth considering in the light of the current debates on inequality in Singapore.


The writer is professor and head of the department of communications and new media at the National University of Singapore and director of the Centre for Culture-centred Approach to Research and Evaluation.

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