American Enterprise Institute
Health Policy Discussion
“Is Inequality Bad for Our Health?”
An event scheduled for October 11, 2001
From the invitation for this event:
“A popular topic in public health research today is that inequality, and in particular income inequality, is one of the most powerful determinants of health and the most important limitation on the quality of life in modern societies.
“While a few studies have provided evidence that the greater the disparity of wealth in a society, the less healthy the population, many researchers have gone well beyond what might be warranted by the weight of evidence alone. The World Bank, World Health Organization, and National Institutes of Health have even lent more credibility to the ‘income inequality as health determinant theory’ and its far-reaching implications such as the restructuring of important sections of our economic system.
“Jeffrey Milyo of the Irving B. Harris School of Public Policy, University of Chicago, will critique the income inequality hypothesis, its validity and its applicability.”
The invitation is available at:
Comment: So the American Enterprise Institute wants to refute the notion that income inequality is a determinant of health. We can anticipate the probable content of the presentation of Jeffrey Milyo by examining some of his work. The papers cited are available at:
In the following paper, Jeffrey Milyo and his colleague, Jennifer Mellor, conclude that “we find no consistent association between income inequality and individual health status.”
“Income Inequality and Health Status in the United States: Evidence from the Current Population Survey” By Jennifer M. Mellor and Jeffrey Milyo Abstract: Several recent studies have identified an association between income inequality and aggregate health outcomes; this has been taken to be evidence that inequality is detrimental to individual health. We use data from the 1995-1999 March Current Population Survey to examine the effect of income inequality on individual health status for both the general population and those individuals in poverty. We find no consistent association between income inequality and individual health status. Our results contradict recent claims that the psycho-social effects of income inequality have dramatic consequences for individual health outcomes.
In the following paper, they hedge a little bit by saying, “while the poor may suffer the most from inequality, it is claimed that the rich also suffer… ”
“Is Inequality Bad for Your Health?” By Jeffrey Milyo & Jennifer M. Mellor Abstract: “A number of recent studies suggest that income and social inequalities have detrimental consequences for population health. While the poor may suffer most from inequality, it is claimed that the rich also suffer, and as a result, redistributive policies may not be zero-sum. Perhaps for this reason, the inequality hypothesis has been met with great enthusiasm. In this paper, we review the basic arguments and evidence that inequality has a causal effect on health and find them wanting in many aspects.”
And in the following paper they concede that “none of this should be construed as a refutation of the claim that relative deprivation may have physical consequences.”
“Re-Examiniing the Evidence of an Ecological Association Between Income Inequality and Health” by Mellor and Milyo An excerpt from the paper: “None of this should be construed as a refutation of the claim that relative deprivation may have physical consequences. However, there are serious shortcomings in the current articulation of the inequality hypothesis, and in the way most authors have tested it.”
What is this all about? Conservatives are very concerned about the prevailing rhetoric that income inequality negatively impacts lower income individuals, especially their health status. This theory provides strong support for distributive policy, using a portion of “excess” wealth to meet our egalitarian desires for health care equity. Because of their strong opposition to distributive policy, they wish to refute the rhetoric of the egalitarians, and replace it with their own rhetoric. They wish to build on prior rhetorical successes such as, “I’m from the government and I’m here to help you.”
Milyo and Miller do present selected data that would suggest that income inequality, as an isolated finding, does not necessarily correlate with impaired health status. A wealthy community, including individuals with massive megawealth, might have significant income inequality, but, because of the paucity of very low income individuals, may not have impaired health status. Whether or not their conclusions are valid, their findings will allow the conservatives to establish the new rhetoric that “income inequality is not a health determinant.” This is very important rhetoric because most individuals will extrapolate the unwarranted conclusion that low income is not a determinant of health.
Newt Gingrich will be the discussant for this event. Hopefully, someone reading this message will attend, and present to him the following posit. Although income inequality alone possibly may not correlate with impaired health status, no person, not even Milyo, disputes that fact that low income is strongly correlated with impaired health status. Clearly, there is a pressing need to improve the status of low income individuals, whether through funding of public programs or through private or regulatory distributive policies. (Don’t hold your breath waiting for adoption of private distributive policies.) Where, in society, should the funding come from, if not from the more affluent individuals who could not possibly experience any change in quality of life through distributive policy? Or should we just concede that we are not egalitarian, and let the unfortunate fend for themselves?
America is better than that. Let’s clobber their rhetoric before it is disseminated.