Home » Uncategorized » Income Disparity and Social Determinants of Health

Income Disparity and Social Determinants of Health

When looking for a topic to blog on, I stumbled upon a Ted Talk given by Richard Wilkinson titled the “How Economic Inequality Harms Societies”. Throughout his talk Wilkison discusses the social effects of income inequality and how social forces affect health. He illustrates this with statistical evidence that among developed countries, societies that are more equal (with a smaller income gap between rich and poor) are happier and healthier than societies with greater disparities in the distribution of wealth.

As a point of reference, please watch his talk here:

In his talk, Wilkison states, “the average well-being of our societies is not dependent any longer on national income and economic growth. … But the differences between us and where we are in relation to each other now matter very much.”

I feel these factors are fundamental social determinants of health. According to the World Health Organization (WHO) the social determinants of health are “the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.”

Poverty data explains what is going on at the bottom of the income ladder. But it is also important to understand the distribution of income, particularly as it relates to its effect on health and well-being. Wilkinson demonstrated that societal well-being bears no relation to per capita income.  He found that the symptoms of inequality trouble all levels of society. Across the board, mental health, levels of violence and addiction, even life expectancy are affected by the psycho-social stress caused by income gaps and status anxiety.

Among developed nations such as Canada, highly significant differences in health status indicators such as life expectancy, infant mortality, incidence of disease, and death from injuries exist. An excellent example is comparison of the social determinants of health differences among Canada, the United States, and Sweden.

Scholarship has noted that the USA takes an especially laissez-faire approach to providing various forms of security (employment, food, income, and housing) and health and social services while Sweden’s welfare state makes extraordinary efforts to provide security and services (Raphael & Bryant, 2006). The sources of these differences in public policy appear to be in differing commitments to citizen support informed by the political ideologies of governing parties within each nation.

What are your thoughts on his presentation? What are social determinants of health that affect your country?

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15 Comments

  1. Laura Chechette says:

    I enjoyed the presentation. I found it very informative and it definitely helped increase my understanding of economic inequality throughout the world. Being from the US I would be interested in seeing a presentation that looks at the same problems but compares the 50 US states. I know that some of his slides were based on the states, but I think because so many tax and social services decisions are made on the state and not national level it would make for an interesting presentation.

    The some of social determinants of health that affect the US are: social mobility, education, obesity, and addiction. Even though the “American Dream” is that if you work hard you can rise above and better your situation, that appears to be more the exception that the rule. If you are born into a poor family that means you probably live in a poor neighbor, with poor schools, poor working conditions, and poor health choices (exercise opportunities and healthy food availability. It is much more difficult for a person in this position to rise above because they don’t have the tools to do so. Again thinking back to those charts that compared the 50 states I think it would be interesting to look at the problems in a state and see how that state is working to fix it. For example on his chart about high school drop out rates (8 minutes in) MA was towards the right but not at the top. MA government is currently working to lower the dropout rate with a law that would raise the dropout age to 18. (http://www.cbsnews.com/8301-505245_162-57394140/mass-panel-backs-school-dropout-age-of-18) There are currently 21 states have a 18 year old dropout law and I would be curious to see how they compare on that chart.

  2. Boon Han says:

    The problem of income disparity is very much the bane of modern societies today. The increasing gulf between the rich and the poor has led to increased discontent and fault lines forming on the social fabric. The occupy movement which pits the 99% against the 1% is simply a culmination of this discontent.

    I think that it should be clear to almost every single person (and even politicians) that the disparity needs to be fixed. However, it takes much political will to change the status quo. The devil is in the details as it involves the interests of several different social groups from different stratas in society. From my limited understanding of American society, I would think that it is especially difficult here due to the nature of the 2 party system representing groups with conflicting interests which leads to policy makers having their hands tied and forced to to what is “politically acceptable” but may not be the best for society. With campaign funding mostly coming from the top 1% of society, it is not difficult to figure out who these politicians are beholden to and whose interests take priority when these politicians get elected? These are just my personal opinions gleaned through watching the GOP race and reading the papers here so do correct me if I am wrong….

    Just to share a little about Singapore, where I come from. At the 2min 36s point in the video, the chart shows that the richest 20% are 9.7 times richer than the poorest 20% of Singaporeans. This is even higher that the 8.5 times in the US.

