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How economic inequality might affect a society's well-being

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People who have more money generally live longer lives. But the reverse is also true-those with less money tend to live shorter lives. Unfortunately, this income-mortality disparity has broadened in recent years.

Research shows that poverty impacts health in multifarious unexpected ways.

For instance, men born in 1930 who are in the highest quartile of earning live an average of 5.1 years longer than men in the lowest quartile of earning-a difference that's projected to increase to 12.7 years for men born in 1960, according to published by the National Academies of Sciences, Engineering, and Medicine.

This gap is even more pronounced in women, with a projected increase in the difference between low- and high-income earners expected to jump from 3.9 years for the 1930 birth cohort to 13.6 years for the 1960 birth cohort.

A plethora of data have linked lower socioeconomic status to morbidity and mortality. But how does poverty directly contribute to worse health?

Stress and environmental factors

The stress of poverty could exert the biggest impact on health status. Extreme stress experienced at home and work can interfere with digestion and reproduction. It can also cause blood pressure levels to increase. Over time, this stress can lead to illness and poor health status.

In addition, financially disadvantaged children are often exposed to more toxins, violence, and noise. These environmental factors can also adversely affect brain development and cause the body to release cortisol, which activates the sympathetic nervous system and places the body in fight-or-flight status.

Cortisol also increases heart rate. In a published in the Undergraduate Journal of Mathematical Modeling: One + Two, heart rate was more highly correlated with longevity than either blood pressure or obesity. (On a related note, people who want to live longer should increase their amounts of aerobic exercise, at least according to this study.)

Epigenetic changes

An emerging line of research suggests that poverty can result in epigenetic changes, or a change in how genes are expressed. Surprisingly, these epigenetic changes can begin even in the fetus.

In, researchers found evidence that poverty can become embedded across wide swaths of the genome. They discovered that lower socioeconomic status is associated with levels of DNA methylation-an epigenetic mark that can shape gene expression-at more than 2,500 sites across more than 1,500 genes. Put another way, poverty leaves a mark on nearly 10% of the genes in the genome.

Impoverished neighborhoods

Sure, diet and exercise are important facets of health. But researchers have shown that these health factors are rooted in where a person lives. Impoverished neighborhoods often lack access to nutritious foods and good schools, and tend to be infested with crime. In some places, simply jogging down the street can be hazardous to your health.

On the upside, strategies to improve lower socioeconomic neighborhoods can also improve the health of the people living there, according to a study by researchers at the University of California San Francisco (UCSF), San Francisco, CA.

"When these children from lower economic-status families were living in more resourced neighborhoods that are quality neighborhoods-those with greater access and supportive services-they had those lower levels of cortisol and fewer health problems than the lower socioeconomic children living in poor-quality neighborhoods," said first author Danielle Roubinov, PhD, assistant professor of psychiatry, UCSF.

Lack of health insurance is a huge problem in the United States. To receive proper treatment for complex diseases, people need access to specialist care. To boot, people need time to see their primary care physicians or specialists. However, those of lower socioeconomic status often have jobs that don't allow much flexibility to take the necessary time off.

Limited access to proper healthcare can even be more insidious. For instance, a mother living in a shelter may lack access to refrigeration needed for her child's prescription antibiotics.

Despite politicians decrying the much-contested Affordable Care Act, analysts have shown that it has substantially improved health insurance coverage and access to healthcare for people of lower socioeconomic status, and has significantly reduced socioeconomic gaps in healthcare access.

In a study published in, investigators looked at the relationship between socioeconomic factors and brain morphometry while controlling for genotype. In 1,099 participants aged 3-20 years, income was related to brain surface area. Keep in mind that surface area increases with cortical folding.

In children from lower-income families, even small differences in income were related to big differences in brain surface area. In children from higher-income households, similar small changes were correlated with small differences in surface area.

Importantly, the researchers found that women who received more education had children with higher brain surface area. Increased surface area was seen in regions of the brain responsible for reading, language, executive function, and special skills. Increased surface area also led to improved neurocognitive capability.

"These differences are the central nervous system underpinnings of growing up in poverty," said Tom Boyce, MD, chief, Division of Developmental Medicine, University of California San Francisco, who was not involved in the study.

"It is especially important to understand that finding neurobiological differences among children from disadvantaged communities does not imply that the differences are genetic in origin," Dr. Boyce added. "Rather, many or even most such socioeconomic disparities in brain structure and function are the direct consequences of early rearing in impoverished, chaotic and stressful conditions."

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How your income determines your overall health | MDLinx

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People who have more money generally live longer lives. But the reverse is also true-those with less money tend to live shorter lives. Unfortunately, this income-mortality disparity has broadened in recent years. Research shows that poverty impacts health in multifarious unexpected ways.

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Income’s Effect on Life Expectancy and Health Outcomes

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The Income Health Connection

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The health of people with low incomes often suffers because they can't afford adequate housing, food, or child care. Such living conditions, and the stress they cause, can lead to higher rates of tobacco and alcohol use and increase the risk of health problems developing or worsening over time.

