january 13 income and wealth

SDOH Lesson #2: Income and Wealth

The Effects of Income and Wealth on Health

Lesson Outline

  • Economic Resources and Disparities

  • Root Causes of Economic Disparities

  • Impact of Economic Status on Health

  • Income Inequality and Health

Understanding Health Distribution

  • Health is not randomly distributed in society.

  • Leonard Syme (2015) emphasizes that medical degree holders must understand societal factors to comprehend health distribution.

Economic Resources

Definitions

  • Wealth: Value of possessions and assets accumulated over time by an individual/family.

  • Income: Earnings over a specific period.

Distribution of Income and Wealth

  • Many middle- and working-class individuals live paycheck to paycheck.

  • The wealthiest individuals account for approximately 68% of net worth, while the least wealthy represent only 2.7% (Statistics Canada, 2023).

  • The wealth gap between rich and poor is increasing continuously.

Income and Wealth Inequality by Gender and Race

  • Average incomes:

    • Male: $51,600

    • Female: $45,700

    • Non-racialized male: $54,100

    • Non-racialized female: $47,800

  • The Black-White wealth gap begins early in life and widens with age (Statistics Canada, 2023).

Reasons for Income and Wealth Gap

  • Systemic and Structural Racism: Creates barriers.

  • Racial Residential Segregation: Limits access to resources.

  • Racial Discrimination: Affects hiring, pay, and promotion.

  • Discriminatory Policing and Sentencing: Contributes to disparities.

Economic Structural Changes

  • Transition from manufacturing to a knowledge economy over the last 50 years.

  • Manufacturing jobs have relocated to countries with lower costs.

  • Current focus on sectors like technology, healthcare, finance, and service.

  • Higher education is becoming essential, making survival without credentials increasingly difficult.

Disparities in Wealth Accumulation

  • Individuals with disabilities experience higher rates of poverty.

  • Wealth disparities favor older demographics, although this may not apply uniformly to racialized groups.

Association Between Income and Health

  • Higher income correlates to longer life expectancy.

  • The gradient effect indicates that health improves with increasing socioeconomic status (SES).

Early Life Effects on Health

  • Lower-income households result in poorer health outcomes for children.

  • Parental wealth significantly impacts children’s health due to early life developmental conditions.

Impact of Wealth on Healthcare Access

  • Greater wealth eases access to healthcare services.

  • Wealth facilitates purchasing of private health insurance and dental care.

  • Reduced risk of debt-related health compromises, improving overall health outcomes.

Living Conditions

  • Wealth improves living conditions, allowing access to:

    • Safer homes

    • Nutritious food

    • Opportunities for physical activity

    • Reduced neighborhood violence and overcrowding

Psychosocial Benefits of Wealth

  • Reduces life stressors and chronic stress.

  • Enhances social cohesion, fostering community ties.

Intergenerational Wealth and Health

  • Wealth accumulation boosts educational and economic prospects, influencing lifelong health trajectories.

Economic Inequality at Population Level

  • Healthier populations tend to emerge in countries with less income and wealth inequality.

  • The distribution of wealth within a population significantly affects overall health.

The Whitehall Studies

Overview

  • A series of studies on British civil servants aimed at understanding SES and health outcomes.

Whitehall I (1967)

  • Focus on male civil servants.

  • Sample size: ~18,000 men aged 40-69 years.

  • Investigated the relationship between employment grades and mortality rates.

Whitehall II (1985)

  • Included both men and women.

  • Sample size: ~10,308 participants.

  • Extended scope to various health outcomes, including mental health and work-related stress.

Key Findings from Whitehall Studies

  • Lower SES is linked to poorer health outcomes.

  • Chronic stress and work control deficiencies are significant contributing factors.

Health-Income Gradient

  • Demonstrates that health improves as income increases, observable across multiple countries.

  • Exists independently of healthcare access.

Explanations for the Gradient

  • Material Factors: Access to essentials like food and healthcare.

  • Psychosocial Factors: Financial insecurity and job-related stress impact health.

  • Behavioral Factors: Differences in lifestyle choices such as smoking and exercise.

Income and Mental Health

  • A widening gap in self-rated mental health over time, with significant disparities between income groups.

Chronic Conditions by Income

  • The presence of multiple chronic conditions varies significantly across income levels (e.g., poorest vs wealthiest populations).

Life Expectancy Disparities

  • Significant life expectancy variations exist within small geographical areas, influenced by socioeconomic status.

Example from London

  • Each tube stop from Westminster to Canning Town approximates a year of life expectancy lost.

Life Expectancy in Canada (2005-2007)

  • Regions with lower life expectancy often share common socioeconomic challenges, including high unemployment and lower educational attainment.

Health Disparities in Toronto

  • The "Unequal City" report highlights significant health inequities correlated with income, showing a lack of improvement over a decade across various health indicators.

Conclusion

  • The Whitehall studies provide critical evidence linking SES to health outcomes, demonstrating that addressing socioeconomic inequalities is essential for improving public health.

References

  • Marmot, M. G., et al. (1978). Health inequalities among British civil servants: the Whitehall II study.

  • Wilkinson, R., & Marmot, M. (2003). Social Determinants of Health: The Solid Facts.