February 3, 2020
More Wealth, Better Health
By Michael D. Shaw
As depressing and fatalistic as the title sounds, this proposition has been demonstrated in numerous studies. And, we’re not just talking about income; a greater net worth and assets correlate in the same manner with better health. Oddly, this trend seems to continue all the way up: Middle-class Americans are healthier than those living in or near poverty, but they are less healthy than the upper class. Even wealthy Americans are less healthy than those Americans with higher incomes.
Moreover, the wealth factor crosses over ethnic lines. While it has long been known that Blacks and Hispanics have higher rates of disease than non-Hispanic whites, such differences are “dwarfed by the disparities identified between high- and low-income populations within each racial/ethnic group.”
One might suggest that a national health insurance plan would even things up, but this is not so easy to analyze. In virtually all national health insurance schemes, there is still a co-pay of some sort, and certain services and drugs may not be covered. Plus, there are also private insurance options available in most cases. Clearly, wealthier people would have greater access to these private options.
What if you compare the health of Americans to a similar cohort in a country with national health insurance? A 2006 study from Rand Corporation, which compared the health of middle-aged Caucasian residents of both countries, found that Americans “get sicker sooner.” The researchers—looking at more than 6,400 Americans and 9,300 English people aged 40 to 70—controlled for all sorts of possible confounding factors, and found that…
U.S. citizens aged 55 to 64 are…
- Twice as likely as their peers in England to be diabetic (12.5 percent of Americans surveyed vs. 6.1 percent of British)
- Ten percentage points more likely to have high blood pressure (42.4 percent vs. 33.8 percent)
- Six percentage points more likely to suffer from heart disease (15.1 percent vs. 9.6 percent)
- At nearly double the risk for cancer (9.5 percent vs. 5.5 percent)
Bear in mind that the only way to compare health in the two countries is to focus on a demographic in the US that would have virtually the same access to healthcare as its counterpart in the UK (with its National Health Service).
In an attempt to explain the poorer American health, the researchers did note that the obesity epidemic could have started earlier in the US, and we tend to do less about it. However, the mortality rates among people around age 60 is about the same in both countries. Thus, our healthcare system may do a better job of keeping individuals alive after they develop diabetes, heart disease, or other illnesses. But we surely fail on the prevention side.
In 2015, the Urban Institute published a report entitled “How Are Income and Wealth Linked to Health and Longevity?” The report proffered these explanations for how wealth is so strongly linked to better health:
1. Lower-income Americans are less able to afford health care services and health insurance. COMMENT—But even if all the basics were “free,” those with more wealth could still obtain better services.
2. Families with greater resources can afford healthy lifestyles and experience place-based health benefits. COMMENT—No argument. Regrettably, there are consequences to poverty. Still, many lower-income folks are prodigious consumers of junk food, which is not necessarily cheap.
3. Consider additional factors, including education, employment, family structure (e.g., single motherhood), neighborhood characteristics, and social policies, as well as culture, health beliefs, and country of origin. It is noted that health and income affect each other in both directions: Not only does higher income facilitate better health, but poor health and disabilities can make it harder for someone to succeed in school or to secure and retain a high-paying job. (aka “reverse causality“) COMMENT—Refer to the next paragraph.
Item 3 refers to what are called “social determinants of health.” As the linked article notes…
“Public health workers and clinicians also can develop health-promotion strategies that reach beyond individual clinical and social services to communities, to influence living and working conditions that are generally the strongest determinants of whether people are healthy or become sick in the first place.”
Ben Franklin said it a long time ago: “An ounce of prevention is worth a pound of cure.”