In addition, partly because they are more likely to be unable to afford care, people with low-incomes use fewer preventive care services. As a result, there are fewer opportunities for practitioners to assess and educate these patients about their health risks. Even when low-income people do see health care providers, the social needs like poor housing that may affect their health and complicate treatment are rarely addressed. If health plans and providers can better meet the needs of these patients, such improvement might spur higher quality improvements throughout the system.

To examine the impact of income on health, we analyzed data from the 2014-16 National Health Interview Survey conducted by the Centers for Disease Control and Prevention. We found that even relatively healthy lower-income people - those who earn 200% or less of the federal poverty level (FPL), or about $24,000 or less a year, and have fewer than three chronic conditions and no functional limitations - have higher health risks, greater social needs, and worse access to care than relatively healthy moderate-income (200%-400% FPL) and higher-income (>400% FPL) people.

Compared to their higher-income counterparts, relatively healthy low-income people are more likely to:

Have poorer self-reported health and greater health risks. One-fifth of low-income adults report their health as fair or poor, compared to only 5 percent of higher-income adults. Rates of obesity are also higher among low-income adults (36%) compared to higher-income adults (28%). Low-income adults are also much more likely to be smokers (25%).

Have more mental health problems. Based on a widely used screening tool for identifying symptoms of depression and anxiety (the K6 distress scale), low-income people are much more likely to be in serious psychological distress (7%) compared to higher-income people (1%). Low-income people also report more difficulty sleeping (18%) than higher-income people (14%).

Have greater social needs or concerns. A high percentage of low-income adults lack a high school degree (21%) and are not employed (48%) relative to higher-income adults. These reduced economic opportunities translate directly into much higher levels of social needs among low-income people. One-quarter of low-income people are food insecure, or lack reliable access to a sufficient quantity of affordable, nutritious food, while more than 40 percent are worried about paying their rent, mortgage, or other monthly bills.

Are more fearful and less trusting of people in their neighborhoods. Higher crime in low-income neighborhoods may increase the risk of bodily harm and psychological distress, while discouraging physical activity and exercise for both adults and children. Closely knit neighborhoods that have a high degree of trust between neighbors are more likely to increase communication and cooperation to achieve goals, provide assistance to neighbors in need, and discourage crime and other unhealthy behaviors such as drug and alcohol use. More than one-fifth of low-income people believe it is unsafe to walk in their neighborhood (compared to 7% of higher-income people). More than one-quarter of low-income people (28%) have a low level of trust of people living in their neighborhood (compared to 8% for higher-income people).

Have more limited access to care. Although research has shown that the Affordable Care Act significantly narrowed income disparities in insurance coverage and access to care, such disparities persist. Lower-income people are still much more likely to be uninsured (26%) compared to higher-income people (4%). In addition, almost one-quarter (23%) of low-income adults lack a usual source of care. They are also much more likely to report delaying care, not being able to afford prescription medications, and experiencing problems paying medical bills relative to higher-income people.

Use less preventive health care. Use of preventive services increases the likelihood of early detection of health problems as well as better outcomes. Lower-income people are less likely to have had a cholesterol test in the past year (41%) compared to higher-income people (64%). Lower-income women ages 50-64 are less likely to have had a recent mammogram (54%) compared to higher-income women (80%). Low-income older adults are also much less likely to have had a colon cancer test (27%) than higher-income older adults (54%).

Identifying and Addresses Social Needs

Our results underscore that low incomes are associated with a persistent cycle of inadequate access to quality food and housing, financial stress, poor health behaviors, threats to personal safety, and lack of access to care. These circumstances, in turn, increase the health risks to low-income people, even in the absence of serious health problems. Identifying these risks is challenging for health care providers, but ultimately necessary for managing patients' health care, preventing more serious health problems, and improving health outcomes.

A number of recent initiatives are designed to identify and address the social needs of patients as an important component of successful treatment. For example, health systems involved in the Centers for Medicare and Medicaid Services' Accountable Health Communities initiative will screen Medicare and Medicaid patients to identify social needs such as food and housing security and refer them as needed to social service organizations in the community. As research continues to demonstrate, efforts to improve the health of people with low incomes is likely to be unsuccessful unless social and environmental conditions that affect health are also addressed.

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The health of people with low incomes often suffers because they can't afford adequate housing, food, or child care. Such living conditions, and the stress they cause, can lead to higher rates of tobacco and alcohol use and increase the risk of health problems developing or worsening over time.

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If the address matches an existing account you will receive an email with instructions to reset your password.

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The Request for Proposals for an holistic suite of communications services to accompany a novel contemporary visual identity as part of design for new World Report on Social Determinants of Health Equity and associated materials is published on the United Nations Global Market website

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The Request for Proposals for an holistic suite of communications services to accompany a novel contemporary visual identity as part of design for new World Report on Social Determinants of Health Equity and associated materials is published on the United Nations Global Market website

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Food for Thought...

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Only 350 miles separate Fairfax County, Virginia, and McDowell County, West Virginia, geographically. But if you look at the average life expectancy in each community, they look like they're on different continents.