    However, in Singapore, the top 20% bear almost 80% of the entire tax burden in Singapore and almost 60% of Singaporeans do not pay tax. Also, almost 80% of Singaporeans live in government subsidized apartments which according to the latest reports, a household with a monthly income of about US$800 will be able to purchase a 2 room apartment from the government after factoring in all government subsidies. There are also indirect taxes on vehicular use and consumption which tilts the tax burden further towards the rich.

    Many of the younger Singaporeans have been complaining that we have very little political freedom as compared to the United States as we have had a one party government ever since independence in 1965. Opposition politicians make up only about 5% of our parliament. However, it is also because of this dominance of the ruling party that they have been able to make bold and pragmatic decisions over the years and have them swiftly implemented to steer Singapore in the right direction even when some of these decisions are unpopular and a bitter pill to swallow for the citizenry. Wages were cut and adjusted during the Asian Financial crisis to much unhappiness in the country but Singapore managed to emerge relatively unscathed when compared to many of our neighboring countries which sort of vindicated the government then.

    Due to Singapore’s uniquely small size, we don’t have a problem with the accessibility of good schools and modern hospitals and no one is deprived of medical treatment or an education in Singapore no matter how poor he or she is. There is much talk in Singapore now about building an inclusive society and the government is taking very concrete steps towards that. The older generation has been largely supportive of a government who places emphasis on bread and butter issues in Singapore and are willing to sacrifice a little bit of their liberty and freedom while the younger generation is increasingly demanding for their voices to be heard. I guess our society will have to eventually reach a consensus of what exactly it is that we want…

  3. KSA ROCKS! says:

    Hey Lisa – I think that Richard Wilkinson’s talk on “How Economic Inequality Harms Society’ presents striking findings about the causes of inequality and its connection to social determinants of health in different nations. It is difficult to disagree with his opinion, because all the presented data is scientifically proven and he just embraced statistical evidence into some conclusions to think about. Even though he omitted interesting countries for this research like India or African states, I liked comparison with Scandinavian or Japanese view to social politics.

    Even though there is no connection between country’s GNP or GDP volume with the life expectancy rate, there is a division within the country itself to rich and poor. This division, when incomes are distributed unequally, causes inequality within the society. It is interesting to have a scientific proof, that economic growths together with national income do not define the state of country’s well-being. Wilkinson mentions the level of trust, mental health, violence and social mobility among others as indicators of health status. I agree that there is no correlation between economic indicators and countries’ level of social welfare. What matters the most is countries’ internal politics and the conditions in which people are born and grow.

    If we look at the US, one of the developed countries with high GDP, the social determinants of health are influenced by democracy and approach to social security. People have equal access to health and social services, employment opportunities together with other forms of security. However there is a challenge to engage with the multiple sectors and understand different layers of society. Arguably, there is much more to consider in improvement of pshyco-social effects of inequality.

    • I think Maha does a great job of summarizing the Ted Talk in terms of economics v. well being and the additional aspects that should be considered.

      To Laura’s point, before moving to Boston I was living in Connecticut- often known as the United States’ most wealthy state. While living there I was working at United Way in New Haven and I learned a GREAT deal about disparities. In New Haven County a study showed that there were income, health and economic disparities between the 9 cities in the county and that for some to thrive, others cannot be struggling. At the time (2007-2008), I could rattle off the number of homeless people in New Haven (in the thousands), the number of domestic violence cases, and the number of youth violence cases (weekly occurrences). I could also tell you where to go for all of these issues. Even though there were great disparities, New Haven was lucky that there were a number of non profits available to (most) people who sought them out. Then of course, there are the large number of people who never seek out help and continue to suffer.

      While some places are seen as wealthy like Connecticut or the US, there truly is so much more to look at in order to determine if those places are successful and happy. Now many people in the US would accuse standardizing health and other options as “Socialism”, but if there is proof that those countries are happier and more sufficient, then why is “Socialism” so scary?

      • lisamedina says:

        @ Laura, I think you bring some really great points up and I think it would be really interesting to see how those 18 states compare. I’m originally from New Jersey and they just recently approved the drop out rate age to increase to 18 this past February. I think this going to be huge for NJ, because in the town I’m from specifically, there is a big divide in income across the community. The town is split in half by railroad tracks where middle income and high income families generally live to east and poorer families live the west. I really don’t know how this came this natural divide came about, but it’s blatantly obvious what the disparities are across the town.

