According to a ‘neo-material interpretation’ John Lynch (2000; 1002) states “the effect of income inequality on health reflects both lack of resources held by individuals, and systematic under-investments across a wide range of community infrastructure”. For example the improvement and provision of better hospitals could be argued to increase the ‘health protective resources’ not only for the community but also for the individuals within that community. However, the psychosocial environment interpretation views health inequalities as the consequence of ‘perceptions of relative income’. Psychosocialist argue that the ‘perceptions’ formed create negativity in terms of emotional welfare which then transcends into a deteriorating health at the individual level, through for example ‘health-damaging behaviours’. Lynch (2000) continues to state “simultaneously, perceptions of relative social position and negative emotions ….are translated into anti-social behaviour …and less social cohesion within the community.” It is therefore concluded that the perceptions of social status place negativity on both biological and social issues therefore it can be argued that “social rank …produces poorer individual and populations health”. Nevertheless, critics such as Sen (1999) (in Lynch 2000; 1003) contend that in terms of understanding poverty and inequality, real deprivation needs to be used, as “mental reactions can be a very defective basis for the analysis of deprivation”. For example, it would be hard to adequately measure rates of depression and stress for efficient comparison.
Richard Wilkinson (1997) argues that mortality, which is influenced by health, is affected more by the relative living standards of that country rather than absolute which is illustrated by three pieces of evidence. Firstly, he argues that ‘mortality is related more closely to relative income within countries than in differences in absolute income between them. Secondly. He argues that statistics show that mortality rates have a trend of being lower in countries, which have less income inequality. Lastly, long-term economic growth rates seem to have no relation to any long-term rise in life expectancy.
Health improvements have been made synonymous with income equality, as Wilkinson argues is ‘to improve social cohesion and reduce the social divisions’. Poverty as a form of social exclusion and racial segregation and discrimination notably have linear effects upon health, as supported in qualitative and quantitative research studies in Italy, it has been observed that health prospects are improved in more egalitarian societies. Psychological factors such as reduced self-esteem, lack of control, insecurity and material insecurity, are a cause for chronic stress within the lower earning bracket, these issues are known to straddle socioeconomic placement and quality of health. Increasing employment rates, improving material security and ultimately integrating the economic society through reducing the variance of income brackets would lead to a more cohesive and healthy society. However it is important to note that absolute poverty has been highly destructive to health in behavioral and psychosocial ways that have resulted in death (Wilkinson 1997).
Deaton (2003) argues that Less economically developed countries feel the effects of income upon health less than MEDCs, (for example Britain’s National Health Service supports the nation’s health concerns from income tax contributions, and this is indiscriminate of income). Poor diet from being unable to purchase food or in some cases food of much nutritional benefit, has short and long term consequences upon an individual. Deaton (2003) in her report states “In many ways, that income should be an important determinant of health is more plausible in poor countries than in rich ones. When many people do not have enough money to buy food, adults and children often suffer the short and long-term effects of a poor diet, and parents who do not have enough money to feed their children report severe consequences for their own wellbeing”. Deaton (2003) goes on to describe a survey done by Anne Case in relation to ‘health and economic wellbeing in South Africa’. The aim of Anne Case’s survey was to investigate the health of pensioners and of the adults and children that they live with. In her work she found evidence of income having an effect on the quality of health. She found that “The household's water source being on-site and the presence of a flush toilet are both significantly more likely, the greater the number of years of pension receipt in the household.” And in addition, adults that lived with a pensioner were less likely to skip a meal by 20%. Asking all the adults in the survey about their daily lives and depression, she found that there was a great link between stress and health status, however, the presence of pensioners aided in reducing the level of reported stress. This implies that although Income does have an impact on health, it is also to do with choice and availability of an adequate lifestyle.
Based on the literature, it is evident that income inequality has is great detrimental to health rates. However, further information is needed to properly confirm weather relative or absolute poverty has the most impact as a determinant of health. The evidence did however, point more in favour of the absolute income determinant rather then the relative. This being the fact that no strong correlation has been found between community inequality and health rates, however, generally, someone who is less better off can not afford the same level of health care as a more economically advantaged individual. Neckerman (2004) goes on to explore the relationships between income inequality and health, beginning with ‘individual income’ and health, he points out that the ‘shape’ between these two variables are nonlinear, meaning a substantial raise in come within the low income groups, should have a “greater positive consequence for the health” (Neckerman, 2004;535) and vice versa. In continuation, Neckerman (2004) argues that new research is needed on the subject as he believes health and inequality needs to be linked with race considering the same places with a high rate of inequality also have the highest percentage of black people. Although the debate is of absolute or relative forms of measurement for determining health is also needed, other factors that attribute to health inequalities also need to be factored in to get a clear overall picture.
To conclude, the fact that there are evident health differences between the higher class to lower class social communities is fundamental in helping to understand the impact of income to health. However, as Lynch (2000) argues, it may be need for researchers to enquire into ‘social connectedness’ of socially marginalized groups and “overall levels of population health and the extent of health inequalities may be driven by how these groups, marginalizes by their educational, economic. Racial/ethic or gender status have access to and control over the society’s health-related resources…” (Lynch 2000; 1004) In this the United States is used as an example where their government provision for the poor is quite limited, the poor often having lack of health care, adequate education, transportation and a very low wage. Therefore countries such as Sweden and Norway that “experience a different set of neo-material living conditions…” have a lower health inequality and the overall levels of their population health tends to be higher than in the US.
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