The average life expectancy in Fairfax County, 82 years for men and 85 for women, is comparable to what it would be in Sweden. In McDowell County, on the other hand, life expectancy is 64 years for men and 73 for women, more like the average for Iraq.

That huge disparity in life expectancy coincides with another significant difference between the counties: income.

The median household income in Fairfax County is $111,079, with 34.5% of households earning more than $150,000, according to stats on the county's website from the US Census Bureau. Census data for McDowell County are very different. Thirty-six percent of McDowell County's residents are below the federal poverty level, and the median household income is only $22,252.

Granted, the counties differ in many other significant ways, and that 350 miles makes a world of difference. Fairfax County is located in the suburbs of Washington, D.C., and is densely populated, with 2,744 people per square mile. McDowell County, in rural Appalachia, has a population density of only 41.5 people per square mile. McDowell County also has a much smaller percentage of residents with at least a Bachelor's degree, 5.8% of people over 25 to Fairfax County's 60%.

Other differences between the two counties make it complicated to say income is for sure the sole or even biggest reason life expectancy differs so much between Fairfax County and McDowell County. But it's likely a crucial factor. The US National Center for Health Statistics calls the association between health and socioeconomic factors such as income and education "well established."

The income-health connection

Comparing life expectancies of Americans at opposite ends of the wealth spectrum, as provides an extreme case that income and health are intertwined. But , said The New York Times did in 2014, your income affects your health no matter how much money you make Laudan Aron of the Urban Institute, a nonpartisan think tank.

Aron is a coauthor of a report from the Urban Institute and Virginia Commonwealth University that traces some of the links between income and health that contribute to the "longevity gap."

"Wherever you are [in terms of income], people much better off than you are going to be healthier and live longer, and people that are less well off financially are probably, as a group, on average, not going to live as long and be less healthy," Aron told Business Insider.

The graph below shows that as family income (measured in relation to the Federal Poverty Level - $24,250 for a family of four in 2015) increases, the number of years an adult can expect to live increases as well. If your family income is two times the Federal Poverty Level, you get on average two more years of life than someone whose family income is less than the Federal Poverty Level, and on up the scale. It seems money can buy you more time alive.

Urban Institute, Virginia Commonwealth University

What's going on?

Length of life isn't the only thing that changes with income level.

In their report, Aron and her colleagues cite data from the Centers for Disease Control and Prevention showing that certain diseases are less widespread among higher-income groups. Coronary heart disease, stroke, diabetes, arthritis, and many other health problems affect smaller and smaller chunks of the population in each increasing income bracket.

For example, strokes affect 3.9% of people with family incomes less than $35,000, 2.5% of people in families earning between $35,000 and $50,000, 2.3% of people in the $50,000 to $75,000 group, 1.8% of people making $75,000 to $100,000, and 1.6% of people whose families earn more than $100,000. The more money you make, the less likely you are to have a stroke, according to the data.

Increased disease incidence with decreasing income is only part of the story. The graph below shows that as income goes up, fewer people say they have fair or poor health. While 22.8% of people in households earning less than $35,000 say they are in "fair or poor health," only 5.6% of people in households earning $100,000 or more say the same.

Urban Institute, Virginia Commonwealth University

In their report, Aron and her colleagues aim to tease out how income affects people's health, keeping in mind that health also influences income (someone with poor health will have a harder time working).
Still, the brief identifies a few explicit ways income affects health:

People with lower incomes typically have less money to spend taking care of themselves, whether paying for visits to the doctor, medicine, or healthy food.

Stress associated with a lower income, especially during childhood, increases risk for heart disease, stroke, cancer, and diabetes.

People with higher incomes live in areas with healthier resources available, like good grocery stores, safe housing, opportunities to exercise, clean air, and better schools.

These bullet points dramatically simplify the numerous and complicated ways income affects health, and it's important to note that every individual will experience different pressures in various degrees.

The researchers acknowledge that poor health and disabilities can get in the way of people earning more money, making it difficult to say whether in any given scenario low income causes poor health or vice versa. All the relationships between health and income are very complex and hard to study, but there's no question that there's a strong connection between low income and poor health.

The researchers point out that public policies primarily considered for their economic impact have consequences for health, too.

"Because of how we've organized our society, and the nature of the safety net in this country relative to some other high income countries, lower income Americans are especially vulnerable to poor health," Aron told Business Insider.

For example, the researchers cited a study comparing mortality in unemployed Americans and Germans. The paper, published in the American Journal of Public Health, found unemployed Americans were more likely to die than working Americans, but Germans were no less likely to die if they were unemployed.

Aron hopes the report will encourage policymakers to consider health effects in discussions about economic problems and initiatives.

Conversations about employment and training programs, for example, "are as much about health as about economic self sufficiency," Aron said. "We're trying to show they're actually very intimately linked."

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Residents of one Virginia county live 18 years longer than people just 350 miles away - here's why

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Only 350 miles separate Fairfax County, Virginia, and McDowell County, West Virginia, geographically. But if you look at the average life expectancy in each community, they look like they're on different continents. The average life expectancy in Fairfax County, 82 years for men and 85 for women, is comparable to what it would be in Sweden.