Income Inequality, Health, and Sustainability: How are they connected Sustainable Seattle Driving Ch

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Income Inequality, Health, and Sustainability
How are they connected?Sustainable Seattle
Driving Change and Getting Results September
14th, 2005

• C. Linn Gould, MS, MPH
• Erda Environmental Services, Inc.
• ErdaEnv_at_aol.com

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U.S. Life Expectancy Where do we stand in World
Health Olympics?

• 1?
• 2-10?
• 11-20?
• gt20?

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Homicide Olympics

World Health Organizations World Report on
Violence and Health, 2002
Saltmarsh, 2004
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Child Poverty Olympics
Percent children living below national poverty
lines - U.S. ranked 25th among rich countries at
21.9
Innocenti Report Card, 2005
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Murray 1998
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Objectives

• What is income inequality and why traditionally
  important as indicator.
• Review sustainability framework by S2 and income
  inequality as social capital indicator.
• How is income inequality related to
• a. personal capital (specifically health)?
• b. natural capital?
• c. built capital?
• 4. Rising income inequality and health problems
  in U.S. and Washington State vs Louisiana
• 5. Discussion/questions

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What is income inequality?

• Different from absolute deprivation (poverty)
• -Poverty definition in U.S. 12,300 for 2 people
• -Developing countries 1.00/person/day
• Distribution of income (gap) between the rich and
  poor.

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Why is income inequality traditionally important
indicator?

• Poverty reduction - both growth and income
  distribution matter
• Bad for growth weakens the rate at which growth
  is converted to poverty reduction (slice of
  economic pie captured by poor)
• Social justice indication of politically
  sustainable and fair economic policies.
• Good standardized indicator - one of the 10
  sustainable development indicators used in Europe

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Sustainability Framework
Personal Capital (health, education, friends,
liberty, etc)
Sustainable Human Wellbeing
Social Capital (income inequality, institutions,
social services, neighborhoods, equity, etc)
Natural Capital (water, air,climate fish,
forests, etc)
Built Capital (cities, parks, waste, transportatio
n, utilities, etc)
Robert Costanza
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Davey Smith 1996 AJPH

• Established association between income and health
  
• Diseases of poverty premature mortality,
  undernourishment, persistent morbidity, poor
  education, etc.

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Relationship between mortality rates and
mean household income in WA State
Worse health

Higher income
Gould, 2003
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Relationship between income inequality and
health among developed countries
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Income Inequality and HealthThree plausible
pathways

• Access to life opportunities (ie., political
  participation, education, competitive spending)
• Erosion of social cohesion social capital
  (i.e., trust, mutual aid, access to services)
• Psychosocial and chronic stress (i.e., social
  support, hopelessness, sense of control, job
  security). Diseases are stress related heart
  attack, cancer, depression, etc.

Kawachi et al, 1999
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Political Participation and Health
Men's mortality is even lower when women's is
lower
Kawachi et. al. 1999
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Violence and Income Inequality
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Mortality Rates by Social Capital (Social Trust)
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Sustainability Framework income inequality and
natural capital
Personal Capital (health, education, friends,
liberty, etc)
Sustainable Human Wellbeing
Social Capital (income inequality, institutions,
social services, neighborhoods, equity, etc
Natural Capital (water, air,climate fish,
forests, etc)
Built Capital (cities, parks, waste, transportatio
n, utilities, etc)
Robert Costanza
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Environmental Kuznets Curve
Environmental degradation
Environmental quality initially worsens but
ultimately improves with income
Per capita income

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Redrawn Environmental Kuznets Curve
Environmental degradation
Environmental quality initially worsens, then
improves, but then worsens due to increasing
income inequality increasing power inequality??
(Torras Boyce, 1998)
Per capita income
Gould, 2005
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Relationship between Gini index and state
environmental stress index (p lt 0.05
significance level)
Gould, 2005
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Sustainability Framework income inequality and
natural capital
Personal Capital (health, education, friends,
liberty, etc)
Sustainable Human Wellbeing
Social Capital (income inequality, institutions,
social services, neighborhoods, equity, etc
Natural Capital (water, air,climate fish,
forests, etc)
Built Capital (cities, parks, waste, transportatio
n, utilities, etc)
Robert Costanza
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Income inequality


Reduced social cohesion

Infrastructure Roads, Sidewalks Public
transport Safety Walk/bike vs. bus/car

Disease/ injury
Injuries/accidents Obesity Mental Health
Environmental Quality Loss of forest/farm
land Global climate change Air pollution Hazardous
waste sites Water supply/purity
Asthma Cancer Chronic
Stress Heart disease Obesity
Degraded built environment
Green Space Recreation Aesthetics Controlled
nature Physical activity
Figure 3 Effects of income inequality on health
through environmental factors
Gould, 2003
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Rising income inequality for families (1947-1998)
www.census.gov
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Washingtons Health (2004)

• Washington ranked 15th in country, down from 11th
• Low support for public health 2 of state
  health budget
• 19.1 of children under age of 18 in poverty, up
  from 13.7

www.unitedhealthfoundation.org
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Louisianas Health (2004)

• Ranked 50th in nation for 14 years
• Ranks in bottom 5 states for high
• -premature death rate
• -infant mortality rate
• -rate of cancer deaths
• -percentage of children in poverty
• - uninsured population
• -prevalence of smoking

www.unitedhealthfoundation.org
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Income Inequality and Sustainability

• Politically unsustainable
• Economically inefficient
• Socially indefensible
• Amount of money needed to lift 1 billion people
  above 1/day poverty line is 300 billion, the
  equivalent of 2 of income of richest 10 of
  worlds population

UN Human Development Report, 2005
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"more egalitarian societies (i.e., those with a
less steep differential between the richest and
the poorest) have better average health" pg. 59

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Political inequality (i.e., voter turnout,
capital investment)
Economic inequality (i.e., income, wealth)
Inequality
Population Health/ Sustainability
Social inequality (i.e., hierarchy, education)
Potential causal pathway between inequality and
health/sustainability
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Thank you

• For more information on income inequality and
  health, visit the Population Health Forum
  website
• http//depts.washington.edu/eqhlth/

Advocating for Action Toward a Healthier Society
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How is income inequality measured?

• Several ways
• Gini index most common
• Robin Hood index, Atkinson index, Theil, etc.
• Health conclusions similar although it depends on
  what is to be measured.

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Gini coefficient/index

• Measurement tool for calculating income
  inequality at the population level
• Characterizes the distribution of income within a
  social unit or group of people and therefore has
  no analogue at the individual level of analysis.
• Ranges from 0 to 1, with 0 indicating perfect
  equality and 1 indicating perfect inequality
• Gini for US states in 1990 ranged from .38 to .50

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Relationship between Inequality and Health

• Health is sensitive indicator of social costs of
  inequality
• Health measured by life expectancy, diseases we
  get, quality of life
• Health mirrors economic inequality

Kawachi et al, 1999
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• The only way to eradicate poverty is to target
  inequalities (UNDP 2005)