        In my town we have an extremely high teenage pregnancy rate per capita (one of the highest in the country) and a subsequently large school drop out rate. I think it’s interesting to see that even on a smaller scale poor living conditions can trickle down and affect so many different parts of a community’s well-being.

        @Jacki – I think you brought up a great point of a lot of resources available are underutilized, specifically nonprofits. I don’t think the government can do a whole lot to change disparity on the local level and I think it’s so important that nonprofits work to help provide resources within the community, because the fact of the matter is they need it. After I graduated from college, I didn’t have health insurance for a over a year and it was definitely an eye opening experience. Luckily for me there a was a “charity care” program in my town which allowed me to have still access to healthcare, but it just wasn’t at all at the same caliber I was used to. I still distinctly remember one day going in for an eyecare appointment in the middle of the summer. The waiting room was packed with over 30 adults and over 20 kids. When I finally got into the examination room the eye doctor broke out a box of lenses because they didn’t have a refractor (glasses prescription instrument). I’ve never seen a test done this way since I had been wearing glasses (for over 15 years), so I knew this method was little archaic. This wouldn’t have bothered me if he didn’t ask me to put a pack of post-its on my eye as part of the vision test.

        Sure we have healthcare “available” to everyone in some way or another, but the truth of the matter is not everyone has access to the same level of healthcare. With a new focus on education by increasing school drop out age it will be interesting to see if more people have access to health insurance and if they’ll have a better opportunity at breaking the barriers they were born into.

    • lisamedina says:

      @Boon & Maha – Boon, I think you did a great job humanizing some of the statistics presented in the Ted Talk. As Maha said Wilkinson did a great job comparing developing countries, but it’s interesting to see how income disparity doesn’t effect all of these countries the same way. It’s so important to take into consideration all of the different factors that can affect a country’s social welfare. Whether it be the type of government, the education systems in place or healthcare systems in place – everything is different in each country.

      While I really liked this presentation, I think Wilkinson bordered on a slippery slope of generalizing countries conditions by lumping them into one category as “developed countries.” I think all too often we try to generalize and over analyze why countries are structured the way they are or how we can hypothetically fix a country. There isn’t always a correlation and situations can’t always be economized. Often we feel like we understand a country based on statistics, but until we’ve experience a country’s internal politics these statistics are just numbers and they don’t have a real meaning to the individual (or at least to me).

  4. Alex says:

    This is an interesting topic, Lisa. It is an unfortunate truth that where one is born can have so many negative effects on so many aspects of health and quality of life.

    I will reflect on this from a local level. I remember a campaign a couple of years ago with signs in the Boston T subway trains that said “What’s your health score?” and it had bullets about risks and characteristics of Americans born in certain areas. I just tried to find something related to this campaign on YouTube so I could post it, but I am not finding anything. I am not sure if the subway campaign was run by the Boston Public Health Commission or some other party. Basically, the campaign was tasked with bringing to people’s attentions how their environments in or around the city impacted different aspects of their health.

    It is really eye opening that the places where we were born, live in, and work in, can have such great effects on our health. How clean is the water? How clean is the air? What kind of food shopping is close by? What do jobs pay? How does my salary impact the quality of food I am able to buy? Or the type of health insurance I have?

    On a national level, it is fascinating how highly developed countries put their emphases on such different policy issues. Health insurance is a hot button in the U.S. I will only touch on it briefly, but many in the U.S. wonder why all Americans can’t have health insurance like in in Canada. I think it is deeper than a health insurance issue, but it has to do with what the ultimate goals and values are.

    To talk about health disparities, I think we also have to talk about income disparities, and even other related issues like tourism. I think there are many countries with different levels of disparities. There are certainly disparities in the U.S. However, when I look at other countries, like some in the Caribbean that we may travel to from a cruise ship, they may have beautiful resort communities, but also greatly impoverished communities. For instance, Honduras is one of the poorest countries in the world, with poverty striking in several ways. However, I could take a cruise ship and spend time in a resort community in Honduras. I am not an economist, and I don’t know what impact the presence of the resort community has on the locals in terms of being positive or negative. But I think that different types of disparities in different places definitely are impacted by what people are conditioned to see as important and what types of initiatives and policies they have put effort into.

