Population health in an era of rising income inequality: USA, 1980–2015

• Published in: The Lancet (British edition) 2017-04, Vol.389 (10077), p.1475-1490
• Main Authors: Bor, Jacob, Prof, Cohen, Gregory H, MPhil, Galea, Sandro, Prof
• Format: Article
• Language: English
• Subjects: Absenteeism; Adult; African Americans; Age; Aged; Antibodies; Bacon; Bankruptcy; Children; Cognitive ability; Cohesion; Control theory; Convergence; Cooperation; Damage; Demographics; Demography; Demography - trends; Divergence; Drug abuse; Economic analysis; Economic factors; Economic models; Education; Falling; Feedback; Female; Geriatrics; Health disparities; Health insurance; Health services; Health Status Disparities; Hum; Humans; Imprisonment; Income; Income - statistics & numerical data; Income - trends; Income distribution; Income inequality; Income redistribution; Internal Medicine; Laws; Life expectancy; Life Expectancy - ethnology; Life Expectancy - trends; Life span; Longevity; Low income groups; Male; Middle Aged; Mobility; Mortality; Negative feedback; Older people; Physical training; Plague; Population Health - statistics & numerical data; Poverty; Poverty - statistics & numerical data; Poverty - trends; Prisons; Productivity; Public health; Reviews; Risk analysis; Risk factors; Secondary schools; Smoking; Social Class; Social factors; Socioeconomic Factors; Socioeconomics; Survival; Survival Analysis; Technological change; Trends; United States - epidemiology; Vegetables; White people; Widening; Women
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(17)30571-8

Summary Income inequality in the USA has increased over the past four decades. Socioeconomic gaps in survival have also increased. Life expectancy has risen among middle-income and high-income Americans whereas it has stagnated among poor Americans and even declined in some demographic groups. Although the increase in income inequality since 1980 has been driven largely by soaring top incomes, the widening of survival inequalities has occurred lower in the distribution—ie, between the poor and upper-middle class. Growing survival gaps across income percentiles since 2001 reflect falling real incomes among poor Americans as well as an increasingly strong association between low income and poor health. Changes in individual risk factors such as smoking, obesity, and substance abuse play a part but do not fully explain the steeper gradient. Distal factors correlated with rising inequality including unequal access to technological innovations, increased geographical segregation by income, reduced economic mobility, mass incarceration, and increased exposure to the costs of medical care might have reduced access to salutary determinants of health among low-income Americans. Having missed out on decades of income growth and longevity gains, low-income Americans are increasingly left behind. Without interventions to decouple income and health, or to reduce inequalities in income, we might see the emergence of a 21st century health-poverty trap and the further widening and hardening of socioeconomic inequalities in health.