  5. sonigreca says:

    Quite interesting and insightful presentation. I like how used date to support his presentation. But, some of the points were hard for me to relate to the society I came from coz he mainly talked about developed countries in his presentation…

    In China income disparity and social inequality is a huge deal. China has a fasti growing GDP but it doesn’t reflect much on individuals, especially poor people… In China, rich people are extremely rich, and poor people are extremely poor. This income disparity and social inequality is also one of the main reasons why there are more and more people in the cities and less and less people in the rural areas. In terms of social determinants of health that affect my country, I think they are similar to what you mentioned in your post like the conditions in which people are born, grow, live, work and age, and also their social levels…Many people in the rural areas have little income by working in the farm. They don’t have health insurance, and even good hospital in the rural areas. A lot of people go to the cities to find good hospitals and doctors. They are not treating well because of where they from. Hospital sometimes refuse to take patients from rural areas because they don’t have enough money… Many patients’ family members don’t have good relationship with doctors… Social inequality and health is quite a mess in my country…

  6. Ji Li says:

    I really agree what he mentions in his presentation that the average well-being of our societies is now dependent on the differences between people, and where people are in relation to each other now matter very much.

    In China, in my opinion, the social determinants of health are mainly work, income, and people’s social status. In fact, these three factors are closely related to each other. Since China is a country with a huge population, hospitals in my country are really busy and crowded all the time. On some special occasions, people even need to line up for a whole day or whole night just in order to get a chance to see the doctor. In the meantime, the cost of seeing a doctor keeps increasing, which makes people with low income desperate. As Sonya mentioned above, social inequality and health is really a mess in China…There is a huge income gap or “social status” gap existing in China’s society, which strongly influences people’s daily life, including health issue for sure. To be more specific, people with low income can hardly afford the expenses of good hospitals, while rich people are occupying most resources and services of good hospitals. Meanwhile, ordinary people can hardly get access to good doctors while people with high social status or authority are much easier to communicate with good doctors. Such inequality leads to serious social contradiction that is still lasting today…That’s why I think that work, income and social status are main social determinants of health in China. If you are rich, if you are senior officials, if you have close relationships with doctors or the hospital, you will be treated really differently. It seems just so depressing to me.

  7. meredithmckenna says:

    I really enjoyed watching this presentation and learned a lot about how the U.S stacks up to other countries in terms of the relationship between GDP and health/ wellness. Even though the U.S. is wealthy, our overall health does not reflect this prosperity because of the unequal distribution of the wealth, which continues to grow annually. I really liked when Wilkison said, “If Americans want to live the American dream, they should go to Denmark.” It is more difficult than ever to achieve a better economic status, and the gap between the rich and the poor continues to widen.

    Although a country’s overall wealth does not determine the overall health of a country, the people inside the country who are the wealthiest will have access to the best health care and will most likely live the longest. I think that income level is the main cause of health disparities but other factors such as ethnicity and race (certain races/ethnicity groups are pre-disposed to certain diseases), and education are major determining factors as well. I think that specifically education can be a factor in improving the lives of the general population in the U.S. (and around the world). As we learned in “The Culture Code”, certain practices can be imprinted into a society at a young age. I think if we do a better job of implementing healthier eating habits, exercise, etc, into our society, we will see changes in preventable diseases such as diabetes and heart disease, two of the U.S.’s biggest health issues.

  8. tjglover23 says:

    This is interesting. I think that each country, like cultures and people value different things. I am not sure in the US that it is because the income disparity is so large that we have lacked in other areas or that the income disparity is due to what we find important. The US puts all value into money, who has it, who doesn’t and how can I get it. If that is the focus then health, education, and societal welfare is not that important. If the US felt that any of those three things were of greater or equal value to money/power then maybe the income disparity would not be what it is.

    I may be a cynic but I just don’t think that the world has or will do what it takes so that everyone will live well and flourish. I say this because if everyone is taken care of then how do people satisfy their need for power and respect unless they are over or better than someone else. I am not saying that this is right, but that it is human nature to want to dominate. So even if say the US decides to take care of every American the way they should, they [the US] will find some other country to keep just above horrible but right below being fruitful.

    Then the US had a chance to have health care for everyone with Obama’s health care plan and you see what we did with that. I think all the facts and figure and great in theory for change but unless people want to change and are willing to put egos aside and work together then change will remain theory.

  9. andreslmc says:

    This is an interesting presentation of economics data. I didn’t realize that economic disparities between the rich and poor played such a pivotal role as a social determinant of health in developed countries. This makes me think about all of the news reports we have seen in recent years about the growth of socio-economic disparity in the U.S. It seems that socio-economic disparities may have gotten wider during the current economic crisis the U.S. This is particularly worrisome because the cost of health care has continued to rise and shows no sign of slowing down.

    In Colombia the socio-economic disparity between rich and poor is greater than in the U.S. The economic disparity in densely populated areas has often led to high rates of violence. The violence has negatively affected public health by lowering the life expectancy age especially of males who live in densely populated urban centers.

    In Colombia’s rural areas the economic disparity between rich and poor is evident in the quality of public utility services. Access to clean drinking water is limited in Colombia’s poorest rural communities. In effect many people who live in these rural areas are exposed to becoming infected with cholera. In addition, many Colombians who live in warm climate poor rural areas are also exposed to tropical diseases such as malaria.

  10. zhoulinjolin says:

    I like the speech, and all the presenter’s data are strongly persuasive. His graphs cover a number of aspects of social health, both physically and mentally, which increase the role of social determinants that affect a country’s health. I think in China, the social determinant of health could be concluded to one term, which is social gap. As Ji stated, social gap has relations with income, social status, and social welfare. When Wilkinson illustrated one of graphs and mentioned Japan and Sweden particularly, I am impressed with his conclusion that it doesn’t much matter how they get more social equality as long as they get it somehow.

    Still taking see doctors as an example, in China, though social welfare is much less than some Europe countries, most employees still have basic health insurance which can cover most of cost in hospitals. But still there are hundreds of thousands t of “unskilled manual” workers who work without health insurance. Most of them are farmers, or low income labors who come from rural areas and work in big cities. If you ever followed news about workers who assemble iPhone and iPad in a Chinese factory, you would have an idea how bad their working environment is. They are just the group earning few and working without insurance. Therefore, when they are sick, they can hardly afford a good doctor or medicines.

    Even for those people who are sponsored with health insurance by employers, not everyone of them can get access to the most professional doctors, or afford the best medicine, or get the best treatment. For one reason, expensive and rare medicine sometimes recommended by doctors are always not covered by basic health insurance. For another reason, as Ji said that, people with higher social status like senior officials or very rich people occupy more resources. For an ordinary person, he can only get a ticket to see a mid-level doctor because those top level doctors have limited tickets; but a senior official can easily and can always go to see expert doctors. Social status play much role in social health and also other social aspects of China. This maybe somehow reflect Chinese culture. But I still believe that to improve social welfare and narrow the social gap between rich and poor people can be a solution.

  11. grabernieto says:

    Interesting topic, I took the topic and looked at it this way. I thought of those countries where they are trying to close the gap between social groups, and I couldn’t stop thinking about the consequences that may have in the health and economic of individuals. I think my home country serves as a great example. The current government has tried to adopt a model where those in lower economical status enjoy and equal status as of those in higher strata. From this model, all I have seen is continuous inequality, the rich are still rich and the poor still poor. In terms of health, all these inequalities and political torn-moil only cause for more issues in the health system of the country, since those in lower status depend on government subsidiary services for their health. It is interesting, how your blog has shown as all how important it is for countries to structure their their government and adopt a more equality model for its inhabitants.

  12. lisamedina says:

    Thank you all for providing insight on the presentation! I think we can all agree that income disparity has a huge effect on the social welfare of a country. Just about everyone expressed there was some level of income disparity within their country, but different determinants of health surfaced as major influences in your countries. As Taja pointed out, this isn’t a problem that is going to disappear anytime soon, but I think through this discussion we see how important it is to narrate these statistics and hear how some countries are affected by income disparity. We should also understand the importance for countries to look to their neighbors for influence – whether in be for healthcare or for policy making and etc.

    While I didn’t realize this earlier, this month is the CDC’s “Minority Health Month”. This is a month where CDC focuses on bringing awareness to and highlighting several efforts towards the advancement of health equity. If you get a chance please check out their website to see some of the efforts they’re making to close the gap in healthcare: http://www.cdc.gov/Features/MinorityHealth/

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